Journal of— E n g l is h e d i t io n —1620

The Japan Association of Radiological Technologists

Journal of

16

20— E n g l is h e d it io n —The Japan Association ofRadiological Technologists

CONTENTS

2

Overview of the Japan Association of Radiological Technologists/general principles
Foreword

3

The Role of Our English Language Journal
Yasuo Nakazawa, President of The Japan Association of Radiological Technologists

Activity

4
9

Introduction to National X-ray Week Events
The 31st Japan Conference of Radiological Technologists (31JCRT) —Reports
The Educational System for Radiological Technologists in Overseas

15

special feature

The Thai Society of Radiological Technologists and RadiologicalTechnologists License System in Thailand.
Sala Ubolchai, President of The Thai Society of Radiological Technologists

22

contribution

The Educational System of Radiological Technology in Taiwan
Chiung-Wen Kuo, President of Taiwan Society of Radiological Technologists, Taipei, Taiwan / Department of Medical Imaging andRadiological Technology, Yuanpei University, Hsin Chu, Taiwan

26

contribution

International Fellowship at National Cancer Center (NCC)
Tomohiko Aso, Manager Radiological Technologist, Department of Radiological Diagnosis National Cancer Center Hospital

Arts and Sciences

32

contribution

Activities of the Japan Disaster Relief Medical Team (First Group)
Following the Massive Earthquake in Federal Democratic Republic of Nepal
Kazuyoshi Yamano

40

special feature

Mastering 3D for Medical Applications
Basis of Medical 3D-CT Image
Hironobu Tomita

50

the original work

Radiation Exposure of Sonogaraphers After Administering
Radiopharmaceuticals
Emi Kinoshita, Isao Komiya, Yoshiyuki Umezu, Noriko Mizoguchi, Kouji Kobayashi, Tatsuyuki Senjyu, Yasuhiko Nakamura

57

the original work

Optimal Bladder Volume in IMRT Planning for Prostate Cancer
Yoshiyuki Kawasaki, Yoshitaka Nemoto, Hisanori Aoki, Mayumi Kuronuma, Yoshiyuki Seya, Norio Mitsuhashi

64

the original work

Optimization for Q-Space Imaging in a Clinical Setting: Setting of
MPG Direction Number
Nozomi Hamasaki, Masaaki Hori, Yuriko Suzuki, Haruyoshi Houshito, Shigeki Aoki

71material

A Survey Regarding Acceptance and Awareness of Autopsy imaging (Ai)among Radiological Technologists in Our Institution: Comparison withThose of Two Other Institutions
Kazuya Tashiro, Tomoya Kobayashi, Satoka Someya, Katsumi Miyamoto, Hiroyuki Takei, Seiji Shiotani, Hideyuki Hayakawa

Note: The contents of this magazine are those that have been published in JART magazine.

Overview of the Japan Association ofRadiological Technologists
The Japan Association of Radiological Technologists, a public interest incorporated
association under the jurisdiction of the Ministry of Health, Labour and Welfare, wasestablished in 1947 with the purpose of contributing to the health of citizens throughraising the professional ethics of members, improving and furthering the study of medical
radiology and medical radiological technology, and enhancing public health.
In light of the startling progress being made in the fields of image diagnostics andradiation therapy where radiological technologists work, it is necessary to stay constantly
aware of the latest know-how and technology. JART collaborates with other certification
agencies to enhance the capacity of all radiological technologists in general throughproviding lifelong learning seminars, short courses, academic conferences and numerous
other learning opportunities. We believe that such activities constitute our obligation as
medical professionals to the general public.
As the only medical profession that has “radiological” in its name, we strive to limit
medical exposure, to raise the standing of our profession, and to realize a professionof specialist technologists that can be advertised. And we are committed to promoting
services with you all for the provision of safe and secure medical care.

general principles
We will render our services to those in need of health care.
We will act as individual members of a health care team.
We will perform our duties in our field of specialty.
We will continue to study for the benefit of mankind.
We will respect and practice the policy of informed consent.

2 ◆ Journal of JART English edition 2016

f o r e w o r d

The Role of Our English Language
Journal
Yasuo Nakazawa (President)

It is very exciting for the Japan Association of Radiological Technologists to publish its second
English edition “Journal of JART (JJART)”. Through introducing the clinical, education, and researchachievements of radiological technologists in Japan every month, the JART serves to standardize andenhance the work capability of radiological technologists and improve safety in medical institutions.

The English language edition features selected articles that have appeared in the journal over the
past year and are thought will prove useful for radiological technologists throughout the world.
Highlights in the second English edition include an introduction to the education system for radiological technologists in Thailand by Dr. Sala, who is the association president in that country, andan introduction to the educational system of radiological technology in Taiwan by the Taiwan society president Dr. Kuo. Understanding the education system for radiological technologists in different
countries is useful for furthering the education system in oneʼs own country. In Japan, education ofradiological technologists is mainly conducted by 29 universities throughout the country. Moreover,each university has established a graduate school, where Masterʼs Courses and Doctoral Courses are
conducted with the aim of educating future leaders. In particular, because radiological technologists
are required to produce clinical, education, and research achievements, it is essential that they acquire Masterʼs and Doctoral qualifications.

The Japan Association of Radiological Technologists conducts modality-separate basic education
geared to nurturing excellent human resources, while also working on developing certified technologists in cooperation with other relevant academic societies. In future, we intend to expand thework area of radiological technologists based on scientifically established materials in the Team
Medicine Promotion Meeting of the Ministry of Health, Labour and Welfare. We will continue to introduce the clinical, education, and research achievements of radiological technologists in the JART
and strive to enhance its contents. I hope that this English language journal will be a useful resource
for radiological technologists throughout the world.

foreword ◆ 3

Activity

Introduction to National X-ray Week Events

To commemorate the discovery of X-rays by W.C. Röntgen on November 8, 1895, the Japan Association of Radiological Technologists has designated the week from November 2 through 8 eachyear as Röntgen Week. For us radiological technologists, the discovery of X-ray by Doctor Röntgen
not only has historical importance, but it is a memorable day that marks the beginning of our profession. Radiation, of which X-rays are the representative example, has made an immense contribution to the development of medical care and science; particularly in the field of medicine, and it is
no exaggeration to say that medical care could not exist without utilization of radiation.
However, due to the negative image created by the nuclear power station accident that ensued
the Great East Japan Earthquake, a feeling of unease regarding radiation has pervaded the generalpublic. In these circumstances, radiological technologists, who are radiation experts, have planned
events aimed at conveying correct knowledge and advertising our work as managers of radiation in
medical care settings. Various events are being staged all over the country.

Yokohama
Röntgen Week was staged at Queenʼs Square in Yokohama on Sunday the 8th of November. The
venue featured a corner where people could experience image processing using CT images, a natural radioactivity measurement corner, a corner for introducing the work of radiological technologists,
and a corner containing panels explaining radiation. In the CT image processing corner, a work station was established so that people could perform three - dimensional image processing using actual
CT images. In the natural radioactivity measurement corner, visitors could conduct actual measurements of fertilizer, hot spring water, flowers and so forth using a survey meter. In the corner for introducing the work of radiological technologists, Z cards giving brief explanations of the different
types of work we do were distributed. On the stage, the event director hosted a talk show and, as a
new feature to mark the 120th anniversary of the discovery of X-ray, explanations were given on radiation including the “Life of Röntgen” and the contents of examinations conducted by radiological

4 ◆ Journal of JART English edition 2016

Introduction to National X-ray Week Events

technologists were demonstrated, with the hoped effect of promoting greater understanding among
onlookers. Participants explored the different corners and gifts were offered in exchange for stamps
received from the characters “Rönt-kun” and “Ray-chan”. In spite of the rainy weather, the event attracted a greater turnout from the general public than expected and was a success.

“Rönt-kun” and “Ray-chan”

Z cardKochi“Relay for Life Japan 2015 Kochi” was staged on the grounds of Kochi University Faculty of Agri-culture (Monobe Campus) on October 10 and 11 (Saturday and Sunday), and attracted approximately 500 participants. The Kochi Prefecture Association of Radiological Technologists set up a Radiation Advice Corner as a public service and offered information and advice on the role of radiological technologists, medical exposure, the importance of breast cancer examinations and so on forsurviving cancer patients and family members, families of bereaved patients, care givers and visitors
to the event.

Activity ◆ 5

Activity

Gifu
On Sunday the 8th of November, the 36th Gifu Citizensʼ Health Festival was staged at Gifu City Culture Center and attracted a total of 14,449 participants. The Gifu Prefecture Association of Radiological Technologists advertised radiation affairs in general and the work of radiological technologists tocitizens in a bone density measurement corner, a radiation advice corner, a hands-on radiation
measurement corner, and a panel display on radiation exposure and radiological examinations.

6 ◆ Journal of JART English edition 2016

Introduction to National X-ray Week Events

Yamanashi
On Sunday the 1st of November, a radiation
festival was staged in the Aeon Hall on thethird floor of the Kofu Showa branch of Aeon
Mall and attracted approximately 120 participants. Staged in cooperation with Yamanashi
Association of Medical Technologists, theevent featured panel displays aimed at spreading knowledge about ultrasound bone density
examinations and breast cancer examinations.

Niigata
The 18th Niigata Citizensʼ Health and Welfare Festival, which was held in the area around Bandai
City Park in Niigata City on Sunday the 18th of October, attracted a great turnout of approximately
60,000 citizens. At the booth run by Niigata Prefecture Association of Radiological Technologists inthe “Health Plaza” zone, on the theme of “Medical radiation in everyday life” panels were used toshow how we radiological technologists utilize radiation in medical care and to demonstrate thesafety of medical radiation in light of various recent issues in the field. In addition, a radiation quiz
was conducted with a view to promoting greater understanding of the subject.

Activity ◆ 7

Activity

ShimaneOn Tuesday the 3rd of November, at Yume Town Izumo, the “Radiation Exhibit for You” - Pink
Ribbon Festival was staged with attendance by approximately 200 people. Through conducting
hands-on bone density measurements and responding to questions about radiological examinations,some contribution was made towards resolving the doubts and questions that people have about
examinations. Moreover, a quiz rally was held for the first time and proved popular with children,
attracting far more participants than expected. The rally helped educate many people from children
to the elderly about the work of radiological technologists.

8 ◆ Journal of JART English edition 2016

Activity

The 31st Japan Conference of RadiologicalTechnologists (31JCRT) ―Reports
The 31st Japan Conference of Radiological Technologists (31JCRT) was held from November 21st(Saturday) to 23th (Monday) in 2015, at the Kyoto International Conference Center (Takaragaike, Sakyo-ku, Kyoto).
We introduce the chairman aggregation of the International session and hospital visits.
We have held an annual scientific conference of Radiological Technologists every year in Japan.
The 32rd JCRT will be held in 2016 at Gifu prefecture. Everyone eager to please join us.

Hospital visits report
Akihiro Kasuya (Kariya Toyota General Hospital)
I will report here on a tour of Kyoto University Hospital and Shimadzu Foundation Memorial Hallby visitors from abroad, which took place during the 31st Japan Conference of Radiological Technologists.
Following the conclusion of the international session on the second day of the conference, approximately 40 participants from abroad and 5 members of the international department of the Japan Association of Radiological Technologists took a tour of the two sites mentioned above.
At Kyoto University Hospital, 5 staff members, including the chief radiological technologist Mr. Higashimura, guided the tour of the Diagnostic Radiation department and Radiation Oncology and Image-Applied Therapy department, despite the clinic was closed on that day.
Visitors were first led to the technologist room. After an introductory remark by the chief Mr. Higashimura, a staff technologist, Mr. Koizumi, provided an overview of the hospital and the radiation
department. Informational handouts in English were available, and the participants appeared to belistening with interest.
Then the visitors were divided into 4 small groups and participated in the guided tour of related
divisions within the facility, including radiography, fluoroscopy, angiography, x-ray computed tomography (x-ray CT), magnetic resonance imaging (MRI), radioisotope (RI), and radiation therapy.
The interior designs and displays that reflected the traditional architecture and gardens of Kyoto
caught the attention of the visitors especially in the rooms for x-ray CT, radiation therapy, and mammography. Questions that were raised by the visitors included topics such as 3-dimentional image

Activity ◆ 9Activity

processing and imaging procedures used by the nurses and the doctors of x-ray CT, image inspection system of radiography, and disposal of radiopharmaceuticals.
The participants then visited the Shimadzu Foundation Memorial Hall, where they were welcomedby Global Marketing Department manager, Mr. Aoyama, and many staff members.
Historical documents and materials on scientific instruments and medical x-ray apparatus that Shimadzu Corporation manufactured since their formation were on display, and it provided an overview of the developmental process of science and technology in Japan. With the help of detailed
guide in English by the staff, the participants listened with enthusiasm.
The building of this hall was once used as the head office of Shimadzu Corporation when it was
founded. It served as a space where visitors could feel the atmosphere of the time and the history.

■ International Session 1
Takaki Takeshi(Hospital of the University of Occupational and Environmental Health)This session included reports that were centered around the CT and MRI, and the content of thepresentations ranged widely from basic science to clinical application studies.
I-001 was a report by the University Medical Center of Ho Chi Minh city on a triple rule-out with
CT. By using 128-row-detector CT, an ECG-gated triple rule-out becomes easy, which leads to many
benefits in the emergency room including cost reductions and quick treatment initiation.
I-002 was a report on radiation dose reduction in multi-detector CT. A 56% reduction in radiation ispossible when the patient was centered in the scanner isocenter, and recent development in CT
technologies enables radiation reductions while improving the image quality. The current study reported on a novel detector that is capable of reducing radiation by 30%. The study also indicated an
additional radiation reduction by using reconstruction methods such as SAFIRE, IRIS, AsiR, and
AIDR 3D.
I-004 was an investigation on the value of multi-detector row CT in the diagnosis of ureteral rupturecaused by urolithiasis. This study reported that plain CT was useful in diagnosing urolithiasis, andthat it was extremely effective to perform delayed imaging in diagnosing ureteral rupture.
I-005 reported on the utility of “Magic-Gips TM” that enabled MRI examinations on infants without
sedation. The infantʼs body temperature was measured at the forehead, chest, and back before andafter a scan. There was no statistically significant difference before and after the scan, and examination was possible in 95% of the cases. Therefore the authors concluded that “Magic-Gips TM” was auseful tool in MRI.
I-006 analyzed cases in which side effects by MRI contrast agents were reported, which led to a revision of the MRI procedure manual. Twenty out of 6993 cases reported mild side effects, and there
were no serious side effects. Then, the authors created a flow chart based on the symptoms and thedegree of side effects. Then a team of radiological technologists, nurses, and radiologists revised theprocedure manual, which they reported would result in safer MRI examinations.
I-007 examined the effects of radio frequency (RF) pulse on the slice profile in biomedical MRI, andanalysis was conducted quantitatively with the Bloch equation. The study reported that the slice
profile was improved by changing the shape of RF pulse.
I-009 examined the relationship between T2 values and the duration from the onset of an acutestroke. The authors reported correlations between T2 values and the duration from the stroke onset,
and therefore prediction of the time of stroke was possible. This finding would be useful for throm-

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The 31st Japan Conference of Radiological Technologists (31JCRT) —Reports

bolytic therapy.
I-010 reported on the effects of RF transmission systems with B0 Filter on B1 inhomogeneity. The
results indicated that dual RF was better than single RF at improving B1 inhomogeneity and thus led
to improved image quality. In particular, this finding would be useful for imaging of the breast region in which fat suppression is necessary.
I wish continued success of the presenters, and I conclude my chairpersonʼs summary of this session.

■ International Session 2
Kojiro Yamaguchi (Fujita Health University)
Yasuo Takatsu (Japan)ʼs presentation was titled “Simulation to Investigate Image Quality Dependent
on the Partial Fourier Fraction in Dynamic Contrast-Enhanced Magnetic Resonance Imaging,” inwhich data were rearranged in k-space and then evaluated by modulation transfer function (MTF).
Lam Io Pong (Macao)ʼs presentation was titled “MRI T2 Mapping Study on Knee Joint Cartilage.” This
study used T2 mapping at pre and post an exercise load of 20 minutes in order to evaluate its effecton the knee.
Yu Sau Yee Wendy (Hong Kong)ʼs presentation was titled “Quantitative evaluation of a quiet MRI sequence PETRA versus MPRAGE in Brain imaging at 1.5Tesla MRI scanner” which reported that the
PETRA sequence was able to reduce the noise from 85 dB to 58 dB without jeopardizing the image
quality.
Chia Hung Tu (Taiwan)ʼs presentation was titled “3D MRCP Image Quality: Comparison between
Respiratory Triggered Technique and Navigator Triggered Technique,” and made a comparison of
respiratory gating methods for magnetic resonance Cholangiopancreatography (MRCP).
Chia-Peng Chung (Taiwan)ʼs presentation was titled “Using T2 imaging to evaluate susceptibility artifacts impact in TOF-MRA,” which evaluated the effect of susceptibility artifacts when imaging internal carotid arterial (ICA) with time-of-flight MR angiography (TOF-MRA).
Chia-Tsung Lin (Taiwan)ʼs presentation was titled “Relation between Liver Function and Cirrhotic
Liver Parenchymal Enhancement in Dynamic Contrast-Enhanced MR using Gd-EOB-DTPA” which
evaluated MR hepatocyte-specific contrast agents, and concluded that Gd-EOB-DTPA provided better contrast than Gd-DTPA.
The following 4 presentations were by 4th year students at Fujita Health University Faculty of Radiological Technology.
Akari Kayukawa (Japan)ʼs presentation was titled “A study on the optimal contrast for Hahn echo
typed RARE - A study of signal intensity for White and Grey Matter.” This study evaluated a Hahn
fast spin echo (FSE) method where the pulse flip angles were modified from the rapid imaging with- 180°) angles. This investigation was performed with white
refocused echoes (RARE) FSE (90°-180°
and grey matter that had similar T1 and T2.
Mayu Yamadaʼs presentation was titled “A study on the optimal contrast for Hahn echo typed RARE
- A study on phase angle dispersion for White and Grey Matter-” in which she examined phase angle dispersion. She studied white and grey matter for this investigation.
Ayako Shojiʼs presentation was titled “A study on the optimal contrast for Hahn echo typed RARE - A
study of signal intensity for Fat and CSF” in which she evaluated a Hahn FSE method where the- 180°). This investigation was
pulse flip angles were modified from those of the RARE FSE (90°-180°
performed with fat, which has short T1 and T2, and cerebrospinal fluid (CSF), which has long T1
Activity ◆ 11

Activity

and T2.
Ayano Itoʼs presentation was titled “A study on the optimal contrast for Hahn echo typed RARE - A
study on phase angle dispersion for Fat and CSF-,” in which she investigated phase angle dispersion
with fat and CSF.

■ International Session 3
Akihiro Kasuya (Kariya Toyota General Hospital)
The current session included a total of 7 presentations from India, Australia, Korea, Taiwan, andJapan and it covered a wide range of topics including radiological technologist education, clinicalpediatric care, radiation exposure, general radiography, and X-ray fluoroscopy. Below is a summaryof these presentations.
Bansal Chand Subhash reported the current status of radiological technologist training in India.
He reported that radiological technologists have become important in India in a manner similar to
Japan, as they manage radiology diagnosis and therapy that became increasingly diversified in theclinical setting, and that the curriculum for technologist training is being revised with the governmentʼs initiative.
Brady Akemi reported on skeletal survey for non-accidental injury cases in children in Australia.
The insight from the study was that skeletal survey is necessary in cases where abuse is suspected
on a child under 5 years old.
Kim Tae Hyoung from Korea investigated a method of radiation exposure reduction in medical
personnel when using multi-detector computed tomography (MDCT), and Tang Ting Kuo from Taiwan measured changes in radiation exposure by different patientʼs positioning during percutaneous
angioplasty. These studies reminded us that it is our responsibility to disseminate accurate knowledge on medical radiation exposure to doctors and nurses.
Three participants from Japan presented in the current session. Naoki Shimada of the National
Cancer Center Hospital compared lesion visibility based on image processing parameters in bronchoscopy using fluoroscopy. Yoshiaki Miyazaki of Kyushu Cancer Center reported on the utility ofcomputer-aided detection (CAD) system in lesion analysis using dynamic breast MRI. Shigeji Ichikawa of Fussa Hospital reported on quantitative evaluation in slot-scanning technology with fluoroscope.
This session provided information on the current status of radiological technologists in various
foreign countries, while making us appreciate the high quality treatment and diagnostic support thatradiological technologists provide in Japan, and reminding us of the necessity for more active international interaction in the future.

■ International Session 4
Seiji Nishio (Komazawa University)
I-030 The Development of Radiation Oncology in Vietnam．

Mr. Huynh Anh Vu reported on the current status of radiation therapy in Vietnam. In Vietnam,
there are only 30 radiation therapy equipment despite its number is increasing. He also reported on
difficulties that radiological technologists face, such as working during the night time in order tomeet the demands of the increasing number of patients.

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The 31st Japan Conference of Radiological Technologists (31JCRT) —Reports

I-031 Effectiveness of iterative reconstruction of X-ray computed tomography for radiation treat-ment planning.
Ms. Satomi Nakahara of Hiroshima University Hospital reported on the effectiveness of iterative
reconstruction of X-ray CT for radiation treatment planning. Iterative reconstruction is effective forradiation treatment as it helps us obtain stable CT values, which leads to improved noise-power
spectrum (NPS) and contrast-to-noise ratio (CNR).
I-032 Extended versus Standard Skin Marking: Toward improving reproducibility among pelvic
VMRT cases.
Ms. Stephanie Loo from Malaysia investigated whether extended skin marking would reduce errors such as rotational error in pelvic volumetric modulated arc therapy (VMAT) cases when compared to the current standard skin marking. She concluded that extended skin marking was a novel
marking method that reduces translational and rotational errors.
I-033 A study of setup deviations of head and neck patients undergoing VMAT using kilo-voltage
Cone Beam CT at Pantai Hospital Ayer Keroh.
Ms. Stephanie Loo reported on setup deviations of head and neck patients who undergo VMAT
using cone beam CT.
I-034 Using Artificial Neural Network to Predict Correlation of Pre-mammography Questionnairewith Breast Cancer.
Ms. Hsiao-Ping Wu from Taiwan performed analyses using artificial neural network to predict correlation between pre-mammography questionnaire responses and breast cancer. She reported that abetter model for early detection and prevention of breast cancer would be possible by improving
the questionnaire and increasing the number of cases.
I-035 The Research of Receiving Factor of Mammography Screening in Taiwan
Mr. Jui-Hsiang Chou evaluated the mammography use by factors such as age group, educationlevel, and ethnicity. He found that the rate of usage went up when the hospital staff conveyed thescreening information via e-mail and phone, and reported that it was important to create a systemthat would encourage women to consider coming in for an examination.
I-036 The risk factors for development of coronary artery calcification in menopausal women
Mr. Ho-Huu Hung from Taiwan reported on the risk factors for coronary artery calcification inmenopausal women. In addition to age, he reported that coronary artery calcification in menopausal
women was related to lipoprotein, cholesterol and creatinine, and that it was not related to bonedensity.
The level of radiological technologists in Asia is advancing year by year, and the number of research presentations is increasing, with rich content. In addition, desire for improvement among
young technologists is remarkable, and not only do they have longer years of education but also
more technologists hold higher-education degrees. Also, many people speak English fluently despite
the fact that English is not the official language. There are not many technologists in Japan who canhandle question-and-answer sessions in English, and additional international academic exchange isdesirable.

Activity ◆ 13

The Educational System forRadiological Technologists in Overseas
special feature

The Thai Society of Radiological Technologists andRadiological Technologists License System in Thailand.
Sala Ubolchai,President of
The Thai Society of Radiological Technologists

contribution

The Educational System of Radiological Technology in Taiwan
Chiung-Wen Kuo,
President of Taiwan Society of Radiological Technologists, Taipei, Taiwan /Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsin Chu, Taiwan

contribution

International Fellowship at National Cancer Center (NCC)
Tomohiko Aso,Manager Radiological Technologist,
Department of Radiological Diagnosis National Cancer Center Hospital

The Thai Society ofRadiological Technologists
and Radiological Technologists
License System in Thailand.
Sala Ubolchai
President of The Thai Society of Radiological Technologists

Today, I would like to talk about Thai Society Radiological Technologists (TSRT) andabout the license system and education in
Thailand to check whether the thing all of you
maybe know. I maybe make two more time
you to make to talk about the history of TSRT
and we talk about the Thai education system
and role development in radiological technology in Thailand. And I would like to talkabout the license, and competency in radiological technology in Thailand too, and future
trend of radiological technology in Thailand.

Also the history of TSRT, we had established on 19th January, 1973. At the start, wehave only 30 members to start the society thattime. And now, we have the member 1,858
members, and now they send to my email tome now around more than 2000, around 2300
something now. Also the members have to
make a membership of TSRT. The member
open to any Thai society, because we havetoo many societies in Thailand also, but not
as much as Japan, we have only five groupsin Thailand, almost that come to the member-special feature ◆ 15

ship with TSRT. At the start, we have showed
you 31 founder members and now the Koreans we have, I can say to change now 2,300.
Also we have a Japan member for the TSRT,
we had three Japanese members.
Each year, we have the new member to join
TSRT around 150 new, but this year, I think
there are about, we have this year the 50-year
anniversary for the Thai RT, not the society.
We have a new member start this month. We
have around 400 members that come to join,
while we keep to 2,300.
So the TSRT, now I am the president, wefound in 1973 and we have Rama Radiographers Association found in 1990 and Medical
Radiographers Association founded in 1995
and Chulalongkorn Radiographers Association found in 2000. And now also we have
the Songkhla University, the Songkhla Group,
they have a new association also. We haveyou can say in Thailand we have now fivegroup together (Fig.1).
So for the presidency in TSRT, each year,
we have two-year for each presidency, maybe
the same in Japan, two-year for the president
or so. For the first president in Thailand, Mr.
Chutchavarn, I think Mr. Chutchavarn also
when they start a society, they come to Japanto join to meeting, I think the former president met him and maybe the former member
maybe know him before, but they have triedRadiographers Association and RadiologicalTechnologists society in Thailand

to start in Japan.
The second president is Dr. Paladej, so myfriend, the Thai, the same faculty and thesame class together, Dr. Paladej. After that wehave a president, Mr.Chalerm, the third president and fourth president Mrs. Vanee andfifth president Mrs.Rachanee and the sixthpresident is Mr. Jitchai maybe some of themknow him also. Seventh president, Mr. Pichit and eighth president Mrs. Sirilux and forninth president maybe to almost know her so
Ms.Ampai and now she is doing the member
also. Tenth president, me, because the TSRT
now we have almost 10 presidents. For me,
the president number 10 and I work for thesociety too long time, almost until now – I
passed president 2003 and until now 2015 andnext month, we will have an election again,so each two year we have the election (Fig.2).
So here actually we have to join all, the firsttime we have to join to ISRRT, we start join
October in the same year, 1973. So about theactivity, we had to pay attention to the TSRT
activity, we had annual meeting and conference on the last week of April every year. We
start to long time for every year and we havethe member to participate meeting, about 300
to 400 persons every year. We have activity,
the conference and education activity withthe medical school, the radiological technol-

Start Establish Society
Start Establish Society

1.

Thai Society of Radiological Technologists(TSRT)
Founded in 1973
2. Rama Radiographers Association
Founded in 1990
3. Medical Radiographers Association
Founded in 1995
4. Chulalongkorn Radiographers Association
Founded in 2000

31 Members participated to start the society
Now::The number of Members 1858 members(All RT in Thailand about 5000 persons)

6

Fig.1

16 ◆ Journal of JART English edition 2016

4

Fig.2

The Thai Society of Radiological Technologists and Radiological Technologists License System in Thailand.

ogy school. In Thai, when the society people
to the activity with the every university had
school of radiological technology school. And
also we have the activity with RT consortium
how to make a good platform for the education to them.
So the education first, we have the activity,
also we have to make the professional tracts
for the RT, the CT, MRI, US, MIIA and for
all the members we have to make call for it.
Also, we have to pay to visit all of the world, I
think we visit all (Fig.3). We have some member go to abroad to try and to cooperation
look like ISRRT, ACRT, AOCR and JART, Hong
Kong and Korea and China and Malaysia,
Singapore, India, and Macau also. Now I cansay, I go to every country, when they have to– when we have time, we have a chance, but
we try to join and cooperate to the overseas.
So the second, I would like to say about RT
education system and role of developmental
project in Thailand. With the history, the RT
programs, we were adopted from two-year
certificate from the England and USA. We had
two country to make for the period for thebachelor of science in Thailand. We make forthe two-year certificate for the England andUSA to change to the four-year bachelor degree.
So the credential requirement, complete

Activities and Pay Attention to
TSRT

study required by the not less than four academic years of eight semesters and not morethan eight economic year or 16 semesters. The
study cost required for curriculum structure,general education, basic and professional education, and fee and again cost for all centers,
not less than 145 credit with cumulative Thai
average of not less than two, I think the same
this developed (Fig.4).
The component structure, bachelor degree
in RT programs, based on standard set by the
RT Professional Committee, Ministry of Public
Health, Kingdom of Thailand, also they had aregistration body. Also now have committee
for Ministry of Public Health also. The committee require bachelor degree level period
to be eligible to take national professional
license exam. When we have to study four
year, after that we have to go through the ex-

Graduation Requirements;
Complete all study requirements by
not less than 4 academic years or 8 semesters andnot more than 8 academic years or 16 semesters.

Educational Course –Professional Tracts for RT
CT Computed Tomography
MRI Magnetic Resonance Imaging
U/S Ultrasound
MIIA Medical Imaging Information
Administrator(Asian Course ‐ the cooperative 7 countries)

Study all courses required according to curriculum structure i.e.
general education, basic and professional education and freeelective courses for altogether not less than 145 credits withthe cumulative grade point average of not less than 2.00

13

16

Fig.3

Fig.4
special feature ◆ 17

amination license again. If you after RT are
required in curriculum including diagnostic
radiography, radiation therapy and nuclear
medicine, in Thai, we have the four year but
we include all. When the RT period, they can
go to the three Thai like diagnostic, therapy,
and nuclear medicine.
For the first two year, we are required forthe basic science, we take about 75 credit at
the faculty of science. And the last two years
for professional radiological technology including diagnostic radiotherapy, nuclear medicine, we take about 70 credit at the faculty of
medical technology. All include all 145 credits.
For a person, a second year basic science,
we have to study physics, chemistry, biology,
mathematics, and social science. We study English, economics, biomedical science, anatomy, physiology, biochemistry, and pathology.
For the third year and fourth year, we have totake for the professional subject for the RT forthe practice work. The students were also required to complete the internship for all three
disciplines, namely, diagnostic, radiotherapy,
and nuclear medicine.
Curriculum design, curriculum is most program designed to fit the professional competency required by the Ministry, first I told you.
However, each school can decide the extra

18 ◆ Journal of JART English edition 2016

content that fit their need or their expertise
because they can more the modern 145 credit.
Look like one of the university, Mahidol, they
are more than 145.
The academic radiological technology inThailand, now we have three to complete it
and for the fourth university, sometime open
for the student to go to the bachelor degree,sometime they open, sometime they close andthis year they try to open all, meaning Mahidol University found in 1965 in Bangkok andChiang Mai University found in 1974, Naresuan found in 1997 in Pitsanuloke. These arethree universities that completed for the medical, for the radiological technology.
For Ramkhamhaeng University, for Khon
Kaen University, Prince of Songklha University, Chulalongkorn University sometime open
for the student, because in Thailand we have
two case, when we start the first time westarted four year for the bachelor degree andthat time, not enough for the service the medical field for the hospital, they make a twoyear curriculum and that we called the assistant, radiologic technology and after that we
had to adapt by the four university to study
two year again, input, almost four year to geta headway.
So bachelor and master degree in radiolog-

The Thai Society of Radiological Technologists and Radiological Technologists License System in Thailand.

Table1 Degree offered by RT schools
University

Bachelor Degree

Master Degree

Doctoral Degree

1. Mahidol

Radiological Technology

Radiological Technology

Medical Technology
Biomedical Science

2. Chiang Mai

Radiological Technology

Medical Radiation Science

3. Naresuan

Radiological Technology

Medical Physics

4. RamkhamhaengRadiological Technology

5. Khon KaenRadiological Technology

6. Prince of Songkhla

Radiological Technology

7. Chulalongkorn

Radiological Technology

ical technology only had in Mahidol University. They had education about bachelor andmaster degree in radiological technology. For
bachelor degree in radiological technology,
we have at Chiang Mai University in Chiang
Mai, Naresuan University in Phitsanuloke,
Khon Kaen in Khon Kaen, Prince of Songklha
in Hadyai, Songkhla, Ramkhamhaeng in Bangkok.
For the degree offered by the RT school, I
put in the two universities, the Mahidol University. They have the offer radiological technology, master degree in radiological technology and doctoral degree medical technology
in Mahidol. At Chiang Mai University, they
have offer bachelor degree in radiological
technology. For the master degree, they havethe medical radiation science. For the doctoral, they have the offer biomedical science.
Naresuan, bachelor degree radiological
technology, for the master degree they haveoffer to medical physics. But for Ramkhamhaeng, Khon Kaen, Prince of Songklha, Chulalongkorn University offer in radiological
technology only (Table1).
So the number enrolled at the academy in
Mahidol, every year we have around 60, in
Chiang Mai every year we have 40, in Khon
Kaen every year sometime year they have
only 30, Prince of Songklha also 75, Naresuan
is 50 every year and Ramkhamhaeng but thisyear they have around 90 (Fig.5).
Anyway, credit for segregating Thailand,
until now we have around 5,000 student un-

Number of Annual RT Graduates
90
90
80
70
60
60
50
50
40
40
30
25

30
20
10
0

Mahidol

Chiang Mai

Khon Kaen

Prince ofSongkhla

NaresuanRamkamhaeng

Befor / Khon Kaen, Prince of Songkhla and Ramkamhaeng Universities only offer 2 years continuing degree program
for those Diploma level RTS currently practice in the healthcare system

25

Fig.5

dergraduate in radiological technology. The
period of study in four year for a B.Sc. First
schedule education, the radiological technology mostly future they are educated in scientific field, in the medical, in medicine andespecially master of science and PhD study.
Master of science and at professional practice,
the radiological technology which we process
in the three main (medical physics, radiation
science, medical imaging) for the master degree.
PhD study, up to now the number of radiological technologists, which I think for
the PhD program has been increased in bothprofessional field such as medical physics,
biomedical engineering, radiation biology,
computer science, basic science, and appliedscience.
About the license, license and competencies
radiological technologists in Thailand. The lispecial feature ◆ 19

cense to practice medicine for the radiological
technologists was approved in June, in July
2002. In Thailand, we start to have the license
in 2002. For me, I had a license in number
two, my friend is number one. But we started
the modern graduate after I finished that got
the license. And now license, we have almost
the number of the license is 3,978 licenses
in Thailand. We have 5,000 members, but almost they have to do have license only 3,978.
And as maybe they don t need a license, they
go to work some job, to work at companies
something like that.
National license exam, we have consists of
two parts examination. The professional RT,
we have the exam about physics and dosimetry, anatomy and pathology for RT. Radiation
protection, radiation biology, technique indiagnostic radiotherapy and nuclear medicine.
And we have the exam of other law and professional teaching (Fig.6).
Competencies, we required to be the registered as license RT. The RT Professional
Committee issue RT professional competency
requirement for those who take the national
license exam. This is regulated by law andpublic in the Royal gazette. This requirement
are used by the educator to ensure the student competency before taking the exam.
Basic competency, they have basic and professional science in radiological technology
subject. They apply knowledge to professional, the professional skill in three major fields,

National Licensing ExamConsists of two parts–Professional RT
Physics and Dosimetry
Anatomy and Pathology for RT
Radiation Protection
Radiation Biology
Techniques in Diagnostic DX
Radiation Therapy RT
Nuclear Medicine NM–Law and Professional Ethics

31

Fig.6

in radiological technology, when they havethe exam they must know skill three major, itmeans the diagnostic, nuclear medicine, andradiotherapy.
Practical skills; diagnostic radiology, ability to perform all plain field exam, ability toperform all fluoroscopic exam, ability to perform CT brain and trauma, and other exam,
mammogram, MRI and additional training required. Professional skill radiotherapy, ability
to deliver radiation treatment using cobalt-60
achieved, ability to give radiation treatmentusing LINAC in all basic treatment, ability toperform simulation procedure at one treatment such as IMRT, IGRT, additional training
required. Providing skill for nuclear medicine,ability to perform standard nuclear medicine
imaging, exam using gamma camera and
SPECT, ability to perform basic quantitative
analysis in nuclear medicine. PET and PET-CT
additional training required.
Thai RT professional committee is now
looking at how to set up continuing educationcredit. For renewal of license and also add
one license for the specialized areas.
The future trend in radiological technology
in Thailand, to access RT in their research,cooperative research network in radiological
technology has been set up especially for RT
in the future plan.

20 ◆ Journal of JART English edition 2016

The Thai Society of Radiological Technologists and Radiological Technologists License System in Thailand.

We hope for the future Thai RT professional
international benchmark, RT and radiography
practitioner especially practice with qualification accepted by government body. Professional with research potentials, strong collaboration with international counterparts. But
we have today I think, in Thai, we have toneed to try to cooperate to continue to longtime because we know from the first president. Then the first time they have start to the
ISRRT they have – also they have started tojoin to the meeting with Chuchawal. And until
now, they have to – I think I tried to charge
more than 12 years, I enjoyed the charge.

So I would like to say thank you very
much, but also from my opinion, I hope I cancome to see you to every year and something
and also I invite you to Thailand every year
too. I hope that Society of the RadiologicalTechnologists of Japan and Thai we will havea good relationship. I think for me the firsttime I come to Japan around 20 years ago after training in Japan. And after that, I go back,I work in the hospital, after that I come tothe society to work and had to join in Japanagain. I hope to can cooperation together tolong. Thank you.

special feature ◆ 21

contribution
c o n t r i b u t i o n

The Educational System ofRadiological Technology in Taiwan
Chiung-Wen Kuo1, 2）1）President of Taiwan Society of Radiological Technologists, Taipei, Taiwan2）Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsin Chu, Taiwan

Introduction
Radiological technologist is a medical
professional after the German professor
Wilhelm Röntgen ʼ s discovery of x-rays on
November 8, 1895. Radiological technologists
use their expertise and knowledge ofdiagnostic imaging, radiotherapy, nuclear
medicine, radiation safety and medical
imaging to perform diagnostic imaging or
therapeutic procedures.
I n Ta i w a n , t h e a c a d e m i c r a d i o l o g i ctechnologist education were initialed 50 years
ago. Currently there are nine universities with
four-year bachelor degree and one collegewith five-year junior college for training
radiological technologist. This paper presents
the current state of educational system in
Taiwan medical institutions.

Background of RadiologicalTechnology Education
Between 1945 and 1964, the radiological
technicians had trained at the National Taiwan
University Hospital. However, the Ministry of
Education which is the ministry responsible forincorporating educational policies considered
the importance of radiological technology edu-

22 ◆ Journal of JART English edition 2016

cation. The vocational education (five-year
junior college) began from 1964 for students
graduated from junior high school. Yuanpei
Junior College is the first institution to cultivate
the radiological technology in Taiwan. Mr. Tsai
Pin-Kung, the school founder, was a specialist
in radiology and graduated from Kyoto Collegeof Medical Science in 1937. This college was
upgraded to offer undergraduate course in1999 and renamed to Yuanpei University of
Medical Technology in 2015.
The second vocational institute namely
Chungtai Junior College was established in
1966. The college offered undergraduate
course in 1998 and officially changed its nameto the Central Taiwan University of Scienceand Technology in 2005. By 1990, there were
only two junior colleges which provided
5-year courses to foster a great number ofoutstanding radiological technologists both in
Taiwan and abroad. Students who complete
at least 220 credits of study at a junior college
were awarded to an associate degree.
In order to cultivate the professional medical
talents, National Yang-Ming University offeredan undergraduate degree in this subject in1990. At present, there are nine universities
and one junior college to foster the over
700 radiological students per year. Table 1

The Educational System of Radiological Technology in Taiwan

Table 1 Educational institutions that offer radiological technology program in Taiwan.
InstituteYear of
Locationthe program

Program
Duration

DegreeGraduate
Credits

Postgraduate
program

Yuanpei University of
Medical Technology

1964

Hsin Chu

4 yearBachelor

142

MasterCentral Taiwan University of
Science and Technology

1966

Taichung

4 yearBachelor

128

Master and Doctoral

National Yang Ming
University

1990

Taipei4 yearBachelor

140

Master and Doctoral

Kaohsiung Medical
University

1994

Kaohsiung

4 yearBachelor

149

Master

Tzu-Chi University of
Science and Technology

1996

Hualian

4 yearBachelor132

MasterChang Gung University

1996

Taoyuan

4 yearBachelor

141

Master

I-Shou University

2001

Kaohsiung

4 yearBachelor

142

MasterChung-Shan Medical
University

2002

Taichung

4 yearBachelor

128

Master and Doctoral

China Medical University

2003

Taichung

4 yearBachelor

141

Master

Shu-Zen Junior College ofMedicine and Management

2004

Kaohsiung

5 year

Diploma

220

indicates the institutions that run radiological
technology programs.
The master program was established in1998 at the National Yang-Ming University.
Similarly, the National Yang-Ming University
offered the doctoral program from 2002 topromote advanced researches on medical
imaging and radiological science.

Radiological Technology Curriculum
The program of radiological technology
i n Ta i w a n i s d e s i g n e d t o p r o v i d e t h egeneral practice of medical imaging andradiotherapy as well as nuclear medicine.
The undergraduate curricula at different
universities are quite similar. Basically, theundergraduate program can be divided
into four parts: (1) general education andhumanities course, (2) fundamental core
course, (3) professional core course, and (4)clinical practicum. General education andhumanities course such as literature, social
science, ethics, basic science and physicaleducation should be taken during the
freshman and sophomore years. Fundamental

core course including anatomy, physiology,
pathology, physics of radiology, radiobiology,
radiochemistry etc. should be completed
within the first three years. Professionalcore courses are composed of three major
disciplines: diagnostic radiology, radiation
therapy and nuclear medicine. These courses
should be taken during the sophomore andjunior years. After three years education,
students are required to participate in clinicalinternship for at least 7 months in three
department in medical centers of Taiwan.
Students should practice at least 12 weeks
at department of medical imaging; at least 4
weeks at department of radiotherapy; at least
4 weeks at department of nuclear medicine.
Even though a majority of clinical practicum
including clinical observation takes placein Taiwan, students can choose to join theoverseas clinical training. The pilot overseasinternships, sponsored by the Ministry of
Education Taiwan, is intended to subsidize
those students to gain experiences in an
overseas enterprise or professional institute 1）.
Those students are selected by their university.
The goal of the program is to give recipientsContribution ◆ 23

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Fig.1 Five students from Yuanpei University of Medical Technology participatedin clinical internship at National Cancer Center (Tsukiji Campus) in 2014.

opportunities to conduct practical training inan overseas enterprise or institute and extend
their vision. Fig.1 shows the students join theoverseas internship in Japan.

Qualification and continuing
medical education
Upon satisfactory completion of the course,
the students are eligible to take the qualification examination. The Professional Regulation
Commission held by Ministry of Examination
started in 1976. At initial stage, qualification for
the radiological technologist exam was subdivided into three subjects: diagnostic imaging,radiation therapy and nuclear medicine. However, the certification exam was amended as
senior professional and technical examinations
for medical personnel after “Radiologic Technologists Acts” which was legislated in 2000 2）.
Base on the “Radiologic Technologists Acts”,
only qualified radiological technologists are eligible to work in the clinics, hospital or healthcare center.
The qualification exam take place twice per
year. The examination paper consists of six
subjects (basic medical science, radiologicalphysics and radiation safety, radiologicalmodalities, diagnostic imaging, radiotherapy
technology, nuclear medicine technology).

24 ◆ Journal of JART English edition 2016

Totally 80 questions of single choice at eachexamination paper should be completedwith 60 minutes. From July 2010, the written
examination paper has been replaced bycomputerized tests owing to the importanceof understanding about medical imaging.
Although the qualification exam takes paceevery January and July, the average pass rate
is relative lower when compare with Japan.
According to the statistic from the Ministry of
Examination, the pass rate in recent five years
is from 8.27% to 45.15% (Table 2) 3）.

Table 2 The pass rate in the recent 5 years.
Year

Examinee

Pass

Pass rate (%)

2010 (1)

428

25

5.84

2010 (2)

849

337

39.69

2011 (1)

451

71

15.74

2011 (2)

828

397

47.95

2012 (1)

485

50

9.69

2012 (2)

830

293

35.3

2013 (1)

470

66

14.04

2013 (2)

868

305

35.14

2014 (1)

516

50

9.69

2014 (2)

976

370

42.77

2015 (1)

540

53

11.8

2015 (2)

766

323

42.17

12,209

3,575

28.42

Total

The Educational System of Radiological Technology in Taiwan

Fig.2 The registered radiological technologists from 2000 to 2014.

All radiological technologists who practicetheir professional work in the clinical, hospitalor health care center should be registered with
the Taiwan Association of Medical Radiologic
Technologists. According to the Ministry of
Health and welfare, there are 5,646 registeredradiological technologists in 2014 (Fig.2) 4）.
U n t i l l a s t y e a r, q u a l i f i e d r a d i o l o g i ctechnologists should maintain records of 150
continuing medical education (CME) credits
within the sexennial renewal cycle. However,
the requirement for renewal license is reform
for reducing CME credits to 120 from thisyear. There are four aspects of CME course:
professional courses, professional quality,
ethics, and regulations. The ways to earn CME
credits include the attendance at radiologicalcourses from the professional authority,internet CME course, participation conference,or publish the research paper.

Post Graduate Year ProgramThis program launched in August 2003
after SARS outbreak. As the result of overemphasis on specialty training, most of theresidency training program neglected general
medicine education. To rectify this drawback,the Ministry of Health and Welfare (former
name for the Department of Health) decided
to sponsor a national project known as “ThePostgraduate General Medicine Training

Program” in 2003. Radiological Technologistʼs
training program was concurrent and persisted
two years namely postgraduate year (PGY) 1
and PGY2. The education goals of PGY areto accumulate experiences for taking careof patients, to enhance the acquisition ofdetailed factual knowledge, and to develop
the professional competence in radiology,
radiotherapy, nuclear medicine.

Conclusion
Radiological technologists play animportant role in helping illness diagnosis
or cure the disease. The rapid developmentin Radiological Technology produces acontinuous stream of new knowledge about
disease processes. Nevertheless the education
system of radiological science is completein Taiwan, the training system should focus
on not only good at their specialty but also
hardworking and devoted to research. We willcontinue to contribute our effort to improve
the quality of health care in our country.

Reference1）https://www.studyabroad.moe.gov.tw/2）Radiologic Technologists Acts. The Legislative Yuan,
2000.
3）http://wwwc.moex.gov.tw/main/ExamReport/
wFrmExamStatistics.aspx
4）http://mohw.gov.tw/CHT/DOS/Statistic.aspx

Contribution ◆ 25

contribution
c o n t r i b u t i o n

International Fellowship at
National Cancer Center (NCC)
Manager Radiological Technologist,
Department of Radiological Diagnosis National Cancer Center Hospital

Introduction
It was spring in 2014 when I first received an
inquiry about international fellowship. It was
just a phone call from Professor Nishio of
Komazawa University. The conversation did
not go into the detail. I answered it affirmatively under the wrong interpretation that it was
just an observation tour. Although our institution is a teaching hospital accepting many local
and international ʻvisitorsʼ, however it wasquite a new to us accepting 5 Taiwanese trainees over 6 weeks. I had to confess that I wasirresolute for some time, but finally I made up
mind to accept them supported by following
two ideas. One is this would be a good opportunity of ʻhuman resource developmentʼ inboth of us. The other is friendly relations that
Yuanpei university assistant professor Kuo andI maintain for a long time. We occasionallymeet in international meetings starting from aninternational JART meeting in Nagasaki. The
most impressive event was dinner held in Yuanpei University in 2012. The studentsʼ smiles
registered with me quite well.
In the following, I would like to mention
how we carried out this fellowship program
successfully.

26 ◆ Journal of JART English edition 2016

Tomohiko Aso

Accepting international trainees
Following four problems came to my mindin accepting international trainees,
1. Language barrier
2. Curriculum difference
3. Monetary burden
4. Responsibility
1. Language barrier

Language barrier is a big problem. The number of staffers who speak English is limited, letalone Taiwanese. Our division has a Chineseradiological technologist (RT), which was agreat help to us. But she cannot train as manyas 5 students at one time.
In spite of my worries, this fellowship turnedout be a good opportunity of ʻhuman resource
developmentʼ and broadened our knowledge
and horizons.
The staff communicated with trainees better
than I expected using language aid applications installed in smartphones.
2. Curriculum difference

Another thing to be mentioned is differencein the college education curriculum between
Taiwan and Japan.

International Fellowship at National Cancer Center (NCC)

their effective learning (Fig.2).
We gave them lectures covering all the fieldof diagnostic radiology. Each 30 minute lecture
was performed in English by a chief RT of his

We have a clinical teaching guide of our own
for domestic trainees (Fig.1). To overcome thisproblem, we prepared a simplified version in
English and provide international trainees for1
1-1

臨床実習指導の基本
臨床実習における指導の進め方

この臨床実習指導ガイドラインは、実習の指導が円滑にできる点において配庶して作成してあります。しかし、実際の臨床実習では、検査内容や指導者、実習期間が異なるため、臨床実習指導ガイドラインの内容すべてを取り上げることが困難な場合があります。実習
指導者の判断で実習項目や詳細項目を決めて指導をすることとします。また、実習の進度
は、各部署で実習期間において設定していただいて構いません。
目標の設定は、学生が工夫することによって到達できるレベルとして下さい。
実習項目の表に履修必要度を記号 A，B，C の 3 段階で示しております。履修必要度:
A :十分な指導を行い、学生に習得、理解させる項目
B:十分な説明を行い、学生に理解させる項目
C:経験しておくと良い項目(特殊検査，特殊装置など)
1-2

評価方 法 につ いて

臨床実習期間中の評価は、各担当の実習責任者・実習指導者でお願いいたします。
一般撮影・造影透視検査(消化管検査)・CT 検査・MRI 検査・血管撮影・RI 検査の部門毎に評価をお願いいたします。
評価項目については以下の項目とします。
(学習評価》
理解力、学習意欲(向上心・探究心)、接遇、記録について評価をお願いいたします。
各評価は、5 段階（5:大変良い、4:良い、3:普通、2:努力を要する、1:かなり努力を要する）とします。
(注意項目評価》
礼儀・服装、言動、責任感、協調性、適正、について評価をお願いいたします。
各評価は、5 段階(5:大変良い、4:良い、3:普通、2:努力を要する、1:かなり努力を要する)とします。

乳房撮影に関する項目（４）

ポータブル撮影に関する項目（５）

造影、透視検査(消化管検査)に関する項目（６）

CT 検査に関する項目（７）

MRI 検査に関する項目（８）

血管撮影に関する項目（９）

RI 検査に関する項目（１０）放射線管理に関する項目

2 放射線診断部における学生実習教育目標
2-1

（３）

（１１）品質管理(QC)・品質保証(QA)に関する項目

総合般目標（GIO：General Instructional Objective）（１２）病院情報システムに関する項目

臨床実習で放射線技師として必要な基礎知識や技術を習得するとともに、専門分野での専（１３）勤務態度、その他

門的知識および技術を修得する。
2-2（1）共通項目

行動目標（SBOs：Specific Behavioral Objectives）

1

検査の内容、必要性について理解させる。

（１） 共通項目

2

患者様の状態に合わせた検査法を選択、実施することを理解させる。

（２） 一般撮影に関する項目

3

放射線による被曝低減を目的とした設定を理解させる。

4

フィルム撮影とデジタル撮影の違いを説明させる。
デジタル画像の有用性について理解させる。

5

デジタルシステムの基本構成について説明させる。

6

ＣＲおよびＦＰＤ撮影の原理を説明させる。

7

画像処理に関して理解させる。

8

階調処理、周波数処理、サブトラクション処理などの処理効果について理解させる。

9

デジタル画像の圧縮法について理解させる。

10 撮影条件（管電圧、撮影時間、距離、焦点サイズ）の違いによる画像効果について説明させる。
11 造影剤の薬理動態を理解させる。
12 造影剤による副作用および禁忌について理解させる。
13 造影剤による副作用発生時に適切な対処を理解させる。
14 検査に使用する薬剤について理解させる。
15 装置の構造、性能を理解させる。
16 装置の特性を理解し安全な操作を理解させる。
17 周辺機器の構造、性能を理解させる。
18 周辺機器の特性を理解し安全な操作を理解させる。
19 装置の基本性能について理解させる。
20 測定の容易な基本性能については測定させる。
21 始業点検、日常点検、引取り検査の必要性を理解させる。

Fig.1
Contribution ◆ 27

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or her own specialty (Fig.3). The trainees weredeeply grateful for our efforts (Fig.4). So webasically followed the domestic clinical teaching system.

3. Monetary burden

Although the government of Taiwan granted
a subsidy to this fellowship, it did not cover
the whole expenses of their stay and travel. I

Xray General

To know the standard positioning during the X-ray.
To know the anatomical planes for the x-ray
To understand the right positioning according to the purpose of X-ray.
To know the appropriate use of instruments.
To understand the right radiograohing condition.
To understand chest X-ray.
To understand abdominal X-ray.
To understand the other general X-rays.
To understand how to determine bone mineral quantity
To understand panoramic radiography

Mammography

To understand the significance of mammography
To understand how to treat the patients
To know the breast anatomy.
To understand the physiology and the right time for mammography
To understand the basics and the blind area of mammography
To understand the checkpoints of the mammography
To understand how to add mammography and its checkpoints
To understand special and magnification radiography
To understand characteristics and right radiographing conditions.
To understand the QA and QC of mammographing devices
To understand the difference between analog and digital imaging

Portable radiography

To understand the significance of portable radiography
To understand how to use the device in a hospital room
To understand the importance of cooperation with nurses and doctors
To understand radiation control of those nearby the examinee.

Fluoroscopy

To understand the significance of fluoroscopy
To understand the kinds and contents of fluoroscopy
To understand side effcets and contraindication of the contrast enhancement.
To understand how to asses image quality.
To understand direct and indirect radiography.
To understand I.I, DR and FPD.
To understand how to proceed the fluoroscopy.
To understand the physiology and anatomy of GI tract.
To understand the basic of GI tract examinations.
To understand the examination ,anatomy and physiology of urinary system
To understand how to deal with digital image.

Computed Tomography (CT)To understand the basics, characetristics and significance of CT
To understand the procedure of CT imaging
To understand pretreatment and precaution of CT imaging.
To understand how to use contarst enhancement and its side effects
To understand the patient treatment and the importance of explanation to and monitoring overthe patient.
To understand the anatomical structure of human body.
To understand image enhancement processing method in ecah function.
To understand the property and the setting of contarst enhancement
To understand the relation between W/W, W/L and CT value and image quality
To understand the principle and application of 3D,MPR amd MIP processing.
To understand how the artifact ocures and how to prevent it.

Magentic Resonace Imaging (MRI)

To understand the basics, characetristics and significance of MRI
To understand admition instructions and patient treatment.
To understand basic system and RF coil characteristics.
To understand how to use contarst enhancement and its side effects
To understand the patient treatment and the importance of explanation to and monitoring overthe patient.
To understand equip management and quenching.
To understand the anatomical structure of human body.
To understand basic image acquisition (pulse sequence).
To understand how sequence affect MR imaging.
To understand artifacts.
To understand the relationship between RF power and SAR.
To understand the diference between oral and IV contarst enhancement
To understand the characteristics of contrast enhancement of Gd.
To understand the diffrence between MRI and CT

Fig.2

28 ◆ Journal of JART English edition 2016

International Fellowship at National Cancer Center (NCC)

worked hard to hold down the teaching fee.
4. Responsibility

Two kinds of responsibility came to mymind, one is for causing damage to the institution and the other is for medical expenses. Former one should be dealt with making a contract, and the latter should be with carrying
medical insurance.
Iʼd like to mention again that we did not findany major problems accepting international
trainees including immunization and epidemic
procedures.

Fig.3

the significance of keeping safe of personal
information of patients and confidential information of any kind that belong to the teaching
hospital.
Environments around the RT have beenchanged gradually. Image reading assistance,
examination explanations, consultation on radiation exposure, expansion of the work
should be included in the teaching program. I
hope what the trainees learned would bring

Closing remark
Smart phone has been widely spread andprovided us uncountable things such as scheduling, internet access besides telephone function. However how to handle Social Networking Services (SNSs) using this device is a very
sensitive issue. In my personal view, it is essential to get the trainees to fully understandNational Cancer Center Visiting Fellowship Program July,27,2015 ～ September,4,2015
Division of Diagnosic Radiology and Radiation Oncology
July

student 1

1日

2日

3日

4日

5日

6日

7日

8日

9日

10日 11日 12日 13日 14日 15日 16日 17日

18日

19日 20日

21日

22日 23日 24日 25日 26日 27日 28日 29日 30日 31日

1日

2日

3日

4日

Mo

Sa

Su

Mo

Tu

We

Th

Fr

Sa

Su

Mo

Tu

We

Fr

Sa

Tu

We

Th

Fr

9

10 13 14

CK
TB

Tu

* XP
* CT

studet 3*

Student 5

SeptemberAugust27日 28日 29日 30日 31日

student 2

Student 4

Ver.2

MR
I
FL
*
U
*

IR

We

Th

NM
NM
NM
NM
NM

Fr

CK
9 10 13 14
TB
CK14
9 10 13
TB
CK
13 14
9 10
TB
CK
9
10 13 14
TB

Tu

We

XP

Th

Fr

IR

Sa

Su

Mo

IR

Th

Fluoro MMG

Su

Mo

Tu

MRI

We

Th

CT

XP

XP

Fluoro

MRI

CT

CT

XP

IR

FluoroFluoro

MRI

MRI

CT

XP

IR

FluoroFluoro

MRI

CT

XP

XP CT

MRI

IR

NM

MMG

IR MMG

Sa

Flu
1

Su

Mo

National
Center for
GlobalHealth andMedicine

CT

MRI

IR

Fr

MR FL
I U
FL
IR
U

†
†

IR
†
FL National
CT Center for
GlobalXP†
IR Health and
MR Medicine
†
CT
CT
IR

Flu
2

Lectures* Orientation and Welcome party
XP:X-ray General Fluoro:Fluoroscopy MMG:Mamaography† No specific schedules
Numerical number of 9.10.13.and 14 represent radiation treatment room number .
CK:Cyberknife TB:TureBeam
Notes○Diagnosic Radiology
・This program starts at eight thirty.
・Lectures begins at three pm.
・Follow mild dress code.
・Keep the patients' personal information to be safe.
・In case of being late or absent, be sure to contact us through the following number.
(Tel :03-3547-5201 ex3551,7728)○Radiation Oncorogy
・There are six linacs in room .9,10,13,14, TB.

Fig.4 National Cancer Center Visiting Fellowship Program 2015
Contribution ◆ 29

c

o

n

t

r

i

b

u

t

i

o

n

Photography with Dr. Kuo and students in Taiwan.

positive effects on the working environment of
the RT in their own country.
In the end, I would like to conclude that international fellowship has helped our human

30 ◆ Journal of JART English edition 2016

resources to develop to a level that nothingcan be compared to. I am determined to continue to develop our human resources throughinternational fellowship.

Arts and Sciences

contribution

Activities of the Japan Disaster Relief Medical Team (First Group) Following the Massive
Earthquake in Federal Democratic Republic of Nepal
Kazuyoshi Yamano

special feature

Mastering 3D for Medical Applications
Basis of Medical 3D-CT Image
Hironobu Tomita

the original work

Radiation Exposure of Sonogaraphers After Administering Radiopharmaceuticals
Emi Kinoshita, Isao Komiya, Yoshiyuki Umezu, Noriko Mizoguchi,
Kouji Kobayashi, Tatsuyuki Senjyu, Yasuhiko Nakamura

the original work

Optimal Bladder Volume in IMRT Planning for Prostate Cancer
Yoshiyuki Kawasaki, Yoshitaka Nemoto, Hisanori Aoki,
Mayumi Kuronuma, Yoshiyuki Seya, Norio Mitsuhashi

the original work

Optimization for Q-Space Imaging in a Clinical Setting: Setting of MPG Direction Number
Nozomi Hamasaki, Masaaki Hori, Yuriko Suzuki, Haruyoshi Houshito, Shigeki Aoki

material

A Survey Regarding Acceptance and Awareness of Autopsy imaging (Ai) among RadiologicalTechnologists in Our Institution: Comparison with Those of Two Other Institutions
Kazuya Tashiro, Tomoya Kobayashi, Satoka Someya, Katsumi Miyamoto,
Hiroyuki Takei, Seiji Shiotani, Hideyuki Hayakawa

Arts and Sciences
Contribution

Activities of the Japan Disaster Relief Medical Team
(First Group) Following the Massive Earthquake inFederal Democratic Republic of Nepal
Kazuyoshi Yamano
Department of Diagnostic Radiology, National Cancer Center Hospital East

A 7.8-magnitude earthquake occurred in the
mid-west region of Nepal on April 25, 2015 at
11:56 am (local time), inflicting immense damage on Nepal and the surrounding countries.
At the request of the Government of Nepal for
medical assistance, the Government of Japandecided to dispatch a broad-based medical
team based on the framework of the Japan Disaster Relief Team (JDR).
In contrast to the previous JDR medial teams,of which activities had been limited to outpatient care, this team was organized for the firsttime as a broad-based medical team that wascapable of providing comprehensive medical
support, including not only outpatient care,
but also surgery, dialysis, and ward-based
treatment, in order to respond to hyperacutemedical needs.
The author participated in the broad-based

medical team from April 28 to May 11, 2015.
This paper describes our medical assistance activities in Bahrabise Village, Sindhupalchok
District (Fig.1).

Damage to life and property
On Saturday, April 25, at 11:56 a.m. (3:11
p.m. in Japan), a 7.8-magnitude earthquake occurred with the epicenter located in Saurpani,
Gorkha District, 77 km northwest of the Nepalese capital of Kathmandu, at a focal depth of
15 km, which was followed by a 7.3-magnitude aftershock on Tuesday, May 12, with theepicenter in Kodari, 76 km east-northeast ofKathmandu. This has affected 8 million people
in Nepal, resulting in more than 8,600 deaths
and more than 21,000 injuries (as of May 27,2015).

Fig.1 Federal Democratic Republic of Nepal

32 ◆ Journal of JART English edition 2016

Contribution
Activities of the Japan Disaster Relief Medical Team (First Group) Following the Massive Earthquake in Federal Democratic Republic of Nepal

In Kathmandu, most collapsed buildings
were of older construction, such as ancient
temples. The majority of buildings in the citywere saved from collapsing, although we noticed that there were several tilted constructs
being propped up with timber supports. Utility

services were mostly resumed. At our hotel,
water and electricity were available without restriction, along with a sufficient connection to
the Internet. We also perceived that there wasno shortage of daily commodities and that
there was heavy vehicular traffic in the city.

Fig.2 Buildings in Kathmandu city

Fig.5 Traffic conditions in the city

Fig.3 Kathmandu city
Fig.6 Life in a cargo container

Fig.4 Collapsed temples

Fig.7 Collapsed constructs in Bahrabise
Arts and Sciences ◆ 33

However, the environments remained stressful,with people rushing out of doors after every
aftershock (Fig.2-5).
In Bahrabise, the majority of collapsed constructs had been made of layers of bricks orstone. Some families evacuated their damaged
houses to cargo containers of their trucks parking on the road (Fig.6, 7). Food had beentransported by helicopter to this landslide-hit
isolated village inaccessible by road.

Broad-based JDR medical teamduring its acute phase” was recognized. The
availability of charter planes increased the potential of a medical team to provide a neighboring country with critical care during the hyperacute phase of a disaster. Efforts were madeto improve the capability of JDR medical teams
in order to provide not only, as in their previous deployments, outpatient services addressing acute and subacute medical needs, but also
hyperacute critical care. The present team was
deployed for the first time as a broad-based
JDR medical team.

< Background of the establishment and deploy-< Members of the broad-based medical teamment of a broad-based medical team >(Table 1) >The JDR medial teams had provided medical
assistance for disaster victims on an outpatientbasis. There was a growing expectation thatsuch medical assistance focusing merely on
outpatient care should be improved to a levelthat would match the resources of Japan, sothat medical teams could provide sufficient
support in the case of a devastating disaster inthe Asian-Pacific region. In light of this, a panel on a broad-based medical team was established, in which “the need to expand the capability of JDR medical teams to respond to amajor disaster in neighboring Asian countries

In addition to the conventional sections of
outpatient services (reception, clinic, pharmacy, and examination/laboratory), surgery, dialysis, and inpatient care sections are to be incorporated into a team, according to the needsof the affected region it is deployed.
The present team included emergency medicine physicians specializing in orthopedic surgery, general surgery, pediatrics, and anesthesiology. Nurses were allocated to three sections(outpatient clinic, ward, and surgical care).

Table 1 Types and numbers of previous and present(broad-based) medical team members
Previous
team

Present broadbased teamPrincipal

1

1

Subprincipal

2

2（1 physician）

Physician

3

7

Nurse

7

16

Pharmacist

1

2

Clinical radiologist

1

2

Laboratory technician

1

2

Clinical engineer

02Medical coordinator

3

2

Project coordinator

4

8

Total

23

44

Type/Title

34 ◆ Journal of JART English edition 2016

< Available surgical care >The broad-based JDR medical team was capable of providing medical and surgical carefor the following disorders:
1. Crush syndrome

Conditions: Metabolic acidosis, hyperkalemia,
acute renal failure, frequent episodes of ventricular arrhythmia,
and a widened QRS complex
2. Limb and soft-tissue injuries

Conditions: Open fractures of the limbs andpelvis, and severe, extensive
soft-tissue injuries
3. Thoracoabdominal trauma

Conditions: Hemopneumothorax, lung inju-

Contribution
Activities of the Japan Disaster Relief Medical Team (First Group) Following the Massive Earthquake in Federal Democratic Republic of Nepal

ries, abdominal parenchymal organ injuries, gastrointestinal injuries, and others
4. Medical conditions requiring inpatient treatment (up to approximately 24 hr of hospitalization followed by transfer), except for thefollowing cases:

1) Extremely poor prognostic features
High risk of death despite surgical treatment
Requiring transfusion
2) High risk of treatment discontinuation due
to the limited availability of medical resources in the deployed area
Having required prolonged cardiopulmonary resuscitation
Impaired consciousness with a Japan
Coma Scale (JCS) of ≥100
Requiring long-term artificial ventilation
OthersActivity reporty
On April 27 (Monday), I had a talk with mysupervisor about the possibility of JDR deployment to Nepal and my willingness to participate in the team, to which he readily agreed.
In the case of a possible deployment of the
JDR, I always talk to my supervisor in advancefor his approval for my JDR participation andinform my colleagues accordingly. At 8 p.m., I
received a notification letter from the JDR secretariat by fax and email indicating that the deployment of a broad-based JDR medical teamto Nepal had been authorized and that they
were assembling team members. I immediately
informed my supervisor accordingly, and received his final approval. I was notified of myacceptance to the team at 11:30 p.m., then attended an initiation ceremony at Narita Airport
at 2 p.m. on April 28 (Tuesday), and left at 5p.m. for Nepal via Bangkok, Thailand, where
the team stayed at a hotel overnight.
On April 29 (Wednesday), we left our hotel,

departed from Bangkok at 10:15 a.m., and arrived at Kathmandu Airport, Nepal, at 4:20
p.m. After checking in a hotel, I attended a
Foreign Medical Teams (FMT) meeting together with the principal and subprincipal of the
medical team, personnel from the Japanese
Ministry of Foreign Affairs, and staff membersof JICA Nepal Office. The members of the JDR
search and rescue team stayed at the same hotel.
On April 30 (Thursday), in the wake of a
proposal from the Nepalese Government forthe provision of medical services in Bahrabise
Village, Sindhupalchok District, 13 members,
including interpreters, were flown into the village by military helicopter in the evening(Fig.8). While in Kathmandu, at Annapurna
Hospital, two physician and two nurse members assisted surgical procedures from 4 to 10
p.m. (Fig.9).
On May 1 (Friday), members in Kathmandu
made a round trip to Bahrabise by car to assess
the conditions of trafficability and the situationin the area, and some of the members remained in Bahrabise to join the advance members. From this assessment, we knew that overland transport was possible, although someparts of the road was half-blocked by earthquake-related landslides. Members in Bahrabise started to provide medical services fromnoon in the premises of a junior high school,
and we transported a patient with a femoral
fracture to Annapurna Hospital in Kathmandu
by land. The patient said a word of thanks to
us after emergence from surgical anesthesia. A
part of medical equipment and supplies arrived from Japan, including an X-ray apparatus
and all related supplies.
On May 2 (Saturday), some members in
Kathmandu left for Bahrabise with some of theequipment and supplies, including the X-ray
apparatus, while some advance members in
the village returned to Kathmandu. Clinic hours
in Bahrabise were set from 8:30 a.m. to around3:30 p.m. (reception closing time).
Arts and Sciences ◆ 35

Fig.8 Military helicopter cabin

On May 8 (Friday), shortly after noon, half ofthe members of the subsequent JDR medical
team (second group), who had arrived in Kathmandu, were deployed in Bahrabise to replace
half of the first group who left the village on
the day. The other half of the first group transferred relevant information to their successors.
On May 9 (Saturday), the other half of thesecond group left Kathmandu for Bahrabise,where the members of the first group provided
medical care with their successors before theyleft the village in the afternoon.

Site of medical care
Conventional tents (used for the reception)
and a part of cross-shaped tent for surgicalcare) were set up on the schoolyard of a local
junior high school. This site was too narrow topitch all tents the team brought, and the school
allowed us to use their vacant facilities. We loFig.9 Surgery at Annapurna Hospital

On May 3 (Sunday), the rest of the equipment and supplies arrived in Kathmandu fromJapan. Since the members located there werescheduled to leave for Bahrabise the next day,they prepared for relocation by organizing theequipment and supplies. In Bahrabise, westarted to perform X-ray examinations.
On May 4 (Monday), all members in Kathmandu moved to Bahrabise and set up a crossshaped tent, in which broad-based medicalcare was provided.
On May 5 (Tuesday), we started to work as abroad-based medical team and provided surgical care in the cross-shaped tent. Three patients received surgical treatment (two ofwhom were hospitalized) on the day, followedby two patients (both were hospitalized) on
May 6 (Wednesday). On May 7 (Thursday),one patient underwent surgical treatment, one
received inpatient care for a non-surgical condition, and one inpatient was transferred.

36 ◆ Journal of JART English edition 2016

Fig.10 Cross-shaped tent

Fig.11 Medical activities in the treatment room

Contribution
Activities of the Japan Disaster Relief Medical Team (First Group) Following the Massive Earthquake in Federal Democratic Republic of Nepal

X-ray examinations

Fig.12 Patient briefing with an iPad

The radiographic system used in the present
operation was the one that had been introduced into the JDR since its medical missions
in the Philippines. This system was equippedwith a flat panel detector (FPD), from which
registered X-ray images were transferred to an
iPad so that they could be viewed from a remote location. The facility of the X-ray examination room and clinical laboratory had a sufficient height and width to perform examinations. A camping mattress placed on top of twobenches firmly connected to each other wasused as an examination table. Perioperative radiography involved a time-consuming transferof the apparatus. Additionally, the low heightFig.13 Night-shift work in the ward

Fig.15 Radiography in the X-ray examination room

Fig.14 X-ray examination roomcated the X-ray examination room and clinicallaboratory in the same facility, and the examination room, treatment room, and ward in separate facilities. The temperature inside thecross-shaped tent rose above 40ºC, and the useof electric fans was poorly effective in cooling,making the mission demanding for surgicalmembers (Fig.10-14).

Fig.16 Intraoperative radiography
Arts and Sciences ◆ 37

of the tent and the use of a fixed-height stretcher as the operating table (of which the height
could not be lowered) interfered with the conventional placement of the apparatus for its
safe use; therefore, the X-ray apparatus was
securely tied to a supporting pole with a rope

Diarrheal
disease8%
Acuterespiratory
infection28%

in order to maintain the highest possible distance between the X-ray tube and the patient.
Due to the earthquake disaster, there were ahigher percentage of trauma patients. We performed radiography not only for routine examinations, but also for the evaluation of reduction provided in the X-ray examination room
and intraoperative confirmation to serve as areplacement for surgical imaging (Fig.15, 16).
Since we had only one X-ray apparatus, radiography was unavailable for outpatients during surgery, which needs to be addressed in
the future.
We often had problems in printing radiographic images and sometime in loading them
to a database on an iPad, and, thereby, physicians needed to visit the X-ray examination
room to view these images.

Trauma64%

Fig.17 Disease categories

70

20
10

31

42

35 40

1
12

3
3
18 12 11

9
8

5

20 17

5
10

Trunk
22%

33 29 30 29 33
26
25 28

Acute respiratory infection

Diarrheal diseaseFig.20 Sites of X-ray examinations

Fig.18 Changes in the number of patients by disease

80
70
60
50
40
30
20
10
0

Lower
limbs
32%

Upper
limbs
28%

May 12

May 11

May 10

May 9

May 8

May 7

May 6

May 5

May 4

May 3

May 2

May 1

0

Trauma

Chest
15%

72
50

Patients

Frequency

9

M

ay

9
ay

8
ay

ay
M

5

27
19
15
13
1112

10

1414

7

6
M

ay

5
M

ay

4
M

ay

3
ay

1415

41
28

M

26
24
21
16
13
11
8

M

30
19

28

M

41

Radiation exposure

Fig.19 Changes in the frequency of radiography

38 ◆ Journal of JART English edition 2016

17
710

12

30

0
6

8

6

ay

40

3 24
16

M

17

Abdomen
1%

11

50

Head
2%

1

ay

2

M

60

Contribution
Activities of the Japan Disaster Relief Medical Team (First Group) Following the Massive Earthquake in Federal Democratic Republic of Nepal

Fig.17-20, respectively, show the diseasecategories and changes in the number of outpatients, changes in the frequency of radiography, and the sites of radiographic examinationin patients treated by the first and second
groups.
Treatment was provided to 987 individuals,
including return patients, of whom 64% weretrauma patients due to earthquake disaster.
There were no marked inter-day variations in
the types of disease treated in the Bahrabisesite.
The number of radiation exposures increasedon the three days when radiography was performed for the confirmation of reduction andsurgical procedures. In terms of the sites of examination, chest X-ray was ordered for a rib
fracture rather than for acute respiratory infection.

Conclusion

amount of equipment and supplies. A team ofthis kind may need at least two clinical radiologists, when the team is deployed to an area
where radiology members are to perform intraoperative radiography as well as conventional
X-ray examinations and where there may be alarge number of trauma patients.
A surgically capable medical team shouldtake the management of the postoperative follow-up system into account, in contrast to its
limited role in providing follow-up care to theirpatients until full recovery. The present mission demonstrated that such a team needs tobuild a firm relationship with local healthcare
institutes when providing surgical care in orderto develop a trusting relationship with patients,
their families, and local healthcare providers
and share detailed postoperative follow-up
plans with them for successful surgical care.

Acknowledgments

Since the present mission was undertaken
for the first time as a broad-based JDR medical
team that was capable of providing surgicaland inpatient care, much time and effort wasdevoted to on-site preparation after arriving in
Nepal, as well as to the transport of a large

I am grateful to the staff members of National Cancer Center Hospital East for allowing me
to participate in the medical activities, despite
short notice. Also, I am grateful to the members of the first group of the JDR medical team(Fig.21).

Fig.21 JDR medical team members (first group) and local staff members
Arts and Sciences ◆ 39

Arts and Sciences
special feature

Mastering 3D for Medical Applications

Basis of Medical 3D-CT Image
Hironobu Tomita
Saiseikai Kawaguchi General HospitalThe ʻ3D PACS Study Groupʼ was established in December 2008 for promoting research and improving knowledge on
image processing technologies and clinical applications. It is targeted at medical science technicians who use 3D PACS
products and their peripheral equipment as well as at contributing to medical sites.
This article features the details of a lecture given at the Seventh Session of the 3D PACS Study Group, which washeld in Nagoya City in December 2014.

○Moderator: I would now like to ask Tomita

from Kawaguchi General Hospital of Saiseikai Medical Association to give us a presentation on the topic titled ʻFundamentals of
3D Display Youʼve Been Embarrassed to Ask
About.ʼ

Introduction
First, I would like to briefly talk about somefundamental issues and then, move onto thesubject of subtraction, which is performed at
almost every facility. There are a variety of subtractions with a variety of set characteristics;
therefore, I would like to talk about these aspects. Furthermore, what is referred to as ʻDual
Energy CTʼ is currently gradually being implemented in clinical applications; therefore, I
would like to mention some of the relevant
applications as well.
I believe that everyone here is aware of how
three-dimensional images are formed, that isby the stacking of two-dimensional images. Aninterpolation technology is generally used forsmoothing out surfaces, and the interpolation
calculation at the most fundamental level is referred to as linear interpolation. Nowadays,
such applications are performed mostly by using ʻmulti-slice CTʼ but require an enormous
amount of information.

40 ◆ Journal of JART English edition 2016

Portraying three-dimensional images. We
then have the intended CT value and refer to it
as the threshold value. How we set this threshold value determines how an image with theintended CT value is rendered and is a commonly used method that we refer to as volume
rendering.
The term ʻMIPʼ is an abbreviation for maximum intensity projection. As the name implies,
this is a method for projecting only the volumedata with the largest voxel value in a specificdirection, features favourable characteristics
for body parts that are susceptible to noise,and offers good renditions for the continuity ofblood vessels with the overlapping of images
that are difficult to discern. I believe that thismethod is often used for displaying images ofthe blood circulatory system.
The term ʻMulti Planer Reconstructionʼ is afunction available as a feature with some of theexisting equipment and makes it possible torender arbitrary cross-sectional images.

Various processes related to
3D images
The important aspects of volume rendering
are that it involves a shading process, which is
performed using the two parameters of threshold value and transmittance. Further, it is a

special feature
Mastering 3D for Medical Applications Basis of Medical 3D-CT Image

method for showing an actual 3D image.
This method is ordinarily most often used inclinical applications. This is an extremely popular method, which allows us to set the thickness to an arbitrary value. Then, we have theʻcurved multi planer reconstructionʼ, which isused for displaying a cross-section along a hypothetical centre line assigned to blood vessels
as well as other thin and long structures. Thisis extremely useful, particularly in viewing theblood vessels of the heart or thin blood vessels, as well as the associated plaque.
ʻVirtual endoscopyʼ is a method that is often
used as an endoscopic mode. It provides viewsof the interior of the blood vessels. The observation of objects with an infinite perspective
provides a view from the inside, as if the observers entered into a human body.
This may still be rarely used, but the methodof display by using the integrated values of the
projected CT value is a method known as theʻRay Sumʼ. Simply put, this method provides
images that resemble X-ray images. This is aminimum intensity projection, which is the reverse of the maximum intensity projection discussed earlier. This is a minimum value projection method and is used for projecting the minimum value for a voxel value. The methodfeatures characteristics similar to those of the
MIP. The ʻshaded surface displayʼ (SSD) meth-Fig.1 Various processes related to images,
including original 3D image

od goes back to the time when the available
CPUs were lacking in power, volume rendering was not possible, and retention of the dataof blood vessel interiors was not possible; thus,
images had to be sort of pasted on, as in paper
mache. This is the best description that I could
come up with for this concept. However, it
would suffice to remember that SSD is a method for displaying images under a paper machecondition. This one here is the MAR for theworkstation supplied by TeraRecon, and this is
an image of the superior mesenteric artery;
SMA.
There is also a method that allows for a displayof a single cross-section of the SMA, namely aresult of tracing a single image (Fig.1).

Arts and Sciences ◆ 41

Nowadays, isotropic imaging features threedimensional spatial resolution for the X, Y, andZ-axes with an extremely high level of spatial
resolution for CT images, referred to as the isotropic voxel. It is sufficient for you to just remember the name.

Relationship between reconstruction
Kernel and spatial resolution
The configuration for the matrix of CT images is more or less 512 × 512 pixels. This implies that in a case where the FOV is 200, asingle pixel will be 0.39 mm. Spatial resolu-

Fig.2 Difference between reconstruction kernel and
MTF

Fig.3 Clinical image

42 ◆ Journal of JART English edition 2016

tions of the equipment in the direction of the
body axis may be 1 mm, 0.6 mm, or even 0.5mm, while in the Z-direction, there may besubstantial resolution, which is referred to as
the effective resolution. The spatial resolution
varies in the X–Y direction, depending on therelevant reconstruction function. Improving
the resolving power improves the expressive
power of images, such as the 3D MPR to levels
with higher definition.
The terms B80 or B60 relevant to this kernelof lungs relate to sections for viewing the lungs
or bones. Soft-tissue kernel include B30 and
B10. This curve of the MTF makes evident the
spatial resolution that offers a more detailed
resolution (Fig.2). An actual clinical image islike this and its appearance may varysignificantly, depending on the reconstruction
kernel (Fig.3).
This slide shows what a 3D image looks like.
As you can see, the spatial resolution and noise
vary between B10 and B30, as well as B60(Fig.4), and I am sure that you make appropriate adjustments at your work sites.
Speaking a bit more in terms of physics, letme show you this curve of the MTF (Fig.5). Let
us assume that such a curve exists. Now, when
the FOV on the left is 350 mm, the pixel size is0.68 mm. The formula for deriving the frequency is shown here, but when we consider thisFig.4 Difference between reconstruction functions andrelationship with rendering performancespecial feature
Mastering 3D for Medical Applications Basis of Medical 3D-CT Image

frequency, the limit of resolution is the MTF.
This implies that in the case of this kernel, thelimit would be just about here. As the limit value approaches the actual limit, for this case,
the FOV value of about 220 mm, expanding
the reconstruction further would not provide
more details.
Further, the original image does not have aspatial resolution for it. It would also be physically useful to prepare an image, while considering an expansion from the curve of the
MTF, and then, perform the reconstruction tosome extent. I hope that this serves as a reference to your work.
Incidentally, the original position for capturing images should not be from the side or on
an edge but right in the centre. This is the difference between centring and off-centring. The
image on the right is an image captured off
centre, while the one on the left is an image
captured in the centre (Fig.6). It may appear asif the selection was made on the basis of how
well the subject appears, but what you need tounderstand is that it would give you a muchbetter view of the subject when the view isbrought to the centre.
A variety of time intervals, such as 1 s or 0.5
s, are also available for capturing images, butthese depend on the amount of projection data
to be captured. Therefore, I hope that you can

Fig.5 pixel size and limit resolution

use this as your reference.
These also depending on the equipmentused. Therefore, it is essential that you have agood understanding of the characteristics of
the individual equipment. Images are categorised by time and off-centre capturing at thisinstance. The data indicate that a short time
duration for capturing images results in a poor
resolution.
These are images for which the resolution in
the body axis direction increases when the
thickness of the slices is decreased. Since these
are images, I shall not provide the detailed descriptions, but your ordinary concept absolutely applies for these (Fig.7).

Fig.6 on-center VS off center

Fig.7 Difference in reconstruction thickness for comb phantoms
and images (reconstruction interval = 1/2 slice thickness)
Arts and Sciences ◆ 43

In terms of images, decreasing the thicknessof the slices results in sharper images. This isclearly visible with the images of the lung.
This is an image of a comb with teeth measuring 1 mm. Finer details are revealed with 3D
images, when the slice thickness decreases.
However,If, for instance, it is sufficient to show only
the external shape of the comb and it is notnecessary to show an image that includes thetips of the comb, then it may be sufficient touse a thickness of 1 mm. Otherwise, it may not
be necessary to use a narrow thickness such as
0.6 mm. Therefore, it is a good idea to changesuch settings, depending on what is desired
and where the emphasis is placed, when taking into consideration different aspects about
the image server, different aspects of thin slices, and other such details. Minimizing themeasurement obviously means that you get tosee more detailed pictures.

Improving resolution (spatial resolution)
Further, equipment of various mechanisms isavailable. I would like you to just remember
the term here, but the spatial resolution improves with the QQ reconstruction or at aplace called the ʻfrying focal spotʼ. In some

Fig.8 UHR Technology

44 ◆ Journal of JART English edition 2016

equipment, there are detailed matrices and it
may be better to vary them slightly, particularly
when displaying the MPR of bones, to evaluate
the images and use the ones that are suitable.
This is an image of my foot and was taken
after I had a surgery for a tibial plateau fracture. The images were captured as a part of myfollow-up observation, but the right side wastaken with the UHR, which is a high-resolution
image capturing method, while the left side
was taken with an ordinary method. As you
can see, the image quality is completely different. Therefore, it is a good idea to try different
equipment to evaluate images that can be captured (Fig.8).

Fundamental examination of CT
image characteristics based on
differences in radiographic
dosage and subtraction method
There are a variety of problems with subtraction. However, it is easier now since we canperform a nonrigid process and a positionalcorrection process (Fig.9), but in the past, weused to perform subtraction, where 512 matrices are subtracted from 512 matrices. Many 3D
images that are available currently involve theapplication of subtraction on voxels. Further,increasing pitch causes a windmill artefact toFig.9 Clinical image

special feature
Mastering 3D for Medical Applications Basis of Medical 3D-CT Image

emerge, which is a problem. It is essential thatthe pitch be adjusted on the equipment to ensure that such problems do not occur.There isequipment with very few windmill artefacts.
Therefore,it is necessary to consider original
data, taking into account the characteristics ofthe equipment. In reality, if position matching
is not conducted appropriately in 2D, there
will be image residues, but we can still obtainclear 3D images (Fig.10).

Actual clinical images with 3D
subtraction
I am sure that in your experiences, all of you
have noticed that the SD is better with actual

Fig.10

Fig.11

images with 3D subtraction. The CT valuechanges slightly if the mask image is drawn incontrast imaging. The arrows indicate ʻAllʼ andthe CT value of the mask. The value of 180 HU
is used here. However, when we ensure thatthe setting does not exceed this value in thedrawing, then the original value of 366 HU is
maintained as the CT value of the blood vessels (Fig.11). Therefore, we need to keep inmind such settings to prevent the CT value
from decreasing and can then obtain a good
subtraction.
I noticed that the SD fluctuated slightly atthis instance, and thus, decided to perform thisexperiment. The method was as described
here, but as you all probably know, SD generally increases with a decrease in the dosage. A
comparison of the 2D subtraction method(hereinafter referred to as the ʻ2D methodʼ) andthe 3D subtraction method (hereinafter referred to as the ʻ3D methodʼ) revealed that the
SD deteriorated as the gap in the mask and live
dosages worsened with the 2D method, the dosage was reduced, and the things were slightly
better with the 3D method (Fig.12). The NPSof the images of subtraction should exhibit asimilar trend for both the 2D and the 3D methods, but the NPS dropped in the low-frequency
areas of the subtraction images of the 3D method, while the high-frequency wave was a

Fig.12
Arts and Sciences ◆ 45

straight line. This indicated that the quality ofthese images was considerably different fromthat of the original. Since the NPS characteristics differ in such a manner, it is necessary toevaluate the final image. Further, it is evident
that much the image was processed with the
3D method.
When subtraction is performed, the image ispulled in the less desirable direction with the
2D method. The image deteriorates slightly
with the 3D method, but the SD improves overthat of the original image. Therefore, it improves or rather does not deteriorate much,even when the dosage is pulled towards a lower figure. Therefore, this should be consideredwhen adjusting images and image qualities forclinical applications. This alone will remove
the roughness of the image. Therefore, whencreating an image in an ordinary manner,slightly reducing the mask dosage would generate such an effect (Fig.13). This is done by
the workstations supplied by TeraRecon, andalthough the behaviour may differ slightly withother workstations, this should be a reference
for you when you use your own workstations.
Performing subtraction results in such outcomes, and it is evident that the image is improved on the left side with the 2D method
and on the right side with the 3D method. Reducing the dosage further improves the image

Fig.1346 ◆ Journal of JART English edition 2016

quality slightly in terms of SD, and since, in theend, the image quality does not deteriorate
with strong signals, and the use of a systemthat allows for a sufficient reduction of the dosage will be suitable for clinical applications(Fig.14).
The upper level is 320 of 100 and 260 of 100,
while the lower level is 100 kV of 320 mAs.
Forgive me for using the unit of milliampere-seconds, but the image would be goodwith a workstation supplied by TeraRecon,
even with a dosage that is only about onetenth of this (Fig.15 and 16). I would imagine
after this subtraction ordinarily involves extracting bones, and an image without the bones
to an image with bones can be added consid-

Fig.14

Fig.15

special feature
Mastering 3D for Medical Applications Basis of Medical 3D-CT Imageerably easily (Fig.17).

About dual energy
I am sure that everyone here has been performing the dual energy function, but I am currently performing virtual/virtual subtraction,
based on various considerations of our facility.
This is a method for drawing a virtual simplified image based on a contrast image of a single virtual colour, using a subtraction methodfor drawing only blood vessels by taking a single image with dual energy and without capturing any simplified image. Equipment supplied by Siemens was used in this case. Further, you can see that the axial image on theright side is considerably jagged. Performing

volume rendering with this will result in a jagged image and will not be very good. Therefore, I wondered what was going on and had
a look at the original image. The pixels of theimage were jagged, while once the subtraction
process was performed with the workstation,
the interpolation of the image was smoothed
out and the lower image actually ended up
looking considerably smooth. This implies thatthe use of a workstation provides a relatively
better image than the use of the existing equipment (Fig.18).
The problem is the phantom image seen in
the dual energy image. The CT value wasmeasured at this instance, and the blue portions are the bones. The various figures shown
here were obtained when the image was cap-

Fig.16

Fig.18

Fig.17

Fig.19Arts and Sciences ◆ 47

tured with the dual energy feature, and the red
portion denotes the contrast agent. When theenergy level increases or decreases, the CT value of the contrast agent is elevated and the
portion surrounded with red is the VNC, a CT
value for the virtual non-contrast bones. The
CT value is the X-ray CT, and therefore, itchanges when the energy is changed. The CT
value of the bones decreases with the virtual
contrast; however, the problem is that thebones remain even when the CT value of thebones is subtracted from the contrast image(Fig.19). Therefore, is this technology uselessfor our purpose? Well no, as the equipment
supplied by TeraRecon that I am currently using allows me to do this. A contrast image series is selected, and a virtual single colour image is selected below. The threshold process isthen set, and the threshold in the range isdrawn, only for the portion that I have set. The
portions where the original CT value was low
are irrelevant, and only the bones are extracted
so that subtraction can still be performed(Fig.20). Capturing the contrast image CT byusing this dual energy feature is considerably
useful. Irradiation only needs to be done once,and even when there are a large number ofpatients, single contrast imaging is sufficient,with the rest all taken care of with subtraction.
Therefore, I would like to do a bit more with

Fig.2048 ◆ Journal of JART English edition 2016

this feature.
This is an image of a patient with an aneurysm on the IC-PC. This is an image from his
follow-up session; the right side represents theaneurysm, while the left side represents theimage captured by the virtual/virtual subtraction of dual energy feature (Fig.21).
I believe that we can expect progress with
the non-rigid process as TeraRecon continues
with its considerations for a commercially implemented product. I am expecting some additional functions that will be suitable for theequipment. I also believe that the ideas of clinical technicians regarding the virtual/virtual
subtraction method that we have been discussing can be very useful, even if they do not end
up changing the world to any substantial de-

Fig.21

special feature
Mastering 3D for Medical Applications Basis of Medical 3D-CT Image

gree. It is important to understand individual
characteristics of the equipment well and clarify what we are seeking and then, perform thework properly, starting from the original 3D
image. I think the rest depends on the application of sequential approximation, which is ordinarily dealt with by equipment, particularlythat which will be introduced in the future as afeature sequential approximation function.
Therefore, we at our association believe that
there will be a reduction of 20% or 25%, or atleast 15% or thereabouts, even though this depends on the targeted part of the body. Suchsequential approximation is not featured at allwith older equipment, but there is no need tocompletely give up on the idea, since noise
reduction can be performed using a workstation, even after a process has already been
completed. Further, there are good that can
provide the outcomes of good quality. I am
hopeful that such technologies that can be implemented after a process has been completed,
when used in combination on a workstation
would reduce the number of irradiations.
○Moderator: Mr. Tomita, thank you very much.

I believe that he explained to us the fundamental details that we have been ʻembarrassed to ask aboutʼ. Are there any questions
anyone would like to ask, now that you havea chance?
○Auditor: Thank you very much for the lec-

ture. While we had no discussion on thesesubjects, I would like to consider the intensity of the light source or its position that may
cause variance in the images or turn theminto images with an extremely metallic impression or images with a matt texture. I also
believe that most of our audience uses systems that are preset and the specifications ofsuch preset values may be poorly defined. If
the presetting is quite extensive, extremely

Left: Chairperson Ushio;
Right: Chairperson Kobayashi

dark edging would appear when the blood
circulatory system is searched and I find thisundesirable. Could you tell us how you ordinarily instruct people to deal with such situations and how your instructions might vary,depending on the symptoms?
○Mr. Tomita: When we enter specifications fordefault values at our facility, we reconsider
the overall framework, according to how weperceive things, such as changing settings forheads to suit the way we perceive how heads
should be imaged. As you mentioned, in theend, what we have is a shadow picture andas such, we obtain dark appearances for theobjects in the distance. The nearby objects
tend to get brighter, and therefore, we needto make adjustments so that the nearby objects are not whitewashed.
We then repeat this process. We also havea button for improving the quality with all of
our workstations. When we use these to improve the image quality, the enhancement of
shadows becomes extremely highly definedand shiny objects remain shiny but appear
clearly when we use the mode available withthis button.
Therefore, we perform our adjustments,
which include adjustments using such modes.

Arts and Sciences ◆ 49

Arts and Sciences
the original work

Radiation Exposure of Sonographers
After Administering Radiopharmaceuticals
Emi Kinoshita1），Isao Komiya，Yoshiyuki Umezu，Noriko Mizoguchi，Kouji Kobayashi，Tatsuyuki Senjyu，Yasuhiko Nakamura
Kyushu University Hospital Department of Medical Technology, Division of Radiology Radiological Technologist
1）Currently University of the Ryukyus Hospital, Department of Radiology Radiological Technologist

Key words: Ultrasound examination, Radiation exposure, Radiopharmaceutical, Shielding effect【Abstract】

An effective dose was sometimes detected by the personal dosimeter (glass badge) worn by the radiological
technologist in an ultrasound examination. The maximum effective dose detected was 0.2 mSv per month and1.1 mSv per year. An investigation suggested that the source of the radiation exposure was the administration ofradiopharmaceuticals before ultrasound examination. We evaluated 921 cases in which radiopharmaceuticals had been
administered before an ultrasound examination between April 2010 and March 2012. The effective dose was higher
when more ultrasound examinations were carried out subsequent to the administration of radiopharmaceuticals. The
shielding ratio for a 4-mm lead sheet was approximately 95% for Tc-99m and approximately 79% for I-131, suggestingthat a lead sheet (masking shield) may be effective.

Introduction
Given the increased interest in radiation exposure in recent years, new issues are arisingin the clinical settings in which radiological
technologists work1). The glass badges issued
as dosimeters to radiological technologists whocarry out ultrasound examinations to measureindividual exposure to radiation have detected
effective doses of 0.2 mSv per month and 1.1
mSv per year. These figures are less than 50
mSv per year and 100 mSv per five years, andwithin the maximum permitted effective doses2, 3), but although the risk of carcinogenesis
or genetic effects due to this level of radiation
exposure is low, this still represents unnecessary radiation exposure that must be avoided.
An investigation of the cause of radiation exposure during ultrasound examinations foundthat it lay in the performance of ultrasound examinations subsequent to the administration ofradiopharmaceuticals for nuclear medicine
tests. We therefore investigated the association
between the radiation exposure experienced
by radiological technologists during ultrasound50 ◆ Journal of JART English edition 2016

examinations and the administration of radiopharmaceuticals to the patients undergoing ultrasound examinations as well as methods ofpreventing such exposure.

1. Methodss
1-1 Analysis of radiation dose experienced byradiological technologists carrying out ultrasound examinations

The subjects were two radiological technologists (Technologists A and B) engaged in performing ultrasound examinations, whose dosimeters had detected radiation exposure. Bothwere women who wore their glass badges in
the right abdominal region. During ultrasoundexaminations, the right abdominal region is on
the side of the patient undergoing the examination. The survey covered a 2-year period
from April 2010 to March 2012.
1-2 Association between ultrasound examinations and nuclear medicine scans

A total of 921 cases in which radiopharmaceuticals were administered before an ultra-the original work
Radiation Exposure of Sonographers After Administering Radiopharmaceuticals

sound examination between April 2010 andMarch 2012 were identified by our hospitalʼsRadiology Information System (RIS) and analysed. The parameters investigated comprised
the type of radiopharmaceutical, time of administration, dose, time from radiopharmaceutical administration to the start of the ultrasound investigation, and time taken by the ultrasound examination. The radioactivity concentration of the radiopharmaceutical was calculated as the internal radioactivity concentration at the start of the ultrasound examinationon the basis of the dose administered and thehalf-life of the radionuclide3). Although excretion from the body should also be taken into
consideration, given the impossibility of additional investigation, only the physical half-life
was calculated.

assumption that it reflects the distance between
the technologist and the patient undergoing
the ultrasound examination with a radiopharmaceutical having accumulated inside his or
her body. A TCS-161 scintillation detector (Hitachi-Aloka Medical Corporation, Tokyo, Japan) was used to take measurements at distances in 10-cm increments from the reference
point, both with and without radiation-protective clothing containing 0.25 mm lead equivalent (Fig.1). Measurements were made threetimes at each location.
1-4 Shielding effect of a lead sheet during ultrasound examination
To reduce the radiation dose during ultrasound examinations, a masking shield consisting of an L-shaped 4-mm-thick lead sheet was
produced that could be placed between thepatient and the technologist and behind thepatientʼs back. The effective dose transmission
factor 4) for γ-rays of a 4-mm-thick lead sheet
is 1.23 10–4 for Tc-99m and 4.2 10–1 for I-131.
A PDM-111 pocket dosimeter (Hitachi-Aloka
Medical Corporation, Tokyo, Japan) was used
to take measurements when this sheet wasused. When carrying out an abdominal ultrasound examination, the technologist stands
near the patientʼs pelvis, and the sites of measurement used were therefore the patientʼs lower abdomen and chest. When carrying out athyroid ultrasound examination, the technologist stands near the patientʼs chest, and measurements were therefore carried out at the patientʼs neck and chest. The pocket dosimeter1-3 Shielding effect of radiation-protective clothing

The shielding effect of radiation-protective
clothing against the γ-rays emitted by radiopharmaceuticals was measured for the radioisotopes Tc-99m and I-131, both of which contribute to radiation exposure. Their respective radioactive concentrations were 297.0 MBq for
Tc-99m and 105.8 MBq for I-131. They werechosen on the assumption that Tc-99m reflects
the radioactivity concentration inside the bodyof a patient undergoing bone scintigraphyscanning and I-131 reflects that during an ultrasound examination. A point 30 cm from theradiation source was used as the reference
point (0 cm). This distance was chosen on the

Reference point

Radiation source

0cm

30cm

10cm

20cm

30cm

40cm

50cm

Fig.1 Layout diagram for measuring the shielding effects from the radiation source
Arts and Sciences ◆ 51

Fig.1 Layout diagram for measuring the shielding effects from the radiation sourcedemic year was 1.1 mSv (Table 1).

was used to take measurements on the surfaceof the lead sheet on the patientʼs side and thetechnologistʼs side as well as at five different
points on the technologist (Fig.2).

2-2 Association between ultrasound examinations and nuclear medicine scans
2-2-1 Association between time of ultrasound examination and effective dose
For both Technologists A and B, a trend wasseen in that the longer the examination, thehigher the effective dose. The effective dose
was over 0.1 mSv per month almost every
month in which the time spent carrying out
ultrasound examinations exceeded 100 hours
for both technologists (Figs.3 and 4).

2. Results
2-1 Radiation dose experienced by radiological
technologists carrying out ultrasound examinations

A high effective dose of 0.2 mSv was detected by Technologist A in August 2010 and by
Technologist B in April and June 2011. An effective dose exceeding 0.1 mSv per month was
detected during nine and eight different months
for Technologist A and Technologist B, respectively, during the 2-year period. The effective
dose for Technologist B during the 2011 aca-

2-2-2 Association with type of nuclear medicine
scan
For both Technologists A and B, the greater
the number of examinations carried out afterFig.2 Layout diagram for measuring during clinical practiceTable1.
Personal
dosimeter(glassbadge)
badge) results
results
Table1
Personal
dosimeter(glassRadiological Technologist A （Female・Abdominal pocket of Right side）
year

Apr

May

Jun

Jul

[mSv]

Aug

Sep
0.1

2010

Effective
dose

0.1

0.2

2011

Effective
dose

0.1

0.1

Oct

Nov

Dec

Jan

Feb

Mar

0.4

0.1

0.1

0.1

0.1

Oct

Nov

Dec

Jan

0.1

0.7

Mar

Total year

0.1

0.1

0.1

1.1

Ragiological Technologist B （Female・Abdominal pocket of Right side）
year

Apr

2010

Effective
dose

2011

Effective
dose

0.2

May

0.1

Jun

0.2

52 ◆ Journal of JART English edition 2016

Jul

0.1

Aug

Total year

[mSv]
Sep

0.1

0.1

0.1

Feb

0.1

the original work
Radiation Exposure of Sonographers After Administering Radiopharmaceuticals

radiopharmaceutical administration, the higher
was the effective dose (Figs.5 and 7).
Bone scintigraphy made the greatest contribution, and in months in which five or morepatients were administered radioisotopes forbone scintigraphy, the effective dose was 0.1
mSv per month or higher. The effective dose
was also 0.1 mSv per month or higher inmonths in which a patient was examined on

the same day as undergoing treatment with radioactive iodine for thyroid cancer (Figs.6
and 8).
2-3 Shielding effect of radiation-protective clothing
Measurements taken at increasing distancesfrom a reference point 30 cm from the radiation source, determined in light of the relative

450
400

Total examination time [min]

350

0.3

300
250

150

0.1

100
50

Effective dose [mSv]

0.2

200

0

0

Fig.3 Relationship between the total
examination time of the ultrasound examination and theradiation exposure dose (Radiological Technologist A)

Fig3. Relationship between the total examination time of the ultrasound examinationand the radiation exposure dose (Radiological Technologist A)
450
400

0.3

300
250

0.2

200
150

Effective dose [mSv]

Total examination time [min]

350

0.1

100
50

0

0

Fig.4 Relationship between the
total examination time of theultrasound examination andthe radiation exposure dose
(Radiological Technologist B)

Fig4. Relationship between the total examination time of the ultrasound examinationand the radiation exposure dose (Radiological Technologist B)
20
18
16

12

0.3

10
8

0.2

6
4

0.1

2
0

Effective dose [mSv]

The number of times

140

Fig5. Relationship between the number of times the ultrasound examination is conducted
and the radiation exposure dose (Radiological Technologist A)

Fig . 5 Relationship between the number of times the ultrasoundexamination is conducted andthe radiation exposure dose
(Radiological Technologist A)
Arts and Sciences ◆ 53

positions of the patient and technologist during ultrasound examinations, revealed that thefurther the distance, the lower the radiationdose, whether or not radiation-protective clothing was used for shielding (Fig.9).
The shielding ratio of 0.25-mm lead-equiva-

lent radiation-protective clothing was 47.7% at
0 cm and 43.9% at 50 cm for Tc-99m, with amean value of 43.9%. For I-131, it was 5.7% at
0 cm and 5.9% at 50 cm, with a mean value of
6.4%. The shielding effect was thus 6.9 times
greater for Tc-99m than for I-131 (Fig.10).

18
16
14

The number of times

12

0.3

10
0.2

6
0.1

4

Effective dose [mSv]

8

2
0

0

Fig.6 The relationship between thenumber of times the ultrasoundexamination is conducted andthe radiation exposure dose
after bone scintigraphy administration and after the oral
administration of radioactive
iodine to treat thyroid cancer(Radiological Technologist A)

Fig6. The relationship between the number of times the ultrasound examination isconducted and the radiation exposure dose after bone scintigraphy administration
andafter the oral administration of radioactive iodine to treat thyroid cancer
20(Radiological Technologist A)
18
16

0.3

12
10

0.2

8
6

0.1

4

Exposed dose [mSv]

The number of times

14

Fig.7 Relationship between the number of times the ultrasound examination is conducted and theradiation exposure dose (Radiological Technologist B)

200

Fig7. Relationship between the number of times the ultrasound examination is conducted
and the radiation exposure dose (Radiological Technologist B)
18

16

12

0.3

10

8

0.2

6

4

0.1

Effective dose [mSv]

The number of times

14

2

0

54

0

Fig8. The relationship between the number of times the ultrasound examination isconducted and the radiation exposure dose after bone scintigraphy administration
and after the oral administration of radioactive iodine to treat thyroid cancer◆ Journal of JART English edition 2016
(Radiological Technologist B)

Fig.8 The relationship between thenumber of times the ultrasoundexamination is conducted andthe radiation exposure dose
after bone scintigraphy administration and after the oral administration of radioactive iodine totreat thyroid cancer (Radiological Technologist B)

the original work
Radiation Exposure of Sonographers After Administering Radiopharmaceuticals

I‐131(105.8MBq)

Tc‐99m(297MBq)

80

Radiation dose [μSv/h]80
70

Pb (‐)70

Pb (‐)

60

Pb (+)

60

Pb (+)

50

50

40

40

30

30

20

20

10

10

0

0cm

10cm

20cm

30cm

40cm

50cm

0

0cm

Distance from the reference point

10cm

20cm

30cm

40cm

50cm

Distance from the reference point

Fig.9 The shielding effects of Tc-99m and I-131 in radioactive protective clothing (the Leadequivalent 0.25mm Aprons)

Fig9. The shielding effects of Tc‐99m and I‐131 in radioactive protective clothing(the Lead equivalent 0.25mm Aprons)

Table 2 The shielding effect of a 4mm thick leadsheet
clinicalpractice
Table2. The
shieldingin
effectof a 4mm
thick lead sheet in clinical practice60

Rate of shield [%]

50

40

30

Tc‐99mRadiologicalTechnologist’s point

Tc‐99m（Abdomen）

95.9

93.5

I‐131（Abdomen）

78.0

79.6

I‐131（Thyroid）

78.0

79.9
[%]

I‐131

20

Patient’s point

10

0

0cm

10cm

20cm

30cm

40cm

50cm

Distance from the reference point

Fig.10 The shielding rate of radioactive protective clothing(the Lead equivalent 0.25mm Aprons)
Fig10. The shielding rate of radioactive protective clothing(the Lead equivalent 0.25mm Aprons)

2-4 Shielding effect of a lead sheet during clinical examinations

The radioactivity shielding ratio of a 4-mmthick lead sheet in clinical practice was 95.9%
in the patientʼs lower abdominal area and93.5% at the technologistʼs position for Tc-99m.
For I-131, it was 78.0% at the patientʼs chestand thyroid and an average of 79.7% at thetechnologistʼs position (Table 2).

3. Discussion
Radiation exposure of 0.1–0.2 mSv per month
was detected in technologists responsible for
performing ultrasound examinations, and an
investigation of its cause revealed that it was
associated with the administration of radiop-harmaceuticals. The present study showed that
it was associated with the type of radiopharmaceutical, time of administration, dose, timefrom radiopharmaceutical administration to thestart of the ultrasound investigation, and time
taken by the ultrasound examination. The
months in which radiation exposure was detected were those in which a large number ofpatients had undergone radiopharmaceuticaladministration before their ultrasound examination, and among them, a trend was seen inthat the greater the number of ultrasound examinations of patients who had undergonebone scintigraphy or treatment with radioactive iodine for thyroid cancer, the higher was
the effective dose. For Tc-99m, which is usedin bone scintigraphy, the mean time between
Arts and Sciences ◆ 55

administration and the start of ultrasound examination was only 64 minutes, and the radioactivity concentration was therefore high. For
I-131, which is used in radioactive iodine treatment for thyroid cancer, not only is its radioactivity concentration high but its half-life is also
long, which has a major effect on the effective
dose even when patients met the conditions
for discharge from inpatient wards.
No radiation exposure was detected forTechnologist B during the 2010 academic year.
This may have been because she had frequently been engaged in x-ray scanning other thanultrasound examinations, and had therefore
taken the appropriate measures for protection
against x-rays. Radiation-protective clothing
was effective for shielding against both Tc-99m
and I-131, and the reason for its lower shielding effect against I-131 compared with Tc-99m
was considered to be their different nuclide
energies3), with the main radiation energy for
Tc-99m being 141 keV and for I-131 being 364
keV. The dose decreased with increasing distance for both Tc-99m and I-131, but as it isdifficult for a technologist to maintain a safe
distance from the patient during an ultrasoundexamination, we designed a lead shielding
sheet, confirmed its effect, and found the anticipated shielding effect of the 4-mm-thick lead
sheet was approximately 95% for Tc-99m andapproximately 70% for I-131. The thicker thelead sheet, the greater the shielding effect, but
as the increased lead also increases the sheetʼsweight, any shield must be placed with due
regard to ensuring the safety of both patient

56 ◆ Journal of JART English edition 2016

and technologist in order to reduce radiation
exposure.

4. Conclusions
In this study, we identified an association between the administration of radiopharmaceuticals and radiation exposure during ultrasoundexaminations. Although the effective dose permonth and per year was below the radiation
exposure limit, it still represents unnecessary
exposure, and in future, it will be necessary toconsider reviewing examination procedures,changing the date of examinations, and using
shielding devices such as lead sheets in an attempt to reduce the amount of exposure. Partof the content of this paper was presented at
the Seventh Annual Meeting of the Kyushu Radiological Medical Technology, the Kyushu Radiological Medical Technology Organization.

References
1）Ishihara Hideki, Nanri Kazuhide: Radiation exposure insonographers after nuclear medicine scans. Japanese
Journal of Medical Ultrasound Technology, vol. 29, No.
1, 48-51, 2004. [In Japanese]）
2 Japan Radioisotope Association: 1990 Recommendations of the International Commission on RadiologicalProtection, pp. 56-57. Japan Radioisotope Association, 1991. [In Japanese]
3）Japan Radioisotope Association: Isotope Notebook,11th Edition, pp. 45, 60, 103, 106, 176. Japan Radioisotope Association, 2012. [In Japanese]4）Nuclear Safety Technology Center: Practical Manual
for Calculating Shielding at Radiation Facilities, pp.
148, 152. Nuclear Safety Technology Center, 2000. [InJapanese]Arts and Sciences
the original work

Optimal Bladder Volume in IMRT Planning for
Prostate Cancer
Yoshiyuki Kawasaki1）, Yoshitaka Nemoto1）, Hisanori Aoki1）, Mayumi Kuronuma1）,
Yoshiyuki Seya1）, Norio Mitsuhashi2）
1）Department of Radiology, Radiological Technology, Hitachinaka General Hospital2）Department of Radiation Oncology, Radiation Therapy Center, Hitachinaka General Hospital

Key words: Prostate cancer, IMRT, 3D-CRT, Treatment planning, Bladder volume【Summary】

Prostate cancer has traditionally been treated with surgery and hormone therapy, but radiotherapy has attracted
attention in recent years as an additional treatment option. A number of studies have been conducted on treatment
by using external irradiation, and highly precise radiation therapy such as three-dimensional conformal radiotherapy
and intensity-modulated radiotherapy has enabled safe and effective treatment. Meanwhile, the reality is that no
examination of the bladder volume is conducted during treatment planning. At our institution, 53 prostate cancer
patients treated with IMRT were designated as the subjects of a study in which we retrospectively analyzed the resultsof DVH and urination frequency to determine the optimal bladder volume. The results indicated that the optimal
bladder volume was 200 mL or larger.

Introduction
Prostate cancer has seen a rapid increase in
its incidence among the male cancers1-3). The
principal conventional treatment methods forprostate cancer are surgery and hormone therapy, but radiotherapy has recently attracted
attention as an additional treatment option.
Prostate cancer can be treated with externalbeam irradiation using a linear accelerator, interstitial brachytherapy or particle radiation
therapy.
However, external radiation therapy withhigh energy X rays is a most common choiceof radiation therapy1-3). Recent technologicalinnovations have led to the clinical applications of highly precise treatment techniques
including 3D conformal radiotherapy and intensity-modulated radiation therapy (IMRT),
which concentrate radiation on the prostate
gland and minimize radiation exposure to thesurrounding normal tissues including the rectum and the bladder, enabling the treatment tobe conducted safely and effectively. Comparedwith surgery, the main superiority of radiotherapy is the high post-treatment quality oflife (QOL) in regards to the urinary and sexualfunctions1-3). Meanwhile, the principal disadvantage is development of rectal complications. Therefore, number of institutions which
introduce IMRT for minimizing adverse reactions is increasing rapidly1-3).
In the treatment planning of IMRT for prostate cancer, a dose limitation for each organ at
risk (OAR) and a planning method based on
an optimization algorithm, known as inverse
planning (IP), should be established. An evaluation standard of the treatment plan should
be cleared before a start of IMRT. Dose limitations are generally set for the prostate gland,
rectum, bladder, and femoral head, and a decrease in position repeatability of OARs does
not guarantee the dose volume histogram(DVH) of the treatment plan. Bone structure
can keep immobility by using various immobilizing devices and the rectum can preserve repeatability by defecation, suction of gas in therectum, and/or administration of laxatives.
Arts and Sciences ◆ 57

Fig. 1 Definition of a target and organs at risk (a) Axial view (b) Sagittal view.

However, it is not easy to control the urine
collection volume in the bladder4). To makeand maintain a bladder with constant volume,
an ultrasound image diagnosis device for the
bladder is used during both treatment planning and radiotherapy to ensure that treatment
is performed under the same conditions as
when formulating the plan. However, there isno current consensus regarding optimal bladder volumes and protocol for preparing optimal bladder volume when planning IMRT andcarrying out daily IMRT. Therefore, we conducted a retrospective analysis to determine
the optimal bladder volume for prostatic cancer patients treated with IMRT.

1. Method
Because a detailed understanding of the
anatomy of the prostate gland is necessary forformulating an IMRT treatment plan, bothcomputed tomography (CT) and magnetic resonance (MR) images were acquired for all patients, and these both images were superimposed to conduct the planning process.
During treatment planning, a region of interest (ROI) for the target site (clinical target volume (CTV)/planning target volume:((PTV))
and the OARs (rectum/bladder/femoral head)are delineated (Fig. 1). The CTV of T1c to T3atumor was contoured as the prostate glandplus the proximal portion of the seminal vesicles, and the CTV of T3b tumor was contoured as the prostate gland plus the entire

58 ◆ Journal of JART English edition 2016

Table 1 Dose assessment standard of
our facility.

seminal vesicles. The PTV included the CTVwith a margin of 0.8 cm except at the postrectal interface, where a margin of 0.5 cm wasused. All patients with localized prostate cancer were treated by IMRT (10 MV photons,
VMAT technique) consisting of a total dose of
74 Gy in 37 fractions of 2Gy per fraction administered 5 times a week over 7.5 weeks,taking into consideration the radiobiologicalcharacteristics of the prostate gland and therectum. An IMRT treatment plan is formulated
by using IP up to meet the evaluation standards by our institution. Plans that do not meetthe standards are rearranged. The assessment
standards on the treatment plan that were decided in reference to some reports 5-12) are listed in Table 1.

the original work
Optimal Bladder Volume in IMRT Planning for Prostate Cancer

In this study, bladder volumes were measured by using previously formulated treatment
plans and classified into seven groups: 0–49
mL, 50–99 mL, 100–149 mL, 150–199 mL, 200–
249 mL, 250–299 mL, and 300 mL or larger.
Following this classification, the relationshipbetween the bladder volume and the bladder
DVH, the success rates against bladder treatment plan assessment standards, and the urination frequency were examined.
1-1 Subjects

Fifty three consecutive patients with a median age of 69 years (range: 59 to 77 years) who
received IMRT radiotherapy for prostate cancer between November 2011 and April 2012were enrolled to this study. All patients provided written informed consent before
study-related procedures.
The number of patients in each bladder volume group; 0–49 mL, 50–99 mL, 100–149 mL,
150–199 mL, 200–249 mL, 250–299 mL, and
300 mL or larger were 5, 7, 9, 9, 8, 8 and 9,
respectively.

1-4 Bladder volume and urination frequency

An international prostate system score (IPSS)
is recorded prior to treatment, and on the final
day of treatment. In addition, urination frequencies in daytime and night-time were recorded by the nursing staff in interviews during treatment. These records were then used
for this study to compare the changes in theurination frequency before and after the treatment. 40 patients who were not administeredα-blockers such as tamsulosin hydrochloride
during their treatment were enrolled to thisstudy. Generally, daytime urination frequencyof eight times or more is diagnosed as pollakiuria. The recorded daytime urination frequencies before and after the treatment were used
for comparing the ratio of the patients exhibiting pollakiuria.
Comparison of the bladder volumes, DVH
Normalized Volume, and urination frequency
scores obtained in this study was conductedby using the Mann-Whitney U-test for statistical analysis. P values of less than 0.05 wereconsidered to denote statistically significant
difference.

1-2 Devices

The devices used in the study were a Synergy linear accelerator by Elekta, a Pinnacle3(Ver. 9.0) radiation treatment planning system
by Philips, a SOMATOM Definition AS+ CT
scanner for treatment planning by Siemens,
and a MT-VL-B40 immobilizing device by Civco Medical Solutions.
1-3 Bladder volume and bladder DVH

A report by Nishimura et al. was used as areference for recording the bladder wall ROI(BW) as the area up to 4 mm into the bladder
ROI and for assessing the bladder DVH5-10).
V20, V40, V50, V60, and V 70 assessments werecompared for each bladder volume, and theachievement rate for the bladder treatment
plan assessment standards was evaluated.

2. Results
2-1 Bladder volume and bladder DVH
Fig. 2 indicates the relationship between the

bladder volume and bladder DVH. A summary of V20, V40, V50, V60, and V70 assessments for each bladder volume is shown in
Table 2 . These data in Fig. 2 and Table 2
demonstrate the average values for the 53 patients.
The larger the bladder volume, the lower thenormalized volume value was. A significant
difference in the value was observed up to
200 mL but no significant reduction in the values of 200 mL or larger. There was a remarkable improvement of the normalized volume
values in the low-dose region. The achievement rates for the treatment plan assessment
standards for each bladder volume are shown
Arts and Sciences ◆ 59

Fig. 2 DVH curves for different bladder volume groups.

Table 2 Average normalized volumes for different bladder volume groups.

Table 3 Achievement ratios of dose assessment standard for different bladder volume groups.

in Table 3. Although all patients with bladdervolumes of 150 mL or larger achieved thetreatment plan assessment standards, the patients with bladder volumes of less than 150
mL decreased in achievement rates as the
bladder volume decreased and bladder dose
became low.

60 ◆ Journal of JART English edition 2016

2-2 Bladder volume and urination frequency
Fig. 3 shows the relationship between the

bladder volumes and the daytime and nighttime urination frequencies. A significant difference was observed in the urination frequency
for bladder volumes of up to 200 mL. An increase in the urination number of times wasthe original work
Optimal Bladder Volume in IMRT Planning for Prostate Cancer

Fig. 3 Daytime (a) and night-time (b) urination frequency as a function of bladder volume.

Table 4 Diagnosis rate of frequent urination for different bladdervolume groups.

only up 2 times or less for the patients with avolume of 200 mL or larger. In particular, forthe patients with bladder volumes smaller
than 200 mL, a significant increase in both
daytime and night-time urination frequency
was observed with every bladder volumes
group. Table 4 demonstrates changes in incidence of the patients who were diagnosed ashaving pollakiuria as a function of bladdervolume. The proportion of pollakiuria decreased as bladder volume became larger.

3. Discussion
Optimal bladder volume for IMRT-based
prostate cancer treatment was investigated bya retrospective analysis of 53 patients who
had received IMRT. The results confirmed that
bladder volumes of at least 200 mL are desirable owing to the bladder DVH and suppression effect of pollakiuria. As the reason, it isconsidered that a larger region of the bladderis irradiated when the bladder volume issmaller.
Acute adverse events of the urinary system
by external radiation therapy for prostate cancer are pollakiuria, decreased urinary flow
rate, and painful urination. Pollakiuria is observed in up to 80% of the patients. But mostof them are Grade 2 or less and the incidenceof Grade 3 or more is extremely rare. Chronic
Grade 2 or more urinary adverse events develop up to 10% of the patients, and havebeen reported to be observed even 5 years after completing the external radiation treatment3,13,14). Therefore, it is very important to
reduce the incident of chronic urinary adverse
events by reducing the normalized volume
value for the bladder DVH. As indicated inFig. 4, bladder volumes with less than 100 mL
result in the inclusion of almost the entire
bladder in the irradiation field. As a result, it
Arts and Sciences ◆ 61

Fig. 4 Irradiation range as a function of bladder volume (a)100mL (b)200mL (c)300mL.

is difficult to restrict the normalized volume
for DVH even by IMRT technology, and theincidence of urinary complications increases.
Therefore, an increase of the urination number of times can be controlled during IMRT by
keeping bladder volume more than 200mL
throughout planning and treatment.
However, it is often difficult to accumulate
urine more than 200 mL in a bladder as theprostate cancer is common in the elderly, andthere are many patients complicated with benign prostatic hypertrophy. In such patients,
an attempt should be kept bladder volume
150–199 mL, which can clear the treatment
planning assessment standards in 100% of patients. If problems are still remained, the bladder volume and/or the prescribed dose should
be re-evaluated for making a treatment plan.
Many efforts have been paid to improve a
reproducibility of bladder during radiation
therapy. However, there is no guideline regarding optimal bladder volumes and protocol
for preparing optimal bladder volume during
IMRT. In many institutes, IMRT is performed
at 30 or 60 minutes after drinking 500 mL ofwater4). But these methods do not make thestable bladder volume reproducibly 13-15).
Recently, bladder ultrasound image diagnosis devices are introduced to confirm the ap-

62 ◆ Journal of JART English edition 2016

propriate bladder volume in some institutes13-15).
Facilities using simplified ultrasound image
diagnosis devices may increase in the future.
At the same time, it is hoped that a protocol
for obtaining appropriate bladder volume ismade and the efficient work processes flow isestablished.

4. Conclusion
This study revealed that the optimal bladdervolume for IMRT-based prostate cancer treatment is 200 mL or larger by the DVH analysis.

References
1）Japanese Society for Radiation Oncology (eds), Radiotherapy Guidelines 2012. 179-188, Kanehara Shuppan, 2012.
2）Aoki M et al. (eds), Everything on radiotherapy forprostate cancer. Kanehara Shuppan, 2013.
3）Onishi H et al. (eds), Cancer/Radiotherapy 2010. 962967, Shinohara Shinsha, 2010.
4）Yabuta K. Researching prostate IMRT. JASTRO NEWSLETTER 2011. No.3, 30-31, 2011.
5）Nishimura Y et al.: Late damages associated withhigh-dose rate intraluminal brachytherapy and radiation therapy treating only one field each day –analysis
by the linear-quadratic model (NTD-2 Gy) –. J Ther
Radiol Oncol, 11(3): 183-90, 1999.

the original work
Optimal Bladder Volume in IMRT Planning for Prostate Cancer6）Yaes RJ et al.: On using the Linear-quadratic model indaily clinical practice. Int J Radiat Oncol Biol Phys.
20(6): 1353-1362, 1991.
7）Brenner DJ et al.: Fractionation and late rectal toxicity.
Int J Radiat Oncol Biol Phys. 60(4): 1013-1015, 2004.
8）Akimoto T et al.: Rectal bleeding after hypofractionated radiotherapy for prostate cancer. Correlation between clinical and dosimetric parameter and the incidence of grade 2 or worse rectal bleeding. Int J Radiat
Oncol Biol Phys. 60(4): 1033-1039, 2004.
9）Boersma LJ et al.: Estimation of the incidence of late
bladder and rectum complications after high-dose (7078 Gy) conformal radiotherapy for prostate cancer, using dose-volume histograms. Int.J.Radiat.Oncol.Biol.
Phys. 41(1): 83-92, 1998.
10）Ezzell GA et al.: Development of treatment planning
protocol for prostate treatment using intensity modulated radiotherapy. J. Appli Clin Med Phys. 2(2): 5968, 2001.

11）Palta JR et al.: Intensity-Modulated Radiation Therapy. The state of the art. Medical physics publishing.
2003.
12）Storey MR et al.: Complication from radiotherapy
dose escalation in prostate cancer. Preliminary results of a randomized trial. Int J Radiat Oncol Biol
Phys. 48(3): 635-642, 2000.
13）Zelefsky MJ et al.: Long-term outcome of high dose
intensity modulated radiation therapy for patientswith clinically localized prostate cancer. J Urol.
176(4): 1415-1419, 2006.
14）Kuban DA et al.: Long-term results of the M. D. Anderson randomized dose-escalation trial for prostatecancer. Int J Radiat Oncol Biol Phys. 70(1): 67-74,
2008.
15）Kawasaki Y et al.: Accuracy of bladder volume measurement using a bladder ultrasound image diagnosis
device. Sysmex Journal, Vol.36(1), 84-90, 2013.

Arts and Sciences ◆ 63

Arts and Sciences
the original work

Optimization for Q-Space Imaging in a ClinicalSetting: Setting of MPG Direction Number
Nozomi Hamasaki1）, Masaaki Hori2）, Yuriko Suzuki3）, Haruyoshi Houshito1）,
Shigeki Aoki2）

1）Department of Radiological Technology, Juntendo University Hospital2）Department of Radiology, School of Medicine, Juntendo University3）Clinical Science MR Marketing Division Healthcare Sector, Philips Electronics Japan, Ltd.

Key words: QSI, Clinical Setting of MPG, Scan time, MPG direction number【Abstract】

Q-Space Imaging (QSI) is widely used to evaluate non-Gaussian, restricted diffusional changes of water molecules.
We scanned the brains of volunteers to evaluate the optimal settings of Motion Probing Gradient (MPG) settings inclinical use. The settings of MPG direction were MPG1, MPG2, MPG3, MPG6, and MPG15. We evaluated analysis
values of the Probability Density Function (PDF) of the cerebrospinal fluid (CSF), corpus callosum ampulla (whitematter), posterior limb of internal capsule (white matter), and thalamus (gray matter). In the MPG3 or more axes,
the comparable results were obtained at all measurement points. In addition, in the MPG2, it was equal to results of
MPG15 by a setting direction. In conclusion, in the clinical use of QSI, the MPG3 or more settings are appropriate.

Introduction
Q-Space Imaging (QSI) was described in a1991 report by Callaghan on the analysis of
the structural mechanics of porous materials
and has since been described in research on
biological applications1) 2) 3). QSI is a method
to visualise, analyse, and evaluate the motionof water molecules in restricted diffusions of
non-Gaussian distribution using dif fusion-weighted imaging with multi-directional
Motion Probing Gradient (MPG), multiple prepared q-values, Δ { Δ : Motion Probing Gradient interval (MPG)}, and δ { δ : the superimposition of MPG}.
MPG is important for diffusion measurements in Magnetic Resonance Imaging as wellas QSI. The Stejskal-Tanner method, commonly used in diffusion-weighted imaging diffusion measurements, is also employed in thisstudy4). In the Stejskal-Tanner method, before
and after a spin echo method 180°pulse, an
MPG of the same size is applied for the sameamount of time. Using the strength of the
MPG and the changes in the signal strength

64 ◆ Journal of JART English edition 2016

produced according to its directionality, thismethod makes possible the analysis of anisotropy, the measurement of the size of the diffusion in the brain, and QSI analysis.
The q-space of QSI is expressed as a wavenumber space that requires as its object thedisplacement of the diffusion; the q-values express the size of the wavenumber vectors
within the q-space. The q-value is defined as q
(cm-1) = γ G δ / 2 π ( γ : gyromagnetic ratio; G:
MPG magnetic-field gradient; δ : MPG application time) and can be calculated from the parameters related to the b-values used in diffusion-weighted imaging, b (s/mm2) = γ 2G2 δ 2( Δ−δ / 3) ( γ : gyromagnetic ratio; G: MPG magnetic-field gradient; Δ : MPG interval; δ : MPG
application time). Moreover, the inverse q-values indicate the displacement of water molecules in the diffusion. In clinical equipment, γ
is constant and the q-values depend upon
G and δ . QSI analysis first seeks a Probability
Density Function (PDF) by applying a Fouriertransform to the measurement signals frommultiple q-values and then evaluates using theMean Displacement as calculated from the

the original work
Optimization for Q-Space Imaging in a Clinical Setting: Setting of MPG Direction Number

PDF half-width and Max Probability or the
peak value. Of the many challenges in clinical
QSI installations, one is the long imaging
time5). QSI imaging time is proportional to thenumber of MPG application axes and the areaof the configured q-values multiplied by Repetition Time (TR), as indicated in the following
equation:
QSI imaging time ∝ No. of MPG application
axes × No. of q-values × TR
Although it is possible to decrease the imaging time by reducing the number of MPG application axes, there are no reports on therecommended number of MPG application
axes for QSI. Therefore, in this study we investigate how modifying the number of MPG
application axes affects the analysis values
and report on the configuration of MPG application axes appropriate for clinical QSI installations.

Subjects and Method[Equipment used and Subjects] We employeda 3T MRI (Achieva, Philips Healthcare, Best,The Netherlands) with a 32ch head coil.
Three male volunteers (average age 39.5 ±0.5 years) agreed to participate in the study.
After receiving approval from the Ethics
Committee, the aim and contents of thisstudy were carefully explained to the volunteers and their written consent was obtained.
[Imaging Conditions] With the condition thatδ be at the lowest on the above equipment,
we used an Spin Echo-type Echo Planar Imaging and the following imaging conditions:
TR (repetation time)/TE (echo time) (ms):4000/98, Field of view (mm): 256 × 256,
Matrix: 64 × 64, Thickness (mm): 4, gap(mm): 0, slice: 10, voxel size (mm): 4 × 4
× 4, Δ / δ (ms): 47.3/37.8, and b-value (s/mm2): 0, 150, 600, 1,350, 2,400, 3,750, 5,400,
7,350, 9,600, 11,250, and 15,000. Further,
the imaging b-values were converted intoq-values and the following q-values wereset at equal intervals: 0 (cm-1), 10.46, 20.93,
31.39, 41.86, 52.32, 62.78, 73.25, 83.71,
90.62, and 104.64. Single-axis MPG applications include the following three directions:vertical encoding on the slice in the SI direction (Slice: S), phase encoding on the AP
direction (Phase: P), and frequency encoding on the RL direction (Frequency: F).
Two-axis MPG applications consist of thefollowing three directions: SP direction
formed by the superimposition of the SI direction (Slice: S) and AP direction (Phase:
P), SF direction from the SI direction (Slice:S) and RL direction (Frequency: F), and PF
direction formed of the AP direction (Phase:P) and RL direction (Frequency: F). This
study focused primarily on imaging the basal ganglia.
[Method 1] We conducted imaging with MPG
application configurations of 1, 2, 3, 6, and15 axes. Although settings of more than 15
axes are possible, they increase the imaging
times to more than 15 minutes. Thus, in thisstudy we considered a maximum of 15 axes.
With 15 axes, the imaging time for one supplemental run was 10 min 12 s; consideringchanges in the SNR (signal to noise ratio)
on other configuration axes, we attempted
to use settings that would ensure that supplements would require the same amount oftime. On a single axis, the imaging time for
12 supplements was 8 min 28 s; for twoaxes, the imaging time for six supplements
was 8 min 28 s; for three axes, five supplements required 10 min 28 s; and for six
axes, two supplements required 8 min 12 s.
[Method 2] Building on the results of Method
1, in this investigation, we used the configuration with the least axes that was not significantly different from the analysis values
yielded by the maximum configuration of
15 axes. We modified the average number
during imaging to determine if the average
number had any influence on the imaging.
Arts and Sciences ◆ 65

Fig. 1 Position of ROI[Analysis and Testing] We used the free Diffu-

sion Tensor Imaging analysis software dTV
II FZR (University of Tokyo Department ofRadiology Imaging Information Processing& Analysis Laboratory) to analyse the QSI
data; this is an improvement upon the original dTV that incorporates the QSI analytics.
The Region of Interest (ROI) was set to Image J using the Max Probability Image andMean Displacement Image as calculated bydTV II FZR. As depicted in Fig. 1, an image
with b-values at 0 s/mm2, the ROI was set
to the cerebrospinal fluid: CSF (right cerebral ventricle anterior horn), splenium of
the corpus callosum, posterior limb of internal capsule, and thalamus. While the ROI
was set on the splenium and posterior limbof the internal capsule, an MPG15 Fractional
Anisotropy Image was consulted. The sizeof each section was identical, an 8 × 8 mm
square. To ensure that each section wasmeasureable even when the number of
MPG axes changed, the ROI position wasrecorded in the software and the analysis
was conducted on identical ROIs for all subjects.
To confirm the statistical significance, aMann-Whitney U test was conducted on theanalytic values of the Mean Displacement
and Max Probability from the MPG15 application, which had the greatest amount of

66 ◆ Journal of JART English edition 2016

data, and on the values from MPG1, MPG2,
MPG 3, and MPG6.

Results of Method 1
The average PDF of the three volunteers is
illustrated in Fig. 2 and the analytic values areprovided in Table 1 . Because the PDF is abell-shaped curve with bilateral symmetry, tobest display the breadth of the curve, we display the right side instead of the centre.
The QSI analysis values under MPG applications of 1, 2, 3, 6, and 15 axes revealed nosignificant differences (P > 0.05) in the Max
Probability and Mean Displacement under application configurations of 3, 6, and 15 axes;
when the number of axes was increased, thestandard deviation decreased.
The analysis results of the MPG2 application
when two application directions included anaxis equivalent to the direction of the whitematter fibres (RL on the splenium, SI direction
on the posterior limb of the inner capsule)and the analysis values from the MPG15 application were not significantly different (P >0.05). However, when configured to two directions that did not include an axis alignedwith the direction of the white matter fibres,
the Max Probability increased and statisticalsignificance was observed (P < 0.05).
In the cerebrospinal fluid and thalamus, de-the original work
Optimization for Q-Space Imaging in a Clinical Setting: Setting of MPG Direction Number

Fig. 2 PDF of MPG-directions

creasing the number of MPG application axes
increased the standard deviation in comparison with the analytic values obtained with
MPG15. However, configurations of more than
two axes were not significantly different (P >0.05).
The analytic results of MPG application on asingle axis were statistically significant (P <0.05), as in the splenium and posterior limb of
the interior capsule areas, when the directionof the application axis aligned with the direction of the white matter fibres (RL direction in
the cerebrospinal fluid area, SI direction inposterior limb of the interior capsule area), resulting in increased Mean Displacement andminimal Max Probability.
Arts and Sciences ◆ 67

Table 1 QSI analysis value
MPG
direction
15
6
3
FP
FS
PS
F
P
S

Max Probability（%）

Mean Displacement（μm）

CSF

corpuscallosuminternal
capsulethalamus1.17 0.40
1.17 0.44
1.18 0.61
1.14 0.84
1.13 1.03
1.14 0.66
1.14 0.98
1.15 1.44
1.16 1.21

3.53 0.41
3.55 0.39
3.92 0.47
4.01 0.32
4.10 0.46
5.87 0.52
2.07 0.12
5.96 0.74
5.45 0.49

3.58 0.39
3.57 0.20
3.71 0.15
4.50 0.62
3.54 0.47
3.55 0.63
4.52 0.85
4.87 0.45
2.53 0.36

3.11 0.19
3.24 0.23
3.21 0.25
3.09 0.32
3.17 0.29
2.97 0.63
3.22 0.81
2.83 0.99
3.17 0.56

corpuscallosum

CSF

internal
capsulethalamus34.08 0.20 9.46 0.22 9.86 0.34 12.84 0.53
34.10 0.14 9.94 0.23 10.67 0.43 12.12 0.85
34.45 0.18 9.40 0.33 10.39 0.47 12.83 0.92
36.45 0.28 9.36 0.33 10.85 0.69 13.42 0.82
38.03 0.92 9.32 0.41 8.99 0.79 12.55 0.67
36.52 0.31 7.85 0.38 9.80 0.71 13.60 0.53
36.66 0.42 22.23 1.44 9.27 0.80 12.67 1.06
36.09 0.52 8.52 0.53 8.60 0.72 14.25 1.76
35.92 0.69 8.64 0.65 17.9 1.90 12.36 0.84

Table 2 MPG3 fixed, average number 1, 3, and 5 of QSI analysis value
Mean Displacement（μm）

Max Probability (%)
Average
5
3
1

CSF

corpuscallosuminternal
capsulethalamusCSF

corpuscallosuminternal
capsulethalamus1.15 0.71
1.17 0.56
1.19 0.60

3.91 0.55
3.99 0.67
4.01 0.69

3.75 0.42
3.66 0.61
3.70 0.71

3.26 0.22
3.29 0.20
3.28 0.24

35.39 1.04
34.74 1.42
34.91 1.39

8.94 0.79
9.09 0.70
9.11 0.84

9.50 0.69
9.53 0.77
9.49 0.86

10.99 0.65
11.09 0.61
11.24 0.78

For all ROIs, the setting with the minimum
number of application axes that did not differ
significantly from the 15-axis setting was the
3-axis setting.

Results of Method 2
Method 2 employed a 3-axis setting drawn
from the results of Method 1 and the resultsof setting the average number of QSI analysis
values to one (imaging time: 2 min 12 s),
three (imaging time: 6 min 20 s), and five (imaging time: 10 min 28 s) are presented inTable 2. Reducing the average number yieldedno significant difference in analysis values (P> 0.05).

Discussion
For all ROIs, there was no significant difference in analysis values for uniform arrangements of 3, 6, and 15-axis MPG application
configurations. The Max Probability and Mean

68 ◆ Journal of JART English edition 2016

Displacement values are displayed as averagevalues because MPG configurations of uniform arrangements of greater than three axes
yielded identical results. Moreover, increases
in the number of axes tended to reduce fluctuations away from the standard deviation of
the analysis values.
It can be assumed that the white matter fibres of the splenium run along the one frequency direction (RL); however, in the MPG2
configuration that includes the direction of thewhite matter fibres, we obtained the same values as when we applied MPG15. Furthermore,because Max Probability was assessed higher
in configurations that did not include axesaligned with the direction of the white matter
fibres than in 15-axis configurations, whenevaluating white matter it seems that setting
an axis to align with the direction of the whitematter fibres is a necessity. Similarly, in theposterior limb of the interior capsule, thewhite matter fibres were extended along a direction close to the direction (SI) perpendicu-

the original work
Optimization for Q-Space Imaging in a Clinical Setting: Setting of MPG Direction Number

lar to the slice plane and a 2-axis MPG settingthat included the white matter fibre direction
obtained values identical to MPG15. In cases
where the target tissue is limited and the direction of the white matter fibres can be assumed, we believe the 2-axis setting to be effective.
For the non-restricted diffusion expected in
the thalamus and cerebrospinal fluid, application configurations of greater than two axes
yielded PDF, Mean Displacement, and Max
Probability values identical to those obtainedwith MPG15. Imaging only non-restricted diffusion organisation configurations with morethan two axes is possible, minimising imaging
time and facilitating clinical introduction.
However, because reducing the number ofapplication axes produces variations in thestandard deviation of the analysis values andeven minimal changes in the ROI position
causes significant changes in the analysis values, sufficient caution is warranted in cases
where the ROI and imaging target tissue aresmall.
Lacking information from other axes, thearithmetic mean of the average number canbe considered a statistically significant factor
on a 1-axis configuration. Because multiple-axis MPG application synthesis is performed on the geometric mean, signal averaging has not confirmed the statistical significance of the analysis values. Further, the lackof image distortion correction was also a factor. Because the signal value of the images
with b-values of 10,000 s/mm2 or greater was
weak, alignment with images of a b-value of 0
s/mm2 was difficult. Moreover, because thecorrective processing of the distorted images
produced tiny blemishes, all of the images inthis study were analysed without the use ofcorrective techniques. Correcting damaged
images with high b-values is a challenge forthe future.
In clinical settings where the target tissue
cannot be determined, an MPG setting ofgreater than three axes is advisable.
On identical axis configurations, even if theaverage number changes, imaging is possible
with an average number of one because theanalysis values are not statistically significant.
It is possible to achieve imaging times of approximately five minutes in clinical installations by setting the MPG application to threeaxes and the average number to one, even in
QSIs using b-values on multiple images.
One of the problems facing the clinical introduction of QSI is the report that it only approaches true values as Δ ≫ δ . However, δcannot be extended beyond the biological safety restrictions in even the maximum gradient of
the magnetic field strength of clinical equipment. In this study, we set δ to be as short as
possible, however, with Δ : 47.3 ms and δ : 37.8
ms, we must admit that we have not satisfied
the condition wherein Δ ≫ δ .

Conclusion
It is possible to reduce imaging time in eachof the tissue structures targeted for imaging by
modifying the number and direction of the
MPG application axes. Further, increasing thenumber of MPG application axes results in averaging of the QSI analysis values within the
ROI. Clinical installations of cranial QSI require stable analysis values by increasing thenumber of MPG application axes; however,considerations of imaging time suggest that
MPG application configurations of three axes
will prove useful.

References:
1） Callaghan PT, Coy A, MacGowan D et al.: Diffraction
like effects in NMR diffusion studies of fluids in porous
solids. Nature, 351: 467-469, 1991.
2） Fatima Z et al.: q-space imaging (QSI) of the brain:comparison of displacement parameters by QSI and
DWI. Magn Reson Med Sci, 9 (3) : 109-10, 2010.
3） Hori M et al.: A comparison of mean displacement
values using high b-value Q-space diffusion-weighted

Arts and Sciences ◆ 69

MRI with conventional apparent diffusion coefficientsin patients with stroke. AcadRadiol, 18 (7) : 837-841,
2011. Epub 2011 Mar 21.
4） Nakada T. Diffusion Tensor and Diffusion Weighted
Imaging: Pictorial Mathematics. Japanese Journal ofMagnetic Resonance in Medicine, 15: 133-144, 1995.
5） Araki T. Diffusion MRI: Brownian Motion and Diffusion
Tensor to Q-space. Shujunsha, 211-226, 2006.
6） Rasband WS. ImageJ, U.S. National Institutes of
Health. Bethesda, Maryland, USA, http://imagej.nih.
gov/ij/.
7） Shir BA, Avram L, Ozarslan E et al.: The effect of the
diffusion time and pulse gradient duration ratio on thediffraction pattern and the structural information estimated from q-space diffusion MR: Experiments andsimulation. Magn Reson, 194: 230-236, 2008.
8） Aoki S, Abe O, Masutani Y (authored and edited): Understanding Diffusion MRI, 2nd edition. 134-135, Shujunsha, 2005.

70 ◆ Journal of JART English edition 20169） Ishigame K, Araki T, Okumura A et al.: Q-space analysis of Diffusion-weighted Images. INNERVISION, 9:
54-56, 2008.
10）Assaf Y, Ben-Bashat D, Chapman J et al.: High b-value q-space analyzed diffusion-weighted MRI: application to multiple sclerosis. Magn Reson Med, 7: 115126, 2002.
11）Fukunaga I, Hori M, Masutani Y et al.: Effects of diffusional kurtosis imaging parameters on diffusion quantification. RadiolPhysTechnol, 2013.
12）M Hori, I Fukunaga, Y Masutani et al.: Visualizing
non-Gaussian diffusion: clinical application of q-space
imaging and diffusional kurtosis imaging of the brain
and spine. Magn Reson Med Sci, 11: 221-233, 2012.
13）N Hamasaki, S Sato, M Hori et al.: Optimal parameters of q-space imaging in clinical setting: setting ofimaging q-value. Japanese Journal of Magnetic Resonance in Medicine, 32 (3), 2012.

Arts and Sciencesmaterial

A Survey Regarding Acceptance and Awarenessof Autopsy imaging (Ai) among RadiologicalTechnologists in Our Institution: Comparison
with Those of Two Other Institutions
Kazuya Tashiro1）, Tomoya Kobayashi 1）, Satoka Someya1）, Katsumi Miyamoto1）,
Hiroyuki Takei 2）, Seiji Shiotani 3）, Hideyuki Hayakawa 4）
1）Department of Radiological Technology, Radiological Technologist, Tsukuba Medical Center Hospital2）Department of Radiology, Radiological Technologist, Gunma University Hospital3）Department of Radiology, Radiologist, Tsukuba Medical Center Hospital（currently Seirei Fuji Hospital）
4）Department of Forensic Medicine, Forensic Scientist, Tsukuba Medical Examinerʼs Office

Key words: Autopsy imaging (Ai), radiological-technologist, questionnaire survey, postmortem CT, postmortem MRI【Abstract】

An anonymous questionnaire survey consisting of 8 questions was conducted to 35 radiological technologists in
our institution regarding their feelings and awareness about autopsy imaging (Ai). Among them, 30 subjects (85%)
responded, with approximately 60% of them indicating an interest in Ai, mainly for its potential contribution to society.
And 90% of the respondents answered an absence of negative feelings associated with the imaging of unnaturally
deceased bodies, as a matter of their routine work. However, only 30% of the respondents were aware of two recent
Japanese laws regarding death-cause detection, while 70% of the respondents had awareness of a model project forpediatric Ai, suggesting insufficient knowledge of the background and reasoning behind the needs of Ai. Our survey
results were compared with two other previously-published surveys. Our comparative investigation suggests necessityof more Ai-related education in training institutes, greater distribution of relevant information by the Japan Associationof Radiological Technologists, and the sharing of experiences among hospital staffs, all of which will help meet theneeds and social demands of Ai.

1. Introduction
Since the introduction of post-mortem examination scans (Autopsy imaging, hereafter referred to as “Ai”) in 2000 1) 2), Ai has come into
widespread regular practice10) throughout theearly adoption phase of the past 10 years 3)–9). In
July 2012, two Japanese laws were introduced
regarding the investigation of the cause ofdeath: “Act on the Investigation into the Causeof Death or the Identity of Corpse by Police or
Security Forces” (Act of Death Investigation
and Identification)11) and “Policy on the Promotion of Corpse Examination” (Policy on Corpse
Examination)12). With the start of enforcementin April 2013, the Act Of Death Investigation
And Identification establishes the “implementation of procedures when the police chief rec-ognizes the need to perform internal bodily
exams to determine the cause of death whenhandling corpses, to the extent required, in order to verify the state of bleeding via body fluid collection, exams to check for drugs and/or
poisoning via the collection of body fluid or
urine, autopsy imaging, and other examinations prescribed by law”13). The Council for the
Promotion of Policy on Corpse Examination,
responsible for the implementation of the Policy on Corpse Examination, released its final
report14) in April 2014, and made a cabinet decision, “Plan for Promotion of Corpse Examination” in June 2014. Ai is listed as one of thosespecific measures15). The “Model Project ofPost-Mortem Imaging for Pediatric Deaths” runby the Ministry of Health, Labor and Welfare
began in September, 201416).
Arts and Sciences ◆ 71

Since our hospital first opened in February
1985, post-mortem computed tomography(CT) has been performed 17) – 20) to estimate andidentify the cause of death in patients whodied after being transported to our facilityʼsemergency department for cardiopulmonaryarrest. Among our radiological technologists,
the daytime CT lead operator (8:30-17:30) andevening (17:30-22:00) and overnight (22:008:30am) on-duty operators perform these
post-mortem CT scans. Our hospital is designated as an autopsy center (a facility commissioned by the prefecture to implement dissection with consent according to the administrative autopsy procedures) to perform post-mortem CT scans to guide and supplement dissection, and perform magnetic resonance imaging(MRI) when possible, for abnormal corpses
sent by the police for autopsy 21) – 23). These
pre-dissection post-mortem CT and MRI scans
are performed the evening before dissection
by a rotation of 5 radiological technologiststhat have been doing Ai for over 10 years, and/or have received official certification from an
Ai certification workshop. Our hospital radiology department is responsible for a wide variety of procedures like common x-rays, ultrasound scans, CT, MRI, nuclear medicine, radiation therapy, and other medical exams 24), but
the main responsibilities of each individual radiologist are fixed to an extent. That is to say,that we can expect differences between technicians regarding their degree of involvementwith Ai, and their levels of interest and knowledge about Ai. Up until now, there have beena few investigations conducted concerning therealities of Ai 25) – 28), and the The Japan Association of Radiological Technologists (hereafterreferred to as “JART”) recently conducted afact-finding survey about Ai 29) that is still being
analyzed (personal communication). However,
although this Ai awareness survey of radiologists has been mentioned in a few conference
presentation abstracts 30) – 32), very few reports
have been published 33) 34). We conducted an Ai

72 ◆ Journal of JART English edition 2016

Table 1 Questionnaire sheet including 8 questions
regarding Ai
Question 1 “Do you have an interest in Ai?”
(Yes, Iʼm interested. / No, Iʼm not interested. / I donʼtknow.)
Question 2 “What is the reason for your interest in Ai?” (select allthat apply)(I want to assist in cause of death investigations. / Itʼs relevant to recent events. / Itʼs an unknown field forme. / Other (free response))
Question 3 “What is the reason for your disinterest in Ai?” (select allthat apply)(It makes me uncomfortable. / I just canʼt handle it. /Other (free response.))Question 4 “How do you feel about Ai as a routine part of work?”(I donʼt mind it as a routine part of work. / I donʼtwant to do it as a routine part of work. / Other (freeresponse.))Question 5 “Are you willing to conduct Ai following a request fromthe police?”(I want to do it. / I donʼt mind doing it. / I donʼt want
to do it.)Question 6 “Do you know the two laws regarding death cause detection?”(I know them. / Iʼve heard of them. / I donʼt know.)
Question 7 “Are you aware of the model project of pediatric Ai?”
(I know it. / Iʼve heard of it. / I donʼt know.)
Question 8 “Please write your thoughts about Ai.”awareness survey among the radiological technologists at our hospital and are sharing theresults here.

2. Materials and Methods
The full staff of 35 radiological technologists(male-to-female ratio 24:11, ages 23-47, average age 34) were surveyed anonymously concerning their awareness and knowledge of Ai(survey period April 22-30, 2014). The 8 survey
questions are listed in Table 1.
Questions 1 through 7 were multiple-choice.
Radiological technologists who answered “Iʼminterested” to Question 1 also answered Question 2, and Questions 4-8. Radiological technologists who answered “Iʼm not interested” toQuestion 1 also answered Question 3, andQuestions 4-8. Radiological technologists who
answered “I donʼt know if Iʼm interested” toQuestion 1 also answered Questions 4-8. A
blank writing space was provided for elaboration on answers of “Other” for Questions 2-4.
For Question 4 “How do you feel about Ai as amaterial
A Survey Regarding Acceptance and Awareness of Autopsy imaging (Ai) among Radiological Technologists in Our Institution: Comparison with Those of Two Other Institutions

routine part of work?” Ai was defined as
post-mortem CT scans performed on patients
whose deaths were confirmed at our hospital,
either by the emergency department or an inpatient wing. For Question 5 “Are you willingto conduct Ai following a request from the police?” Ai was defined as post-mortem CT scans(or MRI, depending on the case) of abnormal
corpses sent to the autopsy center by the police for autopsy and/or post-mortem exam.
The survey results were compared to the results of an Ai survey conducted in 2009 among
43 radiological technologists (citation #33 says
45 people, but it was actually 43) at the Department of Radiology at Gunma University
Hospital (hereafter referred to as “Gunma University Survey” ) 33) which officially began doing
Ai in 2008, and an Ai survey conducted in 2014
among 17 radiology staff members (16 radiological technologists and 1 radiologist) at the
medical technology division of Koyama Memorial Hospital (hereafter referred to as “Koyama
Memorial Hospital Survey” ) 34) which has been
doing Ai since 2004 or earlier. The Gunma University Survey included questions that correspond to Question 1 and 4 of this survey. The
Koyama Memorial Hospital Survey included
questions that correspond to Question 1 and4-7 of this survey. In Question 4 “How do you
feel about Ai as a routine part of work?” theanswer choices of “I donʼt mind it as a routine
part of work” “I donʼt want to do it as a routine
part of work” and “Other” were phrased as “Iwant to do it” “I donʼt mind doing it” and “I
donʼt want to do it” in the Koyama Memorial
Hospital Survey. In order to compare the results more easily, the “I want to do it” and “I
donʼt mind doing it” responses were classified
together as “I donʼt mind it as a routine part ofwork” for convenience in this survey.

3. Results
The survey was completed by 30 out of 35
people (86% completion rate).

Question 1 “Do you have an interest in Ai?”

Among the 30 survey responses, 18 people(60%) selected “Yes, Iʼm interested,” 8 people(27%) selected “No, Iʼm not interested,” and 4
people (13%) selected “I donʼt know” (Fig.1).
Question 2 “What is the reason for your interestin Ai?” (select all that apply)

Among the 18 people who responded “Yes,Iʼm interested” to Question 1, 14 people (78%)
selected “I want to assist in cause of death investigations,” 6 people (33%) selected “Itʼs relevant to recent events,” 5 people (28%) selected“Itʼs an unknown field for me” and 1 person(6%) selected “Other.” The person who selected “Other” wrote “I feel a societal obligation.”
Question 3 “What is the reason for your disinterest in Ai?” (select all that apply)

Among the 8 people who responded “No,Iʼm not interested” to Question 1, nobody selected “It makes me uncomfortable” or “I justcanʼt handle it.” All 8 people selected “Other,”and 7 of those people wrote a freestyle response. Among the “Other” written responses,
4 people (50%) wrote “No particular reason.” 1
person (13%) wrote “It has nothing to do withmy job,” 1 person (13%) wrote “I donʼt feel familiar with Ai” and 1 person (13%) wrote “Unlike living bodies, I donʼt think it will provide
any useful knowledge that can be used in future examinations.”

Tsukuba
Medical Center(2014)*1
I don’t know
4 people(13%)
No
8 people(27%)

Yes
18 people(60%)*1 Survey response rate
30/35 = 86%

Gunma
University(2009)*2No
1 person(6%)

I don’t know
7 people(17%)
No
11 people(27%)

Koyama Memorial
Hospital(2014)*3Yes
23 people(56%)*2 Survey response rate
41/43 = 95%Yes
16 people(94%)*3 Survey response rate
17/17 (100%)

Fig.1 Ratio of respondents regarding the firstquestion, “Do you have an interest in Ai?”
Arts and Sciences ◆ 73

Question 4 “How do you feel about Ai as a rou-

the date and time.”tine part of work?”

Among the 30 survey responses, 27 people(90%) responded “I donʼt mind it as a routine
part of work.” Among their answers to Question 1, 16 out of 18 people (89%) selected “Iʼminterested.” 7 out of 8 people (87%) responded“Iʼm not interested” and 4 out of 4 people(100%) selected “I donʼt know.” On the other
hand, there were no radiological technologists
who selected “I donʼt want to do it as a routine
part of work.” The 3 remaining people selected“Other” (Fig.2a, b, c) and 2 of those people
wrote a freestyle response. 1 person (33%)
wrote “I donʼt think itʼs necessary for cases
where the cause of death of obvious” and 1
person (33%) wrote “I hate that you canʼt read

Tsukuba
Medical Center(2014)
Other
2 people(11%)
I don’t want
to do it0 people(0%)

I don’t mind
16 people
(89%)

Gunma
University(2009)
Other
2 people(9%)

I don’t want
to do it
4 people(17%)

I don’t mind
17 people(74%)

Koyama Memorial
Hospital(2014)* 4
I don’t want
to do it
1 person(6%)

I don’t mind
15 people(94%)*4 Because diﬀerent facilities had diﬀerent sets of questions,“I want to do it” 6 people (38%) and “I don’t mind doing it” 9 people (56%) werecombined as “I don’t mind.”Fig.2 a Acceptance of Ai regarding the 4thquestion, “How do you feel about Ai as
a routine part of work?” (to respondents
who indicated an interest in Ai)

Tsukuba
Medical Center(2014)
Other
1 person(13%)
I don’t want
to do it0 people
I don’t mind
(0%)
7 people
(87%)

Gunma
University(2009)

Koyama Memorial
Hospital(2014)*5
I don’t want
to do it0 people
(0%)

Other
1 person(9%)
I don’t mind
5 people
I don’t want(45%)
to do it
5 people(45%)

I don’t mind
1 person(100%)*5 Because diﬀerent facilities had diﬀerent sets of questions,“I don’t mind it as a routine part of work” was combined with “I don’t mind doing it”

Fig.2 b Acceptance of Ai regarding the 4thquestion, “How do you feel about Ai as
a routine part of work?” (to respondents
who indicated no interested in Ai)

74 ◆ Journal of JART English edition 2016

Question 5 “Are you willing to conduct Ai following a request from the police?”

Among the 30 survey responses, 6 people(20%) selected “I want to do it” regarding police requests, 16 people (54%) selected “I donʼt
mind doing it” and 7 people (23%) selected “I
donʼt want to do it.” (Fig.3).
Question 6 “Do you know the two laws regarding death cause detection?”

Among the 30 survey responses, 9 people(30%) selected “I know them” regarding thetwo laws, 2 people (7%) selected “Iʼve heard ofthem” and 19 people (63%) selected “I donʼtknow.” (Fig.4).

Gunma
University(2009)

Tsukuba
Medical Center(2014)
Other
3 people(10%)
I don’t want
to do it0 people
(0%)

Other
4 people(10%)

I don’t mind
27 people(90%)

I don’t want
to do it
9 people(22%)
I don’t mind
28 people(68%)

Koyama Memorial
Hospital(2014)*5
I don’t want
to do it
1 person(6%)

I don’t mind
16 people(94%)*5 Because diﬀerent facilities had diﬀerent sets of questions,“I want to do it” and “I don’t mind doing it” were combined as “I don’t mind.”Fig.2 c Acceptance of Ai regarding the 4thquestion, “How do you feel about Ai as aroutine part of work?” (to all respondents)

Tsukuba
Medical Center(2014)
No answer
1 person (3%)

I don’t want
to do it
7 people(23%)

I want to
do it
6 people(20%)

I don’t mind
16 people(54%)

Koyama Memorial
Hospital(2014)

I don’t want
to do it
1 person (6%)

I want to
do it
4 people(23%)

I don’t mind
12 people(71%)

Fig.3 Acceptance regarding the 5th question,“Are you willing to conduct Ai following arequest from the police?”material
A Survey Regarding Acceptance and Awareness of Autopsy imaging (Ai) among Radiological Technologists in Our Institution: Comparison with Those of Two Other Institutions

Question 7 “Are you aware of the model projectof pediatric Ai?”

Among the 30 survey responses, 21 people(70%) selected “I know it” regarding the project, no one selected “Iʼve heard of it” and 9
people (30%) selected “I donʼt know.” (Fig.5).
Question 8 “Please write your thoughts about
Ai.”Among the 30 survey responses, 5 people
wrote the following freestyle comments: “I firstheard about Ai back when I was a student, so
I accept it as a part of work in this field.”“Post-mortem MRI arenʼt usually done in otherfacilities so Iʼm interested in it, but Iʼm worried
whether I can do it well.” “I want to know thebackground that led to the creation of thepediatric Ai model project.” “If radiological
technologists can assist with identifying thecause of death, we should do it positively.” “I
think that performing Ai is an important opportunity for the radiology department (the radiological technologists doing the imaging and theradiologists that make the diagnosis) to view
the whole body structure.”

4. Discussion
The proportion of radiological technologists
who said they have an interest in Ai was greater than half of the respondents at all 3 facilities.
Only our hospitalʼs survey asked for the reason

Tsukuba
Medical Center(2014)

I don’t know
19 people(63%)

I know them
9 people(30%)

I’ve heardof them
2 people(7%)

Koyama Memorial
Hospital(2014)
I’ve heardof them
0 people(0%)

I know them
4 people(24%)

I don’t know
13 people(76%)

Fig.4 Awareness regarding the 6th question, “Do
you know the two laws regarding deathcause detection?”

why the respondents had an interest in Ai ornot, and we found that the motivation for interested respondents was their contribution to society rather than their own personal interest.
We also found that uninterested respondents
were not motivated by feelings of discomfort,
and that they might become interested in Ai ifwork related to Ai was to increase at theirworkplace.
The proportion of radiological technologists
who said they donʼt mind it as a routine part ofwork was greater than two-thirds of the respondents at all 3 facilities. The freestyle comment “I first heard about Ai back when I was astudent, so I accept it as a part of work in thisfield” leads us to believe that if a greater number of radiological technologist training facilities (universities and trade schools) included Ai
in the course curriculum, we can predict that agreater proportion of radiological technologists
would consider Ai to be a routine part of work.
The percentage of radiological technologists
who said “I want to do it” or “I donʼt mind doing it” regarding police request Ai was 74%,
lower than the 90% of respondents who answered “I donʼt mind doing it as a routine partof work.” While no radiological technologists
at this hospital selected “I donʼt want to do it asa routine part of work,” 7 people said that theydonʼt want to do police request Ai. It is thoughtthat they might be motivated by the following
two reasons: First, because police request Ai at

Tsukuba
Medical Center(2014)

Koyama Memorial
Hospital(2014)
I know it
2 people(12%)

I don’t know
9 people(30%)

I’ve heard of it
0 people(0%)

I know it
21 people(70%)

I’ve heard of it
2 people(12%)

I don’t know
13 people(76%)

Fig.5 Awareness regarding the 7th question “Areyou aware of the model project of pediatricAi?”
Arts and Sciences ◆ 75

our facility is restricted to only 5 members of
our radiology staff, the remaining radiological
technologists arenʼt as familiar with police request Ai compared to Ai as a routine part ofwork. Second, the freestyle comment “Post-mortem MRI arenʼt usually done in other facilities
so Iʼm interested in it, but Iʼm worried whether
I can do it well” leads us to believe that because police request Ai means post-mortem
MRI, it involves a greater responsibility thanwork performing post-mortem CT scans. A
study group report on the use of post-mortem
examination scans says “Ideally, radiological
technologists that completed training held byorganizations like the JART should be performing post-mortem scans, and we ought to consider making this a certification subcategory
inside JARTʼs certification system” 8). As of 2011,
JART implemented a certification process for
Ai-certified radiological technologists 35), according to the following criteria.
• Applicant has been granted a radiological
technologist license and has 5 years ormore work experience, including at least 2
years of CT scan experience.
• Applicant has taken JARTʼs radiological
technologist basic training “X-Ray CT Examination” and an Ai certification workshop.
• Applicant has previous experience inspecting post-mortem imaging.
These certification requirements show that inorder to take CT scans that are useful in causeof death investigations, a radiological technologist needs a good command of the same technical skill and knowledge that is used in everyday clinical work with living bodies. It might
be more difficult to perform post-mortem MRI
than post-mortem CT scans.
The proportion of respondents that knew thetwo relevant laws was between one-fourth andone-third. Because an increase in police request Ai commissions is expected in the fu-

76 ◆ Journal of JART English edition 2016

ture 36), it would be ideal for the radiological
technologists performing these scans to know
the background of this work. Currently, the Ai
certification workshop is held three times ayear 37), but the number of students is limited to
100 people each time. The JART believes thatitʼs necessary to convey the importance of performing Ai to more radiological technologists
not only through certification workshops, butalso by holding a symposium of the JART general members and by increasing the frequencyof awareness measures 9) like publishing articles about Ai in the Journal of JART.
The proportion of respondents that knew
about the pediatric Ai model project was higher at our hospital than in the Koyama Memorial Hospital Survey. It is thought that they might
be motivated by the following two reasons:First, our hospitalʼs radiology department helda study session about Ai just two weeks before
this survey was done, and the pediatric Ai
model project was also discussed, so itʼs expected that anyone who attended that session
would select “I know it.” Second, our hospital
has a pediatrics department, but Koyama Memorial Hospital does not (note: there is a neonatology department.) One of the purposes ofthe pediatric Ai model project is to identify
child abuse 16). Every year, there are a few requests from our pediatrics department to takefull-body x-rays 38) 39) to confirm the presence ofphysical abuse; this leads us to think that ourradiological technologists can easily understand the purpose of the pediatric Ai model
project, and have a greater interest in it. The
freestyle comment “I want to know the background that led to the creation of the pediatricAi model project” reflects this as well.
This paperʼs scope is limited because we
could only compare the survey from our hospital with two other facilities. Itʼs possible thatcompletely different results could be obtainedat other facilities with a different number ofstaff, range of ages, or male-to-female ratio. A
nationwide survey with a greater number ofmaterial
A Survey Regarding Acceptance and Awareness of Autopsy imaging (Ai) among Radiological Technologists in Our Institution: Comparison with Those of Two Other Institutions

questionnaires will be necessary for future research. This paper will also become comparison data for that project.
Japan is rapidly aging, and is entering aphase when death will be commonplace in society 40). Even though Japan is often called asociety that doesnʼt investigate the cause ofdeath 1) 2), there are great expectations for Ai as
the rate of dissection fails to rise 41). 90.4% of Ai
practitioners are radiological technologists 6).
Just as the freestyle comment “If radiological
technologists can assist with identifying thecause of death, we should do it positively” suggests, we radiological technologists need to respond to the societal demand for Ai. In orderto achieve that, it is necessary to establish Ai as
a field of study at radiological technologist
training facilities 42) 43) and continue the ongoing
implementation of JARTʼs Ai certification workshops and positive public relations work. Giv-

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Journal of JART–English edition 2016–

February 20, 2016
Issuer: Yasuo Nakazawa
Publisher: The Japan Association of Radiological Technologists
31F World Trade Center Building. 2-4-1,
Hamamatsu-cho, Minato-ku, Tokyo. 105-6131
TEL: +81-3-5405-3612 FAX: +81-3-5405-3613
http://www.jart.jp
・Published by The Japan Association of Radiological Technologists.
Ⓒ2016, Printed in Japan.

The Japan Association of Radiological Technologists
http://www.jart.jp