10 2013年医学装备学会CT/MR市场分析研讨会 高建华,武警总医院 2013.08.16 微辐射平台 11 各种迭代技术降低辐射剂量的比较 ——权威文献 Eur Radiol,12 Jan 2013 iDose4降低辐射剂量技术最领先 12 星光iDose4重建速度满足急诊检查需求 IR does clinicallyimportant CT image reconstruction delays emergencysetting. substantialdifferences reconstructiontime speedwere found between different IR levels. Insights Imaging (2013) 4:391–397 13 降低辐射剂量降低辐射剂量 14 研究历时16年 入组154,091病例 全美1/10筛查中心参与 结论: 每年胸片筛查不能提升肺癌检出率 每年胸片筛查不能降低被检者死亡率 每年胸片筛查对肺癌发现时的分期和组织类型无影响 14 15 研究历时7.5年 入组53,454病例 全美33家医学中心参与 结论: 低剂量CT筛查较胸片可以降低被检者肺癌死亡率20% Minnies 2011 final results October 25, 2011 Voting nowcomplete 2011edition Minnies,AuntMinnie'sannual event recognizeexcellence radiologyScientific Paper YearReduced lung-cancer mortality low-dosecomputed tomographic screening. Aberle DR, New England Journal Medicine,August AuntMinnie.com'scoverage paper15 16 American Cancer Society Lung Cancer Screening Guidelines 年龄:55-74岁 吸烟史:有三十年吸烟 史,正在吸烟或者15年 内戒烟的人群 CA Cancer Clin2013 17 按照NLST标准,美国实 行肺癌低剂量筛查,每 年可以拯救1万2千患者 的生命 CT lung cancer screening could save 12K lives yearCancer Feb 25, 2013 18 hybridIR technique low-doseCT imaging 50mAs enabled noise chestphantom referenceacquisitions 200mAs FBP”“Detection ground-glassopacities hybriditerative reconstruction (iDose) low-dose256-section computed tomography: phantomstudy”Ko Higuchi,Michinobu Nagao,Yoshio Matsuo,et al.Radiol Phys Technol 2013 iDose4 Phantom study Radiol Phys Technol 2013 19 综合模型及临床数据结果,针对临 床肺部低剂量诊断及筛查建议采用 的剂量及iDose 水平合适组合:50mAs采用常规FBP就可以满足临 床肺部诊断需要 25mAs采用iDose -4和6可以达到较好的诊断效果 15mAs采用iDose 无法达到100mAs图像质量效果,但是可用于肺部疾 病低剂量的筛查。 长征医院放射科 2013年军队影像沙龙(杭州) 20 radiationdose 71.35%less low-voltageprotocol. Compared standardFBP reconstruction, iDose4iterative reconstruction yields higher SNR, CNR, betterimage quality contrast-enhanced chest CT lowtube voltage settings. 第二军医大学长征医院 21 0.22mSv Radiographer59 201222 23 0.065mSv 0.063mSv 星光iDose 肺部低剂量体检筛查漏斗胸患者 肺癌患者 24 星光iDose 肺部低剂量体检筛查星光iDose 胸部体检筛查剂量 0.049mSv FBP iDose 25incorporating CCTA triagestrategy improved clinicaldecision making CCTA Predicts heart attack peoplewithout risk factors. Nengl med367;4 july 26, 2012 Radiology February 19, 2013 CCTA临床价值获得肯定 26 成功率 图像质量 低剂量 0.27s转速 8cm 探测器 球面探测器 iDoseiDose 44 iCT CTA 27 imagequality radiationdose between iterative reconstruction filteredback projection reconstruction algorithms 256-MDCTcoronary angiography.” Yang etal. AJR 2012. ―Iterativereconstruction can provide equivalent improvedcoronary image quality coronaryCT angiography, compared routine-dose FBP reconstruction, while enabling radiation dose reductions 55%.”Low dose CCTA 中国医科大学附属盛京医院28 optimaldose reduction level using iterative reconstruction prospectiveECG-triggered coronary CTA using 256-slice MDCT.” Yang etal. Eur Radiol2012. ―Iterativereconstruction techniques can provide 63% effective dose reduction prospectively-triggeredcoronary CTA using 256-slice MDCT while maintaining excellent image quality.‖ 中国医科大学附属盛京医院 Low dose CCTA “Optimizingradiation dose level prospectiveECG-triggered coronary CTA using iterative reconstruction techniques: patientstudy.” Yang etal. PLOS ONE 2013. ―iterativereconstruction technique used prospectivelyECG-triggered 256-slice coronary CTA can provide radiation dose reductions acceptableimage quality.‖ 中国医科大学附属盛京医院 Low dose CCTA 30iCT&星光iDose 后门控冠脉CTA检查星光iDose 后门控冠脉CTA扫描心率 135BPM 有效剂量 0.79mSv 0.79mSv 31 iCT&星光iDose 前门控冠脉CTA检查常规FBP重建 星光iDose 有效剂量0.14mSv 0.14mSv 32 Brilliance iCT心脏扫描模式(with iDose=90 前瞻性门控扫描 回顾性门控扫描 0.5-1.5mSv 3-5mSv 33 Low dose CT Neuroimaging e.g.(Head) “Howfar can radiationdose headCT iterativereconstruction? Analysis imagingquality diagnosticaccuracy.” Tunghsin etal. Eur Radiol 2013. ―HeadCT 43%reduced tube current reconstructed IRprovides diagnostic imaging quality outpatientmanagement..‖ 台湾荣民总医院 国立台湾大学 34 Low dose CT Neuroimaging e.g.(Temporal Bone) “Radiationdoss reduction temporalbone CT iterativereconstruction technique.” Yantao etal. AJNR 2012. IRTcan help reduce radiation dose temporalbone CT 50%relative routineinstitution protocols FBP,while maintaining diagnostic image quality.‖ 北京同仁医院 35 Wide coverage brain perfusion assessment LowDose cmNanopanel 3D etal 'Perfusion-CT assessment infarctcore andpenumbra: receiver operating characteristic curve analysis 130patients suspected acutehemispheric stroke.', Stroke 37(4), 979–985. 16 cm Jog Scan 71 femalepresented righthemiparesis; CT brain perfusion demonstrates left MCA stroke; 80 mm coverage; 80 kVp; 125 mAs; 3.2 mSv 36 提高图像质量提高图像质量 37 120 kV, 25 mAs, 1.7 mGy FBP iDose 提高诊断信心克服低剂量伪影 38 CTA FBP iDose 3930 April 2012 ―Low-dose,wide-detector array thoracic aortic CT angiography using iterativereconstruction technique results improvedimage qualite lowernoise fewerartifacts‖ ―IRTis associated reducednoise shoulderartifact low-dose aortic CT imaging‖ 40 改善肥胖患者图像质量 减少低光子形成的噪声及伪影 FBP iDose 41European Journal Radiology82 (2013) 288– 295 ―Improved coronary in-stent visualization using combinedhigh-resolution kernel hybriditerative reconstruction technique 256-slicecardiac CT—Pilot study‖ Seitaro Oda ,etal Iterativealgorithm combined high-resolutionkernel significantly improved diagnostic performance in-stentstenosis.‖ 提高冠脉支架再狭窄诊断信心 42 Acad Acad Radiol Radiol 2012 Nov:19(11):1324 2012 Nov:19(11):1324--31 31 iDose 改善冠脉支架成像 低剂量时改善冠脉支架显像 43 Barry Daly, MD ―Leveraging Iterative Reconstruction OptimizeTriple Low Dose (kVp, mAs, Iodine) CTAngiography‖ http://static.coreapps.net/isct2013mdct/documents/05da2d915bc25a9a687dfcb0a6b6773f.pdf 星光iDose4开启三低临床应用新时代 44 Collimation: 128 0.625