1、 醫學影像科建設與管理 醫學影像科 吳振暄 隨著計算機技術與醫學影像學的發展，X射線成像技術進入了數字化的發展時代,現代醫學影像學是隨著自然科學和臨床醫學科學的發展而發展，醫學影像設備不斷更新和換代，相應的新技術也不斷誕生，飛速發展的影像技術也有效的幫助臨床解決很多實際問題。所以現代醫學影像科的合理建設發展與嚴格的管理培訓至關重要。 我院醫學影像科始建于上世紀70年代初。經過40余載的努力發展，依托院士平臺醫院優勢學科，在人才培養、梯隊建設、科室設置和學術水平等方面均有顯著提高與發展，對于腫瘤專科性影像診斷來說，專業、專注、專心一直是我院診斷的優良傳統，影像科的醫生、技師、護理人員也本著用專業

2、專注更專心的態度在醫學影像的科學世界里探索與發展。多年來，在腫瘤的早期檢出和定性，腫瘤術前評估，精確放射治療靶區勾畫以及放療與化療的療效評估方面積累了豐富的經驗。在腫瘤影像診斷和相關的基礎研究工作中取得了一定的成果，伴隨著新技術的產生，影像檢查也要隨時代變遷而發展，經過科室主任、副主任及護士長的精密研究和科室同事的一致支持下，影像科成立了各個管理組，普通放射診斷組、CT(計算機X線斷層攝影)影像診斷組、MR（磁共振成像）影像診斷組、PET-CT（正電子發射計算機斷層顯像）診斷組，影像檢查技術組，影像檢查護理組，放射性粒子植入組，射頻消融治療組，影像登記組，各組分工明確，制度體系健全，日常工作合

3、理有序進行，在引進設備方面，也有較著重的變革，普通放射設備在原有第一臺的基礎上新增3臺，分別為銳柯醫療集團（CarestreamHealth）無線傳輸DR，西門子醫療集團（SIEMENS）Luminos Select  胃腸機及Inspiration乳腺機。這三臺設備分別具有其時代技術意義，在低計量技術應用及圖像質量問題上表現尤為突出，無線傳輸DR-CARESTREAMDRX-Nova數字化X射線攝影成像系統表現卓越，它集成了業內首款無線、標準規格的DRX-1數字平板探測器。是一種”神奇的“可以拆卸的”CR-IP板“，優點在于使得前來做X線攝影的臥床危重病人可以將

4、探測器直接置于床板一側進行攝片即可。在西門子醫療集團（SIEMENS）Luminos Select  胃腸機投入使用之后，其檢查優勢也逐漸顯露，與第一臺日本東芝胃腸機相比較，Luminos Select  胃腸機在透視過程中的連續曝光中做了程序化調整，在保證圖像分辨率的前提下智能調節曝光條件，有效減少持續曝光所帶來的大劑量照射，將檢查者及操作者的受檢劑量及輻射劑量有效降低約20%。Inspiration乳腺機的引進更是為我院影像技術再添新的高度，我們在此設備基礎上開展了乳腺癌的早期篩查檢查，在微細小鈣化灶的的檢出方面表現突出。乳腺活檢

5、穿刺的臨床應用更是取得了乳腺外科的一致好評。CT（計算機X線斷層攝影）設備在原有兩臺荷蘭飛利浦光輝高端CT（PHILIPS Brilliance iCT/64CT）的基礎上引進了西門子醫療集團（SIEMENS）的SOMATOM Definition AS+，技術優勢為：時間分辨率高：0.33秒/圈，采集薄:0.6mm采集，圖像分辨率高達30pl/cm，最先進的探測器技術超快速稀土陶瓷探測器UFCTM ，余輝效應最短。圖像采集系統為飛焦點采樣技術：雙倍圖像信息，掃描速度快，胸部掃描僅需6秒（對于急癥及躁動病人受檢更加安全），球館-探測器系統每旋轉一圈0.33s,獲得128層0.6mm的人體斷層圖

6、像,掃描長度為350mm（CT128x0.6 mm, 0.33 s350 mm： 6 s)，掃描范圍廣，最長可連續掃描1980mm，圖像重建速度快，對于我院的優勢三維處理軟件為腫瘤學軟件（Oncology）可以將腫瘤自動分離，測量體積, 直徑及形態，對于肺部病變，肝臟病變，淋巴結及全身其他病變，腫瘤學軟件分別有獨立的測量方法，準確率較高。利用此設備的特殊技術優勢，我們提高了放射性粒子植入術的手術量，節約了患者時間，提高了患者的治療質量，也是的我們的粒子植入微創手術更上一個新的嫻熟模式。副主任開展了CT引導下微波射頻消融術，對于腹部微小病灶治療效果甚佳，也同樣的得到了各個臨床科室的認可。這兩項C

7、T引導下技術說明了未來的影像將不僅局限于診斷、功能成像，分子影像學，還要在影像治療學上發展（區別于放射治療學）。我院的磁共振成像設備依然是業界值得稱贊的荷蘭飛利浦（PHILIPS，Ingenia3.0T）,此設備具有dStream全數字影像鏈，能同時兼顧高清圖像和超快速成像，提供了質量控制和高效工作的雙重保障，以患者為中心成像的方面更有突出表現，iPatient技術更是讓技術人員控制患者在行為、條件、解剖學及生理學方面的可變性，使得檢查工作連續而高效。 圖像質量問題的控制一直是影像科的重中之重，雖然現代設備已經在成像原理方面及數字計算方面的將圖像進行質量控制，影像科每天的兩場大型閱片會是科內最

8、精彩的片段，由主任親自帶領分析病例，組織討論，每次都使得大家受益匪淺，總是拿著筆記本不停地記錄，對于圖像質量更是要求嚴格但是，在科室管理及科室業務水平方面，主任一方面注重科學管理，加強科室業務學習，同時又毫不保留的將自身的專業知識和臨床經驗傳授給年輕同事。他制定了完善的科室管理和業務學習制度，多年來一直加強疑難病例隨訪和科室內的回顧性讀片。每周的輪流業務學習講座加大了青年醫生的自學、交流的壓力和動力。他在影像科內部實行的X線、CT、磁共振，PET-CT等各崗位工作的輪換，切實提高了年輕醫生的各種影像綜合、分析、判斷能力。 檢查中選擇合適的檢查協議及細心的影像護理工作同等重要，技術人員只要掌握好

9、檢查方法及病人在檢查過程中的配合就好。而影像護士相對來說就非常辛苦了，檢查前宣教，最佳靜脈通道的選擇建立，保證檢查秩序的有序進行及檢查時的仔細查對，檢查前的準備，檢查過程中謹慎觀察及檢查預后都是做好影像檢查的重要環節，也是整個患者檢查中付出最多的崗位，耐心，細致的態度一直浮現在她們的臉龐，是也正是只有這樣的白衣天使守護在影像科，才使得影像檢查變得安全、安心。護理工作也是影像科抓的最勤，表現最好的管理組，每周定期開會，總結經驗，學習培訓新技術，在護士長的帶領下， 每位護理人員都嚴于律己，在工作上眼勤，手勤，腿勤，都具有敏銳的觀察力，秉承著“一切為了患者的安全，為了患者的一切安全”工作理念去工作，

10、這才使我們影像科護理團隊具有著這么高的素質，這么精的質量。醫學影像科一直奉行用細心的護理，精湛的技術，達到一流的診斷。使得再大的門診檢查量我們也依舊能夠保質，保量的順利完成工作。 我們堅信，用專業的心，醫學影像科的建設會更加附有專業魅力，做專注的事，醫學影像科的管理才會變的盎然生機，也只有這樣，我們的醫院才會更加興旺，我們的國家才會更加富強。 Construction and management of medical imaging department Medical Imaging Division Li Wenwu Yang Guihua Wu Zhenxuan With the de

11、velopment of computer technology and medical imaging technology, X ray imaging technology has entered the era of digital development. Modern medical imaging is developing with the development of natural science and clinical medicine. The new technology is also being developed.Training is very import

12、ant.Our hospital medical imaging department was founded in the early 70's, after more than 40 years of development, relying on the scientific platform of the scientific research, the professional, focused and focused on the scientific world of medical imaging, which has been used to explore and

13、develop. In the early detection and treatment of tumor, the efficacy of radiotherapy and chemotherapy is also the focus. The results were obtained in the study of tumor imaging and related basic research. The imaging examination should be developed with the change of times, and the imaging examinati

14、on should be developed with the change of the times. It was set up by the Department Director, deputy director and the assistant director. The imaging department was set up. CT (magnetic resonance imaging) imaging, MR (positron emission computed tomography) imaging, PET-CT (positron emission tomogra

15、phy) imaging, and radiation. Frequency ablation treatment group, the image registration group, the division of labor is clear, the system is perfect, the daily work of a reasonable and orderly, in the introduction of equipment, also has a more focused, ordinary radiation equipment on the basis of th

16、e original 3 units, respectively, DR (CarestreamHealth) wireless transmission Luminos, SIEMENS medical group (SIEMENS) Select Inspiration breast machine, Wireless transmission DR-CARESTREAMDRX-Nova digital X-ray radiography system performance excellence, which integrates the industry's first wir

17、eless, Standard Specification for digital DRX-1 flat panel detector. It is a "magical" detachable "CR-IP plate" advantages of is making to come and do radiography of critically ill patients with bed can be detectors placed directly on one side of the bed board were taken sheet ca

18、n be. Put into use in the Siemens (Siemens) Luminos select gastrointestinal and the advantage is gradually revealed, and the first Japanese Toshiba gastrointestinal machine compared Select Luminos gastrointestinal machine in the perspective of continuous exposure in the process of adjustment, in ord

19、er to ensure the image resolution under the premise of intelligent regulation of exposure conditions, effectively reduce the exposure to large doses of radiation, and the operator's dose and radiation dose effectively reduce the introduction of 20%.Inspiration breast machine is to add a new heig

20、ht, we carried out early screening of breast cancer, the clinical use of breast biopsy should be made of breast surgery .CT (PHILIPS iCT/64CT CT) based on the introduction of PHILPS medical group (Brilliance) Definition AS+ SOMATOM, technical advantages: 0.33 seconds / circle, collection of thin: 0.

21、6mm acquisition, image resolution up to 30pl/cm, the most advanced detector technology ultra fast rare earth ceramic detector UFCTM, afterglow effect is the shortest. For flying focus sampling technique: double image information, fast scanning speed, scan of the chest only 6 seconds (for emergency a

22、nd restlessness patients examined more secure), arena - detector system rotates a circle was 0.33s, obtained 128 slice 0.6mm human tomographic images, the length of the scan for 350mm (CT128x0.6 mm, 0.33 S350: 6 s), wide range of scanning, the longest continuous scanning 1980 mm, fast speed of image

23、 reconstruction, for the advantages of 3D processing software for Oncology (Oncology) software can automatic separation of tumor, measuring body Product, diameter and morphology, for the lung lesions, lesions of the liver, lymph nodes and other systemic diseases, oncology software respectively indep

24、endent measuring method, the rate of accuracy is high. The use of special technical advantages of this device, we improve the amount of radioactive particles implantation surgery, section about the patient time and improve the quality of treatment of patients with, and our particle implantation mini

25、mally invasive surgery more on a new model of skilled. Deputy director to carry out the CT guided microwave ablation, for the treatment of small lesions in the abdomen effect is very good, the same has been all pro bed department approval. The two CT guided technology that images of the future will

26、not Imaging, molecular imaging, molecular imaging, as well as the industry's highly acclaimed (iPatient, dStream), the industry's magnetic resonance imaging device is still the industry's acclaimed Holland PHILPS (PHILIPS, Ingenia3.0T), which has the dual protection of quality control an

27、d efficient work, Make inspection work continuously and efficiently.Image quality control has been the focus of the image, although modern equipment has been in the imaging principle and digital calculation of the image quality control, image division every day, two large reading piece will be Kone&

28、#39;s most brilliant fragments, the director personally led the analysis of cases, the organization discussed, always take a notebook to record, for the quality of the image is strict but, in the department management and business level, director of scientific management, strengthening the Departmen

29、t business learning, and without reservation of their professional knowledge and clinical experience to young colleagues. To develop a sound management system and business system, for many years has been to strengthen the follow-up and management of patients in the Department of medical imaging, the

30、 weekly business study, the exchange of pressure and power.Inspection protocols and careful selection of appropriate inspection protocols and care work equally important, technical staff as long as a good examination method and patients in the examination process, and the image is very hard, and the

31、 nurse is relatively speaking, to ensure the orderly conduct and examination of the examination, examination of the important link, is also the entire patient examination in their faces, is only such a White Angel Guardian All work under the leadership of the catch, which makes the imaging has become a safe, secure. Nurs