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1、 医学影像科建设与管理 医学影像科 吴振暄 随着计算机技术与医学影像学的发展，X射线成像技术进入了数字化的发展时代,现代医学影像学是随着自然科学和临床医学科学的发展而发展，医学影像设备不断更新和换代，相应的新技术也不断诞生，飞速发展的影像技术也有效的帮助临床解决很多实际问题。所以现代医学影像科的合理建设发展与严格的管理培训至关重要。 我院医学影像科始建于上世纪70年代初。经过40余载的努力发展，依托院士平台医院优势学科，在人才培养、梯队建设、科室设置和学术水平等方面均有显著提高与发展，对于肿瘤专科性影像诊断来说，专业、专注、专心一直是我院诊断的优良传统，影像科的医生、技师、护理人员也本着用专业
2、专注更专心的态度在医学影像的科学世界里探索与发展。多年来，在肿瘤的早期检出和定性，肿瘤术前评估，精确放射治疗靶区勾画以及放疗与化疗的疗效评估方面积累了丰富的经验。在肿瘤影像诊断和相关的基础研究工作中取得了一定的成果，伴随着新技术的产生，影像检查也要随时代变迁而发展，经过科室主任、副主任及护士长的精密研究和科室同事的一致支持下，影像科成立了各个管理组，普通放射诊断组、CT(计算机X线断层摄影)影像诊断组、MR（磁共振成像）影像诊断组、PET-CT（正电子发射计算机断层显像）诊断组，影像检查技术组，影像检查护理组，放射性粒子植入组，射频消融治疗组，影像登记组，各组分工明确，制度体系健全，日常工作合
3、理有序进行，在引进设备方面，也有较着重的变革，普通放射设备在原有第一台的基础上新增3台，分别为锐柯医疗集团（CarestreamHealth）无线传输DR，西门子医疗集团（SIEMENS）LuminosSelect胃肠机及Inspiration乳腺机。这三台设备分别具有其时代技术意义，在低计量技术应用及图像质量问题上表现尤为突出，无线传输DR-CARESTREAMDRX-Nova数字化X射线摄影成像系统表现卓越，它集成了业内首款无线、标准规格的DRX-1数字平板探测器。是一种”神奇的“可以拆卸的”CR-IP板“，优点在于使得前来做X线摄影的卧床危重病人可以将探测器直接置于床板一侧进行摄片即可。
4、在西门子医疗集团（SIEMENS）LuminosSelect胃肠机投入使用之后，其检查优势也逐渐显露，与第一台日本东芝胃肠机相比较，LuminosSelect胃肠机在透视过程中的连续曝光中做了程序化调整，在保证图像分辨率的前提下智能调节曝光条件，有效减少持续曝光所带来的大剂量照射，将检查者及操作者的受检剂量及辐射剂量有效降低约20%。Inspiration乳腺机的引进更是为我院影像技术再添新的高度，我们在此设备基础上开展了乳腺癌的早期筛查检查，在微细小钙化灶的的检出方面表现突出。乳腺活检穿刺的临床应用更是取得了乳腺外科的一致好评。CT（计算机X线断层摄影）设备在原有两台荷兰飞利浦光辉高端CT（
5、PHILIPS Brilliance iCT/64CT）的基础上引进了西门子医疗集团（SIEMENS）的SOMATOM Definition AS+，技术优势为：时间分辨率高：0.33秒/圈，采集薄:0.6mm采集，图像分辨率高达30pl/cm，最先进的探测器技术超快速稀土陶瓷探测器UFCTM ，余辉效应最短。图像采集系统为飞焦点采样技术：双倍图像信息，扫描速度快，胸部扫描仅需6秒（对于急症及躁动病人受检更加安全），球馆-探测器系统每旋转一圈0.33s,获得128层0.6mm的人体断层图像,扫描长度为350mm（CT128x0.6 mm, 0.33 s350 mm： 6 s)，扫描范围广，最长
6、可连续扫描1980mm，图像重建速度快，对于我院的优势三维处理软件为肿瘤学软件（Oncology）可以将肿瘤自动分离，测量体积, 直径及形态，对于肺部病变，肝脏病变，淋巴结及全身其他病变，肿瘤学软件分别有独立的测量方法，准确率较高。利用此设备的特殊技术优势，我们提高了放射性粒子植入术的手术量，节约了患者时间，提高了患者的治疗质量，也是的我们的粒子植入微创手术更上一个新的娴熟模式。副主任开展了CT引导下微波射频消融术，对于腹部微小病灶治疗效果甚佳，也同样的得到了各个临床科室的认可。这两项CT引导下技术说明了未来的影像将不仅局限于诊断、功能成像，分子影像学，还要在影像治疗学上发展（区别于放射治疗学
7、）。我院的磁共振成像设备依然是业界值得称赞的荷兰飞利浦（PHILIPS，Ingenia3.0T）,此设备具有dStream全数字影像链，能同时兼顾高清图像和超快速成像，提供了质量控制和高效工作的双重保障，以患者为中心成像的方面更有突出表现，iPatient技术更是让技术人员控制患者在行为、条件、解剖学及生理学方面的可变性，使得检查工作连续而高效。 图像质量问题的控制一直是影像科的重中之重，虽然现代设备已经在成像原理方面及数字计算方面的将图像进行质量控制，影像科每天的两场大型阅片会是科内最精彩的片段，由主任亲自带领分析病例，组织讨论，每次都使得大家受益匪浅，总是拿着笔记本不停地记录，对于图像质量
8、更是要求严格但是，在科室管理及科室业务水平方面，主任一方面注重科学管理，加强科室业务学习，同时又毫不保留的将自身的专业知识和临床经验传授给年轻同事。他制定了完善的科室管理和业务学习制度，多年来一直加强疑难病例随访和科室内的回顾性读片。每周的轮流业务学习讲座加大了青年医生的自学、交流的压力和动力。他在影像科内部实行的X线、CT、磁共振，PET-CT等各岗位工作的轮换，切实提高了年轻医生的各种影像综合、分析、判断能力。 检查中选择合适的检查协议及细心的影像护理工作同等重要，技术人员只要掌握好检查方法及病人在检查过程中的配合就好。而影像护士相对来说就非常辛苦了，检查前宣教，最佳静脉通道的选择建立，保
9、证检查秩序的有序进行及检查时的仔细查对，检查前的准备，检查过程中谨慎观察及检查预后都是做好影像检查的重要环节，也是整个患者检查中付出最多的岗位，耐心，细致的态度一直浮现在她们的脸庞，是也正是只有这样的白衣天使守护在影像科，才使得影像检查变得安全、安心。护理工作也是影像科抓的最勤，表现最好的管理组，每周定期开会，总结经验，学习培训新技术，在护士长的带领下， 每位护理人员都严于律己，在工作上眼勤，手勤，腿勤，都具有敏锐的观察力，秉承着“一切为了患者的安全，为了患者的一切安全”工作理念去工作，这才使我们影像科护理团队具有着这么高的素质，这么精的质量。医学影像科一直奉行用细心的护理，精湛的技术，达到一
10、流的诊断。使得再大的门诊检查量我们也依旧能够保质，保量的顺利完成工作。 我们坚信，用专业的心，医学影像科的建设会更加附有专业魅力，做专注的事，医学影像科的管理才会变的盎然生机，也只有这样，我们的医院才会更加兴旺，我们的国家才会更加富强。 Construction and management of medical imaging department Medical Imaging Division Li Wenwu Yang Guihua Wu Zhenxuan With the development of computer technology and medical imaging t
11、echnology, 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 important.Our hospital medical imaging department was founde
12、d in the early 70s, 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 develop. In the early detection and treatment of tumor, the
13、 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 examination should be developed with the change of the times. It was
14、 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 tomography) imaging, and radiation. Frequency ablation treatment g
15、roup, 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 the original 3 units, respectively, DR (CarestreamHealth) wir
16、eless 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 industrys first wireless, Standard Specification for digital DRX-1 flat panel detec
17、tor. 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 can be. Put into use in the Siemens (Siemens) Luminos select gastrointestinal and the adva
18、ntage 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 order to ensure the image resolution under the premise of intelligent regulation of exposur
19、e conditions, effectively reduce the exposure to large doses of radiation, and the operators dose and radiation dose effectively reduce the introduction of 20%.Inspiration breast machine is to add a new height, we carried out early screening of breast cancer, the clinical use of breast biopsy should
20、 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: 0.6mm acquisition, image resolution up to 30pl/cm, the most advanced detector technology ultra
21、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 and restlessness patients examined more secure), arena - detector system rotates a circle was
22、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 reconstruction, for the advantages of 3D processing software for Oncology (Oncology) softwar
23、e 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 independent measuring method, the rate of accuracy is high. The use of special technical advantage
24、s 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 minimally invasive surgery more on a new model of skilled. Deputy director to carry out the CT gu
25、ided 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 not Imaging, molecular imaging, molecular imaging, as well as the industrys highly acclaimed
26、(iPatient, dStream), the industrys magnetic resonance imaging device is still the industrys acclaimed Holland PHILPS (PHILIPS, Ingenia3.0T), which has the dual protection of quality control and efficient work, Make inspection work continuously and efficiently.Image quality control has been the focus
27、 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 Kones most brilliant fragments, the director personally led the analysis of cases, the organization discussed, al
28、ways 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 Department business learning, and without reservation of their professional knowledge and clinical experience to young col
29、leagues. 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 weekly business study, the exchange of pressure and power.Inspection protocols and careful selection of appropri
30、ate 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 nurse is relatively speaking, to ensure the orderly conduct and examination of the examination, examination of t
31、he 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. Nursing work is Department of Radiology; the most frequently, the best performance of managemen
32、t group, regular weekly meetings, sum up experience, learning and training of new technologies in the head nurse, each nursing staff are strict with themselves in the eye frequently, diligent, Tuiqin have keen powers of observation, adhering to the everything for the patients safety for the patient
33、safety concept to work, which makes our image of nursing team has so high quality, so fine quality. Medical imaging department a straight pursued with careful nursing, exquisite technology, reach the top of diagnosis. The big We can still be able to check out the amount of the quality, quantity of t
34、he smooth completion of the work.We firmly believe that, with the professional heart, the construction of medical imaging will be more professional charm, do focus, medical imaging division management will become full of vitality, and only in this way, our hospital will be more prosperous, our country will be more prosperous.