醫(yī)學(xué)影像科建設(shè)與管理.doc

醫(yī)學(xué)影像科建設(shè)與管理 醫(yī)學(xué)影像科 吳振暄 隨著計算機技術(shù)與醫(yī)學(xué)影像學(xué)的發(fā)展，X射線成像技術(shù)進入了數(shù)字化的發(fā)展時代,現(xiàn)代醫(yī)學(xué)影像學(xué)是隨著自然科學(xué)和臨床醫(yī)學(xué)科學(xué)的發(fā)展而發(fā)展，醫(yī)學(xué)影像設(shè)備不斷更新和換代，相應(yīng)的新技術(shù)也不斷誕生，飛速發(fā)展的影像技術(shù)也有效的幫助臨床解決很多實際問題。所以現(xiàn)代醫(yī)學(xué)影像科的合理建設(shè)發(fā)展與嚴(yán)格的管理培訓(xùn)至關(guān)重要。 我院醫(yī)學(xué)影像科始建于上世紀(jì)70年代初。經(jīng)過40余載的努力發(fā)展，依托院士平臺醫(yī)院優(yōu)勢學(xué)科，在人才培養(yǎng)、梯隊建設(shè)、科室設(shè)置和學(xué)術(shù)水平等方面均有顯著提高與發(fā)展，對于腫瘤?？菩杂跋裨\斷來說，專業(yè)、專注、專心一直是我院診斷的優(yōu)良傳統(tǒng)，影像科的醫(yī)生、技師、護理人員也本著用專業(yè)專注更專心的態(tài)度在醫(yī)學(xué)影像的科學(xué)世界里探索與發(fā)展。多年來，在腫瘤的早期檢出和定性，腫瘤術(shù)前評估，精確放射治療靶區(qū)勾畫以及放療與化療的療效評估方面積累了豐富的經(jīng)驗。在腫瘤影像診斷和相關(guān)的基礎(chǔ)研究工作中取得了一定的成果，伴隨著新技術(shù)的產(chǎn)生，影像檢查也要隨時代變遷而發(fā)展，經(jīng)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(fā)射計算機斷層顯像）診斷組，影像檢查技術(shù)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，日常工作合理有序進行，在引進設(shè)備方面，也有較著重的變革，普通放射設(shè)備在原有第一臺的基礎(chǔ)上新增3臺，分別為銳柯醫(yī)療集團（CarestreamHealth）無線傳輸DR，西門子醫(yī)療集團（SIEMENS）LuminosSelect胃腸機及Inspiration乳腺機。這三臺設(shè)備分別具有其時代技術(shù)意義，在低計量技術(shù)應(yīng)用及圖像質(zhì)量問題上表現(xiàn)尤為突出，無線傳輸DR-CARESTREAMDRX-Nova數(shù)字化X射線攝影成像系統(tǒng)表現(xiàn)卓越，它集成了業(yè)內(nèi)首款無線、標(biāo)準(zhǔn)規(guī)格的DRX-1數(shù)字平板探測器。是一種”神奇的“可以拆卸的”CR-IP板“，優(yōu)點在于使得前來做X線攝影的臥床危重病人可以將探測器直接置于床板一側(cè)進行攝片即可。在西門子醫(yī)療集團（SIEMENS）LuminosSelect胃腸機投入使用之后，其檢查優(yōu)勢也逐漸顯露，與第一臺日本東芝胃腸機相比較，LuminosSelect胃腸機在透視過程中的連續(xù)曝光中做了程序化調(diào)整，在保證圖像分辨率的前提下智能調(diào)節(jié)曝光條件，有效減少持續(xù)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(shù)再添新的高度，我們在此設(shè)備基礎(chǔ)上開展了乳腺癌的早期篩查檢查，在微細(xì)小鈣化灶的的檢出方面表現(xiàn)突出。乳腺活檢穿刺的臨床應(yīng)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(shè)備在原有兩臺荷蘭飛利浦光輝高端CT（PHILIPS Brilliance iCT/64CT）的基礎(chǔ)上引進了西門子醫(yī)療集團（SIEMENS）的SOMATOM Definition AS+，技術(shù)優(yōu)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(shù)超快速稀土陶瓷探測器UFCTM ，余輝效應(yīng)最短。圖像采集系統(tǒng)為飛焦點采樣技術(shù)：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(tǒng)每旋轉(zhuǎn)一圈0.33s,獲得128層0.6mm的人體斷層圖像,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(xù)掃描1980mm，圖像重建速度快，對于我院的優(yōu)勢三維處理軟件為腫瘤學(xué)軟件（Oncology）可以將腫瘤自動分離，測量體積, 直徑及形態(tài)，對于肺部病變，肝臟病變，淋巴結(jié)及全身其他病變，腫瘤學(xué)軟件分別有獨立的測量方法，準(zhǔn)確率較高。利用此設(shè)備的特殊技術(shù)優(yōu)勢，我們提高了放射性粒子植入術(shù)的手術(shù)量，節(jié)約了患者時間，提高了患者的治療質(zhì)量，也是的我們的粒子植入微創(chuàng)手術(shù)更上一個新的嫻熟模式。副主任開展了CT引導(dǎo)下微波射頻消融術(shù)，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(rèn)可。這兩項CT引導(dǎo)下技術(shù)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(xué)，還要在影像治療學(xué)上發(fā)展（區(qū)別于放射治療學(xué)）。我院的磁共振成像設(shè)備依然是業(yè)界值得稱贊的荷蘭飛利浦（PHILIPS，Ingenia3.0T）,此設(shè)備具有dStream全數(shù)字影像鏈，能同時兼顧高清圖像和超快速成像，提供了質(zhì)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(xiàn)，iPatient技術(shù)更是讓技術(shù)人員控制患者在行為、條件、解剖學(xué)及生理學(xué)方面的可變性，使得檢查工作連續(xù)而高效。 圖像質(zhì)量問題的控制一直是影像科的重中之重，雖然現(xiàn)代設(shè)備已經(jīng)在成像原理方面及數(shù)字計算方面的將圖像進行質(zhì)量控制，影像科每天的兩場大型閱片會是科內(nèi)最精彩的片段，由主任親自帶領(lǐng)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(zhì)量更是要求嚴(yán)格但是，在科室管理及科室業(yè)務(wù)水平方面，主任一方面注重科學(xué)管理，加強科室業(yè)務(wù)學(xué)習(xí)，同時又毫不保留的將自身的專業(yè)知識和臨床經(jīng)驗傳授給年輕同事。他制定了完善的科室管理和業(yè)務(wù)學(xué)習(xí)制度，多年來一直加強疑難病例隨訪和科室內(nèi)的回顧性讀片。每周的輪流業(yè)務(wù)學(xué)習(xí)講座加大了青年醫(yī)生的自學(xué)、交流的壓力和動力。他在影像科內(nèi)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(yī)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(xié)議及細(xì)心的影像護理工作同等重要，技術(shù)人員只要掌握好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(xì)查對，檢查前的準(zhǔn)備，檢查過程中謹(jǐn)慎觀察及檢查預(yù)后都是做好影像檢查的重要環(huán)節(jié)，也是整個患者檢查中付出最多的崗位，耐心，細(xì)致的態(tài)度一直浮現(xiàn)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(xiàn)最好的管理組，每周定期開會，總結(jié)經(jīng)驗，學(xué)習(xí)培訓(xùn)新技術(shù)，在護士長的帶領(lǐng)下， 每位護理人員都嚴(yán)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，這才使我們影像科護理團隊具有著這么高的素質(zhì)，這么精的質(zhì)量。醫(yī)學(xué)影像科一直奉行用細(xì)心的護理，精湛的技術(shù)，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(zhì)，保量的順利完成工作。 我們堅信，用專業(yè)的心，醫(yī)學(xué)影像科的建設(shè)會更加附有專業(yè)魅力，做專注的事，醫(yī)學(xué)影像科的管理才會變的盎然生機，也只有這樣，我們的醫(yī)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 development 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 important.Our hospital medical imaging department was founded 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 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 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 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 the 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 industrys first wireless, 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 can 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 order 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 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 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 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 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) 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 independent 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 minimally 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 not Imaging, molecular imaging, molecular imaging, as well as the industrys highly acclaimed (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 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, 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 Department 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 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 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.