井野賢司 赤城輝哉 君島正一 - adct.kenkyuukai.jp

1 1 adct .2010 3 13 2 adct .2011 1 15 3 adct .2012 1 21 4 adct .2013 1 12 2009 7 RealPrep BodyPerfusion AcutePerfusion 4D-DSA 2010 8 160 AIDR 2011 10 AIDR3D VolumeEC DEHelical vHP DoseReport 4 adct 2012 11 1 11 31 60 2013 1 1 64 CABG Dynamic volume scan DE(dual energy ct) CABG CABG Real Prep. ,Test Injection, TBT ROI, Scan ROI, mA, , Volume EC ,40 160mm, , OSR , ,AIDR3D 20 54 60 3 0 10 20 30 40 50 60 70 1 2 4 Helical 160 Helical 80 Helical 64 Volume 60 ,100% Volume Scan ,160 Helical 39 24 7 4 15 27 1 5 8 0 10 20 30 40 50 60 70 1 2 4 vHP Helical 160 Helical 64 Wide-Volume 160 Helical Helical Vol +Vol 2 Volume Real Prep.

2 CT Test Injection 8 15mL TBT TBT test 18 52 58 2 2 2 1 0 10 20 30 40 50 60 70 1 2 4 TBT Test Injection RealPrep. 58 ,96 Real Prep. TBT (10 )or BT (11 ) BT 11 TBT 2 TB CABG 300mgI/kg 12 370 12 25 370 10 5 24mgI/kg sec 10 | 30ml 370 50ml CT F-dose 23mgI/kg/s 13 CABG 15 | 20cc 370 22mgI/kg/sec 10 30ml sec 11 |2beat 3beat 24mgI/kg/sec 10 3segment 12 16 64 ROI CT 100 200HU Prep Prep ROI

3 150 100 200 HU ROI, Scan ROI ROI CT 100HU 260HU ROI Prep Real Prep. 2 48 7 37 9 53 17 0 10 20 30 40 50 60 70 ROI ScanROI ROI,ScanROI, ON OFF ScanROI 100 200HU ROI 150HU ScanROI 300HU ROI 100HU ScanROI 260HU ROI, 250HU CT 60 65 / CT / CT 70 / 46 N Engl J Med 2008;359:2324-36.

4 8 46 6 0 10 20 30 40 50 60 70 4 ON OFF 32 35 8 8 0 10 20 30 40 50 60 70 80 90 4 / / 1 100 80 60 II ACC AHA 2010 SCCT 2009 ASCII 2010 2010 Appropriate CT Appropriate CT PCI SCCT 100 120kV 100 V, 80 V 8 25mSV 120 V 80 V 8mSV 4 3 0 3 4 5 12 51 53 1 8 3 9 0 10 20 30 40 50 60 70 80 1 2 4 135kV 120kV 100kV 80kV 4 13 5 3 16 2 12 21 11 35 9 0 10 20 30 40 50 60 70 1 2 4 Volume EC Volume EC mA mA 0 5 10 15 20 25 30 35 40 45 SD Volume EC Frank J.

5 Rybicki Initial evaluation of coronary images from 320-detector row computed tomography Int J Cardiovasc Imaging 0 4 0 14 3 35 13 5 24 42 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 2 4 6 18 25 8 19 11 1 5 15 2 1 8 6 3 4 6 11 0 10 20 30 40 50 60 70 80 1 2 4 FC44 FC43 FC05 FC04 FC13 FC14 -Fc3 - FC50 - CPR FC15 5 - FC05 - postPCI CPR Filter Sharp+++ - AIDR strong +FC42orFC43 FC13 FC14 FC43 FC04 Kakuya Kitagawa , MD., Characterization and Correction of Beam-hardening Artifacts during Dynamic Volume CT Assessment of Myocardial Perfusion Radiology: Volume 256: Number 1 July 2010 FC04 FC50 SR FC50 SR Zooming [ mm ]relative valueSR Volume scanVolume scanFWHM(mm) FWTM(mm) SR Volume scan Volume scan 1 5 48 19 49 9 2 0 10 20 30 40 50 60 70 1 2 4 ON QDS OFF 1 10 42 1 0 10 20 30 40 50 60 Strong Standard Mild Weak Real Prep.

6 ,Test Injection, TBT mA, , Volume EC , OSR , ,AIDR3D : 6 19 20 0 2 3 8 23 25 5 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 2 4 Helical 80 Helical 64 Wide-Volume Volume 32 64 80 100 SD=20 CTDI mGy DLP HP27 HP45 HP65 HP87 EUROPEAN GUIDELINES ON QUALITY CRITERIA FOR COMPUTED TOMOGRAPHY P70 TABLE3 Region of body Effective dose per DLP (mSv(mGycm)-1) Head Neck Chest Abdomen pelvis NRPB-W67 Dose from Computed Tomography(CT) Examinations in UK 2003 Review TABLE3 Region of body Effective dose per DLP(mSv(mGycm)-1)

7 By age Head & neck Head Neck Chest Abdomen & pelvis Trunk 0y old 1y old 5y old 10y old Adult 9 9 2 7 13 25 35 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 2 4 135kV 120kV 100kV 80kV 4 5 30 41 16 0 10 20 30 40 50 60 70 2 4 Volume EC mA 0 2 4 6 8 10 12 14 16 18 20 SD Volume EC( ) 1 3 5 5 19 18 1 2 8 0 5 10 15 20 25 30 35 40 1 2 4 FC04 FC03 FC02 FC13 FC12 2 0 14 14 12 14 1 2 0 5 10 15 20 25 30 35 3D Strong Standard Mild Weak 14 48 0 10 20 30 40 50 60 70 A , CABG Dynamic volume scan DE(dual energy ct) 1 7 10 0 2 4 6 8 10 12 14 16 18 20 1 4 18 0 5 10 15 20 25 - CABG Dynamic volume scan DE(dual energy ct)