具結石粉碎分析功能之高效率震波產生器研究

學 生：萬龍瑞
指導教授：梁勝明 馬亞尼

中文摘要
自體外震波碎石術發展至今尚未有一套能判斷結石粉碎程度的系統，在以往的治療過程中通常是以專業醫師的經驗來判斷結石的粉碎情況，但人力有限且判斷結果通常會隨者判斷者的不同而有所改變，因此我們希望建立一套能由電腦判讀結石粉碎程度的系統，如此一來我們不斷可以精確的判斷接石粉碎的程度更可以有一套客觀的標準。在本研究中，我們以多種影像分析的方法判斷結石在超音波掃瞄器下的破碎情形，並找出其中2種有效的方法來做為判讀系統的基礎。然而在我們的方法中Entropy和ASM的判讀有令人滿意的結果，以上兩者的判讀值有一定的趨勢並且會在結石完全粉碎時會出現一個峰值並開始有相反的趨勢，如果我們在結石粉碎後繼續給予震波則粉碎的石頭會開始因為震波的高壓而聚合成另外一個密實的固體，這給予我們一個明確的指標：當峰值出現時我們就必須停止震波的治療，否則會造成反效果而形成另一個結石的出現。傳統的觀念上認為如果不考慮震波對組織的傷害，給予越多的震波會使得結石的粉碎率越高，所以在治療的過程中大多是在病人的疼痛容忍範圍內或是止痛藥的時效內盡量給予大量的震波治療，本研究的結果顯示傳統的治療方式有待商榷並給予體外震波碎石術一個明確的指標。

Study on Efficient Shock Wave Generator with Stone Fragmentation Analysis

Student: Long-Ray Wan
Advisor: Shen-Min Liang, Ioannis Manousakas

Abstract
Up to date, there is no any extracorporeal shock wave lithotripsy system equipped with a kidney stone fragmentation estimation device. Therefore, doctors have to estimate status of the stone fragmentation by using ultrasound or X-ray justified it by their experience. Thus, the extent of stone fragmentation is always different depending on each doctor’s experience. A computerized system with a standard method for estimating the stone fragmentation has been investigated. In this study, four methods of image processing on the ultrasound images have been tested, and two methods of which work efficiently. The results on the pattern texture by the Entropy method and Angular Second Moment (ASM) methods are suitable for our requirements. Both have a stable trend, no matter the trend is increasing or decreasing, when kidney stone is being fragmented. It is found that both trends can be reversed as the stone is fully fragmented. This implies that, if we apply too many numbers of shock waves, the stone fragments will be compressed together to a compact form. This gives us a clear indication, namely, terminating stone treatment is needed when a peak or valley appears in the curve-fitted line obtained from fragmentation measurements, otherwise a solid stone will be regenerated. This result differs from the current treatment philosophy, and is worthwhile to implement this methodology for the next-generation lithotripsy in future work.

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