http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/108 Thu, 12 Mar 2026 03:57:38 GMT 2026-03-12T03:57:38Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/46107 標題: Ｔ質子治療中心營運可行性推估; Evaluation of Operation of Proton Therapy Center 作者: Hon-Man Liu; 廖漢文 摘要: 癌症在近年來已成為台灣最重要的疾病及人死亡原因之首。隨著科技進步許多新穎的癌症治療方式及藥物不斷的發明及採用。但放射線治療仍為主要治療癌症的方式之一。傳統放射線治療最大缺點是會傷及正常組織及不能全部能量加褚癌病灶上。所以治療上會發生不少後遺症或容易復發。基本上，質子治療針對傳統放射線治療的上述兩大缺點具有其特別優勢。但由於質子治療系統造價昂貴，相關配備及硬體設置也較傳統放射線治療成本增加很多，所以台灣遲遲未有質子治療的成立。 在未來二至三年內，台灣會有兩個質子治療中心相繼成立。本研究主要針對Ｔ質子治療中心的特性(硬體由外界捐贈)，公家機構營運，以及沒有前例可循的情況下，作出各種不同的分析推算。 文中首先針對質子治療的歷史，質子治療的物理與生物基礎及目前全球質子治療的現況作簡單扼要的介紹。然後依文獻報告了解目前質子治療的適應症，以作為研究中討論的參考。 雖以Ｔ質子治療中心乃以捐贈為主，但是由於涉及日後營運維護成本，所以在成本分析中仍要計算儀器及建築成本等。文中依國外資料參考推估建造一個有5個治療房(含3 gantry+2 fixed beam)的質子治療中心建置總成立約為台幣五十億。而營運成本方面，最主要討論人事成本，公用事務成本，設備管理維護與服務成本，設備與工程整修費用折舊，作業及行政管理費用的成本，以一般計算方式。Ｔ質子治療中心在第三年以後要自行負擔設備管理維護費用，所以成本會突然高漲。此外，其中最重要是指出所謂fraction的成本概念，主要原因是美國，和歐洲目前針對質子治療的支付都是以fraction為給付單位。質子治療隨著不同方法和疾病有不同的治療量及方式，每個病患接受的fraction數目，可以從1個到40個或以上，而每個fraction的照野次數及方式也不一定相同。 所以依文獻說明假定以平均每位病人接受25fraction為整體質子治療的數量。研究中也指出影響fraction的單位成最主要的因素分別為工作時間，start-up與turn-down time，up-time的百分比及名目治療時間(正式治療時使用質子的時間加上每fraction前準備時間)，研究中針對上述因素作出敏感分析。 針對未來質子治療收入部份，研究中也以fraction為單位，參考目前台灣，美國，日本，瑞士的傳統放射線，立體定位放射線治療與質子治療的給付情況，作出合理的推算，未來合理的質子治療給付為每fraction，合台幣20,928。以上針對前面所得結果，推算Ｔ質子治療中心的營運財務情況。爾後，就治療費用人員營運成熟度，及每年工作時數作出不同敏感分析，針對淨現值與內部報酬率作出試算。 結果顯示其中影響最大是每年工作時數(名目治療時間)，對淨現值與內部報酬率，從每週上班六天，工作十六小時變成每週上班五天，工作十二小時兩值均有60~70%的影響，而以名目治療時間分析發現，工作人員營運成熟度影響較小約為3~5%，治療費用如從每fraction台幣20,000元降為15,000元時，淨現值也會有7%的變動，而內部報酬率變動較小。 最後討論其他對質子治療中心營運可能影響因素。 就全國病人數目而言，目前依質子治療的適應症Ｔ質子治療中心未來是有很大發展空間，但必需配合工作時數，相關人力與人才培育，使早日有達到完全營運狀況。此外，要靠智慧型的排程及人員成熟度來減輕病人複雜度對營運的影響。建議提出聘僱相關重要人力是重要的一環。研究中也指出semi-fixed cost在放射線治療以及質子治療同屬重要，日後經營也必然要多作考量。也討論到外在影響如Open system，政府政策，Ｃ醫院的定價策略，捐贈單位的長期補助與否等。最後提出國際醫療的可行性。; Recently, cancer has become one of most important diseases and also the first leading cause of death in Taiwan. Though there are many newly developed medication and implementation of many innovative treatments, radiotherapy still play an important role in cancer treatment. Damage to normal tissue and cannot put all the energy into the lesions are the major disadvantages of conventional radiotherapy. These make radiotherapy can cause sequelae and recurrence occasionally. Proton therapy has the advantage over conventional radiotherapy to avoid the damage of normal tissue during the treatment and put almost all the energy to the designed lesion location. However, it is very expensive to build an integrate proton treatment system and cost of each proton treatment is much higher than the conventional radiotherapy. In the next few years, two proton treatment centers will start to operate. In this research, we try to analysis the operation of T proton treatment center which is characterized by the aspect of public center donated by private funds, run by government owned university, and without local reference. In the first part of this study, the history of proton treatment, its physical and biological basis in treatment of cancer, the current status of proton therapy in the world, and the indication of proton treatment were briefly reviewed. A private fund donated all the major hardware to the T proton treatment center, but this fix cost was closely related to operation cost in the future, so the construction cost and equipment cost was also calculated according to references. All the calculation will be set upon a presumption that the T proton treatment center will have 3 gantries and 2 fixed beam treatment rooms and costs about NT$ 5,000,000,000 (construction cost + equipment cost). In the terms of operation cost, we discussed the personnel cost, cost of utilization, cost of management and maintenance, deprivation, cost of operation and administration according to the traditional way in T hospital. Three years after the installation, the total operation cost will be rising suddenly due to cost of management and maintenance. Most of all, the cost of fraction in treatment is the key factor. In the USA and Europe, the unit of reimbursement in proton treatment is “fraction”. In different disease and different location, the use of proton therapy will be different. This means the number of fraction of each treatment in different patient will be not the same. One patient may receive one fraction (stereotactic radiosurgery) to more than 40 fractions in one course of proton treatment. Even, the number of portal is different in each fraction also. In this study, the assumption is a total of 25 fractions will be averagely delivered to every patient. The important factors that impact the fraction are working hours, start-up and turn-down time, nominal treatment time(time for preparation and using proton beam in each fraction). The sensitivity analysis was done for these factors too. Working hours is the key factor effect the cost of fraction. Regarding to revenue, fraction is also the unit of income. With reference to the data from USA, Japan, and Swiss and the ratio of payment to stereotactic radiosurgery and proton treatment in these 3 countries, the reimbursement of each fraction can be predict to be NT$20,928. With all these results, we can evaluate the operational financials in NTU proton treatment center. Sensitivity analysis of net present value and IRR with the variants such as maturity of person performance, nominal treatment time, and working hours were also performed. Working hours and nominal treatment time are the two key factors to net present value and IRR. If the schedule is working 6 days a week and 16 hours a day, that will be a remarkable increase in both values as compare to a schedule of working 5 days a week and 12 hours a day. The percentile of change is about 3%-5% in the variant of maturity of person performance, and it is about 7% change in NPV but minimum in IRR if the reimbursement decreased from NT$20,000 to NT$15,000. The study found that the new cancer patient that can be the candidates using proton therapy is far more than the capacity of the 2 new proton treatment centers in Taiwan. If T proton treatment center can provide enough working hours for treatment, accelerate the maturity of staffs, the fully operation of whole system can be foreseen in a short time. However, this also acquires intelligent scheduling to relief the problem of patient-mixed. Early appointment of key leading person such as director and medical physicists is also important. The concept of semi-fixed cost is important in conventional radiotherapy as well as proton treatment center. Other factors such as open system, governmental policy, the pricing of C hospital, the support from private funds are also discussed. Finally, the possibility of international medicine is also mentioned briefly. Fri, 01 Jan 2010 00:00:00 GMT http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/46107 2010-01-01T00:00:00Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/71702 標題: 齒列矯正治療醫師與病患對醫療服務品質認知之研究; A Study on Orthodontic Treatment Medical Service Quality Perception of Dentists and Patients 作者: Li-Hua Cheng; 鄭麗華 摘要: 齒列矯正是近年來台灣牙科醫療重要的新興產業。一般牙醫主要為功能性醫療，而齒列矯正治療則要呈現良好的咬合功能、牙齒與咬合的穩定、顏面與齒列的美觀以及身心靈的健康，因而需要牙醫師與患者充分溝通，讓患者以最適當的治療方式，獲得最健康、理想又美觀的整體性醫療服務。然而，也因為齒列矯正有別於一般功能性牙醫治療，患者對於醫療品質會有較高期望值與不同的滿意度評判標準，可能與牙醫師的專業觀點有所差距。因此，本研究主旨在探討患者與牙醫師，對於齒列矯正治療的品質之認知，從而為牙醫師以及牙科醫療診所對齒列矯正醫療品質提升時提供具體建議與參考。 本研究採用問卷進行調查，受測對象包含患者201位，執行齒列矯正的牙醫師32位。透過問卷分析，了解患者對齒列矯正醫療品質的認知，以及牙醫師從專業角度對齒列矯正治療的服務品質認知，同時比較雙方差異。 研究結果顯示，在醫師部分，有半數以上為40歲以下的新生代醫師，主要為學士學歷，有半數以上在一般牙科診所從事一般牙科兼齒列矯正業務，顯示台灣目前齒列矯正治療的產業正值蓬勃發展的階段，但是在專科的產業特色與規範方面還有進一步發展的空間。 患者方面，高學歷者接受齒列矯正，或者讓家中兒童接受齒列矯正的意願較高。患者獲知齒列矯正的資訊管道以親友為主(72.1%)，其次為牙醫師(42.3%)，而衛教資訊僅有1%，顯示接受齒列矯正與人際關係網絡有極高關聯性。在醫師與診所的選擇上，醫師的醫術醫德、親友介紹、診所內的服務態度，以及距離方便性是主要考量。在材質上，有74.1%使用經濟實惠的金屬材質，不會要求使用較貴的陶瓷或可拆式膠膜，且有13.4%不清楚自己使用何種材質，推論患者主要信賴醫師，且以效果目的性強，對材質較不重視。 另外，本研究的樣本中，兒童僅佔1/4，與國外文獻有極大差異，或為抽樣上的問題，但在兒童樣本中，家長是決策關鍵，未來可進一步探究。; Orthodontic Treatment has flourished in Taiwan in recent years and has largely expanded the turnover of clinics. Different from the functional-purposed general dental treatment, the orthodontic treatment requires good occlusion of teeth, aesthetics of face and dentition, and the care of patients’ mind and health at the same time. Therefore, the dentist needs to communicate with the patients, so the patients get the medical services with the most appropriate treatment. Orthodontic Treatment has generally been self-paid and oftentimes high-priced, patients hence have higher expectation and criteria toward Orthodontic Treatment medical service quality. The main purpose of this study is to explore the factors that influence the cognitions of patients and dentists’ orthodontic treatment service quality. The result of this study would provide specific recommendations for dentists and dental clinic managers to improve the service quality of Orthodontic Treatment. The results of the study infer that more than half of the dentists are under the age of 40. The education levels are mainly bachelor's degrees. More than half of dentists practice in general dental clinics. Furthermore, Taiwan's orthodontic treatment industry is at the stage of vigorous development, young dentists are willing to engage in this paticular field. However, there is still room for further development in the characteristics and norms for the orthodontic treatment to be a special medical division. As for the patients, highly educated people are the main customers of orthodontic treatment, or have higher willingness to let their children receive orthodontic treatment. Patients with orthodontic treatment gathered the information mainly from relatives and friends (72.1%), dentists’ advice (42.3%), and only 1% from dental health education information. The result indicates that Orthodontic Treatment has a high correlation with interpersonal networks. In the choice of doctors and clinics, doctors' medical ethics, family and friends’ advice, service attitudes in the clinic, and transportation convenience are the main considerations. In terms of brace materials, 74.1% use economical metal materials, and 13.4% lack of knowledge about which materials they use. It is inferred that patients care about the curative effect instead of appearances during the treatment, and their decision-making rely on dentists’ advice. In addition, in this study, only 1/4 patients are children, which is very different from the research studies in America and Japan. This result may be caused by the sampling limitation. However, we found the parents’ decision-making is important in their child’s orthodontic treatment decision. Hence, further investigation is needed to understand the parents-child behavior in orthodontic treatment in the future studies. Mon, 01 Jan 2018 00:00:00 GMT http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/71702 2018-01-01T00:00:00Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/22794 標題: 點集合資料庫之時空樣式探勘; Mining Spatial and Temporal Patterns in Pointset Databases 作者: Wen-Kwang Tsao; 曹文光 摘要: 本論文提出一個新的資料表示方式與三種探勘頻繁樣式的演算法：MaxFSP、PCP 及CVP。MaxFSP演算法從二維點集合資料庫中探勘最大頻繁空間樣式；PCP演算法從二維點集合資料庫中探勘封閉性頻繁空間樣式；CVP演算法則從視訊點集合資料庫中探勘封閉性頻繁時空樣式。在MaxFSP 及PCP 演算法中，我們除了運用Apriori 演算法所提出之反單調修剪原則，修剪不可能的候選樣式外，我們還針對空間關係的特性，提出快速修剪方法。並參考MAFIA與CHARM演算法，各別加入最大頻繁樣式與封閉性頻繁樣式所需的修剪方法。透過這些方法，我們可以在探勘過程中有效刪除不可能的候選樣式。CVP演算法更進一步考慮了時間軸上的關係，探勘視訊資料庫中封閉性頻繁時空樣式。CVP 演算法除了應用了空間中修剪方法之外，並提出「快速成長」(fast-grow)的策略，可有效地在樣式索引樹中標示不須延展的節點，進而避免重複檢查的運算，減少耗時的候選樣式產生時間。實驗結果顯示，MaxFSP 演算法的執行效率優於改良式的MAFIA演算法；PCP演算法的執行效率優於改良式的Apriori演算法、SASMiner演算法與MaxGeo演算法；CVP演算法的執行效率優於改良式的Apriori演算法。; In this dissertation, we propose a novel data representation and three algorithms, MaxFSP, PCP, and CVP algorithms. The MaxFSP algorithm is proposed to find the maximal frequent spatial patterns in image databases. The PCP algorithm is designed to find the frequent closed spatial patterns in image databases. The CVP algorithm is developed to find the frequent closed spatial-temporal patterns in video databases. In the MaxFSP and PCP algorithms, in addition to using the anti-monotone pruning strategy to prune unnecessary candidate patterns, we utilize the characteristics of the spatial relationships to design the pruning strategies. Specifically, we design pruning strategies based on the MAFIA and CHARM algorithms respectively to prune non-maximal and non-closed candidates. By using these strategies, we can prune a large number of unnecessary candidate patterns. The CVP algorithm is further considering temporal information to mine all frequent closed spatial-temporal patterns in video databases. In the CVP algorithm, we not only use the spatial relationship to prune unnecessary candidate patterns, we also propose a fast-grow pruning strategy, which can speed up the mining process in the temporal dimension. Therefore, the CVP algorithm can effectively prune the unnecessary branches in the frequent pattern tree and avoid the costly candidates’ generation. The experimental results show that the MaxFSP algorithm outperforms the modified MAFIA algorithm; the PCP algorithm outperform the modified Apriori, SASMiner, and MaxGeo algorithms; and the CVP algorithm outperform the modified Apriori algorithm Fri, 01 Jan 2010 00:00:00 GMT http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/22794 2010-01-01T00:00:00Z http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/9826 標題: 點集合資料庫中封閉性樣式之資料探勘; Mining Closed Patterns in Pointset Databases 作者: Po-Yin Chen; 陳柏吟 摘要: 隨著行動運算及定位技術的進步，位置定位服務（Location Based Services，LBS）也跟著蓬勃發展。透過定位裝置，我們可以將大量點座標資料搜集到點集合資料庫中，而點集合是由一些點座標所形成的集合。藉由資料探勘的技術，可以幫助我們在點集合資料庫中發現物體移動的經常路徑或行為。因此，這篇論文將探討如何在點集合資料庫中尋找經常出現的樣式或路徑，我們提出一個有效率的探勘演算法叫「PCP-Miner」，用來找尋點集合資料庫中的封閉性樣式。演算法主要可分為兩個階段。第一階段，我們產生出所有長度為2的頻繁樣式。第二階段，我們利用頻繁樣式樹以深先搜尋法的方式遞迴產生所有的頻繁樣式。在產生的過程中，我們會對這些樣式做檢查，檢查它們是否為封閉的。由於PCP-Miner只需掃描資料庫一次，且能避免產生不必要的候選樣式，實驗結果顯示，不管在合成資料或真實資料中，我們所提出的方法皆比改良式的Apriori演算法有效率。; With advance in mobile computing and positioning technologies, location-based services (LBS) have gained significant progress. By using these technologies, a large amount of pointsets can be collected in an LBS database where a pointset contains a set of points. Mining frequent pointset in a pointset database can help us understand the movement patterns of objects. In this thesis, we proposed a novel algorithm, PCP-Miner (Pointset Closed Pattern Miner), to mine frequent closed pointset patterns. Our proposed algorithm consists of two phases. First, we find all frequent patterns of length two in the database. Second, for each pattern found in the first phase, we recursively generate frequent patterns by a frequent pattern tree in a depth-first search manner. During the process of pattern generation, we check whether the frequent patterns are closed or not. Since the PCP-Miner only needs to scan the database once and doesn’t generate unnecessary candidates, it is more efficient than the modified Apriori algorithm. The experiment results show that the PCP-Miner outperforms the modified Apriori by one order of magnitude in both synthetic and real data. Tue, 01 Jan 2008 00:00:00 GMT http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/9826 2008-01-01T00:00:00Z