研究介紹:
骨骼掃描是核子醫學中最常見的檢查且和癌症病人的治療計畫有關。然而，很少有文獻探討它的使用概況。

研究方法:
本研究使用2005到2010年的國家衛生研究院2005年承保抽樣歸人檔和基本資料檔。在這些檔案當中，所有作過骨骼掃描的病人都會被納入分析，而進行骨骼掃描的醫院，病人和醫院的地理因素也會一併分析之。

結果:
研究發現共有15118人做了27837次骨頭掃描（平均每人1.8次）。門診骨骼掃描的使用趨勢逐漸上升，而2009到2010年住院骨骼掃描數量下降。骨骼掃描的年齡分群中，45~49和50~54歲較其他組別的數量多。64%的病人只進行一次骨骼掃描。醫學中心和財團法人醫院為各自類別中的最多者。健保的台北分局給付最多的骨骼掃描。考慮歸人檔中都市或鄉村地區的老人數量後，老人的住院骨骼掃描的比率在都市和鄉村地區不易區分，但是門診的比率在都市老人仍高於鄉村地區的老人。

結論:
本研究觀察到2005到2010年骨骼掃描的使用隨著時間、年齡和區域而改變。它在地理分佈上不均勻。

Introduction:
The bone scan is the most common study used in nuclear medicine, relating to cancer patient treatment planning. However, few literatures discuss its utilization.

Methods and Materials:
Longitudinal Health Insurance Database 2005 and Registration files from 2005 to 2010 data released by National Health Research Institutes were used in this study. All patients undergoing bone scan were identified and calculated. The hospitals ordering bone scan and the geographic factors of hospitals and patients were also analyzed.

Results:
We identified 15118 patients receiving 27837 bone scans (average 1.8 per patient). The trend rose for outpatients (OPD) but decreased from 2009 to 2010 for inpatients (IPD). The 45~49 and 50~54 years-old group had the higher number than all the other groups. 64.0% of patients underwent only one bone scan. Medical centers and non-profit hospitals had highest number in hospital accreditation level group and ownership group. The Taipei branch reimbursed the largest number. After dividing the elder bone scan number by all the urban and rural elder number in the cohort, IPD rate for urban and rural elders could not be clearly differentiated, but OPD rate for urban elders was higher than that for rural elders.

Conclusions:
The bone scan utilization changed with time, age and area in 2005 to 2010 period. It was geographically heterogeneous in Taiwan.

論文審定書……………………………………………………….….. i
論文公開授權書………………………………………………….….. ii
誌謝……………………………………………………………….….. iii
中文摘要………………………………………………………….….. iv
英文摘要………………………………………..……………………. v
圖次…………………………………..………………………………. viii
表次…………………………………..………………………………. ix
Chapter 1 Introduction..……………………………..……………… 1
1.1 Background…..………….…………………………………. 1
1.1.1 Bone scan…….………………………………………. 1
1.1.2 National health insurance research database (NHIRD). 2
1.2 Purpose of the Study…….……...…………………………… 4
Chapter 2 Literature review..………………..……………………...... 5
2.1 Clinical application of bone scan…..………………..………. 5
2.2 The utilization of bone scan…….…………………....……… 6
2.3 The influence of hospital level on medical service.......…...… 7
2.4 The influence of location on medical service..........……….… 8
Chapter 3 Methods and Materials..…………………..……...……...... 10
3.1 Data source…..………………………………...…..………... 10
3.2 Data processing…..……………….…………...……..………. 12
Chapter 4 Results……………..…………………..………………....... 14
4.1 Number of bone scan in 2005-2010…..……………...………. 14
Chapter 5 Discussions……………..……………...………………....... 20
5.1 The trend of utilization of bone scan…..………….....………. 20
5.2 The difference of utilization in age and gender..….....………. 22
5.3 The difference of utilization in hospital type..….....……..…. 24
5.4 The difference of utilization in geographic factor .…........…. 25
5.5 The limitation of this study……………………….…........…. 26
Chapter 6 Conclusions and Suggestions……………..……..……....... 28
6.1 Conclusions..….....……..……………………………………. 28
6.2 Suggestions.….....................................................................…. 28
References…………………………………………..…..……..……....... 29

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