JP2013135738A - Operation support system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an operation support system for improving operation accuracy.SOLUTION: A 3D volume image is captured by a nuclear magnetic resonance imaging apparatus 1, the 3D volume image is processed to draw a specific region, a treatment path is drawn from the 3D volume image and the specific region, information related to an operation is displayed on a display device in time of the operation, the information related the operation is continuously recorded, a surgical instrument or a surgical instrument position is led to the specific region to assist treatment, surgical instrument-leading position accuracy, the fatigue of an operator or a treatment region of a patient is decided based on the led surgical instrument or the position tip of the surgical instrument, and a distance from the center of the specific region or the continuously recorded information, and a warning is issued based on the result of the decision.

Description

  The present invention relates to a surgery support system that continuously monitors the surgeon's fatigue, surgical instrument guidance position accuracy, and treatment area by recording / analyzing surgery information, thereby contributing to improvement of surgery accuracy.

  A conventional surgery support system is disclosed in Patent Document 1. Patent Document 1 records who performed what and when in a series of work activities such as surgery so that it can be easily and accurately grasped in a list in time series.

JP 2010-005326 A US Patent No. 5522870 JP 2005-160553 A

Palmeri ML, Wang MH, Dahl JJ, Frinkley KD, et al.Quantifying hepatic shear modulus in vivo using acoustic radiation force.Ultrasound in Medicine & Biology 2008; 34: 546-58

  In Patent Document 1, in a series of work activities such as surgery, it is realized with a simple device configuration to record when and what has been performed so that it can be easily grasped in a list in a time series. Although the event is identified, it was not considered to improve the accuracy of the operation by stopping the event identification and providing feedback and warning to the operation site in real time.

  An object of this invention is to provide the surgery assistance system for improving the surgery precision.

  In order to achieve the above object, the surgical operation support system of the present invention captures a 3D volume image by a medical image diagnostic apparatus, processes the 3D volume image, draws a specific area, the 3D volume image and the specific area The treatment route is drawn, and information about the operation is displayed on the display at the time of the operation, and the information about the operation is continuously recorded, and the treatment tool and the surgical instrument position are guided to a specific area to assist the treatment. Determining the accuracy of surgical instrument guidance position, operator fatigue or patient treatment area based on the distance from the position tip of the guided surgical instrument or surgical instrument and the center of the specific area or continuously recorded information, and the determination A warning is issued based on the result of.

  ADVANTAGE OF THE INVENTION According to this invention, the surgery assistance system for improving a surgery precision can be provided.

The figure which shows the whole structure (IVR-ISC) of the surgery assistance system of this invention The figure which shows the whole structure (MRI + ultrasound apparatus) of the surgery assistance system of this invention The figure which shows the whole structure of an ultrasonic device Diagram explaining focused ultrasound treatment Diagram explaining navigation guide display function (surgical instrument) Diagram explaining the navigation guide display function (HIFU) The figure explaining the method of monitoring the precision of the treatment area | region using a surgical instrument in embodiment of this invention. The figure explaining the method of monitoring the precision of the treatment area | region using HIFU in embodiment of this invention. The figure explaining the method to set the threshold value regarding the surgical instrument guidance position accuracy of embodiment of this invention The figure explaining the method of monitoring the fatigue of the operator of embodiment of this invention The figure explaining the method of continuously monitoring the treatment area | region of embodiment of this invention The figure which shows the imaging cross-section structural example of the ultrasonic wave and MRI of this invention The figure which shows the example of a GUI display at the time of the setting of the preoperative / treatment parameter of this invention The figure which shows the example of GUI display at the time of the surgical instrument guidance of this invention, and a navigation The figure which shows the example of GUI display at the time of HIFU probe guidance and navigation of the present invention The figure which shows the GUI display example at the time of the treatment by HIFU of this invention The figure which shows the example of GUI display at the time of the treatment by the surgical instrument of this invention The figure which shows the time chart at the time of the treatment of this invention The figure which shows the example of timing of MRI and ultrasonic alternate imaging The figure which shows the whole structure of the cryotherapy apparatus of this invention The figure which shows the whole structure of the thermotherapy apparatus of this invention The figure which shows the flowchart of the surgery assistance system of this invention

  Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings.

  Here, among the above-mentioned prior art documents, Patent Document 2, Patent Document 3, and Non-Patent Document 1 are cited in the column of the mode for carrying out the invention.

  FIG. 1 shows the overall configuration (IVR-ISC) of the system of the present invention. A nuclear magnetic resonance imaging apparatus (hereinafter referred to as an MRI apparatus) 1 shown as a representative example of a medical diagnostic imaging apparatus is, for example, a vertical magnetic field type permanent magnet MRI apparatus, and an upper magnet 3 and a lower magnet 5 that generate a vertical static magnetic field, Includes support column 7 that connects these magnets and supports upper magnet 3, position detection device 9, arm 11, monitor 13, 14, monitor support unit 15, reference tool 17, personal computer 19, bed 21, control unit 23, etc. It consists of A gradient magnetic field generator (not shown) of the MRI apparatus 1 generates a territorial magnetic field in a pulsed manner. Furthermore, the MRI apparatus 1 includes an RF transmitter (not shown) for generating nuclear magnetic resonance in the patient 24 in a static magnetic field and an RF receiver (not shown) for receiving a nuclear magnetic resonance signal from the patient 24.

  The position detection device 9 includes two infrared cameras 25 and a light emitting diode (not shown) that emits infrared light, and detects the position and posture of a pointer 27 that is a tomographic plane indicating device. Further, the position detection device 9 is connected to the upper magnet 3 so as to be movable by an arm 11, and appropriately changes the arrangement with respect to the MRI apparatus 1.

  The monitor 13 displays an image of the tomographic plane of the patient 24 indicated by the pointer 27 held by the operator 29, and is connected to the upper magnet 3 by the monitor support unit 15 in the same manner as the infrared camera 25. The reference tool 17 links the coordinate system of the infrared camera 25 and the coordinate system of the MRI apparatus 1, includes three reflection spheres 35, and is provided on the side surface of the upper magnet 3.

  Information of the pointer 27 detected and calculated by the infrared camera 25 is transmitted to the personal computer 19 as surgical instrument position data, for example, via the RS232C cable 33. The control unit 23 includes a workstation and controls an RF transmitter, an RF receiver, and the like (not shown).

  The control unit 23 is connected to the personal computer 19. In the personal computer 19, the position of the pointer 27 detected and calculated by the infrared camera 25 is converted into position data of the imaging range in the MRI apparatus 1 and transmitted to the control unit 23. The position data is reflected on the imaging section of the imaging sequence. Here, biological information such as respiration, heartbeat, and pulse is acquired in real time by the synchronization (time phase) measurement device 39 and is often used as a synchronization signal for synchronous imaging. The MRI image acquired with the new imaging section is displayed on the monitor 13. Further, the MRI image is simultaneously recorded in the video recording device 34. For example, when the pointer 27, which is a tomographic plane indicating device, is attached to a puncture needle or the like and is configured so that the position where the puncture needle is located is always taken as an imaging cross section, the cross section always including the needle is displayed on the monitor 13. In addition, a camera / video acquisition / recording device 41 that monitors the actions of the surgeon and staff is provided, and records the eyeball, head position, and posture in addition to the overall action.

  FIG. 2 shows the overall configuration (MRI + ultrasound apparatus) of the system of the present invention. Although the MRI configuration is basically the same as that in FIG. 1, an ultrasonic device 40 is connected to a personal computer 19 that controls the MRI device 1 as an attached function. Furthermore, the ultrasonic image obtained by the ultrasonic probe 37 to which the pointer 27 for detecting the position is attached is not only displayed on the dedicated monitor 38, but also transferred to the personal computer 19 to perform image processing. It is displayed on the monitors 13 and 14 for the surgeon. The ultrasonic probe 37 is formed of a non-magnetic material such as ceramic that can be operated even in the magnetic field of the MRI apparatus 1. Thereby, the MRI image of the same cross section as the ultrasonic imaging cross section can be acquired simultaneously.

  FIG. 3 shows the configuration of the ultrasonic diagnostic treatment apparatus. The ultrasonic diagnostic treatment apparatus 301 forms and displays a two-dimensional ultrasonic image or a three-dimensional ultrasonic image on a diagnostic region using a reflected echo signal obtained by transmitting and receiving ultrasonic waves in the patient 302, and also displays the patient 302. Ultrasound treatment is performed by irradiating a focused ultrasonic wave on the surface. The ultrasonic diagnostic treatment apparatus 301 includes an ultrasonic probe 303 including a transducer element that irradiates and receives an ultrasonic wave to a patient 302, an ultrasonic transmission / reception unit 304 that transmits and receives an ultrasonic signal, and a reception signal. Ultrasound image composing unit 305 composing a 2D ultrasonic image (B-mode image) or 3D ultrasonic image, ultrasonic image composing unit 305 configured to display an ultrasonic image, and irradiating the patient 302 HIFU controller 309 that switches the amount of ultrasonic waves to be transmitted, control unit 307 that controls each component, and control panel 308 that gives instructions to control unit 307. When operating as a diagnostic device, the HIFU controller 309 reduces the amount of ultrasound applied to the patient 302, and when operating as a treatment device, the HIFU controller 309 increases the amount of ultrasound applied to the patient 302. Control the size.

  In this example, the ultrasonic diagnostic apparatus and the ultrasonic therapeutic apparatus are configured as one ultrasonic diagnostic therapeutic apparatus, but the ultrasonic diagnostic apparatus and the ultrasonic therapeutic apparatus may be configured as separate apparatuses.

  FIG. 4 shows an outline of treatment using focused ultrasound. As shown in FIG. 4 (a), the focused ultrasonic wave 404 from the therapeutic probe 401 is irradiated so as to be focused on one target 403. As shown in FIG. 4 (b), the range to be cauterized by one irradiation of focused ultrasound has a diameter Φ of 5 to 10 mm. Therefore, when performing treatment with focused ultrasound, as shown in FIG. 4 (c), the position of the target 403, which is the focused ultrasound irradiation position, is sequentially moved so that focused ultrasound is applied to the entire treatment region 402. Irradiate. Here, by performing focus visualization with ARFI (Acoustic Radiation Force Impulse) as shown in Non-Patent Document 1, the actual affected area in the living tissue is calculated for the ideal ablation area, and three-dimensional measurement is performed. By doing so, a three-dimensional treatment planned area can be calculated.

  Here, the guidance support display (navigation) function of this system will be described with reference to FIGS. For example, a patient 501 is fixed on an operating table and treats the affected area using a surgical tool or a treatment device. In this example, the surgical instrument 502 is used, and a state in which noninvasive treatment is performed is shown. The surgical instrument 502 detects the position of the surgical instrument from the position of the pointer 503 with an infrared camera 25 attached to the position detection device 9, and guides each image of an axial (Axial) 504, sagittal 505, and coronal 506. Displayed on the support images 504 to 506, respectively. In addition to the guidance support images 504 to 506, a Volume Rendering image 507 and the like can be arbitrarily set. The operator 29 sets a specific area (treatment area, etc.) 510 and a warning area / margin 511 in each of the guidance support images Axial 504, Sagital 505, and Coronal 506 before the operation. On the guidance support image 504-506, the position of the surgical instrument 508 is superimposed on the image. A treatment schedule area (simulation result) corresponding to the surgical instrument may be further displayed on the guidance support image 504-506.

  In addition, when the scheduled treatment area 510 on the guidance support image 504-506 enters the warning area 511, the guidance support image 504-506 and treatment parameters are automatically changed. In addition, the conditions can be changed according to the surgical environment.

  Here, the focused ultrasound probe 601 may be used as an alternative treatment device for the surgical instrument 502. The focused ultrasound probe 601 is integrated with the diagnostic ultrasound probe, and the probe position is detected from the position of the pointer 602 by the infrared camera 25 attached to the position detection device 602, and the axial (Axial) 504, sagittal ( Sagittal) 505 and Coronal 506 are displayed on the image guidance support images 504 to 506, respectively, and similarly to the surgical instrument, the treatment planned area 604 at the current position of the focused ultrasound in addition to the treatment planned area 510 and the warning area 511. It has a function to display.

  In addition, the camera / video acquisition / recording device 41 is attached to the arm 11 and can record surgical information from various angles.

  FIG. 22 shows a flowchart of the present invention. The flowchart of HIFU treatment area | region visualization of this invention is shown. Multiple 3D volume imaging and 3D reconstruction of 3D images are performed using the MRI machine 1 (S101), and a specific area is rendered by image processing from the 3D images reconstructed using this image (treatment required area) : Segmentation) (S102). After the treatment plan is executed (S103), parameters necessary for the treatment device are input (S104). A surgery support guidance function such as navigation is activated (S105), and surgery is started (S106).

  At the time of surgery, all the actions and image information of the surgeon are monitored and recorded as continuous time series information (S107). By following the position of the surgical instrument 36 and displaying it superimposed on the guidance support image 504-2506 (S108), the surgical instrument 36 is guided to the treatment planned position (target position) using the GUI and numerical information (S109). . After the guidance, the position of the target is confirmed by an ultrasonic image or an MRI image (S110), and preparation for treatment by focused ultrasound is performed. By identifying the planned treatment position with HIFU, it is possible to determine which region within the tumor: target is to be treated.

  At the start of treatment, monitoring with images (MRI, ultrasound, etc.) is always performed (S111). At this time, the surgical tool (treatment instrument) guidance position accuracy with respect to the target position is always displayed on the navigation screen (S112). The surgical tool (therapeutic instrument) guidance position accuracy with respect to the target position of the surgeon is built in a position sensor such as a magnetic sensor, and the position at which the surgical tool is guided is compared with the target position that is sequentially stored in the memory. Then, for example, if the detected value of the position sensor is shifted from the target position by a predetermined threshold value or more compared with the detected value of the position sensor and the stored target position, the accuracy of the surgical instrument (therapeutic instrument) guidance position accuracy is increased. Decrease.

  Here, when it is confirmed that the surgical tool (therapeutic instrument) guide position accuracy has decreased with respect to the target position of the operator (S113), the operator is prompted to take a break (or change of operator) (S114). When the operator's fatigue is detected by the video information (S115), the operator is prompted to take a break (or change of operator) (S116). In addition, when the deformation of the shape including the tumor is confirmed from the viewpoint of the image information (S117), a warning for prompting the update of the image is issued (S118). The therapeutic effect is confirmed by MRI or an ultrasonic diagnostic apparatus, and it is determined whether there is a remaining (additional) treatment area (S119). Specifically, by acquiring images before and after treatment and determining the treatment effect based on the difference between the specific region and the contrast (tumor) region from the image, it is possible to identify the treatment range and visualize the remaining treatment region. If there is a treatment area (S120), the process is repeated from recording (S107) and following the position of the surgical instrument 36 (S108).

  7 to 9 show a method of monitoring the surgical instrument / HIFU irradiation position accuracy in the navigation according to the embodiment of the present invention. For example, the control unit 23 takes an image of the abdomen 701 with a diagnostic apparatus such as MRI, and specifies the region 702 to be treated. Here, when the surgical instrument 703 is displayed on the navigation, the user approaches toward the center of the specific area (treatment area) 704. The control unit 23 records the distance 706 between the center 705 of the specific area (treatment area) 704 indicated by the navigation and the distal end of the surgical instrument 707, and graphs 901 in time series.

  On the other hand, when the HIFU probe is used, the approach is performed toward the center of the specific region (treatment region) 704 in the same manner. Specifically, the control unit 23 causes the center of the specific region (treatment region) 704 and the center of the focus position 803 of the HIFU probe to overlap. Then, the control unit 23 records the distance 807 between the irradiation position center 705 indicated by the navigation and the irradiation position center 806 set by the user, and graphs it in time series (901). In addition, the control unit 23 automatically determines that the accuracy of the surgical instrument / HIFU irradiation position has decreased when the threshold value 902 or higher set by the user is higher than the threshold value. A warning for prompting can be issued (903).

  FIG. 10 shows a method for monitoring the fatigue of the surgeon according to the embodiment of the present invention. Using the camera and video 41 information to monitor the surgeon / staff 1002 during the surgery, the surgeon's eye movement distance (stability) 1004, head movement distance (stability) 1006, body (posture) change amount 1008 can be continuously monitored and graphed, and 1003, 1005, 1007 can be warned if there is an amount of movement or change greater than a preset value of 1009 to 1011, and a break or operator change can be encouraged.

  FIG. 11 shows a method for continuously monitoring the treatment area according to the embodiment of the present invention. For example, in the HIFU treatment, an ultrasonic treatment 1101 is performed on a tumor 1102 in a tissue 1105 in a state before image expansion / contraction (non-energy application). 1111 and 1115 for monitoring a tissue bulge (or deformation 1110 and 1113) due to inflammation and swelling with respect to the treatment area 1103. Specifically, tissue bulges due to HIFU irradiation occur 1107 to 1109, and as a result, when the skin 1106 is deformed, the amount of change 1114 exceeds a predetermined threshold value 1115. In this state, if the treatment using the navigation image is continued, there is a concern about erroneous treatment of a normal tissue different from the target position. Therefore, a warning for prompting the update of the navigation image can be automatically issued.

  FIG. 12 is a diagram showing a configuration example of an MRI imaging cross section of the present invention. The operator 1202 approaches the treatment target (target) using the surgical instrument 1203 with respect to the patient 1201. The image information is displayed on the monitors 13 and 14. Here, a pointer 1205 for detecting a position is attached to the surgical instrument 1203, and follows the position of the target using the position detection device 9. By feeding back this information to the MRI system continuously and in real time, it is possible to obtain the same MRI imaging cross section 1212 image including the surgical instrument 1203 in the target region 1210. That is, the surgeon can apply the two-dimensional real-time image by MRI and the three-dimensional image information by navigation to the surgery as needed. As one application of the high-speed imaging sequence of the MRI apparatus 1, a real-time dynamic imaging method called fluoroscopy (fluoroscopic imaging) is being clinically applied. In fluoroscopy, by repeating imaging and image reconstruction with a period of about 1 second or less, it can be used to extract the dynamics of internal tissues and grasp the position of an instrument inserted from the outside like a fluoroscopic imaging. Generate and display dynamic images. This application is also applied to three-dimensional high-speed imaging.

  FIG. 13 shows a GUI display example when setting pre-operative / treatment parameters according to the present invention. A 3D volume imaging is performed 1311 using a 3D imaging, 3D reconstruction button 1301. The captured images are displayed as 3-axis image displays 1320 to 1322 and a Volume Rendering display 1323. Next, a specific area rendering button 1302 is pressed to detect a volume of a specific area (segmentation) as a target from the 3D image 1313 and 1324. Moreover, you may set the warning area | region containing a specific area | region as needed. Next, the treatment plan button 1303 is pressed, and the approach direction of the surgical instrument is calculated 1314 and 1325. At this time, a route that hinders a route such as a lung or a bone is considered in advance. The navigation software also has a surgical simulation function, and supports indirect treatment functions such as HIFU transducers in addition to the surgical instrument approach. By pressing a treatment parameter button 1304, treatment device setting information is input and detailed information is set 1331. Here, it is an example of a cryotherapy device, and information such as the type of needle to be used, a temperature threshold value, a scheduled treatment volume, a maximum tumor diameter, and a minimum tumor diameter is displayed. Furthermore, by pressing a treatment parameter (threshold value) setting button 1305, each of threshold values 1335 to 1337 for eyeball movement distance 1332, head movement distance 1333, and body (posture) change amount 1334 is set 1315, When the navigation start button 1306 is pressed, the related software is started 1316, and the operation is started 1317.

  FIG. 14 shows a GUI display example at the time of surgical instrument guidance / navigation according to the present invention. The screen configuration consists of an image display unit 1401, a surgery support message unit 1402 and a button configuration. Perform a 3D image captured in advance or 3D imaging as necessary 1403, Axial 1413, Sagittal 1414, Coronal 1415, Volume Rendering 1416 Is displayed. By pressing the Planning button 1404, the surgical route is simulated on the 3D image 1421. By pressing the navigation 1406 during surgery, the surgical simulation information 1421 and the actual surgical tool position 1420 are displayed on the Axial 1413, Sagittal 1414, Coronal 1415, and Volume Rendering 1416 screens, and the surgeon can visually compensate the surgical route. . This treatment route can be displayed / hidden by a button 1407. Further, when the ISC 1405 is pressed, a two-dimensional real-time image is captured and displayed 1417, and a surgical route 1423 and an actual surgical instrument position 1422 by simulation are displayed. The message unit 1419 displays device information, patient information, various function information, and surgical tool information in real time. The surgeon continues the operation while correcting the information with reference to this information. Further, specific regions 1426 to 1428 on the MRI absolute axis, surgical tool position 1424, and surgical route simulation result 1425 are displayed independently. Since these are displayed as a three-dimensional configuration as an independent screen 1418, the three-dimensional and relative distance from the surgical instrument can be grasped at a glance.

  In addition, by pressing the parameter change / treatment instrument change button 1407 and the image information change button 1408, various parameters necessary for the operation, treatment equipment settings, and three-dimensional images 1413 to 1416 displayed as navigation images can be changed at any time. In addition to this, it is also possible to display and change the planned treatment area according to the surgical instrument.

  The treatment parameter information 1419 obtained in advance can be freely turned ON / OFF by the monitoring button 1409, and the respective monitoring information 1436 to 1438 are continuously updated until a stop instruction is issued from 1433 to 1435. At that time, by pressing the automatic warning button 1410 to automatically issue a warning, various warnings with sounds and colors that can be understood by the surgeon when the threshold value exceeds 1430-1432 Can do. When guidance of the surgical instrument by navigation is completed, the treatment mode is shifted to by pressing a treatment start button 1411.

  FIG. 15 shows an example of GUI display during guidance and navigation of the HIFU probe of the present invention. By pressing an ultrasonic image button 1501, a real-time video is displayed on the ultrasonic screen 1512 in the ultrasonic information screen 1511. Furthermore, the focused ultrasound path 1514 and the specific area / target 1513 drawn by the specific area drawing 1502 button are also displayed in different colors. At the same time, patient information and surgery information necessary for the operation are displayed, so that the situation can be visually grasped 1515. Information details such as patient information and surgical tools (treatment devices) are also displayed, and various parameters such as depth and frequency of the HIFU probe are also displayed.

  Furthermore, pre-set treatment parameters 1504 and 1505 can be displayed on the same screen 1516-1519, and pre-set threshold values are also displayed 1520-1522. These values can be changed even during surgery, and can be freely changed at any time by pressing a parameter change / treatment instrument change button 1503. On the other hand, by pressing the navigation image button 1502 for the navigation image, a Volume Rendering image 1534 is displayed in addition to the three-axis cross sections 1531 to 1533, and the position of the ultrasonic probe 1535 can be superimposed on the image. It is also possible to display a planned treatment area corresponding to the surgical instrument.

  In addition, by setting a specific area (treatment area, etc.), target 1536, and warning area, it is possible to superimpose and display on the Volume Rendering image 1534 in addition to the triaxial sections 1531 to 1533. Surgery can be performed using the information. The center of the three-axis cross section is generally set in the treatment planned area, but the ultrasonic probe 1535 and the treatment planned area can always be displayed.

  Further, the 3D image can be changed in real time by pressing an image information change button 1504, and can be freely displayed at the request of the operator. These images can be MRI, CT, and US images captured in advance, but real-time images captured on the spot can also be used. Information set in treatment parameter settings 1503, 1504, and 1505 (HIFU irradiation intensity overall, HIFU irradiation accuracy threshold, operator fatigue threshold, image deformation threshold) can be turned ON / OFF with the monitoring button 1505 The monitoring information 1523 to 1525 can be freely changed, and the information is continuously updated 1517 to 1519 until a stop instruction is issued. At that time, by pressing the automatic warning button 1506 for automatically issuing a warning, various warnings with sounds and colors that can be understood by the surgeon when the value exceeds the threshold value 1520-1522 Can do. When guidance of the surgical instrument by navigation is completed, the treatment mode is shifted to by pressing a treatment start button 1507.

  FIG. 16 shows an example of GUI display during treatment with HIFU of the present invention. By pressing a treatment button 1601 in accordance with a treatment start (or end) instruction, HIFU irradiation is performed. In addition, patient information, operation information, treatment progress / log are recorded in conjunction with the treatment button 1601. With this function, pre-treatment information, during treatment, and difference information (treatment progress information, remaining treatment area, etc.) are displayed as image information.

  The log information 1606 is used for reviewing the progress of treatment performed in the past. As biological information, information details such as patient information and surgical tools (treatment devices) are displayed, and various parameters such as depth and frequency are displayed. By pressing a residual treatment region rendering button 1607, difference information (residual treatment region) from the specific region / target 1614 before treatment to the region 1615 being treated can be clearly seen. As a result, the change of the image before and after the treatment can be displayed 1612, and the change from the shape 1611 before the treatment can be seen at a glance.

  In conjunction with the above functions, the navigation image displays three-axis cross sections 1621-1623 and a Volume Rendering image 1624. The position of the ultrasonic probe 1625 can be superimposed on the image, and a treatment plan corresponding to the surgical instrument is also possible. Region 1626 can also be displayed. In addition, by setting a specific area (treatment area or the like) 1627 and a warning area (margin), it is possible to superimpose them on the triaxial sections 1621 to 1623, and to perform an operation using image information. Here, when the additional treatment / treatment end button 1608 is pressed, the repositioning position of the HIFU transducer can be simulated. For example, the repath 1628 can be displayed in the triaxial sections 1621 to 1623 and the Volume Rendering image 1624.

  As in FIG. 15, the information set in the treatment parameter setting 1605 (HIFU irradiation intensity overall, HIFU irradiation accuracy threshold, operator fatigue threshold, image deformation threshold) is turned ON / OFF with the monitoring button 1602 In addition to the HIFU transducer information 1617 display function set in advance, each of the monitoring information 1618 to 1220 is continuously updated until a stop instruction is issued.

  Also, by pressing the automatic warning button 1603 for automatically issuing a warning, various warnings with sounds and colors that can be understood by the surgeon when the threshold value exceeds 1624-1626. can do. In addition, the image information update button 1604 and the parameter change button 1605 are as described above. The treatment result is finally displayed on the GUI, and if there is no problem, the additional treatment / treatment end button 1608 is pressed to end the operation / treatment.

  Fig. 17 shows an example of clinical GUI display. In this example, a state in which an approach to a target by the surgical instrument 1717 is supported by an MRI image and an ultrasonic image is shown. On the GUI, three-axis cross sections 1710 to 1712 and a Volume Rendering image are displayed 1713, and a surgical instrument 1717 and an ultrasonic probe 1714 are also displayed on the image. In addition, by depressing a specific area depiction button 1702, a pre-rendered area is displayed in the triaxial sections 1710 to 1712 and the Volume Rendering image.

  Here, by pressing the ultrasound image button 1703 and the Doppler button 1704, the Doppler image is superimposed on the three-axis cross sections 1710 to 1712 and the Volume Rendering image 1713, and the blood flow approaching the ultrasound probe is red 1716. Distant blood flow is displayed 1715 in blue. When the elastography button 1705 is further pressed, an elastography image 1720 by the ultrasonic device is displayed, and not only the tumor 1724 and the surrounding tissue 1721 are identified and displayed according to the hardness, but also the treatment planning region 1725, the surgical instrument 1723 and Doppler information 1722 are also displayed. Using this information, the surgeon approaches the target. Further, it is possible to display the information in a superimposed manner on the 3D image 1750, and the stereoscopic display can be performed according to the operator's request in 1751.

  Treatment is performed in the next phase. When the treatment image button 1706 is pressed after the approach such as puncture is finished, an image 1720 before treatment and an image 1730 being treated are displayed, and a difference image is also displayed 1740. The images 1720 and 1730 before and after treatment are the same for the surgical tools 1723 and 1733 and the treatment plan areas 1725 and 1735, but the area 1736 currently being treated is drawn.

  With this image, in the difference image, Doppler information is displayed as necessary in the surgical instrument 1743, tumor 1741, treatment region 1742, and treatment plan region 1744, and can be used as a material for determining treatment continuation. Imaging of the treatment area by MRI alternately with ultrasound images is monitored 1760. A surgical tool 1761 that approaches the tumor 1762 begins treatment, and the image is updated in real time as treatment is performed 1763. A treatment plan area 1764 is also displayed in the same manner as the ultrasound image, and both images can be browsed in a ratio.

  In addition, there is a screen that displays the tumor 1771 and the treatment area 1776 in three dimensions, 1770, there is also a function that the cross section 1774 including the surgical instrument 1773 and the imaging cross section 1776 by the ultrasonic probe 1775 are displayed in three dimensions on the Volume Rendering image . At the time of treatment, there is also a display screen for biological information and anatomical information 1707, emergency management is performed by patient information in biological information, and in anatomical information, for example, qualitative complementary information or normal tissue or tumor tissue (bile duct invasion, It also has a function to automatically determine if the surrounding inflammation is present.

  FIG. 18 shows an image processing time chart of the present invention. 1801 performs 3D imaging after the patient is equipped with a biological monitor. After the start of the operation 1803, the position of the surgical tool is detected by the three-dimensional position detection device 1804. The detected position information is transmitted to the image processing apparatus, the MRI system, and the ultrasonic apparatus 1805, 1806, and 1808, respectively. An ultrasonic image 1807 and an ISC image 1809 are captured using the surgical instrument position information, and the image data is transmitted to the image processing apparatus 1810 and 1811, respectively. Inside the image processing, 3D images are continuously displayed based on biological monitor information 1812, and surgical tool information, treatment images, treatment information, biological information, blood flow images, and elastography images are aggregated on one screen 1813 . In addition, judgment and identification of a normal tissue and a tumor tissue are obtained by internal processing as required 1814, and the surgeon uses this image information to judge the treatment continuation 1815.

  FIG. 19 shows MRI and ultrasound imaging timing. Times for acquiring MRI signals on the time axis, 1902, 1909, 1911 and 1917, and times 1905 and 1913 for acquiring ultrasonic signals are provided separately, and the MRI image is obtained using a user-specified sequence. 1903, 1910, 1912, 1918 to obtain image information during a ding or treatment. On the other hand, since ultrasonic images can be acquired at high speed from their characteristics, multiple types of images such as normal B-mode images 1906 and 1914, Doppler images 1907 and 1915, and elastography images 1908 and 1916 are repeated. An image can be taken. Further, 3D imaging may be performed as necessary to obtain morphological / anatomical information.

  Cryotherapy to locally freeze / necrotize tissues, including treatment of Arnott J. in the middle of the 19th century, using ice and saline, perfused to advanced cancer such as breast, cervix, head and neck, He had reduced size and remission of pain and drainage. For example, Arnott, J .: The remedial efficacy of a low or anaesthetic temparature. Lancet, 2, 257, 1850.

  Currently, MRI-compatible medical cryotherapy device (sophisticated cryoablation system for internal surgery) using argon gas for freezing with high-pressure gas and helium gas for answering has been developed.・ Used to treat kidney cancer, uterine fibroids, etc. The temperature measurement range of the device is -190 ° C to + 80 ° C, and the conversion of freezing and thawing is easy, and temperature changes of -165 ° C and + 54 ° C can be obtained in 10 seconds. The range in which the cryogenic temperature can be obtained is 2 cm at the tip of the probe, and the other parts are kept at room temperature. Also, there are probes that are MRI compatible and bent at right angles. This apparatus is proposed in Patent Document 2, for example.

  On the other hand, radiofrequency (RF) thermocoagulation therapy, which has been attracting attention as being effective with minimal invasiveness, collects an RF wave generator, a puncture electrode that is derived from it and communicates with the living body, as well as an electric knife, and collects current from the living body. Biomedical that coagulates and denatures biological proteins, using Joule heat and dielectric heating due to RF alternating current and tissue impedance, and generating heat in the tissue itself around the high current density around the puncture electrode Engineering (BME) treatment. With BME, temperature and other measurement locations can be displayed and recorded easily, and complex calculations and data processing are easy. Furthermore, systematization of telemetry, automation, simulation, navigation, etc. is also in progress.

  There are X-ray, CT, US, MRI, etc. for drawing the heat / frozen area, but the MRI machine is particularly preferred because it has a sharp surface line in cryotherapy and has excellent ice drawing ability. ing. A means for visualizing the position of a lesion and a heat / frozen region by performing image diagnosis during treatment has been proposed in Patent Document 3, and a clinically effective result has been obtained.

  FIG. 20 shows the overall configuration of the cryotherapy apparatus of the present invention. Mainly composed of a control unit 2001 and a probe 2002. The cryotherapy device utilizes the “Joule-Thomsos effect” and is an MR compatible cryotherapy device that can be frozen and thawed. In this apparatus, argon gas 2003 is used for freezing and helium gas 2004 is used for thawing. The probe has a two-cavity structure 2005, high-pressure refrigeration gas is ejected from the tip of the internal thin tube 2006, the gas cooled by the Joule-Thompson effect passes through the heat exchanger 2005, and the frozen gas in the forward path is further cooled, 2007 released into the atmosphere through a hose. When argon gas 2003 having a higher pressure (24 to 27 MPa) is jetted into the small chamber at the probe tip at atmospheric pressure, the temperature becomes -185 ° C. at the probe tip. On the contrary, in the injection of high-pressure helium gas (17 to 27 MPa) 2004, the temperature rises at the tip, and thawing becomes possible. The actual frozen part is 2 cm of the tip of the probe, and the frozen areas 2011 and 2012 become larger as the number of probes increases, so the number of probes can be increased or decreased according to the size of the lesion 2010.

  FIG. 21 is a block diagram showing the overall configuration of the thermotherapy apparatus according to the present invention. The configuration mainly includes a control unit 2101 and a probe 2102. The thermotherapy device is mainly composed of a generator 2103, a handpiece 2104, and disposable handpiece cables 2105, 2106 connected to the generator 2103, and a counter electrode 2107, and is mainly used for the treatment of tumors, etc. It is transmitted to the diseased tissue to cause heat-induced coagulation necrosis. The disposable handpiece with temperature sensor can monitor the solidification temperature in real time and control the solidification temperature setting. The actual coagulation has a diameter of 2 to 3 cm centering on the tip of the needle, and the thermal regions 2109 and 2110 increase as the number of handpieces increases, so that the number can be increased or decreased according to the size of the lesion 2108.

  In addition, the image information may have a function of displaying a change in image information with respect to treatment progress in time series and recording past surgery / treatment progress as a history.

Further, the 3D volume image and the selection image can be updated even during the operation, and the parameters and the like may be easily changed on the GUI.
The image used for the 3D navigation may be applicable to all apparatuses capable of volume imaging such as an X-ray apparatus, an X-ray CT apparatus, an MRI apparatus, and an ultrasonic apparatus.
Further, an ultrasonic treatment apparatus having an ultrasonic probe and treating a patient with HIFU, means for setting a HIFU basic irradiation intensity from the 3D volume image, and means for making a HIFU treatment plan from the specific region, You may prepare.

  In addition, the specific area (treatment area) may be a certain area of a reserve area including the specific area obtained from the 3D volume image.

  The HIFU basic irradiation intensity setting is for registering the energy distribution for the treatment instrument, and the expansion / contraction amount of the tissue may be set according to the energy amount and time.

  Further, the means for monitoring the treatment area of the information related to the operation is to record the action of the operator (for example, the focus, head position, body (posture) position) of the eyeball in time series by the video camera, The information may be recorded on the memory and displayed in comparison with past information.

  The means for guiding the therapeutic ultrasound probe to the treatment area sets a margin area from the calculated treatment-required area in advance, determines whether or not the treatment planned area is within that area, The situation in the area may be presented (warned) to the surgeon.

  Further, the means for determining the accuracy of the surgical instrument guidance position monitors the difference of the operator's installation position with respect to the HIFU irradiation target display position on the navigation image, and when the difference distance equal to or greater than the specified value is repeated a certain number of times. May have a function of prompting a warning (for example, a break or a surgeon change).

  Further, the means for determining the operator's fatigue is monitoring the operator's eyeball position using camera / video information, and focusing on the difference information (focal stasis and eyeball mobility) from the start of the operation. When it is determined that the force is decreasing, the head movement distance and body (posture) change amount are recorded in time series, and the displacement amount (or the difference amount between the past and the present) more than the regulation value from the start of the operation A warning may be issued when the value exceeds the limit, and a function may be provided to encourage a break or change of the operator.

  Further, the means for determining the treatment area of the patient records, for example, an ultrasound image and position information attached thereto, and there are specific areas such as the start of surgery and the current tumor position shift, the position / shape of the skin surface, and the like. If the displacement exceeds the regulation value, a warning may be issued and a function for prompting the update of the 3D navigation image may be provided.

  Further, the image information can also display a time series display of changes (expansion / contraction) of the image information with respect to the treatment progress, and may have a function of recording past surgery / treatment progress as a log.

  Further, the 3D volume image and the selection image can be updated even during the operation, and the parameters and the like may be easily changed on the GUI.

  The image used for the 3D navigation may be applied to all apparatuses capable of volume imaging such as an X-ray apparatus, an X-ray CT apparatus, an MRI apparatus, and an ultrasonic apparatus.

  The preferred embodiments of the present invention have been described above with reference to the accompanying drawings, but the present invention is not limited to such examples. It will be apparent to those skilled in the art that various changes or modifications can be conceived within the scope of the technical idea disclosed in the present application, and these are naturally within the technical scope of the present invention. Understood.

  1 MRI machine, 3 upper magnet, 5 lower magnet, 7 struts, 9 position detection device, 11 arm, 13, 14 monitor, 15 monitor support, 17 reference tool, 19 personal computer, 21 bed, 23 control, 24 patient , 25 Infrared camera (position detection device), 27 pointer, 29 surgeon, 33 RS232C cable, 34 video recording device, 35 reflection sphere, 36 surgical tool (surgical tool), 37 ultrasonic probe, 38 ultrasonic monitor, 39 synchronization (Time phase) Measurement device, 40 ultrasound device, 41 video camera, 301 ultrasound diagnostic treatment device, 302 patient, 303 ultrasound probe, 304 ultrasound transmitter / receiver, 305 ultrasound image pusher, 306 display 307 control unit 308 control panel 309 HIFU controller 401 treatment probe 402 treatment area 403 target 404 focused ultrasound.

Claims (7)

A medical image diagnostic apparatus;
A three-dimensional position detection device for detecting the position of surgical tools and surgical instruments;
A surgery support system comprising a video recording device for storing video information including behaviors of staff members including an operator,
First means for capturing a 3D volume image by the medical image diagnostic apparatus;
A second means for processing the 3D volume image and rendering a specific area;
A third means for rendering a treatment route from the 3D volume image and the specific region;
A fourth means for displaying information about the operation on the display unit at the time of the operation and continuously recording the information about the operation;
A fifth means for assisting treatment by guiding the surgical instrument or surgical instrument position to a specific region;
Sixth means for determining the accuracy of the surgical instrument guidance position, the fatigue of the surgeon, or the treatment area of the patient based on the distance from the position tip of the guided surgical instrument or surgical instrument and the center of the specific area or continuously recorded information When,
Seventh means for issuing a warning based on the determination result of the sixth means;
An operation support system comprising:   The operation support system according to claim 1, wherein the second unit obtains the specific area as a certain range of spare area including the specific area obtained from the 3D volume image.   The means of 4 captures video information including the action of the surgeon with a video camera in time series, records the video information in a memory, and compares the video information with past video information and the display. The operation support system according to claim 1, wherein the operation support system is displayed.   The sixth means calculates the distance from the surgical tool or surgical instrument tip and the center of the specific region, determines whether the calculated distance exceeds a preset distance, the seventh means, 2. The surgery support system according to claim 1, wherein when the calculated distance exceeds a preset distance, a warning that accuracy has not been achieved is clearly indicated to the surgeon.   The sixth means calculates a treatment area in 3D volume images before and after treatment, determines whether or not a treatment result equal to or more than a prescribed ratio can be obtained by differing from the specific area, and the seventh means comprises: 2. The surgery support system according to claim 1, wherein a warning is given to the surgeon when a therapeutic result cannot be obtained.   The sixth means detects the eyeball position of the surgeon using the fourth means, and determines whether or not the surgeon's concentration is reduced based on the current difference information from the start of the surgery. When it is determined that the surgeon's concentration is decreasing, the amount of change in the operator's head movement distance or body posture is recorded in time series, and the seventh means 2. The operation support system according to claim 1, wherein a warning is issued when a displacement amount exceeding the regulation value or a difference amount between the past and the present is exceeded.   The sixth means records the ultrasonic image and the positional information attached thereto, and the singular region including the displacement of the start of surgery and the current position of the tumor and the position or shape of the skin surface has a displacement that is greater than or equal to the regulation value. The operation support system according to claim 1, wherein the seventh means issues a warning when the singular region exceeds a displacement amount not less than a specified value.

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