JP4557261B2 - Ultrasonic therapy device - Google Patents

Ultrasonic therapy device Download PDF

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JP4557261B2
JP4557261B2 JP2006195174A JP2006195174A JP4557261B2 JP 4557261 B2 JP4557261 B2 JP 4557261B2 JP 2006195174 A JP2006195174 A JP 2006195174A JP 2006195174 A JP2006195174 A JP 2006195174A JP 4557261 B2 JP4557261 B2 JP 4557261B2
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ultrasonic therapy
therapy apparatus
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誠 荻原
和之 加藤
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Hitachi Healthcare Manufacturing Ltd
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本発明は、体内に超音波振動子から経皮的に超音波を放射して病変部を治療する超音波治療装置及び病変部を診断する超音波診断装置に係わり、心臓の拍動により移動してしまう治療部位にめがけて治療用超音波照射行う際に、診断用超音波画像上で治療部位を追跡し、治療部位と治療用超音波の焦点が重畳した際にのみ治療用超音波を照射することで健常部位に治療用ビームが照射されず、安全で確実な治療が可能な機構を持つ超音波治療装置に関する。   The present invention relates to an ultrasonic therapy apparatus for treating a lesioned part by radiating ultrasonic waves percutaneously from an ultrasonic transducer in the body and an ultrasonic diagnostic apparatus for diagnosing a lesioned part, and moves by the pulsation of the heart. When performing therapeutic ultrasound irradiation toward the treatment site, the therapeutic site is traced on the diagnostic ultrasound image, and treatment ultrasound is irradiated only when the focus of the treatment site and the therapeutic ultrasound overlap. Thus, the present invention relates to an ultrasonic therapy apparatus having a mechanism capable of performing a safe and reliable treatment without irradiating a treatment beam to a healthy site.

特許文献1では、頭蓋内脳血管の塞栓を溶解する経頭蓋超音波治療法について発明され、また、経皮的心臓冠動脈血栓溶解法についても言及しているように、血栓溶解に超音波を利用した治療は発明されている。超音波照射を利用した血栓溶解においては、血栓部への持続した治療用の超音波照射が重要となる。脳血栓へのtPAと超音波の併用による急速再開通の例はある。しかし、心筋梗塞の例では心臓のような動きの激しい臓器に関しては血栓部位に治療用超音波を照射し続けるのは困難であった。腹部領域においては、下記特許文献2では、呼吸の位相に合わせて照射のタイミングを計り治療用ビームの照射を行う方法をCTやMRIなどによる3D診断画像を元に実現している。
特開2004-024668号公報 特開平07-047079号公報 Patent Document 1 invented a transcranial ultrasound treatment method for dissolving intracranial cerebral vascular embolism, and also referred to percutaneous cardiac coronary artery thrombolysis, using ultrasound for thrombolysis. The treatment has been invented. In thrombolysis using ultrasonic irradiation, continuous ultrasonic irradiation for therapeutic treatment to the thrombus is important. There is an example of rapid recanalization of cerebral thrombus with tPA and ultrasound. However, in the case of myocardial infarction, it has been difficult to continue irradiating therapeutic ultrasonic waves to the thrombus site for an organ with rapid movement such as the heart. In the abdominal region, in Patent Document 2 below, a method of measuring the timing of irradiation in accordance with the phase of respiration and irradiating a therapeutic beam is realized based on a 3D diagnostic image by CT, MRI, or the like.
JP 2004-024668 A JP 07-047079 A

しかし、上記特許文献では、治療までの時間がかかり、術者や患者にとって苦痛が増加することにつながる可能性がある。そこで本発明では、動きの激しい心臓部の梗塞部位を超音波診断画像上で確認し、梗塞部位が超音波焦点と一致したタイミングで治療用超音波を照射させることにより安全で確実な超音波治療を行うことを目的とする。   However, in the above-mentioned patent document, it takes time until treatment, which may lead to increased pain for the surgeon and patient. Therefore, in the present invention, a safe and reliable ultrasonic treatment is performed by confirming an infarcted portion of a heart part with intense motion on an ultrasonic diagnostic image and irradiating therapeutic ultrasound at a timing at which the infarcted region coincides with the ultrasonic focus. The purpose is to do.

治療用超音波を被検体に照射させて治療を行う超音波治療装置において、治療用ビームと診断用ビームを同一プローブにて照射する治療診断プローブと、心拍による周期的な動きを利用して治療用超音波の焦点に治療部位が重なるタイミングのみに治療用超音波を照射する制御手段とを有する。
前記制御手段は、診断用ビームで取得されたMモード画像に基づいて、治療用ビームの照射タイミングを制御する。
In an ultrasonic therapy apparatus that performs treatment by irradiating a subject with therapeutic ultrasound, a therapeutic diagnostic probe that irradiates a therapeutic beam and a diagnostic beam with the same probe, and treatment using periodic movement due to heartbeat Control means for irradiating the therapeutic ultrasound only at the timing when the treatment site overlaps the focal point of the therapeutic ultrasound.
The control means controls the irradiation timing of the therapeutic beam based on the M mode image acquired with the diagnostic beam .

本発明によれば、安全で確実な超音波治療を行うことができる。   According to the present invention, safe and reliable ultrasonic treatment can be performed.

本システムが実現可能となる装置の構成を以下に述べる。本システムは、図1に示す様に、超音波診断装置100、超音波治療装置101、および、治療・診断を同一のプローブから放射する複合プローブ102を備える。複合プローブ102には、治療用ビームを放射する治療用振動子16と、診断用ビームを送受信する診断用振動子17を備え、それらを交互、もしくは同時に放射することで治療・診断を行う。診断用ビームは組織の音響インピーダンスの異なる界面で反射し、ここでは詳細は記載しないが診断装置にて体内の様子がリアルタイムにモニタ10上に表示される。   The configuration of an apparatus that can realize this system is described below. As shown in FIG. 1, this system includes an ultrasonic diagnostic apparatus 100, an ultrasonic therapeutic apparatus 101, and a composite probe 102 that emits treatment / diagnosis from the same probe. The composite probe 102 includes a therapeutic transducer 16 that emits a therapeutic beam and a diagnostic transducer 17 that transmits and receives a diagnostic beam, and performs treatment and diagnosis by radiating them alternately or simultaneously. The diagnostic beam is reflected at the interface where the acoustic impedance of the tissue differs, and the state inside the body is displayed on the monitor 10 in real time by the diagnostic device, although details are not described here.

治療用ビームは診断用とは異なる周波数の超音波ビームを放射する。超音波治療用装置101は治療用超音波を送波するため、超音波診断装置100とは別に設けられる。
治療時には、超音波診断画像を見ながら、治療部位を探索し、治療用ビームを照射することで心筋梗塞の治療を行う。 The therapeutic beam emits an ultrasonic beam having a frequency different from that for diagnosis. The ultrasonic therapeutic apparatus 101 is provided separately from the ultrasonic diagnostic apparatus 100 in order to transmit therapeutic ultrasonic waves.
At the time of treatment, a myocardial infarction is treated by searching for a treatment site while observing an ultrasonic diagnostic image and irradiating a treatment beam.

上記目的を達成させるため、治療・診断の両ビームを一つのプローブから照射可能な治療診断複合プローブを使用する方法について述べる。治療診断のそれぞれのビームを照射する振動子が並列的、もしくは直列的に並んでいる場合に実現可能である。   In order to achieve the above object, a method of using a combined therapeutic and diagnostic probe capable of emitting both therapeutic and diagnostic beams from a single probe will be described. This can be realized when the transducers that irradiate each beam for treatment diagnosis are arranged in parallel or in series.

本システムの使用について図を用いて説明を行う。
心筋梗塞での治療部位は心臓の外壁に存在し、治療部位は心拍により周期的に同じ位置の移動を繰り返す。この移動が周期的であるため、診断用ビームで取得したMモード画像から治療部位の移動を観察することが可能である。Mモード(1D)診断を行う超音波診断画面のみでも心拍は推測可能であるが、同時に外部の心拍計21にて計測を行うと明確に心拍の周期を計測する事が可能である。治療部位の動きと心拍との同期を確認する。この場合、図2に示すMモードのような1D表示でも図3に示すBモードのような2D表示でも、2次元振動子などによる3D表示でもよい。確認後はMモード表示上で治療部位の動きを割り出し、心拍計測制御部22にて心拍1周期内での治療部位の動きを分析し、治療用ビームの焦点深度と治療部位の深度の一致するポイントを治療時間としてセットする(図4)。焦点深度と治療部位とが一致していないところでは、治療用ビームは健常組織に照射されてしまうため、治療用超音波照射を中止する必要がある。このようにして、治療用超音波の照射時間は1周期内でON、OFFを繰り返す。治療タイミングは、治療タイミング制御部20により制御され、治療用パルス発生回路13、送波アンプ15を介して治療用振動子17から治療用ビームが照射される。 The use of this system will be described with reference to the drawings.
A treatment site in myocardial infarction exists on the outer wall of the heart, and the treatment site periodically moves to the same position by the heartbeat. Since this movement is periodic, it is possible to observe the movement of the treatment site from the M-mode image acquired with the diagnostic beam. Although the heartbeat can be estimated only by the ultrasonic diagnostic screen for performing the M mode (1D) diagnosis, it is possible to clearly measure the cycle of the heartbeat by measuring with the external heart rate monitor 21 at the same time. Check the movement of the treatment area and the heart rate. In this case, a 1D display such as the M mode shown in FIG. 2, a 2D display such as the B mode shown in FIG. 3, or a 3D display using a two-dimensional vibrator or the like may be used. After confirmation, the movement of the treatment area is determined on the M mode display, and the movement of the treatment area within one cycle of the heartbeat is analyzed by the heart rate measurement control unit 22, and the depth of focus of the treatment beam matches the depth of the treatment area. Points are set as treatment time (Figure 4). Where the depth of focus does not match the treatment site, the treatment beam is emitted to the healthy tissue, and thus it is necessary to stop the treatment ultrasonic irradiation. In this way, the treatment ultrasound irradiation time repeats ON and OFF within one cycle. The treatment timing is controlled by the treatment timing control unit 20, and a treatment beam is emitted from the treatment transducer 17 via the treatment pulse generation circuit 13 and the transmission amplifier 15.

Mモード画像はプローブ表面から深部方向への表示であるので、治療部位がプローブから見て横方向に移動する場合は、観測点から外れてしまう。このような場合でも心拍の周期で繰り返す移動であれば一心拍で再び治療部位が画像上に表示されることになるので、術者が繰返し現れる治療部位をマーキングしておくことで、観測地点に断続的に現れる治療部位への対応も可能である。(図5、図6、図7)   Since the M-mode image is displayed in the deep direction from the probe surface, when the treatment site moves in the lateral direction when viewed from the probe, the M-mode image deviates from the observation point. Even in such a case, if the movement is repeated in the cycle of the heartbeat, the treatment site is displayed again on the image in one heartbeat, so by marking the treatment site where the operator repeatedly appears, It is also possible to deal with treatment sites that appear intermittently. (Figure 5, Figure 6, Figure 7)

また、超音波プローブ・被検体にそれぞれ位置センサを付属することで、超音波プローブと被検体との相対位置を感知することが可能となる。プローブが動いた場合、治療用ビームの焦点が治療部位に対して変化してしまっても、健常部位に治療用ビームが誤照射されるのを防ぐ仕様とすることも可能である。
この様にして、健常部位に治療用ビームが照射されず、治療部位にのみ治療用ビームが照射されるため、安全性・確実性の向上、術者、被検体への負担の軽減を図ることが可能となる。 In addition, by attaching a position sensor to each of the ultrasonic probe and the subject, it is possible to sense the relative position between the ultrasonic probe and the subject. When the probe moves, it is possible to make the specification to prevent erroneous irradiation of the therapeutic beam to the healthy site even if the focus of the therapeutic beam changes with respect to the therapeutic site.
In this way, the treatment beam is not irradiated to the healthy site, but the treatment beam is irradiated only to the treatment site, so that safety and certainty are improved and the burden on the operator and the subject is reduced. Is possible.

図8に治療の流れを示すフローチャートを記す。
治療用フロー開始後、Mモード診断と同時に心拍計測を行う。心拍の周期とMモード画面とのマッチングを行い、治療部位が観測されたら治療部位の1周期内での動きを観察する(ステップ1)。このとき、Mモード画面上に治療部位が断続的に表示される場合は、超音波プローブの位置・角度を変更し、治療部位が連続的に観察される部位を探す。もしくは、そのままの位置で治療を行う。(ステップ2)1心拍の周期内で、治療部位と超音波焦点の一致する部位を探し出し、治療時間を決める。その後、治療部位と診断画像に位置ずれが生じていれば診断に戻り、位置ずれが認められなければ治療タイミング決定に移る(ステップ3)。 FIG. 8 shows a flowchart showing the flow of treatment.
After starting the treatment flow, heart rate measurement is performed simultaneously with M-mode diagnosis. Matching between the heartbeat period and the M-mode screen, when the treatment site is observed, the movement of the treatment site within one cycle is observed (step 1). At this time, if the treatment site is intermittently displayed on the M mode screen, the position / angle of the ultrasonic probe is changed to search for a site where the treatment site is continuously observed. Alternatively, treatment is performed in the same position. (Step 2) Within one heartbeat period, find the site where the treatment site and the ultrasound focus coincide, and determine the treatment time. Thereafter, if there is a positional deviation between the treatment site and the diagnostic image, the process returns to the diagnosis, and if no positional deviation is recognized, the process proceeds to the treatment timing determination (step 3).

治療を開始するため、超音波治療装置に治療用ビームを照射するタイミングを送信する。治療開始とともに、心拍計の表示から治療タイミングを計算し、治療部位が超音波焦点と一致した時刻のみ治療用ビームを照射する(ステップ4)。途中で治療部位がずれてしまい、治療タイミングと治療部位が一致しなくなったら始めに戻って治療タイミングの再読み込みを行う。また、心拍数の変化を観測しておき、心拍数に変化があればその増減に応じて治療のタイミングを変化させ、また、不整脈など急激な変化を生じた場合には治療を中止、治療部位の再設定を行う(ステップ5)。   In order to start treatment, a timing for irradiating a therapeutic beam to the ultrasonic treatment apparatus is transmitted. At the start of treatment, the treatment timing is calculated from the display of the heart rate monitor, and the treatment beam is irradiated only at the time when the treatment site coincides with the ultrasonic focus (step 4). If the treatment site shifts in the middle and the treatment timing does not match the treatment site, the procedure returns to the beginning and the treatment timing is read again. Also, observe changes in heart rate, and if there is a change in heart rate, change the timing of treatment according to the increase or decrease, stop treatment if sudden changes such as arrhythmia occur, treatment site Is reset (step 5).

梗塞部位に再潅流が認められればその時点で治療を終了し、認められなければ治療を継続し、照射プロトコルの終了まで治療を行う。(ステップ6)   If reperfusion is observed at the infarct site, treatment is terminated at that point, otherwise treatment is continued and treatment is continued until the end of the irradiation protocol. (Step 6)

本発明の治療システム概要を示す図。The figure which shows the treatment system outline | summary of this invention. 本発明の治療部位が連続して表示されるMモード画像例を示す図。The figure which shows the M mode image example in which the treatment site | part of this invention is displayed continuously. 本発明の治療部位が連続して表示されるＢモード画像例を示す図。The figure which shows the B-mode image example by which the treatment site | part of this invention is displayed continuously. 本発明の治療部位が連続して表示される場合の治療タイミング例を示す図。The figure which shows the example of a treatment timing in case the treatment site | part of this invention is displayed continuously. 本発明の治療部位が断続的に表示されるMモード画像例を示す図。The figure which shows the M mode image example in which the treatment site | part of this invention is displayed intermittently. 本発明の治療部位が断続的に表示されるBモード画像例を示す図。The figure which shows the B mode image example in which the treatment site | part of this invention is displayed intermittently. 本発明の治療部位が断続的に表示される場合の治療タイミング例を示す図。The figure which shows the example of treatment timing in case the treatment site | part of this invention is displayed intermittently. 本発明の治療の流れを示すフローチャートを示す図。The figure which shows the flowchart which shows the flow of the treatment of this invention.

符号の説明Explanation of symbols

７ 送受波整相回路、８ 超音波画像記憶部、１０ モニタ、１１ 操作器、１３ 治療用パルス発生回路、１５ 治療用アンプ、１６ 診断用振動子、１７ 治療用振動子、２０ 治療タイミング制御部、２１ 心電計、２２ 心拍数計測制御部、１００ 超音波診断装置、１０１ 超音波治療装置、１０２ 複合プローブ   DESCRIPTION OF SYMBOLS 7 Transmission / reception wave phase circuit, 8 Ultrasonic image memory | storage part, 10 Monitor, 11 Operation device, 13 Treatment pulse generation circuit, 15 Treatment amplifier, 16 Diagnosis vibrator | oscillator, 17 Treatment vibrator, 20 Treatment timing control part , 21 electrocardiograph, 22 heart rate measurement control unit, 100 ultrasonic diagnostic apparatus, 101 ultrasonic therapy apparatus, 102 composite probe

Claims (7)

治療用超音波を被検体に照射させて治療を行う超音波治療装置において、
治療用ビームと診断用ビームを同一プローブにて照射する治療診断プローブと、
心拍による周期的な動きを利用して治療用超音波の焦点に治療部位が重なるタイミングのみに治療用超音波を照射する制御手段と、
を有する超音波治療装置であって、
前記制御手段は、前記診断用ビームで取得されたＭモード画像上で前記治療部位の動きを検出して、前記治療用ビームの焦点深度と治療部位の深度とが一致する期間に前記治療用ビームを照射することを特徴とする超音波治療装置。 In an ultrasonic therapy apparatus that performs treatment by irradiating a subject with therapeutic ultrasound,
A therapeutic diagnostic probe that irradiates the therapeutic beam and the diagnostic beam with the same probe;
Control means for irradiating the therapeutic ultrasound only at the timing when the treatment site overlaps the focal point of the therapeutic ultrasound using the periodic movement due to the heartbeat;
An ultrasonic therapy apparatus comprising:
The control means detects the movement of the treatment site on the M-mode image acquired with the diagnostic beam, and the treatment beam is in a period in which the depth of focus of the treatment beam matches the depth of the treatment site. An ultrasonic therapy apparatus characterized by irradiating with a laser beam . 治療用超音波を被検体に照射させて治療を行う超音波治療装置において、
治療用ビームと診断用ビームを同一プローブにて照射する治療診断プローブと、
心拍による周期的な動きを利用して治療用超音波の焦点に治療部位が重なるタイミングのみに治療用超音波を照射する制御手段と、
を有する超音波治療装置であって、
前記制御手段は、前記診断用ビームで取得されたＭモード画像上で前記治療部位の動きを検出して、前記治療用ビームの焦点深度と治療部位の深度とが一致しない期間に前記治療用ビームの照射を停止することを特徴とする超音波治療装置。 In an ultrasonic therapy apparatus that performs treatment by irradiating a subject with therapeutic ultrasound,
A therapeutic diagnostic probe that irradiates the therapeutic beam and the diagnostic beam with the same probe;
Control means for irradiating the therapeutic ultrasound only at the timing when the treatment site overlaps the focal point of the therapeutic ultrasound using the periodic movement due to the heartbeat;
An ultrasonic therapy apparatus comprising:
The control means detects the movement of the treatment site on an M-mode image acquired with the diagnostic beam, and the treatment beam is in a period in which the focal depth of the treatment beam does not match the treatment site depth. The ultrasonic therapy apparatus characterized by stopping the irradiation . 治療用超音波を被検体に照射させて治療を行う超音波治療装置において、
治療用ビームと診断用ビームを同一プローブにて照射する治療診断プローブと、
心拍による周期的な動きを利用して治療用超音波の焦点に治療部位が重なるタイミングのみに治療用超音波を照射する制御手段と、
を有する超音波治療装置であって、
前記制御手段は、前記診断用ビームで取得されたＭモード画像上で前記治療部位の動きを検出して、前記治療部位が超音波焦点と一致する時刻のみ前記治療用ビームを照射することを特徴とする超音波治療装置。 In an ultrasonic therapy apparatus that performs treatment by irradiating a subject with therapeutic ultrasound,
A therapeutic diagnostic probe that irradiates the therapeutic beam and the diagnostic beam with the same probe;
Control means for irradiating the therapeutic ultrasound only at the timing when the treatment site overlaps the focal point of the therapeutic ultrasound using the periodic movement due to the heartbeat;
An ultrasonic therapy apparatus comprising:
The control means detects the movement of the treatment site on an M-mode image acquired with the diagnostic beam, and irradiates the treatment beam only at a time when the treatment site matches an ultrasonic focus. Ultrasonic therapy device. 請求項１乃至３のいずれか一項に記載の超音波治療装置において、
前記制御手段は、心拍計からの情報に基づいて、前記被検体の心拍の周期を計測することを特徴とする超音波治療装置。 The ultrasonic therapy apparatus according to any one of claims 1 to 3,
The ultrasonic therapeutic apparatus , wherein the control means measures a heartbeat cycle of the subject based on information from a heart rate monitor . 請求項４に記載の超音波治療装置において、
前記制御手段は、心拍数の増減に伴う心拍周期の変化に応じて前記治療用ビームによる治療タイミングを変化させることを特徴とする超音波治療装置。 The ultrasonic therapy apparatus according to claim 4, wherein
The ultrasonic therapy apparatus , wherein the control means changes a treatment timing by the treatment beam in accordance with a change in a heartbeat cycle accompanying an increase or decrease in a heart rate . 請求項４に記載の超音波治療装置において、
前記制御手段は、前記心拍数の変化を感知し、前記治療用ビームの照射を停止することを特徴とする超音波治療装置。 The ultrasonic therapy apparatus according to claim 4, wherein
The ultrasonic therapy apparatus , wherein the control means detects a change in the heart rate and stops the irradiation of the therapeutic beam . 請求項１乃至６のいずれか一項に記載の超音波治療装置において、
前記Ｍモード画像には、その治療部位になされたマーキング結果が表示されることを特徴とする超音波治療装置。 The ultrasonic therapy apparatus according to any one of claims 1 to 6,
The ultrasonic therapy apparatus, wherein the M-mode image displays a marking result made on the treatment site .
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