JP5463214B2 - Treatment support apparatus and treatment support system - Google Patents

Description

  The present invention relates to a treatment support apparatus and a treatment support system, and more particularly to a navigation technique for a surgical instrument during a thermal treatment.

  2. Description of the Related Art Conventionally, there is a surgical navigation system using a position detection device and volume data captured in the past. In this surgical navigation system, a position designated by a pointer or the like for a patient at the time of surgery is displayed on a tomographic image having a cross section of each of three orthogonal planes of the patient including the position. It has been applied to high-precision surgery such as neurosurgery.

  Here, a tomographic image of a patient in such a surgical navigation system is generated in advance by volume data that is three-dimensional data imaged by an MRI apparatus. On the other hand, methods for detecting the position of the pointer required for determining the designated position by the pointer include methods such as a mechanical method, an optical method, a magnetic method, and an ultrasonic method. A technique combining the I-MRI and the 3D surgical navigation system is described in Patent Document 1.

JP 2003-190117 A

  In general, when therapeutic energy for thermotherapy is applied to a living body, the site irradiated with the therapeutic energy is swollen, and the shape, area, and volume of the site change. However, if a three-dimensional image whose shape has changed is to be used in navigation in Patent Document 1, the procedure is temporarily suspended for image data (three-dimensional volume imaging by an MRI apparatus) for constructing the three-dimensional image, In addition, the navigation image cannot be updated during the time required for the reconstruction calculation of the three-dimensional image, and there is a problem that it is difficult to smoothly advance the procedure and secure the real-time property of the navigation image.

  The present invention has been made in view of the above problems, and provides a treatment support apparatus and a treatment system that display a three-dimensional navigation image that can immediately follow a change in the shape or the like of a lesion site caused by a thermal treatment. For the purpose.

  In order to solve the above problems, a treatment support apparatus according to the present invention uses a parameter storage means for storing a treatment parameter for calculating an expansion amount of a specific part of a subject to be subjected to a thermal treatment, and the treatment parameter. Expansion amount calculating means for calculating the expansion amount of the specific part by the thermotherapy, and three-dimensional reconstruction based on the three-dimensional volume data of the subject acquired before the thermotherapy based on the calculated expansion amount Update image generation means for performing an image expansion / contraction process and generating an updated three-dimensional reconstructed image reflecting the amount of expansion of the specific part by the thermal treatment; and display means for displaying the updated three-dimensional reconstructed image. It is characterized by providing.

  The treatment support system according to the present invention includes a treatment device that includes a treatment device that performs a thermal treatment on a specific part of a subject, and a drive unit that drives and controls the treatment tool. Parameter storage means for storing a treatment parameter for calculating an expansion amount, an expansion amount calculation means for calculating an expansion amount of the specific part by thermal treatment using the treatment instrument using the parameter, and before the thermal treatment The post-update 3 reflecting the expansion amount of the specific part by the thermal treatment is performed based on the calculated expansion amount based on the expansion processing of the three-dimensional reconstruction image based on the three-dimensional volume data of the subject acquired A treatment support apparatus comprising: an updated image generating means for generating a three-dimensional image; and a display means for displaying the updated three-dimensional image.

  According to the present invention, it is possible to display a three-dimensional navigation image that can immediately follow a change in the shape or the like of a lesion site caused by a thermal treatment.

Schematic configuration diagram of a treatment support system according to the present embodiment Block diagram showing the configuration of an ultrasonic diagnostic treatment apparatus Explanatory drawing which shows the structure of the treatment probe 36 The block diagram which shows the structure of the treatment assistance program used for the treatment assistance system 10 The flowchart which shows the flow of a process of the treatment assistance system which concerns on this embodiment. Schematic diagram showing an example of GUI when setting treatment parameters Explanatory diagram showing energy distribution for each treatment device Graph showing the relationship between energy dose and expansion (expansion) coefficient Explanatory drawing which shows the expansion simulation around the treatment area | region using the expansion coefficient of FIG. It is a graph which shows the relationship between energy dosage and an image expansion-contraction radius. It is a GUI display example (during treatment) of the present invention. Explanatory drawing explaining the navigation image expansion / contraction process according to the parameter Schematic diagram showing an example of GUI during surgical instrument navigation Schematic diagram showing an example of GUI during treatment

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. The same reference numerals are given to the procedures having the same functions and the same processing contents, and the description thereof will not be repeated.

  The treatment support system according to the present embodiment heats a lesion site (for example, a tumor) by irradiating focused ultrasound to a lesion site of a subject, for example, a tumor, using an ultrasonic diagnostic treatment apparatus. In the treatment method, the tumor is swollen with heat treatment, so that the shape of the lesion area and its surrounding area depicted in the navigation image using the three-dimensional volume data before the treatment, and the actual lesion area of the subject And a treatment support system that suppresses inconsistencies with the shape of the surrounding region.

  In this embodiment, an ultrasonic diagnostic treatment apparatus capable of irradiating focused ultrasound is used as the heat treatment apparatus. However, the heat treatment apparatus is not limited to the ultrasonic diagnosis support apparatus, and for example, puncture is performed on a lesion site in a subject. Alternatively, a technique may be used in which a thermotherapy device using a monopolar method or a deployment needle method using a pair of electrodes is connected to the puncture needle, and heat treatment is performed using the puncture needle. In general, changes in the physical quantity (for example, shape, area, volume, etc.) of a lesion site due to thermotherapy are significant in heat treatment, but this embodiment can also be applied to changes in a lesion site due to cryotherapy. In addition, since the change of the lesion site caused by the heat treatment is remarkable in the expansion (dilation) of the tissue, the deformation amount of the tissue is described as the expansion amount (expansion amount) in this specification. May include a contraction amount of the tissue (a negative expansion amount).

  Prior to the description of this embodiment, the basic technology of this embodiment will be described. An MRI apparatus is known as an example of a subject image imaging apparatus. This MRI apparatus continuously measures nuclear magnetic resonance signals (hereinafter referred to as MR signals) from hydrogen, phosphorus, etc. in a subject and visualizes nuclear density distribution, relaxation time distribution, and the like. is there. At present, the imaging target of the MRI apparatus that is widely used clinically is the main constituent substance of the subject, proton. MRI images the form or function of the human head, abdomen, limbs, etc. in a two-dimensional or three-dimensional manner by imaging the spatial distribution of proton density and the spatial distribution of the relaxation phenomenon in the excited state.

  A real-time image may be generated during the operation using this MRI apparatus. In such intraoperative imaging, for example, cardiac imaging, puncture monitoring at the time of surgery, percutaneous therapy, etc., an I-MRI apparatus (interventional-MRI apparatus or an abbreviated name of Intraoperative-MRI apparatus) is used in real time. There is a demand to arbitrarily set a tomographic plane to be imaged. As a method for arbitrarily selecting a tomographic plane to be imaged, a method of displaying an MRI image on a graphical user interface, clicking a button on the screen, and determining a tomographic plane to be imaged next, or a three-dimensional mouse is used. There are methods.

  In these methods, since the position and orientation of the tomographic plane to be imaged must be adjusted and set by an input means such as a mouse, the MRI apparatus can adjust the position and orientation of the tomographic plane to be imaged more easily. It is desirable that it can be set. Therefore, a pointer is provided at the distal end of the surgical instrument, the position of the pointer is detected by a three-dimensional position detection device, and based on this, the position and orientation of the tomographic plane are adjusted and set.

  On the other hand, in recent years, there is an ultrasonic diagnostic treatment apparatus in which an ultrasonic diagnostic apparatus that obtains a diagnostic image and an ultrasonic therapeutic apparatus that performs heat treatment by irradiating focused ultrasonic waves are integrated. In the present embodiment, an example in which heat treatment is performed on a tumor region that is a lesion using this ultrasonic diagnostic treatment apparatus will be described.

  The ultrasonic diagnostic apparatus 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 subject. An ultrasonic probe including a transducer element that receives and receives ultrasonic waves, an ultrasonic transmission / reception unit that transmits / receives ultrasonic signals, and a two-dimensional ultrasonic image (B-mode image) or 3 based on the received signals An ultrasonic image composing unit that configures a three-dimensional ultrasonic image, a control unit that controls a display unit element that displays the ultrasonic image configured by the ultrasonic image composing unit, and a control panel that gives instructions to the control unit ing.

  As an example of ultrasonic image processing, there is a color Doppler method in which the blood flow in the direction toward the probe is displayed in red and the blood flow in the direction away from the probe is displayed in blue. As an advantage, not only the fast blood flow and the slow blood flow can be displayed simultaneously, but also the blood flow can be evaluated by adjusting the color gain and displaying brighter as the speed increases.

  A conventional general ultrasonic diagnostic apparatus not only displays a structure of a living tissue inside a subject as, for example, a B-mode image, but recently has been artificially introduced to a living body by using a compression device or a probe from the body surface of the subject. Distortion is obtained by compressing the internal tissue, obtaining the displacement at each point using the correlation calculation of the ultrasonic reception signals of two adjacent frames (two consecutive frames) in time series, and further spatially differentiating the displacement. A method of measuring and imaging this strain data, and a method of imaging elastic modulus data typified by Young's modulus of living tissue from stress distribution and strain data due to external force are becoming realistic. . According to the elastic image based on such strain and elastic modulus data (hereinafter referred to as elastic frame data), the hardness and softness of the living tissue can be measured and displayed. Such a function is generally called elastography.

  On the other hand, it is possible in principle to perform treatment with low invasiveness by focusing ultrasound from outside the body or inside the body cavity. The ultrasonic diagnostic treatment apparatus according to this embodiment is configured by integrating a probe for obtaining the above-described diagnostic image and a probe for irradiating focused ultrasonic waves.

  Based on the above technique, embodiments of the present invention will be described below.

  The treatment support system according to the present embodiment is based on a medical diagnostic apparatus (an X-ray apparatus, an X-ray CT apparatus, an MRI apparatus, an ultrasonic apparatus, etc.) having an image processing function and a surgical instrument position detection by a three-dimensional position detection apparatus. A specific area (segmentation) registered before surgery is monitored as image information in the image guidance function, the treatment device that treats the affected area of the living body, and the function that detects and corrects distortion in the field of view (FOV). Display and guide the surgical tool to the treatment area. In addition, the shape / volume (or area) before and after treatment is detected using treatment parameters registered in advance, and when the shape / volume is different from the original shape / volume, the image information is expanded / contracted / updated according to the parameters. In addition, it has a treatment image compensation function that improves the treatment accuracy by displaying a residual treatment area and prompting re-treatment and guiding a surgical instrument.

<Outline configuration>
Hereinafter, based on FIG. 1, the structure of the treatment assistance system which concerns on this embodiment is demonstrated. FIG. 1 is a schematic configuration diagram of a treatment support system according to the present embodiment.

  In the treatment system according to the present embodiment, a nuclear magnetic resonance imaging apparatus (hereinafter referred to as an MRI apparatus) 1 and an ultrasonic diagnostic treatment apparatus 40 integrated with a treatment apparatus are connected to a personal computer 19. Connection information between the MRI apparatus 1 and the ultrasonic diagnostic treatment apparatus 40 is displayed on the monitors 20 and 13. Then, the position detection device 9 continuously follows the pointer 27 attached to the treatment probe 36 and transfers the position information of the pointer 27, thereby connecting the ultrasound image, the MRI (or CT) apparatus, and the treatment apparatus. Is done.

  The MRI apparatus 1 shown in FIG. 1 is a vertical magnetic field type 0.3T permanent magnet MRI apparatus, in which an upper magnet 3 and a lower magnet 5 that generate a vertical static magnetic field around a patient are arranged side by side by columns 7 in a vertical direction. Is done. The subject 24 is placed on the bed 21 and transported in the opening 32 formed between the upper magnet 3 and the lower magnet 5. Although not shown, the MRI apparatus 1 includes a gradient magnetic field generator that generates a gradient magnetic field in the static magnetic field space. This gradient magnetic field generator generates a pulsed gradient magnetic field in pulses, with a maximum gradient magnetic field strength of 15 mT / m and a slew rate of 20 mT / m / ms. The MRI apparatus 1 further includes an RF transmitter (not shown) for generating nuclear magnetic resonance in the subject 24 in a static magnetic field, and an RF receiver (not shown) for receiving a nuclear magnetic resonance signal from the subject 24. Is constituted by a resonance type gradient magnetic field coil of 12.8 MHz. The gradient magnetic field coil is configured by gradient magnetic field coils in three directions of X, Y, and Z, and each generates a gradient magnetic field in response to a signal from a gradient magnetic field power supply. The RF coil generates a high-frequency magnetic field according to the signal from the RF transmitter. The signal of the RF coil is detected by the signal detection unit, processed by the signal processing unit, and converted into an image signal by calculation. The image signal is displayed as a tomographic image on the display unit. The gradient magnetic field power source, the RF transmission unit, the signal detection unit, and the like are controlled by the control unit, and the control time chart is generally called a pulse sequence. The subject 24 is transported to a space in the MRI apparatus 1 lying on the bed 21 and surrounded by an RF receiving coil, an RF coil, a gradient magnetic field coil, and the like, and imaging of a tomographic plane is performed.

  The monitor 13 displays an image of the tomographic plane of the subject 24 indicated by the pointer 27 provided on the treatment probe 36 held by the operator 29, and the upper magnet as with the infrared camera 25 by the monitor support unit 15. 3 is connected.

  The MRI apparatus 1 of the present embodiment includes a position detection device 9 for use as an I-MRI apparatus. The position detection device 9 includes a plurality of infrared cameras 25 and 25 provided at intervals (with a parallax), and a light emitting diode (not shown) that emits infrared rays, and is a tomographic plane pointing device. 27 positions and postures are detected. This position detection device 9 is connected to the upper magnet 3 so as to be movable by an arm 11, and the arrangement relative to the MRI apparatus 1 can be changed as appropriate. The method for detecting the position of the pointer 27 is not limited to the above. A mechanical type, an optical type, a magnetic type, an ultrasonic type, or the like may be used.

  The reference tool 17 is for detecting the relative positional relationship between the pointer 27 and the MRI apparatus 1, and links the coordinate system of the infrared camera 25 and the coordinate system of the MRI apparatus 1, and includes three reflections. A marker 35 made of a sphere is provided and provided on the side surface of the upper magnet 3. The marker may be a light source such as a light emitting diode instead of the reflecting sphere. The position detection method will be described in the <Registration> column described later.

  Information on the pointer 27 detected and calculated by the infrared camera 25 is transmitted to the personal computer 19 as surgical instrument position data via, for example, the RS232C cable 33.

  The control unit 23 is composed of a workstation and is electrically connected to the main body and the MRI apparatus 1. Then, an RF transmitter, an RF receiver and the like (not shown) are controlled. Further, the control unit 23 is connected to the personal computer 19. The personal computer 19 acquires the position data of the treatment probe 36 from the position of the pointer 27 detected and calculated by the infrared camera 25, converts the position data into position data that can be used by the MRI apparatus 1, and transmits the position data to the control unit 23. . The position data is reflected on the imaging section of the imaging sequence. The image acquired by the new imaging section is displayed on the monitor 13 and the monitor 20 which are liquid crystal monitors. For example, when the pointer 27 which is a tomographic plane indicating device is attached to the treatment probe 36 and configured so that the position of the treatment probe 36 is always an imaging cross section, the monitors 13 and 20 are focused ultrasonic waves irradiated from the treatment probe 36. A cross section including the focal point is displayed. In addition, in the procedure using the puncture needle instead of the treatment probe 36, when the position where the puncture needle is always set as the imaging section, the monitors 13 and 20 have a section that always includes the tip of the puncture needle. Will be displayed. In addition, it is also possible to perform measurement in synchronization with biological information, and various information (pulse wave, electrocardiogram, respiration) can be acquired by a synchronous (time phase) measurement device 41 attached to the subject 24. .

  The MRI apparatus 1 and the ultrasonic diagnostic treatment apparatus 30 are installed in the operating room 100, and the personal computer 19, the monitor 20 connected thereto, the control unit 23, and the video recording apparatus 24 are arranged in the operation room 101 adjacent to the operating room. Provided within. Then, the operator 13 visually recognizes the monitor 13 and the monitor 20 is visually recognized by an operator (not shown) in the operation chamber 101. Further, a video recording device 34 is connected to the personal computer 19, and a moving image (video signal) during operation is simultaneously recorded on the video recording device 34.

  Next, the ultrasonic diagnostic treatment apparatus 40 will be described. Hereinafter, the configuration of the ultrasonic diagnostic treatment apparatus 40 will be described with reference to FIGS. FIG. 2 is a block diagram showing the configuration of the ultrasonic diagnostic treatment apparatus, and FIG. 3 is an explanatory diagram showing the configuration of the treatment probe 36.

  The ultrasonic diagnostic treatment apparatus 40 is connected to the control panel 41 including a GUI for the operator 29 to input an output condition of the focused ultrasonic wave and the like, and controls the operation of the ultrasonic diagnostic treatment apparatus 40. A control unit 42, an ultrasonic transmission / reception unit 43 connected to the control unit 42 for transmitting radial ultrasonic waves 45 and focused ultrasonic waves 46 (see FIG. 3) and detecting reflected waves, and an ultrasonic transmission / reception unit 43 and the control unit 42, and an ultrasonic image constructing unit 44 that constructs an ultrasonic image based on the received reflected wave. A monitor 38 is connected to the ultrasonic image construction unit 44, and the generated ultrasonic image is displayed on the monitor 38.

  In the treatment probe 36, transducer elements are arranged for 1 to m channels in the long axis direction of the ultrasonic probe. Here, when k pieces are cut in the short axis direction and arranged for 1 to k channels, the short axis is changed by changing the delay time applied to each transducer element (1 to k channels) in the short axis direction. It is configured so that transmission and reception focus can be applied to the direction. Also, transmission weighting is applied by changing the amplitude of the ultrasonic transmission signal applied to each transducer element in the short axis direction, and the amplification level or attenuation level of the ultrasonic reception signal from each transducer element in the short axis direction is set. The received wave weight is applied by changing. Further, the aperture control can be performed by turning each transducer element in the short axis direction on and off.

  The therapeutic probe 36 has an ultrasonic transmission / reception sensitivity, that is, an electromechanical coupling coefficient that changes in accordance with the magnitude of a bias voltage applied to the drive signal supplied from the ultrasonic transmission / reception unit 43, for example, CMUT ( Capacitive Micro machined Ultrasonic Transducer) can be applied. CMUT is an ultrafine capacitive ultrasonic transducer manufactured by a semiconductor microfabrication process (for example, LPCVD: Low Pressure Chemical Vapor Deposition).

  The ultrasonic transmission / reception unit 43 supplies a transmission signal to the treatment probe 36 and processes the received reflected echo signal, and includes a transmission circuit that controls the treatment probe 36 and emits an ultrasonic beam. And a receiving circuit that receives a reflected echo signal of the emitted ultrasonic beam from within the subject and collects biological information, and a control circuit that controls them.

  The ultrasonic image constructing unit 44 converts the reflected echo signal processed by the ultrasonic transmitting / receiving unit 43 into an ultrasonic tomographic image, and a digital scan converter that forms an ultrasonic image based on the sequentially inputted reflected echo signal; , A magnetic disk device that stores ultrasonic images, and a storage device that includes a RAM, and processes the reflected echo signals received by the ultrasonic transmission / reception unit 43 to process two-dimensional ultrasonic images, three-dimensional ultrasonic images, and various types. Convert to Doppler image and output.

  The monitor 38 displays the ultrasound image created by the ultrasound image construction unit 44, and is composed of, for example, a CRT monitor and a liquid crystal monitor.

  The control unit 42 controls the operation of each of the above components, and is configured by a control computer system having an interface (corresponding to the control panel 41) with a user interface circuit. The control unit 42 controls the ultrasonic transmission / reception unit 43 based on a user interface included therein, information from the user interface, and the like. Also, control is performed such as transferring biological information received by the ultrasonic transmission / reception unit 43 to the ultrasonic image construction unit 44 or transmitting an ultrasonic image imaged by the ultrasonic image construction unit 44 to the monitor 38.

  As shown in FIG. 3, the treatment probe 36 is a treatment probe in which a diagnostic convex ultrasound probe (hereinafter referred to as “diagnostic probe”) 43 is built in a treatment probe 44 that generates focused ultrasound. While the diagnostic probe 43 emits radial ultrasound 45, the treatment probe 44 emits focused ultrasound 46 that converges toward a focal point 47. The therapeutic probe 36 is configured by integrating the diagnostic probe 43 with the therapeutic probe 44 so that the focal point 47 of the focused ultrasonic wave 46 and the central axis of the radial ultrasonic wave 45 substantially coincide with each other.

  When the focused ultrasound is irradiated from the treatment probe 36 to the treatment planned area, one time of ultrasonic irradiation is usually several seconds, and when treating a plurality of parts, an interval of usually several tens of seconds is provided. It is considered that the therapeutic effect can be obtained by heating to a temperature higher than the temperature at which the tissue is thermally coagulated by ultrasonic irradiation.

  Next, a treatment support program used in the treatment support system 10 will be described with reference to FIG. FIG. 4 is a block diagram illustrating a configuration of a treatment support program used in the treatment support system 10. The treatment support program is stored in a storage device (not shown) of the personal computer 19.

  The treatment support program includes an image data acquisition unit 19a that acquires 3D volume data of the subject 24, and a reconstructed image of the subject based on the 3D volume data (for example, three axes including an axial image, a sagittal image, and a coronal image). An image reconstruction unit 19b that generates a tomographic image or a volume rendering image) and a region where a lesion site is imaged from the reconstructed image of the subject (hereinafter referred to as a “specific site” and a region where a lesion site is imaged) A specific area extracting unit 19c for extracting a specific area), a treatment instrument registering part 19d for registering a treatment instrument (hereinafter referred to as “surgical instrument”) used for thermal treatment, and a reconstructed image of the subject. A navigation image generation unit 19e that generates a navigation image in which the position and the position of the treatment probe 36 are displayed in a superimposed manner; An expansion amount calculation unit 19g that calculates an expansion amount, a parameter storage unit 19f that stores a treatment parameter for calculating the expansion amount of a specific site, and a volume data storage unit that stores three-dimensional volume data of a subject before surgery 19h and based on the position information from the position detection device 9, the positions of the treatment probe 36 and the subject 24 in the real space are obtained, converted into a coordinate system of a detection space that can be used by the MRI apparatus 1, and A position detection processing unit 19i that converts the coordinate system of the detection space into a coordinate system on the reconstructed image of the subject, and matches the subject image with the coordinates of the treatment probe 36 and the real space of the subject 24; A marking unit 19j that applies a marker to a specific region in the reconstructed image of the specimen, and a path of the surgical tool, particularly in this embodiment, the focal position and path of the focused ultrasound (how the central axis of the focused ultrasound travels) (Corresponding to the z-axis in FIG. 7 and the following) is calculated based on parameters such as the inclination of the pointer 27 obtained by the position detection device 9 and the frequency and depth of the focused ultrasound, or is treated in a specific region. A route calculation unit 19k that calculates an approach direction to a non-existing region (hereinafter referred to as “residual treatment region”), a display control unit 19l that controls display of navigation images and ultrasonic images on the monitors 20 and 13, and a shape of a specific part Tissue expansion determination unit 19m that measures a physical quantity and compares the shape and physical quantity before surgery with the shape and physical quantity during thermotherapy to determine whether or not a specific site has expanded, and the irradiation time of focused ultrasound A time measuring unit 19n for measuring the amount of energy, and a treated region display unit 19o for displaying the energy administration region calculated based on the position and route of the treatment instrument and the amount of energy administered as a treated region A log generation unit 19p for generating log information in which treated areas are recorded in time series, a log storage unit 19q for recording log information, and a remaining treatment for obtaining a remaining treatment area obtained by removing a treated area from a specific area An area calculation unit 19r. The image reconstruction unit 19b is not essential when the image data acquisition unit 19a acquires a reconstructed image.

  The programs are loaded into a memory (not shown) provided in the personal computer 19 and executed by the CPU, whereby each program and the hardware configuring the personal computer 19 cooperate to realize the functions provided in the program. The

<Flow of treatment support system>
Hereinafter, based on FIGS. 5 to 13, the temperature measurement combined treatment assistance function according to the present embodiment will be described. FIG. 5 is a flowchart showing a processing flow of the treatment support system according to the present embodiment. FIG. 6 is a schematic diagram illustrating an example of a GUI for treatment parameters. FIG. 7 is an explanatory diagram showing the energy distribution for each treatment instrument. FIG. 8 is a graph showing the relationship between the energy dose and the expansion (expansion) coefficient. FIG. 9 is an explanatory diagram showing an expansion simulation around the treatment region using the expansion coefficient of FIG. FIG. 10 is a graph showing the relationship between the energy dose and the image expansion / contraction radius. FIG. 11 is an explanatory diagram for explaining navigation image expansion / contraction processing according to parameters. FIG. 12 is a schematic diagram illustrating an example of a GUI during surgical instrument navigation. FIG. 13 is a schematic diagram illustrating an example of a GUI during treatment.

  Hereinafter, description will be made along the order of steps in the flowchart of FIG. In an initial state before the processing of the treatment support system 10 is started, a screen 60 for treatment parameters shown in FIG. 6 is displayed on the monitor 20. The screen 60 includes an image display area 61 in which an image of the subject 24 is displayed, a selected therapeutic instrument information display area 62 in which information on the selected / registered therapeutic instrument is displayed, and a button area 63 in which operation buttons are displayed. And including.

In the button region 63, a button “treatment device registration / selection” 631 for performing registration / selection of a treatment device used for the thermal treatment, a “specific region designation” button 632, and an imaging button “3DScan” for performing 3D volume imaging of the subject. (T ₁ W) ”633 and“ 3DS scan (T ₂ W) ”634, and a“ specific region rendering ”button for detecting a region (hereinafter referred to as“ specific region ”) in which a lesion site is imaged in a three-dimensional reconstructed image 635, a surgical instrument (corresponding to the treatment probe 36 in the present embodiment), and a “registration” button 636 for registering the initial position thereof.

(Step S1)
The operator presses a “treatment instrument registration / selection” button 631 immediately before the operation to select / register a surgical instrument to be used for the operation (S1). This is because, since the distribution of external energy generated from the surgical instrument differs depending on the surgical instrument, a treatment parameter corresponding to the surgical instrument is read in step S5 described later.

  When the “treatment instrument registration / selection” button 631 is pressed, the treatment instrument registration unit 19d displays, for example, a list of surgical tools corresponding to the treatment parameters stored in the treatment parameter storage unit 19f in advance on the screen 60. Designates with a pointing device such as a mouse, the treatment instrument is selected and registered. The therapeutic instrument registration unit 19d has detailed information on the selected therapeutic instrument in the selected therapeutic instrument information display area 62, for example, the type of surgical instrument as character information, the therapeutic radius in the x, y, and z directions, and the expansion / contraction ranges A and B. Are expressed by a numerical value 631 and a schematic diagram 633. In the schematic diagram 633, a probe 632, a specific region 634, an expansion / contraction range A635, and an expansion / contraction range B636 are illustrated.

(Step S2)
The operator depresses “3D Scan (T ₁ W)” 633 or “3D Scan (T ₂ W)” 634 and captures a three-dimensional volume image including the treatment target portion of the subject 24 (S2). These three-dimensional volume images are used for surgical instrument navigation, but this step can be omitted when generating a surgical instrument navigation image using previously acquired three-dimensional volume data.

When “3DScan (T ₁ W)” 633 or “3D Scan (T ₂ W)” 633 is pushed down, the MRI apparatus 1 performs three-dimensional volume imaging of the subject 24, and the image data acquisition unit 19 a starts from the MRI apparatus 1. Three-dimensional volume data is acquired and stored in the volume data storage unit 19h. The image reconstruction unit 19b reads out three-dimensional volume data from the volume data storage unit 19h, performs image reconstruction calculation, and reconstructs a three-axis tomographic image (axial image, sagittal image, coronal image) and volume rendering image. . The reconstructed subject image is displayed in the image display area 61 as an axial image 620, a sagittal image 621, a coronal image 622, and a volume rendering image 623, respectively.

  In the present embodiment, a preoperative three-dimensional volume image is imaged using the MRI apparatus 1 included in the treatment support system 10, but if the position of the subject marker with respect to the subject 24 is the same, other The subject image reconstructed using a three-dimensional volume image in which the subject marker is captured by an imaging device different from the MRI device 1, such as an MRI device 1, for example, another MRI device or an X-ray CT device. May be displayed on the monitor 20, and based on this, a specific area to be treated may be extracted.

  For example, when the treatment target region of the subject 24 is in the abdomen, a xiphoid process portion reflected in a preoperative three-dimensional volume image is obtained by attaching a subject marker to the xiphoid projection of the subject and performing 3D imaging. The subject marker and the actual coordinates of the sacral portion of the subject 24 placed on the bed 21 are matched to prevent positional displacement due to body movement due to breathing, while preoperative and intraoperative 3 Dimensional volume images can be aligned.

(Step S3)
When the operator depresses the “render specific area” button 635, a specific area that is an area in which a lesion site is imaged is extracted from the three-dimensional volume data. Further, by selecting a desired specific area from the extracted specific areas and depressing the “specify specific area” button 632, a specific area for which the amount of expansion is to be calculated is set (S3).

  The specific region extraction unit 19c extracts a specific region from the three-dimensional subject image generated by the image reconstruction unit 19d based on the density value (CT value) and shape. Extraction of the specific area is not performed automatically by the specific area extraction unit 19c, but on the axial image, sagittal image, coronal image, or volume rendering image displayed on the monitor 20, the control unit 23 (not shown) by the operator is shown. You may input using the mouse | mouth with which it was equipped. The tissue expansion determination unit 19m measures the shape and volume (or area) of the extracted specific region. The measured value is used to determine whether or not the specific region has been expanded (expanded) by the thermal treatment.

  When the operator designates the specific area extracted on the three-dimensional image and presses the “specify diffusion (expansion) area” button 632, the expansion amount calculation unit 19g sets the designated specific area as the expansion amount. This is set as a specific area to be calculated. As a result, even when a plurality of specific areas are included in the navigation image, it is possible to specify a specific area where the expansion amount is to be calculated among the specific areas scheduled to be treated.

  The marking unit 19j attaches a marker to the extracted specific area 624. Moreover, it is a region including the specific region 624 as necessary, and is a warning region for issuing a warning when tissue degeneration (expansion or temperature rise) exceeds an assumed value in order to suppress excessive thermal treatment. (Warning area 1026 in FIG. 13) may be set and marking may be performed on the warning area.

(Step S4)
When the operator depresses the “registration” button 636, the position detection processing unit 19i starts registration processing (referred to as registration) of the surgical instrument (the treatment probe 36 in the present embodiment) and its initial position (S4). ).

  The position detection processing unit 19i first calculates the relative coordinates of the pointer 27 with respect to the MRI apparatus 1 in the real space with reference to the reference tool 17.

  The position detection processing unit 19i initially sets each marker 35 to the position detection device 9 from the displacement of the position of the marker 35 of the reference tool 17 in each image taken by each camera 25, 25 of the position detection device 9. Find the coordinates in the defined detection space. Then, based on the coordinates of each marker 35, the definition of the detection space is corrected so as to match the detection space defined in the MRI apparatus 1. That is, the coordinates on the detection space detected by the position detection processing unit 19i corresponding to the coordinates in the same real space are matched with the coordinates on the detection space used by the MRI apparatus 1.

  Next, the position detection processing unit 19i determines the coordinates in the detection space of each pointer 27 and the coordinates of the tip of the pointer 27 from the displacement of the position of the pointer 27 in each image captured by each camera 25, 25 of the position detection device 9. Is calculated. In the present embodiment, the position detection processing unit 19i also calculates the pointing direction of the pointer 27, that is, the direction of the pointer 27 from the coordinates on the detection space of each marker 27. The path calculation unit 19k calculates the advancing direction of the surgical instrument from the direction of the pointer 27 (in the present embodiment, the central axis (z-axis) direction of the focused ultrasound), and reconstructed images 620 and 621 using dotted lines 625. , 622, 623 are displayed in a superimposed manner.

  Next, the position detection processing unit 19i calculates the volume data from the coordinates of the detection space at the tip of the pointer 27 calculated for the state indicating the subject marker 24a placed on the sword-like projection of the subject 24. Relational expression between the coordinates of the image system of the volume data stored in the storage unit 19h and the coordinates on the detection space, that is, the position where the current patient's xiphoid process is on the detection space, and the subject in the volume data A relational expression for associating the position (coordinates of the image system) at which 24 sword-like projections are obtained is obtained and stored as a registration result. More specifically, for example, the coordinates of the detection space at the tip of the pointer 27 calculated are converted into the coordinates in the volume data of the subject marker 24a pointed to by the tip of the pointer 27 at that time, or Then, a coordinate conversion formula for performing the reverse conversion is obtained and stored as a registration result. The coordinates of the detection space are converted into the coordinates on the image in the image displayed on the monitor 20.

  If the position of the subject marker 24a relative to the subject 24 is unchanged, in step S1, the subject 24 with the subject marker 24a mounted thereon may be imaged by an apparatus different from the MRI apparatus 1, for example, an X-ray CT apparatus. . Since the subject marker 24 a is also reflected in the three-dimensional volume image obtained by a different apparatus, the subject marker 24 a of the subject 24 placed on the bed 21 is pointed with the tip of the pointer 27 to detect the position. Thus, even if the real space coordinates of the subject 24 placed on the bed 21 and the real space coordinates of the subject 24 when imaged by the X-ray CT apparatus are different, the subject 24 placed on the bed 21 The real space coordinates of the subject marker 24a can be converted into coordinates on the detection space, and the converted coordinates can be matched with the coordinates on the image of the subject marker 24a reflected in the three-dimensional volume image. An image obtained from the pointer 27 can be displayed on the volume image by matching the coordinates on the image. When using a three-dimensional volume image obtained from an X-ray CT apparatus, the specific area extraction unit 19c may automatically extract a specific area based on the CT value.

  Further, when a pointer cannot be attached to the subject 24, a surface scanning method using a laser may be used. In this surface scan method, a surface scan with a laser is performed prior to surgery to acquire and record the object shape, registration is performed based on the data, and the object shape is continuously acquired with a laser during surgery. The same effect as a pointer is obtained. As a result, even when the subject 24 is displaced due to respiratory movement or body movement, the imaging cross section is automatically tracked and corrected based on the result of the surface rescanning by the laser, so that the three-dimensional space and the image pixel are always changed. The positional relationship can be kept constant.

  When the registration is completed, the screen of the monitor 20 changes from the screen 60 at the time of setting treatment parameters in FIG. 6 to the screen 120 at the time of navigation of the surgical instrument in FIG. The screen 120 includes a real-time image area 121 that displays a real-time image, a navigation image area 122 that displays a navigation image, and a button area 123 in which various buttons are arranged.

  The button area 123 includes a “Planning” button 1231 “Biological information” button 1232, “Ultrasound image” button 1233, “Navigation image” button 1234, “Parameter / treatment instrument change” button 1235, “Image information change (MRI, CT image) ”button 1236,“ expansion (expansion) rate simulation ”button 1237, and“ device activation ”button 1238.

  When the “Planning” button 1231 is pressed down, the route calculation unit 19k creates a surgical route (in this embodiment, the route of the central axis of the focused ultrasound) and displays it superimposed on the navigation image using a dotted line 625. In addition, the “Planning” button 1231 can be used to set various treatment conditions necessary for the thermal treatment, such as the energy dose used for the thermal treatment and the irradiation time of the focused ultrasound.

  When the “biological information” button 1232 is pressed down, information on the subject 24, for example, patient information such as pulse and respiration, is displayed on the screen 1216 together with detailed information such as a surgical instrument (therapeutic device). The display position is not limited to the real-time image area 1211 and can be changed as appropriate.

  When the “ultrasound image” button 1233 is pressed down, an ultrasound image 1211 captured by the ultrasound diagnostic treatment apparatus 40 is displayed. The ultrasonic image 1211 also displays various parameters such as depth and frequency. Since the ultrasonic image captured by the ultrasonic diagnostic treatment apparatus 40 is used as a real-time image, the ultrasonic image is displayed in the real-time image area 1211.

  When the “navigation image” 1234 is pressed down, a reconstructed image reconstructed based on the three-dimensional volume data imaged before the operation, that is, a three-axis sectional axial image 620, a sagittal image 621, a coronal image 622, and a volume rendering image 624 are displayed. The used navigation image is displayed. The position 1212 of the treatment probe 36 is superimposed on the navigation image. The center of the triaxial cross-sectional image displayed in the navigation image area 122 is generally set to the registered specific area 624, but the specific area corresponding to the current position of the treatment probe 36 is reconstructed. It is also possible to display it.

  By depressing the “parameter / treatment instrument change” button 1235, a preset parameter group (energy amount, energy distribution and image expansion rate, ultrasonic image setting, navigation setting, etc.) can be changed all at once. The parameters can be changed in real time. It is also possible to change a pre-registered treatment instrument.

  When the “change image information (MRI, CT image)” button 1236 is pressed down, an image based on a plurality of three-dimensional volume data such as a CT image as well as an MRI image is registered in advance as a navigation image. The reconstruction image to be used can be changed. That is, a plurality of three-dimensional volume data is stored in the volume data storage unit 19h, and the image reconstruction unit 19b generates a reconstructed image in advance using each of these three-dimensional volume data and stores it in a storage device (not shown). Keep it. When the “change image information (MRI, CT image)” button 1236 is pressed, the navigation image generation unit 19e recreates the navigation image using a different type of reconstructed image from that previously used for the navigation image. To display.

  When the “expansion (expansion) rate simulation” button 1237 is depressed, the state of image expansion / contraction (swelling) when the ultrasonic image 1211 and the navigation images 620 to 623 are treated with the prescribed energy can be simulated and displayed on the GUI. .

  When the “treatment start” button 1238 is pressed down, devices used for surgery such as the ultrasonic diagnostic treatment device 40, image-guided navigation, and an operation support device such as an anesthesia machine are activated.

(Step S5)
Treatment planning is performed (S5). When the operator depresses the “Planning” button 1231, a GUI for setting conditions for the thermal treatment such as the energy dose to be administered from the surgical instrument selected in step S 1 on the monitor 20 and the energy irradiation time (not shown). Is displayed. Also, treatment parameters are read according to the selected surgical tool. The input setting may be performed by using the GUI of the monitor 20, or the input setting may be performed from the control panel of the ultrasonic diagnostic apparatus 40 and the personal computer 19 may acquire the data. The expansion amount calculation unit 19g reads the treatment parameters stored in the treatment parameter storage unit 19f.

  In general, since the distribution of energy administered from the therapeutic instrument differs depending on the therapeutic instrument, the therapeutic instrument is selected and registered in this step, and the therapeutic parameters suitable for the selected therapeutic instrument are set. Here, the treatment parameter setting is to register the energy distribution with respect to the direction of the treatment instrument, and sets the amount of tissue expansion and contraction according to the amount of energy and time.

  Hereinafter, based on FIG. 7, it demonstrates that energy distribution differs for every treatment instrument. Hereinafter, the traveling direction of the focused ultrasound is defined as the z-axis, and the two axes orthogonal to the z-axis are defined as the x and y axes.

  When energy is administered to the specific part 702 with the surgical instrument A (puncture needle 701) in FIG. 7, the energy distribution with respect to the outside of the puncture needle 701 is relatively higher than the energy administration region 703 that is relatively high dose. A two-stage configuration of an energy administration region 704 for low administration is obtained. The energy administration region 703 includes a specific portion 702 and is distributed in a circular shape with the tip of the puncture needle 701 as the center. The energy administration region 704 is distributed in a donut shape excluding the energy administration region 703 out of a circle centered on the tip of the puncture needle 701. The energy administration regions 703 and 704 are distributed concentrically around the tip of the puncture needle 701.

  Further, in the focused ultrasonic wave 711 irradiated from the surgical instrument B (therapeutic probe 711), as in the case of the puncture needle 701, an energy administration region 713 that is relatively high with respect to the specific part 712, The energy administration region 714 that is relatively low dose is distributed substantially concentrically (the major axis and the minor axis are the same).

  On the other hand, in the focused ultrasound 721 irradiated from the surgical instrument C (therapeutic probe 521), the distribution of the energy administration region 712 that is relatively high with respect to the specific portion 722, and the relatively low administration The distribution of the energy administration region 724 is smaller in the minor axis direction than in the major axis direction (corresponding to the traveling direction of the focused ultrasound 721). This is due to the characteristic of the focused ultrasound that the energy administration region is distributed along the traveling direction of the focused ultrasound 521.

  In other words, since the treatment effect (energy distribution) differs depending on the surgical instrument, the surgical instrument is selected and registered in advance, and the energy distribution suitable for the surgical instrument is registered three-dimensionally for treatment. Simulation is possible.

  Hereinafter, the treatment parameter and the extended region simulation method will be described using the surgical instrument C as an example. 1 corresponds to the surgical instrument C.

  FIGS. 8A, 8B, and 8C are graphs showing the relationship between the energy dose along each direction of the x, y, and z axes and the expansion (expansion) coefficient. The graphs (a), (b), and (c) of FIG. 8 show the expansion coefficient k in the high energy administration region that is relatively close to the treatment region and the low energy region that is located outside the high energy administration region. And an expansion coefficient m. The expansion coefficient here means an expansion rate after energy administration with respect to a specific region before treatment. In general, the greater the energy dose, the greater the tissue expansion (expansion) coefficient. In the case of the surgical instrument C, since it expands substantially concentrically in the x and y directions (short axis direction), the expansion coefficients kx and ky, mx and my for each of the x and y directions are shown in FIGS. ), The z-direction (major axis direction) has a higher tissue expansion rate than the short-axis direction, so kz and mz are larger than kx and ky and mx and my. Indicated by

  Based on FIG. 9, the process of performing an expansion simulation around the treatment region using the expansion coefficient of FIG. 8 will be described. FIG. 9 shows a two-stage energy distribution in each direction in which the expansion coefficient of FIG. 8 is applied to the x, y, and z directions with respect to the specific portion 903. The expansion area 904 (the expansion area 904 is an area including the specific part 902 and is the entire area within the dotted circle indicating the expansion area 904 in FIG. 9) has a relatively high expansion rate, and the expansion area 905 ( In the dotted circle indicating the specific part 903 in FIG. 9, the expansion rate is relatively low in a donut-shaped region excluding the expansion region 904.

Since the expansion rate is the same in the xy plane, two-stage circular energy administration regions are distributed concentrically. On the other hand, in the yz plane and the xz plane, an elliptical energy administration region composed of a major axis along the z direction and a minor axis along the x and y directions is distributed concentrically. The expansion rate of each area can be obtained by the following formula.
Expansion rate in the expansion region 902 in the x-axis direction = k _x · e ^−x · t (−c <x <c)
Expansion rate in the expansion region 903 in the x-axis direction = m _x · e ^−x · t (−c <x <−e, e <x <c)
Expansion rate in the expansion region 902 in the y-axis direction = k _y · e ^−y · t (−d <y <d)
Expansion rate in the y-axis direction of the expansion region ^{_{903 = m y · e -y ·}} t (-f <y <-d, d <y <f)
Expansion rate in the z-axis direction expansion region 902 = k _z · e ^−z · t (−g <z <g)
Expansion rate in the expansion region 903 in the z-axis direction = m _z · e ^−z · t (−h <z <−g, g <y <h)
(Where t is the time when energy is administered)

  In the above description, the expansion rate is used. However, the same effect can be obtained by replacing the expansion rate with the expansion amount or the image shrinkage radius. In the above formula, in this embodiment, c = d and f = e.

Based on FIG. 10, the relationship between the energy dose and the image expansion / contraction radius will be described. The image contraction radius in FIG. 10 indicates a result of the expansion amount calculation unit 19g calculating the image expansion / contraction radius based on the expansion coefficient in FIG. 8 and the expansion rate in FIG. FIGS. 10A, 10B, and 10C show the relationship between the energy dose and the image stretching radius in the x, y, and z directions, respectively. As the energy dose increases, the amount of tissue expansion increases. Therefore, it is necessary to expand and contract the image of the specific area captured in the navigation image according to the amount of expansion. Since the expansion coefficient of the surgical instrument c in FIG. 7 is the same in the x and y directions, the image expansion and contraction radii are equal to the energy dose in the x and y directions, as shown in FIGS. . Further, expansion factor _k x, _{k y,} so m x, greater than _{m y,} k x, image stretch radius corresponding to the _{k y is} m x, greater than the image expansion and contraction radius corresponding to the _{m y.} Further, since the expansion coefficient in the z direction is larger than the expansion coefficient in the x and y directions, the image expansion / contraction radius is also increased.

  The treatment parameter storage unit 19f stores treatment parameters for calculating the energy dose and the image expansion / contraction radius for each surgical instrument. The extension amount calculation unit 19g obtains the x, y, and z axis directions based on the route (z axis) calculated by the route calculation unit 19k. Subsequently, the expansion amount calculation unit 19g obtains information indicating the energy dose, or calculates the energy dose from the energy output and the irradiation time, and applies this energy dose to the treatment parameter, so that x, y The expansion amount in each direction of the z-axis direction is obtained, and the image expansion / contraction radius corresponding to this is calculated. The navigation image generation unit 19e generates an updated navigation image in which an image of a part where a specific area of the navigation image (axial image, sagittal image, coronal image, volume rendering image) is captured is expanded or contracted according to the image expansion / contraction amount, indicate.

  10 does not show the relationship between the energy administration time t and the image expansion / contraction radius. However, as the energy administration time t increases, the energy dosage increases accordingly. May be replaced with the energy administration time t. A parameter indicating the relationship between the energy administration time t and the image expansion / contraction radius may be prepared in advance, and the image expansion / contraction processing may be performed according to the energy administration time t as described above. In the above description, the two-stage expansion range is set. However, the expansion range may be one stage or three or more stages. By specifying an expansion coefficient according to the number of stages, the two-stage expansion range may be set. Similarly to the case, the image expansion / contraction processing according to the energy dose and / or the energy administration time can be performed.

  The graphs in FIGS. 8 and 10 can be changed by the user according to the characteristics of the surgical instrument. These FIG. 8 and FIG. 10 are the treatment parameters in the present embodiment, but the treatment parameters are not limited to FIG. 8 and FIG. Regardless of structure.

(Step S6)
The extension area registered in step S5 is calculated, and simulation display is performed (S6).

  When the operator presses an “expansion (expansion) rate simulation” button 1237, the route calculation unit 19k calculates a route to a specific region when using a registered surgical tool. As described above with reference to FIG. 7, the distribution of the energy administration region has a three-dimensional region (corresponding to the shape of a rugby ball) having a long axis along the traveling direction (z-axis direction) of the focused ultrasound. Since it may depend on the traveling direction of the focused ultrasonic wave, the extended region is calculated after obtaining the path. However, when the energy administration region is equally distributed in the three-dimensional equal direction and the expansion of the equal amount occurs in the three-dimensional equal direction, the path calculation unit 19k is not the path but the tip position of the surgical instrument (energy The central position of administration) may be calculated.

  Next, the expansion amount calculation unit 19g calculates an expansion region based on the energy dose set in step S4.

  Hereinafter, the navigation image expansion / contraction process according to the parameters by the expansion amount calculation unit 19g and the navigation image generation unit 19e will be described with reference to FIG. FIG. 11 is an explanatory diagram for explaining navigation image expansion / contraction processing according to parameters.

  FIG. 11A shows a state before image expansion / contraction (energy is not applied). It is assumed that there is a specific region (for example, a tumor) 1102 in the tissue 1105, and a treatment region 1103 that irradiates the focused ultrasound 1101 is included therein. The expansion amount 1104 for the treatment region 1103 heated by the focused ultrasonic wave 1101 is obtained by the expansion amount calculation unit 19g applying the energy dose to the treatment parameter in FIG. 10, and the image contraction radius corresponding to this expansion amount. It is also obtained. Therefore, the navigation image generation unit 19e performs image compensation on the assumption that the treatment region 1103 is enlarged by the calculated image contraction radius.

  This process is illustrated by the image expansion / contraction process of FIG. The navigation image generation unit 19e expands the original specific area 1102 to the area 1110 as the treatment area 1103 changes to the enlarged area 1104. Further, the surrounding tissue is pushed out 1111 to 1113 and the shape 1115 of the tissue surface is changed.

  Therefore, the navigation image generation unit 19e generates a linear image in which the image from the specific region 1102 to the surface of the tissue 1115 is linearly and entirely expanded by the amount of change from the treatment region 1103 to the enlarged region 1104, and the navigation image An updated navigation image is generated by replacing the image of the specific area portion with the generated linear image. In the linear image expansion / contraction processing by the navigation image generation unit 19e, the expansion / contraction amount may be changed according to the amount by which the expanded tissue pushes out the surrounding tissue or the position of the tissue. For example, the image expansion / contraction process may be performed so that the change in the shape of the tissue surface becomes greater as the depth of the specific region from the body surface is shallower. In addition, since the magnitude of the change in the shape of the surrounding tissue is considered to be affected by, for example, the influence of abdominal pressure in the abdomen and the hardness of the tissue, the navigation image generation unit 19e determines the image expansion / contraction radius of the tissue, You may change the image expansion-contraction amount of a surrounding tissue according to a position (depth and site | part from the body surface) and the hardness of a structure | tissue. Therefore, the navigation image generation unit 19e treats parameters that should be taken into consideration as image expansion / contraction parameters, such as tissue expansion (expansion) amount, tissue position (for example, depth below the body surface), tissue hardness, and the like. The data necessary for applying each parameter, for example, the tissue depth and tissue hardness, is acquired from the ultrasound diagnostic apparatus 40 and the navigation image, and the expansion (expansion) considering these parameters is obtained. ) Linear conversion by quantity may be performed.

  As an example, when the image stretching radius of the tissue is 2 cm and the tissue is 2 to 3 cm below the body surface, the navigation image generation unit 19e performs image stretching so that the body surface rises by 1.5 to 2 cm. Even if the stretch radius is 2 cm, if the tissue is deeper than 5 cm below the body surface, even if the surrounding tissue is pressed, the body surface will rise because there is little effect on the body surface. Instead, only the image expansion / contraction processing of the tissue peripheral part may be performed.

  The display control unit 19l replaces and displays the navigation image (axial image 620, sagittal image 621, coronal image 622, and volume rendering image 623) of FIG. 6 with the updated navigation image. Alternatively, during the simulation of this step, another window is launched on the navigation image (axial image 620, sagittal image 621, coronal image 622, volume rendering image 623), and an updated navigation image by simulation is displayed therein. May be.

  By this step, the approach method (angle / distance) using the registered surgical tool can be visualized and function as a surgical simulation. This step may be omitted when the surgical simulation is unnecessary.

(Step S7)
When the “device activation” button 908 is depressed, the treatment device and the image guided navigation function are activated, and the operation is started (S7). The screen of the monitor 20 changes from the screen 120 at the time of surgical instrument navigation to the screen 130 at the time of treatment in FIG. The screen 130 includes a real-time image area 131 that displays a real-time image, a navigation image area 132 that displays a navigation image, and a button area 133 in which various buttons are arranged.

  In the real-time image area 131 of FIG. 13, the biometric information 1320, the pre-operative ultrasound image 1311, the ultrasound image 1313 being treated (acts as a real-time image at the time of treatment), and the ultrasound image 1318 after treatment (treatment) Later, a real-time image is displayed, and an ultrasonic image 1313 is a past image). Although not shown in FIG. 13, various parameters such as depth and frequency when each ultrasonic image is captured may be displayed.

  Further, the specific area 1312 before treatment included in the ultrasonic image 1311 is displayed with its display mode changed so that the treated area 1315 and the remaining treatment area 1317 can be discriminated in the ultrasonic image 1313 being treated. Furthermore, in the ultrasonic image 1313, the outer edge portion 1316 of the energy administration region is displayed in a superimposed manner. Note that the tissue 1314 of the ultrasonic image 1311 has not yet changed its shape.

  Further, in the ultrasonic image 1318, the expansion of the tissue caused by the treatment is displayed (the tissue surface is raised and displayed), and the expanded region 1319 is displayed. The shape of the tissue 1314 changes as the expanded region 1319 is expressed.

  In the navigation image area 132, navigation images 1320, 1321, 1322, and 1323 using the three-axis cross section of the subject and the volume rendering image are displayed, similar to the screen 120 at the time of surgical instrument navigation.

  Similar to the screen 120, a “Planning” button 1231, a “biological information” button 1232, an “ultrasound image” button 1233, and a “navigation image” button 1234 are displayed in the button area 133. Further, an “expansion (expansion) display” button 1331, a “navigation image expansion (expansion) rate reflection” button 1332, a “treatment start” 1333, a “log” button 1334, and a “treatment progress” button 135 are provided.

  When the “treatment start” button 1333 on the screen 130 is pressed, the “navigation image expansion (expansion) rate reflection” button 1332 and the “log” button 1334 are turned on in conjunction with it, but are manually turned off as necessary. It can also be.

  When the “expand (expansion) region display” button 1331 is pressed, a list of images before and after treatment (image expansion / contraction) and parameter setting statuses are displayed.

  When the “Navigation Image Expansion (Expansion) Rate Reflection” button 1332 is pressed, the MRI image or CT image captured before surgery expands or contracts according to the surgical instrument parameters, and the navigation image is changed to an image after treatment. When the remaining treatment area exists, a marker 1328 indicating the approach direction with respect to the area is displayed three-dimensionally, and the next action is presented to the operator. The route calculation unit 19i calculates the approach direction, and the display control unit 19l displays the marker in a superimposed manner.

  When the “log” button 1334 is pressed, the log generation unit 19p displays the treatment progress status based on the information recorded in the time series on the treatment completion site and the incomplete site recorded in the log recording unit 19n. An image (including a moving image) to be shown is generated and displayed on the monitors 20 and 13 by the display control unit 19l.

  When the “treatment progress” button 135 is pressed, a difference image between the preoperative three-dimensional image and the updated three-dimensional image during the operation is generated, and a treatment progress image is generated by superimposing the difference area on the preoperative three-dimensional image. ,Is displayed. The treatment progress image may be generated by the treated region display unit 19o, or a means for generating a separate treatment progress image may be provided.

  In addition, in the ultrasonic images 1311, 1313, 1318 and the navigation images 1320, 1321, 1322, 1323, an overload (overtreatment) to a normal tissue located around a specific region (treatment region) is monitored, and a predetermined value A warning area for issuing a warning when the above load is applied is displayed. Thus, the surgeon can move the surgical tool and perform additional treatment while viewing the future treatment area. Information before and after treatment can be displayed as numerical data in addition to the ultrasonic image and the navigation image.

(Step S8)
The position detector 19i detects the position of the treatment probe 36 and the body position (movement) of the subject 24 in real time (S8).

(Step S9)
The navigation image generator 19e updates and displays the navigation image (S9). In step S9, when there is a change in the body position of the subject 24 compared to when registration (S5) is performed, the position of the 3D navigation image is corrected according to the above function, and the navigation image is used using the correction data. Update. “Correction data” here means that when the posture of the subject is changed after the registration (registration) of the captured volume image, the movement amount is reflected in the image. For example, when the posture of the subject is tilted by 30 ° after registration, the volume image is also tilted (rotated) by 30 °. When the surgical instrument (treatment probe 36) is guided to the target position, treatment is started in the next step.

(Step S10)
The operator depresses the “treatment start” button 1333 and irradiates focused ultrasound from the treatment probe 36 to a specific site. Alternatively, an ultrasonic wave irradiation button provided in the ultrasonic diagnostic treatment apparatus 40 is pressed to irradiate ultrasonic waves. At the same time, the timer unit 19n starts measuring the irradiation time of the focused ultrasound (S10).

(Step S11)
The timer unit 19n determines whether or not the irradiation time set in step S5 has elapsed (S11). If the result is affirmative, the process proceeds to step S14. If the result is negative, the time measurement is continued until the irradiation time elapses.

(Step S12)
The tissue expansion determination unit 19m detects the shape / volume (or area) of the specific part (specific region) based on the two-dimensional ultrasonic image that is a real-time image (S12). In this embodiment, an ultrasonic image is used as the two-dimensional real-time image, but an MRI image captured in real time may be used.

(Step S13)
The tissue expansion determination unit 19m has the shape / volume (or area) of the specific part (specific area) obtained in step S3 and the shape / volume (or area) of the specific part (specific area) obtained in step S12. It is determined whether they are different (S13). If the determination is affirmative, the process proceeds to step S14. If the determination is negative, the process returns to step S8.

(Step S14)
The navigation image is expanded and contracted along the treatment parameter (S14).

  The navigation image generation unit 19e performs the image expansion / contraction process described with reference to FIG. 11, and generates an updated navigation image by three-dimensionally performing partial expansion / contraction and accompanying movement of the external tissue around the specific part. In the navigation images 1320, 1321, 1322, and 1323 displayed in the navigation image area 132 of FIG. 13, an expansion (expansion) area 1327 for a specific part is displayed. Further, the outer edge portion 1326 of the energy administration region is also displayed in a superimposed manner.

(Step S15)
The treated area display unit 19o calculates a treated area included in the updated navigation image in a state where the expansion and contraction of the image is taken into account, and the marking unit 19j marks (logs) the treated area of the updated navigation image (S15). In this case, the marking (log) of the treatment area is not the treatment area 1325 that is the energy irradiation site but the expansion area 1327.

(Step S16)
The remaining treatment area calculation unit 19r calculates a remaining treatment area 1329 by subtracting the treated area 1327 obtained in step S15 from the specific area. The route calculation unit 19k calculates the approach direction to the remaining treatment area 1329, and displays the marker 1328 indicating the approach direction on the updated navigation image in a superimposed manner (S16). Warning means for issuing a warning when there is a remaining treatment area may be provided.

(Step S17)
If there is a treatment termination instruction, the treatment is terminated, and if there is no termination instruction, the process returns to step S8, and the repeated treatment is continued until there is no remaining treatment area including the operation tool guidance / treatment / image compensation (S17).

  According to the present embodiment, the image expansion / contraction amount of the navigation image is obtained from the treatment parameter and the energy dose used for the treatment, and the updated navigation image obtained by performing the image expansion / contraction of the navigation according to the image expansion / contraction amount is displayed. Therefore, when generating a three-dimensional navigation image reflecting tissue expansion (expansion) associated with treatment, it is not necessary to perform real-time three-dimensional volume imaging and reconstruction calculation, so that tissue expansion can be performed without causing a time lag. A three-dimensional navigation image reflecting (expansion) can be generated and displayed.

  In other words, in hyperthermia using ultrasonic therapy, by changing the navigation image in conjunction with the tissue deformation due to swelling at the same time as the treatment, it becomes possible to link the grasp of the treatment area and the image guidance function and control it before surgery. The position of the surgical instrument can be accurately pointed out without re-imaging the MRI / CT image. Thus, the prediction and effect of the treatment effect can be performed at the same time, and the improvement of the reliability of the image support and the improvement of the operation result can be expected by combining a plurality of diagnostic devices.

  This embodiment can be used as a treatment support system using any of an X-ray apparatus, an X-ray CT apparatus, an MRI apparatus, an ultrasonic apparatus, and the like. The present embodiment can also be applied to support for indirect surgery using a robot / manipulator in addition to support for treatment based on the operator's confidence (procedure).

1: MRI apparatus, 3: upper magnet, 5: lower magnet, 7: support, 9: position detection device, 10: treatment support system, 11: arm, 13: monitor, 15: monitor support, 17: reference tool, 19: personal computer, 20: monitor, 21: bed, 23: control unit, 24: subject, 25: infrared camera, 27: pointer, 29: operator, 32: opening, 33: cable, 34: video recording Device: 35: reflection sphere, 36: treatment probe, 38: monitor, 40: ultrasonic diagnostic treatment device, 41: synchronization (time phase) measurement device

Claims (10)

Parameter storage means for storing treatment parameters for calculating the amount of expansion of a specific part of the subject to be subjected to the thermal treatment;
An expansion amount calculating means for calculating an expansion amount of the specific site by the thermotherapy using the treatment parameter;
Based on the calculated expansion amount, the three-dimensional reconstructed image based on the three-dimensional volume data of the subject acquired before the thermal treatment is subjected to expansion / contraction processing, and the expansion amount of the specific part by the thermal treatment is reflected Updated image generating means for generating an updated three-dimensional reconstructed image;
Display means for displaying the updated three-dimensional reconstructed image;
A treatment support apparatus comprising: The treatment parameter defines a distribution of an energy administration region with respect to a position or direction of a treatment instrument used for the thermotherapy,
The treatment support apparatus further comprises position detection means for measuring at least one of the position or direction of the treatment instrument,
The expansion amount calculation means calculates the expansion amount of the specific part using the distribution of the energy administration region according to the position or direction obtained by the position detection means,
The treatment support apparatus according to claim 1. The treatment parameter is a treatment parameter that relates the amount of energy that can be administered in the thermotherapy and the amount of expansion of the specific site,
The expansion amount calculation means obtains information indicating the amount of energy administered in the thermotherapy, or calculates the energy amount and applies the energy amount to the treatment parameter, thereby expanding the specific target region. To calculate,
The treatment support apparatus according to claim 1. The treatment parameter is a treatment parameter associating a time during which the thermal treatment is performed on the specific site and an expansion amount of the specific site,
The treatment support apparatus further includes a time measuring unit that measures a time during which the thermal treatment is performed on the specific part,
The expansion amount calculation means calculates an expansion amount of the specific target site by applying a time during which the thermal treatment is performed to the treatment parameter.
The treatment support apparatus according to claim 1. Measure at least one of the shape or physical quantity of the specific part of the subject during the thermotherapy, and expand the specific part compared to the shape or physical quantity of the specific part of the subject before the thermotherapy Or further comprising a judging means for judging whether or not it has expanded or contracted,
When the determination unit determines that the specific part is expanded or contracted, the update image generation unit generates the updated three-dimensional reconstructed image.
The treatment support apparatus according to any one of claims 1 to 4, wherein The updated image generation means is configured to detect the region where the specific part is imaged based on the boundary of the region where the specific part is imaged in the three-dimensional reconstructed image based on the image contraction rate according to the calculated expansion amount. Perform image expansion / contraction processing,
The treatment support apparatus according to any one of claims 1 to 5, wherein Marking means for adding a marker to a region where the specific part in the three-dimensional reconstructed image is imaged,
The marking means expands and contracts the marker attached to the area where the specific part is imaged in the three-dimensional reconstructed image in conjunction with the expansion / contraction process of the area where the specific part is imaged, and updates the 3D Superimposed on the reconstructed image,
The treatment support apparatus according to any one of claims 1 to 6. On the updated three-dimensional reconstructed image, further comprising a treated region display means for displaying the region subjected to the thermal treatment as a treated region,
The treated area display means displays an area reflecting the expansion amount of the specific area obtained by the expansion amount calculation means as the treated area.
The treatment support apparatus according to any one of claims 1 to 7, A residual treatment region calculation means for calculating a region obtained by removing the treated region from the region where the specific part is imaged, as a residual treatment region;
A route calculation means for calculating and displaying an energy administration route for the remaining treatment area;
The treatment support apparatus according to claim 8. A treatment device comprising a treatment instrument for performing a thermal treatment on a specific part of a subject, and a drive unit for driving and controlling the treatment instrument;
Parameter storage means for storing a treatment parameter for calculating an expansion amount of the specific part; and an expansion amount calculation means for calculating an expansion amount of the specific part by thermal treatment using the treatment instrument using the parameter; The three-dimensional reconstructed image is expanded / contracted based on the three-dimensional volume data of the subject acquired before the thermal treatment, and the expansion amount of the specific part by the thermal treatment is reflected based on the calculated expansion amount. A treatment support apparatus comprising: an updated image generating means for generating the updated three-dimensional image; and a display means for displaying the updated three-dimensional image;
A treatment support system comprising: