JP6274005B2 - X-ray imaging apparatus and method of operating X-ray imaging apparatus - Google Patents

Description

  The present invention relates to an X-ray imaging apparatus that acquires an image including a catheter inserted into a body of a subject in an interventional treatment or the like, and particularly emphasizes a complete occlusion site of a blood vessel in the image and displays the enhanced image. Related to display technology.

  Recently, coronary intervention treatment (PCI: Percutaneous Coronary Intervention) is performed on patients with cardiovascular diseases such as myocardial infarction and angina pectoris. In coronary intervention therapy, a catheter having a guide wire therein is inserted into a blood vessel of a subject, and treatment is performed on the affected part of the blood vessel. Examples of intravascular treatment using a catheter include stent placement and atherectomy.

  In the PCI technique, as shown in FIG. 14A, the catheter 103 is passed through the blood vessel 101 in the direction of the arrow to allow the guide wire 105 to reach the stenosis 107, which is the affected area. After the distal end of the guide wire 105 passes through the stenosis 107, the device 109 reaches the stenosis 107 through the guide wire 105 from the inside of the catheter 103 as shown in FIG. Examples of the device 109 include a stent and a rotab radar. The device 109 performs a treatment such as expanding a blood vessel or cutting a calcified blood vessel wall in the narrowed portion 107.

  When performing a PCI technique, X-ray fluoroscopy is performed using an X-ray imaging apparatus. That is, the subject is irradiated with a low dose of X-rays, and X-ray images are acquired continuously. At this time, a contrast agent is administered to the subject and spread throughout the blood vessel, so that an image of the blood vessel 101 with high visibility appears in the X-ray image. The surgeon can appropriately advance the PCI technique by checking the positions of the catheter 103 and the guide wire 105 as needed with reference to continuously displayed X-ray images.

JP 2005-510288 A JP 2012-505006 A

However, the conventional example having such a configuration has the following problems.
That is, in the case of a conventional apparatus, when a patient's blood vessel is completely occluded, such as chronic total occlusion (CTO), it is difficult to appropriately perform treatment by PCI.

  Here, the problem relating to the conventional apparatus will be specifically described with reference to FIG. In the case of chronic complete occlusion, as shown in FIG. 15A, the blood vessel 101 is completely occluded by the occlusion portion 111 composed of atheroma or a calcified blood vessel wall. In this case, in order to perform an intravascular treatment by the device 109, it is necessary to pass through the blocking portion 111 with the guide wire 105. At this time, by pushing the guide wire 105 through the blocking portion 111, the guide wire 105 may advance through the blocking portion 111 and provide a path for the device 109 (FIG. 15B).

  However, in many cases, the guide wire 105 penetrates from the blood vessel cavity 113 into the blood vessel wall 115 when the guide wire 105 tries to pass through the blockage 111 (FIG. 15C). In such a case, the route of the device 109 cannot be secured, and it is difficult to advance the PCI technique. Moreover, since damage and perforation are formed in the blood vessel wall 115, there is a concern that the burden on the subject increases. Therefore, when the blood vessel is in a completely occluded state, it is important to confirm the exact position of the occluded portion 111 at any time in order to appropriately perform treatment by PCI.

  Since the occlusion part 111 completely occludes the blood vessel 101, the blood flow is stopped in the peripheral part of the occlusion part 111. Therefore, the contrast agent cannot be distributed to the peripheral part of the blocking part 111. That is, since the visibility of the blood vessel 101 is low in the X-ray image, it is difficult to check the occlusion portion 111 using the X-ray image.

  Therefore, conventionally, before performing the PCI technique, an X-ray image of a still image is taken for the occlusion portion 111, and the PCI technique is performed while referring to the obtained X-ray image. An X-ray image of a still image is acquired by irradiating a higher dose of X-rays compared to a case of a fluoroscopic image. Therefore, the image of the blocking part 111 can be visually recognized in the X-ray image of the still image.

  However, a real-time image of the closed portion 111 cannot be confirmed with a still image X-ray image. The exact position of the occlusion part 111 changes over time due to the breathing of the subject and the heart beat, so the X-ray image of the still image shows the exact position of the occlusion part 111 when performing the PCI technique. It does not necessarily reflect. Therefore, the conventional X-ray imaging apparatus cannot confirm the exact position of the blocking portion 111 at any time, so that it is very difficult to appropriately perform endovascular treatment by passing the blood vessel wall 115 through the guide wire 105 in PCI.

  The present invention has been made in view of such circumstances, and an X-ray imaging apparatus and an X-ray image generation method capable of acquiring a highly visible X-ray fluoroscopic image of an obstructed portion of a completely occluded blood vessel The purpose is to provide.

In order to achieve such an object, the present invention has the following configuration.
That is, an X-ray imaging apparatus according to the present invention includes an X-ray source that irradiates a subject with X-rays, an X-ray detection unit that detects X-rays transmitted through the subject and outputs a detection signal, and the detection An image generating means for intermittently generating an X-ray image based on the signal; a specific portion of the first insertion member inserted into the subject for each of the X-ray images; and an inserted into the subject. In addition, member extracting means for extracting at least a specific part of the second insertion member different from the first insertion member, and each of the plurality of specific parts extracted by the member extraction means for each of the X-ray images Integrating to generate an integrated image in which the region of the subject between the specific part of the first insertion member and the specific part of the second insertion member is emphasized Means

[Operation / Effect] According to the X-ray imaging apparatus of the present invention, the member extraction unit includes the specific part of the first insertion member inserted into the subject for each X-ray image generated by the image generation unit. At least a specific part of the second insertion member that is inserted into the subject and is different from the first insertion member is extracted. Then, the integrating means aligns with reference to the positions of the plurality of specific parts extracted by the member extracting means, and generates an integrated image by superimposing each of the X-ray images.

In this case, by superimposing each of the X-ray images, the region of the subject between the specific part of the first insertion member and the specific part of the second insertion member, which is a reference, is highlighted in the integrated image. The Therefore, even if the visibility of the region of interest in the X-ray image is low, by making the region of interest be located between the specific part of the first insertion member and the specific part of the second insertion member , An accumulated image in which the region of interest is highlighted can be acquired. Therefore, by referring to the integrated image, it is possible to confirm accurate real-time information about a region that is difficult to confirm with an X-ray image.

Further, in the above-described invention, the accumulating unit is configured to extract a predetermined number of the X-ray images most recently generated by the image generating unit from the extracted specific part of the first insertion member and the specific part of the second insertion member. by overlapping in alignment with reference to the position of, it is preferable to generate a new accumulated image.

[Operation / Effect] According to the X-ray imaging apparatus of the present invention, the integrating means extracts the predetermined number of the X-ray images most recently generated by the image generating means , and the specific part of the first insertion member extracted. And the position of the second insertion member with the specific part of the second insertion member are aligned and overlapped to generate a new integrated image. In this case, the new integrated image generated by the integrating unit is an image reflecting the latest X-ray image information. And since an image production | generation means produces | generates an X-ray image intermittently, a new integration image is produced | generated intermittently based on the newest X-ray image produced | generated intermittently. Therefore, by referring to the newly generated accumulated image, the operator can always check the latest real-time information and perform appropriate treatment for areas that are difficult to confirm with X-ray images. It becomes.

Further, in the above-described invention, the integration unit specifies the extracted first insertion member by extracting the integration image most recently generated by the integration unit and the latest X-ray image generated by the image generation unit. It is preferable to generate a new integrated image by aligning and superimposing the positions of the part and the specific part of the second insertion member as a reference.

[Operation / Effect] According to the X-ray imaging apparatus of the present invention, the integration unit extracts the integration image most recently generated by the integration unit and the latest X-ray image generated by the image generation unit. In addition, a new integrated image is generated by aligning and superimposing the positions of the specific part of the first insertion member and the specific part of the second insertion member as a reference. In this case, the new integrated image generated by the integrating unit is an image reflecting the latest X-ray image information. Therefore, by referring to the newly generated accumulated image, it is possible to confirm more accurate real-time information about a region that is difficult to confirm with an X-ray image.

  And since an image production | generation means produces | generates an X-ray image intermittently, a new integration image is produced | generated intermittently based on the newest X-ray image produced | generated intermittently. Therefore, the operator can perform more appropriate treatment by always referring to the accumulated image reflecting the latest X-ray image information. Furthermore, since the new accumulated image is generated based on the previously generated accumulated image and the latest X-ray image, the amount of calculation associated with the generation of the new accumulated image can be reduced. Therefore, since the accumulated image is generated more quickly, more accurate real-time information can be confirmed in the PCI technique.

Further, the inventor odor mentioned above, before Symbol member extraction means, it is preferable to detect the leading end of the insertion member.

  [Operation / Effect] According to the X-ray imaging apparatus of the present invention, the member extraction means detects the tip of the insertion member inserted into the body of the subject. That is, an accumulated image is generated by superimposing images with reference to the positions of the tips of the plurality of insertion members. In this case, by inserting the insertion member so that the region of interest is positioned between the tips of the insertion member, an integrated image emphasized for the region of interest can be generated. Accordingly, it is possible to more easily generate an integrated image having accurate real-time information for a region that is difficult to confirm with an X-ray image.

Further, in the invention described above, the member extraction means, it is preferable to detect the end of the granulation Kagezai.

  [Operation / Effect] According to the X-ray imaging apparatus of the present invention, the member extraction means detects the end of the contrast agent. That is, an integrated image is generated by superimposing images with reference to the positions of the ends of a plurality of contrast agents. In this case, the contrast image is administered so that the region of interest is located between the tips of the contrast agent, thereby generating an integrated image emphasized for the region of interest. Accordingly, it is possible to more easily generate an integrated image having accurate real-time information for a region that is difficult to confirm with an X-ray image.

In order to achieve such an object, the present invention may take the following configurations.
That is, the present invention provides an image generation unit that generates an X-ray image, a feature point specifying unit that extracts a feature point from the X-ray image, and an integration unit that superimposes a plurality of the X-ray images based on the feature point a method of operating a X-ray imaging apparatus including bets, by detecting X-rays transmitted through the object, an image generating step of said image generating unit is intermittently generate an X-ray image, the X-ray image in each of the first insertion member of the tip, and the first insertion member disposed on the downstream side of the full occlusion stenosis disposed upstream of the full occlusion stenosis formed in a blood vessel in the subject position of the tip of the different and member specifying step in which the feature point identification unit the position of the tip of the second insertion member is specific, the tip of the first insertion members identified in said member identification step and said second insertion member from the X-ray image with reference to By superimposing each said integrating unit is characterized in further comprising an integrating step of generating a new accumulated image the complete occlusion stenosis is enhanced.

[ Operation / Effect] According to the operation method of the X-ray imaging apparatus according to the present invention, an image generation unit that generates an X-ray image, a feature point specification unit that extracts a feature point from the X-ray image, and the feature point And an integration unit that superimposes a plurality of the X-ray images on the basis of the X-ray image , the X-ray image is intermittently generated in the image generation step. In the member specifying step, in each of the X-ray images, on the distal end of the first insertion member arranged on the upstream side of the completely occluded stenosis site formed in the blood vessel in the subject and on the downstream side of the fully occlusion stenosis site. The feature point specifying unit specifies the position of the tip of the second insertion member that is different from the arranged first insertion member . In addition integration process, complete obstruction stenosis by the position of the tip of the tip and the second insertion member of the first insertion member as a criteria specified in the member specifying step, integrating unit is superposed each of the X-ray image A new integrated image in which is emphasized is generated.

In this case, by superimposing each of the X-ray images, the accumulated image is formed in the region between the distal end of the first insertion member and the distal end of the second insertion member as a reference, that is, in the blood vessel in the subject. The complete occlusion stenosis site is highlighted. Therefore, even if the visibility of the completely occluded stenosis site is low in the X-ray image, the distal end of the first insertion member and the distal end of the second insertion member are arranged upstream and downstream of the completely occlusion stenosis site. The integrated image in which the region of interest is highlighted can be acquired. Therefore, by referring to the integrated image, it is possible to confirm accurate real-time information regarding a completely occluded stenosis site that is difficult to confirm with an X-ray image.

According to the X-ray imaging apparatus and the X-ray image generation method according to the present invention, for each of the intermittently generated X-ray images, the specific portion and the second insertion of the first insertion member inserted into the subject. A plurality of specific parts of the member are extracted. Then, the positions of each of the plurality of extracted specific parts are aligned as a reference, and the X-ray images are superimposed to generate an integrated image in which the completely occluded stenosis part is emphasized .

  In this case, by superimposing each of the X-ray images, the region between the plurality of reference members is displayed with emphasis in the integrated image. Therefore, even when the region of interest in the X-ray image is low in visibility, an integrated image in which the region of interest is highlighted is obtained by positioning the region of interest between a plurality of members. it can. Therefore, by referring to the integrated image, it is possible to confirm accurate real-time information about a region that is difficult to confirm with an X-ray image.

1 is a schematic diagram illustrating a configuration of an X-ray imaging apparatus according to Embodiment 1. FIG. 1 is a schematic diagram illustrating a configuration of a catheter system according to Example 1. FIG. (A) is a figure explaining schematic structure of a catheter system, (b) is a longitudinal cross-sectional view explaining the structure of a wire front-end | tip part. 3 is a flowchart according to the operation of the first embodiment. FIG. 6 is a schematic diagram illustrating a process of step S1 according to the first embodiment. (A) is a longitudinal cross-sectional view showing a completely occluded blood vessel, (b) is a diagram showing a state of a catheter reflected in an X-ray image, and (c) shows a state of a wire tip that has reached the occlusion. FIG. It is the schematic explaining the process of step S2 which concerns on Example 1. FIG. (A) is a figure which shows the state of the catheter reflected in an X-ray image, (b) is a figure which shows the state of the wire front-end | tip part which reached | attained the obstruction | occlusion part. It is a figure explaining the process of step S3 and step S4 which concern on Example 1. FIG. (A) is explanatory drawing which shows the integration image and cutout image which concern on Example 1, (b) is a figure explaining the combined image which concerns on Example 1. FIG. It is a figure explaining the process of step S3 and step S4 which concern on Example 1. FIG. (A) is explanatory drawing which shows the integration image and cutout image which are produced | generated after the newest X-ray image is produced | generated, (b) is the description of the combined image produced | generated after the newest X-ray image is produced | generated. It is a figure to do. It is a figure explaining the process of step S5 and step S6 which concern on Example 1. FIG. (A) is a longitudinal cross-sectional view which shows the wire front-end | tip part which crosses an obstruction | occlusion part in step S5, (b) is a figure explaining the process of mounting a stent in an obstruction | occlusion part in step S6, (c ) Is a diagram for explaining a step of expanding the stent placed on the occlusion in step S6. It is a figure explaining the problem in the X-ray imaging apparatus which concerns on a prior art example. (A) is a longitudinal cross-sectional view which shows the blood vessel of a completely occluded state, (b) is a figure explaining the area | region with high visibility in an X-ray image. It is a figure explaining the effect of the X-ray imaging apparatus which concerns on Example 1. FIG. (A) is a figure explaining the area | region highlighted in an integrated image, (b) is a figure explaining the area | region with high visibility in an integrated image. It is a figure explaining the effect of the X-ray imaging apparatus which concerns on Example 2. FIG. (A) is a figure explaining the front-end | tip part of the contrast agent in an X-ray image, (b) is a figure explaining the area | region with high visibility in an integration image. It is a figure explaining the process of step S3 and step S4 which concern on a modification. (A) is explanatory drawing which shows the integration image and cutout image which concern on a modification, (b) is a figure explaining the combined image which concerns on a modification. It is a figure explaining operation | movement of the X-ray imaging apparatus which concerns on a modification. (A) is a longitudinal cross-sectional view which shows the wire front-end | tip part reached to the obstruction | occlusion part, (b) is a figure explaining the process of pressing a wire front-end | tip part and crossing an obstruction | occlusion part, (c) is a wire It is a figure explaining the process which pushes forward a front-end | tip part further and crosses an obstruction | occlusion part. It is a figure explaining the process of PCI which concerns on a prior art example. (A) is a longitudinal cross-sectional view which shows the wire front-end | tip part which passes a constriction part, (b) is a figure explaining the process of making a device reach a constriction part. It is a figure explaining the problem in PCI which concerns on a prior art example. (A) is a longitudinal cross-sectional view which shows the wire front-end | tip part reached to the obstruction | occlusion part, (b) is a figure explaining the state which presses a wire front-end | tip part and crosses over the obstruction | occlusion part, (c) is a wire It is a figure explaining the state which a front-end | tip part penetrates into the blood vessel wall.

Embodiment 1 of the present invention will be described below with reference to the drawings.
FIG. 1 is a schematic diagram illustrating the configuration of the X-ray imaging apparatus according to the first embodiment.

  In the X-ray imaging apparatus 1 according to the first embodiment, as shown in FIG. 1, an X-ray tube 5 and an X-ray detector 7 are arranged to face each other with a top plate 3 on which a subject M in a horizontal posture is placed. ing. The X-ray tube 5 irradiates the subject M with X-rays. The X-ray detector 7 detects X-rays that are transmitted through the subject M from the X-ray tube 5, converts them into electrical signals, and outputs them as X-ray detection signals. A flat panel detector (FPD) or the like is used as an example of the X-ray detector 7. The X-ray tube 5 corresponds to the X-ray source in the present invention, and the X-ray detector 7 corresponds to the X-ray detection means in the present invention.

  The collimator 9 is provided below the X-ray tube 5 and limits the X-rays emitted from the X-ray tube 5 to a cone shape that is a pyramid. The X-ray irradiation control unit 11 is connected to the X-ray tube 5 and is configured to output a high voltage to the X-ray tube 5. Then, based on the high voltage output given by the X-ray irradiation control unit 11, the X-ray dose irradiated by the X-ray tube 5 and the timing of X-ray irradiation are controlled. The detector control unit 13 is connected to the X-ray detector 7 and controls the operation of reading the charge signal converted by the X-ray detector 7, that is, the X-ray detection signal.

  The image generation unit 15 is provided in the subsequent stage of the X-ray detector 7 and intermittently generates an X-ray image based on the X-ray detection signal output from the X-ray detector 7. The feature point extraction unit 17 is provided in the subsequent stage of the image generation unit 15 and extracts feature points that appear in the X-ray image generated by the image generation unit 15. Details of the feature points will be described later. The integrating unit 19 is provided in the subsequent stage of the feature point extracting unit 17 and generates an integrated image by superimposing the X-ray images generated by the image generating unit 15 on the basis of the feature points extracted by the feature point extracting unit 17. .

  The image cutout unit 21 is provided in the subsequent stage of the integration unit 19 and generates a cutout image by cutting out and enlarging a specific area from the integration image generated by the integration unit 19. The image combining unit 23 is provided in the subsequent stage of the image cutout unit 21 and combines the cutout image generated by the image cutout unit 21 and the X-ray image generated by the image generation unit 15 to generate a combined image. The monitor 25 is provided after the image combining unit 23 and displays the combined image generated by the image combining unit.

  The main control unit 27 controls the X-ray irradiation control unit 11, the detector control unit 13, the image generation unit 15, the feature point extraction unit 17, the integration unit 19, the image cutout unit 21, and the image combination unit 23. The input unit 29 is a keyboard input type or touch input type panel as an example, and the main control unit 27 performs overall control in accordance with an instruction input to the input unit 29 by the operator.

  FIG. 2A is a schematic diagram showing a configuration of a catheter system 31 used for coronary intervention treatment (PCI). The catheter system 31 includes a catheter 33, a guide wire 35, and a stent 37. The catheter system 31 corresponds to the insertion member in the present invention.

  The guide wire 35 is inserted into the tubular catheter 33. A wire tip 35 a is provided at the tip of the guide wire 35. The length of the wire tip 35a is, for example, about 3 cm. For convenience of explanation, the wire tip 35 a is drawn slightly thicker than the guide wire 35. The stent 37 is provided inside the catheter 33 and has a configuration that allows movement along the guide wire 35 in the direction indicated by the arrow. The wire tip 35a corresponds to the tip of the insertion member in the present invention.

  Here, an example of the configuration of the guide wire 35 and the wire tip portion 35a will be described with reference to FIG. The guide wire 35 includes an external shaft body 39 and an internal shaft body 41 that passes through the inside of the external shaft body 39. Examples of the material constituting the external shaft body 39 include resins such as polyester and polyurethane. In addition, it is preferable that the distal end of the external shaft body 39 is configured to have high rigidity so that a passage can be secured by pushing open the blood vessel blockage. The inner shaft body 41 is made of a material having high flexibility and kink resistance. Examples of the material constituting the internal shaft body 41 include nickel / titanium alloy and stainless steel.

  The wire tip portion 35 a is constituted by an outer shaft body 39, an inner shaft body 41, and an impermeable portion 43. The impermeable portion 43 has a coil shape, a tube shape, or the like, and is provided between the inner wall of the outer shaft body 39 and the inner shaft body 41. The opaque part 43 is made of a radiopaque material. Since the opaque portion 43 provided in the wire tip portion 35a has a low X-ray transmittance, the wire tip portion 35a has higher visibility in the X-ray image than other components such as the guide wire 35. Examples of the radiopaque material constituting the wire tip 35a include a palladium alloy as well as a platinum alloy such as Pt / Ir.

  The stent 37 is a grid-like cylindrical body made of a metal wire such as stainless steel, and a balloon (not shown) is provided inside. In PCI, the stent 37 is placed on a narrowed portion of the coronary artery. The deployed stent 37 is inflated with a balloon, and the inflated stent 37 is placed in a blood vessel, so that the coronary artery can be expanded and blood flow can be kept normal.

<Description of operation>
Next, the operation of the X-ray imaging apparatus 1 according to the first embodiment will be described. FIG. 3 is a flowchart for explaining the operation of the X-ray imaging apparatus according to the first embodiment, and FIG. 4A is a cross-sectional view showing a blood vessel of a subject. In FIG. 4A, the blood vessel 45 is completely occluded by the occlusion portion 47 formed of atheroma or calcified blood vessel wall. The obstruction | occlusion part 47 is corresponded to the complete occlusion stenosis site | part in this invention.

  In Example 1, two sets of catheter systems are used. Therefore, the first catheter system is distinguished from the catheter system 31, and the second catheter system is distinguished from the catheter system 31P by the reference symbol P. That is, the components included in the catheter system 31P, which is the second catheter system, are distinguished by further adding a symbol P to the symbols assigned to the components included in the catheter system 31.

Step S1 (insertion of the first catheter)
In performing PCI, the operator makes a small hole in the elbow or thigh base of the subject and inserts the catheter system 31 into the blood vessel. The surgeon administers a contrast agent to the subject via the inserted catheter 33 as necessary.

  The catheter system 31 inserted into the blood vessel of the subject is continuously imaged by the X-ray imaging apparatus 1. That is, X-rays are intermittently emitted from the X-ray tube 5 to the subject M. X-rays transmitted through the subject M are detected by the X-ray detector 7. The detected X-ray is converted into a charge signal and output to the image generation unit 15 as an X-ray detection signal.

  The image generation unit 15 intermittently generates an X-ray image 49 on which the catheter 33, the guide wire 35, etc. are projected based on the output X-ray detection signal (FIG. 4B). In the first embodiment, the X-ray image 49 is generated at a frame rate of about 15 to 30 FPS, for example. Each of the X-ray images 49 generated by the image generation unit 15 is displayed on the monitor 25. The process in which the image generation unit 15 generates the X-ray image 49 corresponds to the image generation process in the present invention.

  The surgeon advances the catheter 33 through the blood vessel 45 while referring to the X-ray image 49 displayed on the monitor 25, and causes the wire distal end portion 35a to reach the occluded portion 47 as shown in FIG. In the first embodiment, it is assumed that the operator reaches the wire distal end portion 35a on the proximal side of the blood vessel of the occlusion portion 47, that is, on the upstream side closer to the heart. In each drawing, the blood vessel proximal side of the occlusion portion 47 corresponds to the left side of the occlusion portion 47, and the blood vessel distal side of the occlusion portion 47 corresponds to the right side of the occlusion portion 47.

Step S2 (insertion of second catheter)
After the guide wire 35 reaches the occluded portion, the operator further inserts the second catheter system, that is, the catheter system 31P into the blood vessel of the subject. Then, the operator administers a contrast medium via the catheter 33 </ b> P as necessary, and intermittently irradiates X-rays from the X-ray tube 5. The image generation unit 15 intermittently generates an X-ray image 49 in which the catheter 33P, the guide wire 35P, and the like are projected.

  The surgeon advances the catheter 33P while referring to the X-ray image 49 displayed on the monitor 25, and causes the wire distal end portion 35aP to reach the occluded portion 47 as shown in FIG. In Example 1, it is assumed that the surgeon causes the wire tip 35aP to reach the blood vessel distal side of the obstruction 47, that is, the downstream side farther from the heart. Therefore, when step S2 is completed, in the X-ray image 49, the wire tip portion 35a and the wire tip portion 35aP are positioned so as to sandwich both sides of the blocking portion 47.

Step S3 (generation of integrated image)
After the guide wire 35P has reached the closing part 47, an integrated image is generated. That is, the integrating unit 19 generates an integrated image 51 by superimposing a plurality of X-ray images 49 in order to highlight the blocking unit 47. The superimposition of the X-ray images 49 is performed based on the feature points extracted by the feature point extraction unit 17. In the first embodiment, the number of sheets to be superimposed is five, but the number of sheets may be changed as appropriate.

  6A, the newest X-ray image 49 generated by the image generation unit 15 is referred to as an X-ray image 49a, and the X-ray image 49 next to the X-ray image 49a is sequentially denoted by reference numerals 49b to 49e. Shall. That is, in the first embodiment, the integrated image 51 is generated using the five X-ray images 49a to 49e that the image generation unit 15 generates most recently.

  In the first embodiment, when the integrated image 51 is generated, the wire tip portion 35a and the wire tip portion 35aP are used as feature points. That is, the feature point extraction unit 17 extracts, for each of the X-ray images 49a to 49e generated by the image generation unit 15, the wire tip portion 35a and the wire tip portion 35aP on the image as feature points.

  Each of the wire tip portion 35a and the wire tip portion 35aP includes an impermeable portion 43. The opaque portion 43 has a low X-ray transmittance as compared with the blood vessel 45 and other configurations of the catheter system 31. For this reason, in the X-ray image 49, the regions corresponding to the wire tip portion 35a and the wire tip portion 35aP have high brightness, so that they can be easily distinguished from other regions.

  The feature point extraction unit 17 calculates position information on the image of the X-ray image 49 for each extracted feature point. The position information calculated by the feature point extraction unit 17 is transmitted to the integration unit 19. The step in which the feature point extraction unit 17 calculates the position information by extracting the wire tip portion 35a and the wire tip portion 35aP as the feature points corresponds to the member specifying step in the present invention.

  The positions of the blood vessel 45 and the blockage 47 shown in each of the X-ray images 49a to 49e differ depending on the pulse and respiration of the subject M. The integrating unit 19 generates the integrated image 51 by superimposing the X-ray images 49a to 49e transmitted from the image generating unit 15 based on the position information of the feature points calculated by the feature point extracting unit 17 (FIG. ) Lower left). The process in which the integrating unit 19 generates the integrated image 51 corresponds to the integrating process in the present invention.

  By superimposing X-ray images 49a to 49e with the wire tip 35a and the wire tip 35aP as feature points, contrast enhancement in which the brightness difference between the regions sandwiched by these feature points and the neighborhood of the regions is enlarged is enlarged. Displayed. As a result, the blocking portion 47 positioned between the wire tip portion 35a and the wire tip portion 35aP is highlighted in the integrated image 51. The generated integrated image 51 is transmitted from the integrating unit 19 to the image clipping unit 21.

Step S4 (generation of combined image)
The image cutout unit 21 cuts out an image of an area including the wire tip portion 35a, the wire tip portion 35aP, and the blocking portion 47 from the accumulated image 51 transmitted from the accumulation unit 19 to generate a cutout image 53 (FIG. 6 ( a) Lower middle). The formed cutout image 53 is transmitted to the image combining unit 23. The image combining unit 23 enlarges the cut-out image 53 to generate an enlarged image 55 (lower right in FIG. 6A).

  In addition, the latest X-ray image 49 a is transmitted from the image generation unit 15 to the image combining unit 23 as needed. The image combining unit 23 generates the combined image 57 by paralleling the transmitted X-ray image 49a and the enlarged image 55 (FIG. 6B). The generated combined image 57 is transmitted to the monitor 25, and the monitor 25 displays the combined image 57.

  The enlarged image 55 included in the combined image 57 is an image with excellent visibility of the closed portion 47 because the closed portion 47 is highlighted and enlarged. The X-ray image 49a is the latest X-ray image 49. Therefore, the surgeon refers to the combined image 57 displayed on the monitor 25, and performs an operation related to the next step S5 while confirming a real-time image of the closed portion 47 excellent in visibility.

  In addition, after the process of step S4 is complete | finished, each of the integrating | accumulating part 19, the image clipping part 21, and the image coupling | bond part 23 repeats the process which concerns on steps S3-S4 sequentially. That is, as shown in the upper part of FIG. 7A, after generating the X-ray image 49a, the image generation unit 15 further generates an X-ray image 49n as the latest X-ray image.

  When the X-ray image 49n is generated as the latest X-ray image, the five X-ray images most recently generated by the image generation unit 15 are the X-ray images 49a to 49d and the X-ray image 49n. Therefore, when the X-ray image 49n is generated after the X-ray image 49a, the accumulated image 51 is newly generated using the X-ray images 49a to 49d and the X-ray image 49n.

  The integrating unit 19 generates an integrated image 51 by superimposing the X-ray images 49a to 49d and the X-ray image 49n based on the position information of the feature points calculated by the feature point extracting unit 17 (the lower part of FIG. 7A). left). The image cutout unit 21 generates a cutout image 53 from the accumulated image 51 transmitted from the accumulation unit 19 (the lower center of FIG. 7A). The image combining unit 23 enlarges the cut-out image 53 to generate an enlarged image 55 (lower right in FIG. 7A). As described above, by repeating the processes related to steps S3 to S4, the real-time image of the highly visible blockage portion 47 reflecting the information of the latest X-ray image 49 is continuously displayed in the combined image 57.

Step S5 (crossing the closed part)
The surgeon confirms the positional relationship among the wire tip 35a, the wire tip 35aP, and the block 47 by referring to the image of the block 47 shown in the combined image 57. Then, the catheter 33 is accurately operated to press the wire tip portion 35a against the blocking portion 47. Since the accurate positional relationship between the wire tip 35a and the blockage 47 is confirmed by referring to the combined image 57, the wire tip 35a does not intrude into the blood vessel wall of the blood vessel 45 without accidentally penetrating the blockage 47. Advancing across (FIG. 8 (a)).

  When the wire tip 35 a crosses the occlusion portion 47, a path 59 through which the catheter 33 passes from the blood vessel proximal portion side of the occlusion portion 47 to the blood vessel distal portion side of the occlusion portion 47 is formed. In addition, you may press the wire front-end | tip part 35aP against the obstruction | occlusion part 47 instead of the wire front-end | tip part 35a. In this case, a path through which the catheter passes from the distal portion side of the blood vessel of the closed portion 47 to the proximal portion of the blood vessel of the closed portion 47 is formed by the wire tip 35aP crossing the closed portion 47.

Step S6 (stent placement)
The operator confirms the real-time image of the stent 31 displayed in the combined image 47. And the stent 37 provided in the inside of the catheter 33 is moved along the guide wire 35, and the stent 37 is made to reach | attain the path | route 59 formed in the obstruction | occlusion part 47, as shown in FIG.8 (b). Then, the balloon provided inside the stent 37 is inflated.

  Since the stent 37 is inflated by the balloon, the blocking portion 47 is expanded from the inside (FIG. 8C). By placing the swollen stent 37 in the blood vessel, the blood flow in the coronary artery is kept normal. After placing the stent 37, the PCI system is completed by extracting the catheter system 31 and the catheter system 31P from the body of the subject M along the blood vessel 45.

<Effects of Configuration of Example 1>
As described above, according to the X-ray imaging apparatus according to the first embodiment, it is possible to generate an X-ray image in which a real-time image of an occluded portion with high visibility is shown for a completely occluded blood vessel. Hereinafter, effects of the configuration according to the first embodiment will be described.

  In the X-ray imaging apparatus according to the conventional example, it is difficult to perform the PCI treatment on the blood vessel 101 that is completely closed by the closing portion 111 as shown in FIG. This is because it is necessary to spread the contrast agent in the blood vessel 101 in order to acquire an X-ray image in which the blood vessel is reflected. However, since the blood flow is stopped in the peripheral part of the obstruction part 111, the contrast agent does not reach the peripheral part of the obstruction part even if the contrast medium is administered to the subject.

  In addition, since the tissue constituting the occlusion portion 111 such as atheroma and calcified blood vessels has high X-ray transmittance, the visibility of the occlusion portion 111 in the X-ray image is low. Therefore, in the X-ray transmission image 117 generated by the X-ray imaging apparatus according to the conventional example, the region with high visibility is a region corresponding to a blood vessel cavity away from the occlusion portion 111, that is, a region G without a halftone dot. Yes (FIG. 9B).

  In this case, in addition to the blocking part 111, the vicinity of the blocking part 111 is also less visible, so it is very difficult to check the exact position of the blocking part 111 as needed even with reference to the X-ray transmission image 117. . As a result, when the guide wire 105 is used to cross the blocking portion 111, in many cases, the problem that the guide wire 105 penetrates into the blood vessel wall 115 occurs as shown in FIG.

  As a result of intensive studies, the inventors have made real-time images of occluded portions with high visibility by superimposing X-ray transmission images for a plurality of frames with a plurality of wire tip portions as feature points in the X-ray imaging apparatus according to the present invention. Can be acquired. That is, by operating the two catheter systems, the guide wires reach the blood vessel proximal portion side and the blood vessel distal portion side of the occlusion portion, respectively. By this operation, each of the distal end portions of the guide wire is positioned with the blocking portion interposed therebetween.

  An impervious portion is provided at the distal end portion of the guide wire. Since the opaque portion is made of a material having a low X-ray transmittance, the luminance of the image portion corresponding to the wire tip portion in the X-ray transparent image is clearly different from that of the other image portions.

  Therefore, in the first embodiment, when the guide wire 35 and the guide wire 35P reach the blocking portion 47, the region corresponding to the wire tip portion 35a and the wire tip portion 35aP in the X-ray transmission image 49 has high luminance, so that visibility is improved. It is excellent (FIG. 10 (a)). Therefore, the feature point extraction unit 17 can extract regions corresponding to the wire tip portion 35a and the wire tip portion 35aP as feature points, and can easily calculate position information thereof.

  The integrating unit 19 generates an integrated image 51 by superimposing a plurality of frames of the X-ray image 49 generated by the image generating unit 15. The integrated image 51 is generated by superimposing the feature point positions calculated by the feature point extraction unit 17 on each of the X-ray images 49 as a reference. Therefore, in the accumulated image 51, image information for a plurality of sheets is accumulated in a region sandwiched between the wire tip portion 35a and the wire tip portion 35aP that are feature points, that is, a region H indicated by a dotted line. As a result, as shown in FIG. 10B, the contrast highlighting display in which the brightness difference in the region H is enlarged in the integrated image 51 is displayed.

  Since the blocking portion 47 is located between the wire tip portion 35a and the wire tip portion 35aP, the blocking portion 47 is included in the region H. Therefore, the blocking portion 47 is low in visibility in each X-ray image 49 but is emphasized in the integrated image 51. Further, the X-ray images 49 a to 49 e used for generating the integrated image 51 are a plurality of images sequentially selected from the latest X-ray transmission images generated by the image generation unit 15. Therefore, the blocking portion 47 shown in the integrated image 51 reflects the real-time image of the blocking portion 47 more faithfully.

  In addition, the image cutout unit 21 cuts out the feature points shown in the accumulated image 51 and the blockage unit 47 and the area in the vicinity thereof to generate a cutout image 53. The image combining unit 23 generates a combined image 57 by juxtaposing the enlarged image 55 obtained by enlarging the cut-out image and the latest X-ray image 49a. The enlarged image 55 included in the combined image 57 is an image with excellent visibility of the closed portion 47 because the closed portion 47 is highlighted and enlarged. Therefore, the surgeon can advance the PCI technique while referring to the combined image 57 displayed on the monitor 25 while confirming the exact position of the blocking portion 47 as needed.

  In the X-ray imaging apparatus 1 according to the first embodiment, by having such a configuration, the operator can easily confirm an accurate real-time image of the occluded portion 47. Therefore, when crossing the obstruction 47 with the wire tip 35a, the wire tip 35a can be prevented from accidentally penetrating into the blood vessel wall, and the obstruction 47 can be more reliably traversed. A passage 59 through which the catheter 33 passes is formed by crossing the obstruction 47. Then, by placing the stent 37 on the path 59, the path 59 is expanded and blood flow is secured in the occluded portion 47. Therefore, by using the X-ray imaging apparatus 1 according to the first embodiment, it is possible to more appropriately perform treatment with PCI for a blood vessel that is completely occluded.

  Next, an X-ray imaging apparatus according to Embodiment 2 of the present invention will be described with reference to the drawings. The overall configuration of the X-ray imaging apparatus according to the second embodiment is the same as that of the X-ray imaging apparatus according to the first embodiment. However, the feature points extracted by the feature point extraction unit 17 are different from those in the first and second embodiments. That is, in Example 1, the wire tip portion 35a and the wire tip portion 35aP are extracted as feature points. On the other hand, in Example 2, the tip of the contrast agent injected into the subject M is extracted as a feature point.

  Here, an operation process of the X-ray imaging apparatus according to the second embodiment will be described. Detailed description of points common to the first embodiment will be omitted.

Step S1 (insertion of the first catheter)
First, the operator inserts the catheter system 31 into the blood vessel of the subject. Then, the X-ray imaging apparatus 1 continuously images the catheter system 31 inserted into the blood vessel of the subject. While referring to the X-ray image 49, the surgeon advances the catheter 33 through the blood vessel 45 toward the blood vessel proximal side of the occluded portion 47.

  A small amount of contrast medium is administered to the subject from the distal end of the inserted catheter 33 as necessary. By administration of the contrast agent, contrast is performed on the region of the blood vessel 45 closer to the occluded portion 47 than the catheter 33. By advancing the catheter 33 toward the occluded portion 47 and further administering a small amount of contrast medium, contrast is performed on the region of the blood vessel 45 closer to the occluded portion 47.

Step S2 (insertion of second catheter)
Next, the operator inserts the second catheter system 31P into the blood vessel of the subject. Then, the X-ray imaging apparatus 1 continuously images the catheter system 31P inserted into the blood vessel of the subject. While referring to the X-ray image 49, the surgeon advances the catheter 33P through the blood vessel 45 toward the blood vessel distal side of the obstruction 47. A small amount of contrast medium is administered to the subject from the distal end of the inserted catheter 33P as necessary, and blood vessels are imaged.

  The catheter 33 and the catheter 33P are advanced to the occlusion portion 47, and a contrast agent is administered from the catheter 33 and the catheter 33P, whereby both sides of the occlusion portion 47 are imaged by the contrast agent as shown in FIG. In addition, the area | region contrasted with a contrast agent is shown by the area | region G without the halftone dot.

Step S3 (generation of integrated image)
In the X-ray image 49, the region G contrasted by the contrast agent has high visibility, and regions other than the region G have low visibility. For this reason, each of the regions L that are the tip of the region G (the tip of the contrast agent) is a region that can be easily identified in the X-ray image 49. Further, the blocking portion 47 is located between each region L. Therefore, by superimposing the X-ray image 49 with the region L as a feature point, an image with a contrast-enhanced display can be obtained for the blocking portion 47.

  Therefore, first, the feature point extraction unit 17 extracts a region L on the predetermined number of X-ray images generated by the image generation unit 15 most recently, that is, X-ray images 49a to 49e, as feature points. Then, for each extracted feature point, position information on the image of the X-ray image 49 is calculated. The position information calculated by the feature point extraction unit 17 is transmitted to the integration unit 19.

  The integrating unit 19 generates an integrated image 51 by superimposing the X-ray images 49 a to 49 e based on the position information of the feature points calculated by the feature point extracting unit 17. By superimposing the X-ray images 49a to 49e with the region L as a feature point, a plurality of pieces of image information are integrated in a region sandwiched between the regions L, that is, a region N indicated by a dotted line. As a result, as shown in FIG. 11B, the contrast highlighting display in which the contrast of the region N is enlarged in the integrated image 51 is displayed. Since the blocking portion 47 is located between the regions L, it is included in the region N. Accordingly, the closed portion 47 shown in the integrated image 51 is displayed with a contrast emphasis display in which the brightness difference is enlarged.

  In addition, the area | region made into a feature point is not restricted to the whole area | region L which is the front-end | tip part of a contrast agent, It is good also considering the area | region G contrasted with the contrast agent as a feature point. Further, the integrated image may be generated using any point in the region L as a feature point.

Step S4 (generation of combined image)
The integrated image 51 is transmitted from the integrating unit 19 to the image cutout unit 21, and the image cutout unit 21 cuts out an image of a region including the region L and the blocking unit 47 from the integrated image 51 and generates a cutout image 53. The image combining unit 23 enlarges the cut-out image 53 to generate an enlarged image 55, and further generates a combined image 57 by arranging the latest X-ray image 49a and the enlarged image 55 in parallel.

Step S5 (crossing the occlusion), step S6 (stent placement)
The surgeon refers to the image of the blocking portion 47 displayed in the combined image 57 and presses the wire tip 35a against the blocking portion 47 to traverse (step S5). When the wire tip 35a crosses the occlusion portion 47, a path 59 through which the catheter 33 passes is formed from the blood vessel proximal portion side of the occlusion portion 47 to the blood vessel distal portion side. The operator causes the stent 37 to reach the path 59, inflates the stent 37 with a balloon, and places the stent 37 (step S6). After placing the stent 37, the PCI system is completed by extracting the catheter system 31 and the catheter system 31P from the body of the subject M.

  As described above, in the X-ray imaging apparatus according to the second embodiment, an integrated image is generated using the tip of the contrast agent as a feature point. The tip of the contrast agent has high visibility in each of the X-ray images, and the blocking portion is located between the tip of the contrast agent. Therefore, by superimposing a plurality of X-ray images on the basis of the distal end portion of the contrast agent that is a feature point, an integrated image in which a real-time image of the occluded portion with high visibility can be generated for a completely occluded blood vessel.

  The surgeon refers to the accumulated image and confirms a real-time image of the occluded portion with high visibility, thereby avoiding accidental penetration of the wire tip 35a into the blood vessel wall and reliably traversing the occluded portion 47. Can do. A passage 59 through which the catheter 33 passes is formed by crossing the obstruction 47. Then, by placing the stent 37 on the path 59, the path 59 is expanded and blood flow is secured in the occluded portion 47. Therefore, in Example 2, the same effect as Example 1 can be produced. Therefore, using the X-ray imaging apparatus according to the second embodiment, it is possible to more appropriately perform PCI treatment on a completely occluded blood vessel.

  Furthermore, in Example 2, a contrast medium is administered from the distal end of the catheter 33, and an integrated image is generated using the distal end portion of the administered contrast medium as a feature point. Therefore, it is not necessary to bring the wire tip portion 35a closer to the closing portion 47 than necessary. Therefore, it is possible to more reliably avoid a situation where the wire tip 35a is erroneously inserted into the blood vessel wall. As a result, when the X-ray imaging apparatus according to the second embodiment is used, it is possible to more reliably avoid the burden on the patient in PCI.

  The present invention is not limited to the above-described embodiment, and can be modified as follows.

  (1) In each of the above-described embodiments, the accumulated image is generated using the five X-ray images 49a to 49e that the image generating unit 15 generates most recently, but the present invention is not limited thereto. In other words, a new integrated image may be generated using the integrated image most recently generated by the integrating unit 19 and the latest X-ray image generated by the image generating unit.

  Here, it is assumed that the X-ray image 49n is generated as the latest X-ray image after the image generation unit 15 generates the X-ray image 49a. When the X-ray image 49n is generated, as shown in the middle part of FIG. 12, the integrated image generated most recently by the integrating unit 19 is the integrated image 51 generated by integrating the X-ray images 49a to 49e. . That is, in the configuration according to the modified example, when the X-ray image 49n is generated next to the X-ray image 49a, the integrated image 51 and the X-ray image 49n are superimposed to generate a new integrated image 51A (lower left in FIG. 12). ).

  When generating the integrated image 51A, it is preferable to superimpose the weighted coefficient of the latest X-ray image 49n higher than the weighted coefficient of the previously generated integrated image 51. As an example, a new accumulated image 51A is generated by adding an image obtained by multiplying the accumulated image 51 by 0.2 and an image obtained by multiplying the X-ray image 49n by 0.8.

  In such a modification, the two images required for generating a new integrated image are the previously generated integrated image and the latest X-ray image 49. That is, since it is not necessary to add a large number of X-ray images each time an integrated image is generated, the calculation required for generating the integrated image becomes simpler. Therefore, it is possible to reduce the burden on the calculation mechanism accompanying the generation of the integrated image, and to generate the integrated image more quickly.

  In addition, when a new integrated image is generated, the weighting coefficient of the latest X-ray image 49n is set higher than the weighting coefficient of the previously generated integrated image. In this case, in the newly generated accumulated image, the influence of the latest X-ray image becomes stronger. Therefore, it is possible to perform the PCI technique by referring to the integrated image that more accurately reflects the real-time image.

  (2) In each of the above-described embodiments, first, the wire tip 35a is made to reach the blood vessel proximal portion side of the occlusion portion 47, and then the wire tip portion 35aP is made to reach the blood vessel distal portion side of the occlusion portion 47. The position to be reached may be reversed. That is, the wire tip 35a may first reach the blood vessel distal portion side of the occlusion portion 47, and then the wire tip portion 35aP may reach the blood vessel proximal portion side of the occlusion portion 47.

  (3) In each of the above-described embodiments, the wire tip portion 35a is made to reach the blood vessel proximal portion side of the occlusion portion 47, and the wire tip portion 35aP is made to reach the blood vessel distal portion side of the occlusion portion 47. Not limited. That is, as shown in FIG. 13A, a technique may be adopted in which both the wire tip 35a and the wire tip 35aP reach the blood vessel proximal portion side of the blockage 47. In this modification, the surgeon presses the wire tip 35a against the occlusion portion 47 and crosses the occlusion portion 47 from the blood vessel proximal portion side to the blood vessel distal portion side.

  The region that is highlighted by the superimposition of the X-ray image 49 includes a region near the region in addition to the region sandwiched between the feature points. That is, the highlighted image in the integrated image 51 is a region H indicated by a dotted line in FIG. The region H includes a region 47a corresponding to the vicinity of the wire tip portion 35a in the blocking portion 47. That is, in the integrated image 51, a region 47a with high luminance is reflected, and by referring to the combined image 57, it is possible to confirm the accurate position of the region 47a in the vicinity of the wire tip portion 35a in the blocking portion 47. Since the operator can confirm the exact position of the blocking portion 47 in the vicinity of the wire distal end portion 35a, it is possible to avoid erroneously penetrating the wire distal end portion 35a into the blood vessel wall when the wire distal end portion 35a is pushed forward. While referring to the combined image 57, the surgeon operates the catheter 33 to push the wire tip 35a further toward the distal side of the blood vessel (FIG. 13C).

  Generation of the integrated image 51 and generation of the combined image 57 are performed as needed. The position of the region H that is highlighted in the integrated image 51 is determined based on the positions of the wire tip 35a and the wire tip 35aP. Therefore, as shown in FIG. 13 (c), as the wire tip 35a is pushed toward the blood vessel distal portion, the region H changes so as to further spread toward the blood vessel distal portion. That is, regardless of the position of the wire tip portion 35a, an image with high visibility appears in the integrated image 51 as needed in a region corresponding to the vicinity of the wire tip portion 35a. For this reason, the surgeon refers to the combined image 57 to prevent the wire tip 35a from penetrating into the blood vessel wall, while moving the wire tip 35a from the proximal portion of the blood vessel to the distal portion of the blood vessel. It can be made to cross suitably. As a result, a path for placing the stent 37 is formed, and the PCI technique can be suitably advanced.

  In this modification, a technique may be adopted in which both the wire tip portion 35a and the wire tip portion 35aP reach the blood vessel distal portion side of the blocking portion 47. In this case, at least one of the wire tip portion 35a and the wire tip portion 35aP is traversed from the blood vessel distal portion side of the occlusion portion 47 to the blood vessel proximal portion side to form a path on which the stent 37 is placed.

  (4) In each of the above-described embodiments, the catheter system including a stent has been described. However, the configuration of the catheter system includes a low tab radar used for atherectomy in addition to the stent.

  (5) In each of the above-described embodiments, the impermeable portion 43 is provided between the outer shaft body 39 and the inner shaft body 41, but is not limited thereto. That is, the impermeable portion 43 may be provided outside the external shaft body 39 or may be provided inside the internal shaft body 41.

DESCRIPTION OF SYMBOLS 1 ... X-ray imaging apparatus 5 ... X-ray tube (X-ray source)
7 ... X-ray detector (X-ray detection means)
15 Image generating unit (image generating means)
17 ... Feature point extraction unit (member extraction means)
19 ... Integration unit (integration means)
31 ... Catheter system (insertion member)
33 ... Catheter 35 ... Guide wire 35a ... Wire tip (tip of insertion member)
37 ... Stent 43 ... Impervious part 45 ... Blood vessel 47 ... Occluded part (completely occluded stenosis site)

Claims (6)

An X-ray source for irradiating the subject with X-rays;
X-ray detection means for detecting X-rays transmitted through the subject and outputting a detection signal;
Image generation means for intermittently generating an X-ray image based on the detection signal;
For each of the X-ray images, a specific part of the first insertion member inserted into the subject and a specific part of the second insertion member inserted into the subject and different from the first insertion member Member extracting means for extracting at least ,
Each of the X-ray images is aligned and overlapped with respect to the position of each of the plurality of specific parts extracted by the member extraction means , whereby the specific part of the first insertion member and the second insertion part are overlapped. An X-ray imaging apparatus comprising: an integration unit that generates an integrated image in which the region of the subject between specific parts of the member is emphasized. The X-ray imaging apparatus according to claim 1,
The accumulating unit is configured to use a predetermined number of the X-ray images most recently generated by the image generating unit based on the positions of the extracted specific part of the first insertion member and the specific part of the second insertion member. An X-ray imaging apparatus that generates a new integrated image by aligning and overlaying. The X-ray imaging apparatus according to claim 1,
The integrating means includes an integrated image most recently generated by the integrating means and the latest X-ray image generated by the image generating means, and the extracted specific part of the first inserting member and the second inserting member. An X-ray imaging apparatus that generates a new integrated image by aligning and overlapping with the position of the specific part as a reference. The X-ray imaging apparatus according to any one of claims 1 to 3,
The member extraction unit is an X-ray imaging apparatus that detects a tip of the insertion member. The X-ray imaging apparatus according to any one of claims 1 to 3,
It said member extraction means, X-rays imaging device for detecting the end of the granulation Kagezai. X-ray imaging comprising: an image generation unit that generates an X-ray image; a feature point specifying unit that extracts feature points from the X-ray image; and an integration unit that superimposes a plurality of the X-ray images based on the feature points A method of operating the device, comprising:
An image generation step in which the image generation unit intermittently generates an X-ray image by detecting X-rays transmitted through the subject;
In each of the X-ray image, said located downstream of the tip of the first insertion member disposed on the upstream side of the full occlusion stenosis formed in a blood vessel, and the total occlusion stenosis in the subject A member specifying step in which the feature point specifying unit specifies the position of the tip of the second inserting member different from the first inserting member ;
By the integration unit to each of the X-ray image is superimposed on the basis of the position of the tip of the tip and the second insertion member of the specified the first insertion member in the member specifying step, the total occlusion stenosis is An operation method of an X-ray imaging apparatus, comprising: an integration step of generating a new enhanced integrated image.

Images