WO2020196337A1 - 画像診断用カテーテル - Google Patents
画像診断用カテーテル Download PDFInfo
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- WO2020196337A1 WO2020196337A1 PCT/JP2020/012493 JP2020012493W WO2020196337A1 WO 2020196337 A1 WO2020196337 A1 WO 2020196337A1 JP 2020012493 W JP2020012493 W JP 2020012493W WO 2020196337 A1 WO2020196337 A1 WO 2020196337A1
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- Prior art keywords
- ultrasonic
- sheath
- distal end
- housing
- distal
- Prior art date
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Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0883—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the heart
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
- A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
- A61B8/445—Details of catheter construction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/5269—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving detection or reduction of artifacts
Definitions
- This disclosure relates to a diagnostic imaging catheter.
- Patent Document 1 describes this type of diagnostic imaging catheter.
- the diagnostic imaging catheter described in Patent Document 1 is used to obtain a tomographic image of a thin tube such as a blood vessel.
- the diagnostic imaging catheter described in Patent Document 1 may be used, for example, in a heart chamber.
- it is necessary to increase the output of ultrasonic waves in order to obtain a clear tomographic image.
- the present inventor has discovered a new problem that an object other than the target is easily reflected as noise in a tomographic image by increasing the output of ultrasonic waves.
- an object of the present disclosure is to provide a catheter for diagnostic imaging having a configuration capable of suppressing the reflection of a non-target object as noise on a tomographic image.
- the diagnostic imaging catheter as the first aspect of the present disclosure includes a sheath inserted into a living body, an ultrasonic vibrator capable of transmitting and receiving ultrasonic waves in the sheath, and the ultrasonic vibrator in the sheath.
- a drive shaft attached to the proximal side of the housing and rotatable in the sheath is provided, and an ultrasonic transmission / reception surface of the ultrasonic vibrator facing the radial direction of the sheath is proximal.
- the housing is inclined with respect to the extending direction of the sheath so that the distal end is closer to the inner peripheral surface of the sheath than the end, and the housing is the ultrasonic wave in the in-plane direction of the ultrasonic wave transmitting / receiving surface. Do not block the distal side of the oscillator.
- the distal end of the housing is not located distal to the distal end of the ultrasonic transducer, or the housing is from the distal end of the ultrasonic transducer. It is located on the distal side only on the back side of the ultrasonic transmission / reception surface of the ultrasonic transducer.
- the distal end face of the ultrasonic oscillator includes a curved surface.
- the housing has a proximal tubular portion arranged coaxially with the drive shaft and a proximal tubular portion projecting distally from the proximal tubular portion to the ultrasonic oscillator. It is provided with a protruding portion located on the back side of the ultrasonic wave transmitting / receiving surface.
- the distal end of the protrusion is not located distal to the distal end of the ultrasonic transducer, or the protrusion is distal to the ultrasonic transducer. It is located distal to the end and only on the back side of the ultrasonic transmission / reception surface of the ultrasonic transducer.
- the protruding portion is below the central axis of the proximal tubular portion. To position.
- the diagnostic imaging catheter according to one embodiment of the present disclosure is a backing material that is located between the protruding portion and the ultrasonic vibrator and supports the ultrasonic vibrator from the back side of the ultrasonic transmission / reception surface. Be prepared.
- the protruding portion is a concave plate portion curved in an arc shape in a cross section in a direction orthogonal to the central axis direction of the proximal tubular portion, and at least a part of the backing member is a concave plate portion. It is located in the recess of the concave plate portion.
- the backing material includes a distal cover portion that covers the distal end face of the ultrasonic transducer.
- the housing does not cover the side end faces of the ultrasonic transducer, and the side end faces of the ultrasonic transducer include a curved surface.
- the backing material contains a scattering agent that scatters ultrasonic waves.
- the position of the ultrasonic vibrator is inside the outer peripheral surface of the proximal cylinder portion in the radial direction.
- a diagnostic imaging catheter having a configuration capable of suppressing the reflection of a non-target object as noise on a tomographic image.
- FIG. 5 is a cross-sectional view taken along the line I-I of FIG.
- FIG. 7A is a side view of the imaging core portion.
- FIG. 7B is a top view of the imaging core portion.
- FIG. 7A is a side view of the imaging core portion.
- FIG. 7B is a top view of the imaging core portion.
- FIG. 7A is a side view of the imaging core portion.
- FIG. 7B is a top view of the imaging core portion.
- FIG. 2 is inserted into the right atrium of a heart.
- the side to be inserted into the organ or the like of the diagnostic imaging catheter according to the present disclosure is the “distal side” or the “tip side”
- the hand side to be operated is the "proximal side” or the “proximal end”. Describe as “side”.
- the extending direction of the sheath of the diagnostic imaging catheter according to the present disclosure is simply described as “extending direction A”
- the circumferential direction of the sheath of the diagnostic imaging catheter according to the present disclosure is simply described as "circumferential direction B”.
- the radial direction of the sheath of the diagnostic imaging catheter according to the present disclosure is simply referred to as "diameter direction C”.
- FIG. 1 is a block diagram showing a schematic configuration of an image diagnosis catheter 20 as an embodiment of the image diagnosis catheter according to the present disclosure and an image processing device 1 to which the image diagnosis catheter 20 is connected.
- FIG. 2 is a schematic view showing a state in which the diagnostic imaging catheter 20 and the image processing device 1 are connected.
- FIG. 3 is a cross-sectional view showing the distal end of the diagnostic imaging catheter 20.
- the image processing device 1 includes a drive unit 50, a pedestal 59, and an image processing unit 60.
- the image processing unit 60 includes a display unit 51, an input unit 52, a storage unit 53, a control unit 54, and an information input unit 55.
- the image processing unit 60 generates a tomographic image based on information on organs, blood vessels, or medical instruments acquired by the imaging core unit 21 described later of the diagnostic imaging catheter 20 inserted into the living body.
- the diagnostic imaging catheter 20 includes an imaging core portion 21, a drive shaft 22, and a sheath 23.
- the information input unit 55 of the image processing device 1 is electrically connected to the imaging core unit 21 of the diagnostic imaging catheter 20.
- the imaging core unit 21 acquires information on an organ or blood vessel such as the heart (hereinafter, appropriately referred to as “organ or the like”) or a medical device located inside the organ or the like.
- the imaging core unit 21 includes an ultrasonic oscillator 31.
- the ultrasonic transducer 31 of the imaging core unit 21 transmits ultrasonic waves to an organ or the like or a medical device located inside the organ or the like, and receives the ultrasonic waves reflected from the organ or the medical device.
- the image processing device 1 generates a tomographic image of an organ or the like or a medical instrument based on the ultrasonic information received by the ultrasonic vibrator 31 of the imaging core unit 21 via the information input unit 55. Further, the image processing device 1 may generate and display a three-dimensional image of an organ or the like or a medical device based on a plurality of sequentially generated tomographic images.
- the drive unit 50 has a built-in motor and is connected to the drive shaft 22 of the diagnostic imaging catheter 20. As shown in FIG. 3, the imaging core portion 21 is attached to the distal side of the drive shaft 22. Therefore, the rotational driving force of the driving unit 50 is transmitted to the imaging core unit 21 via the driving shaft 22. As a result, the imaging core portion 21 can rotate in the circumferential direction B in the sheath 23 described later.
- the drive unit 50 is attached to the pedestal 59 so as to be slidable.
- the diagnostic imaging catheter 20 is connected to a drive unit 50 attached to the pedestal 59.
- the drive unit 50 can move with respect to the pedestal 59 along the extending direction A. Therefore, the drive shaft 22 connected to the drive unit 50 moves along the extension direction A together with the drive unit 50.
- the imaging core portion 21 attached to the distal side of the drive shaft 22 also follows the drive shaft 22 and moves in the sheath 23 along the extending direction A.
- the display unit 51 displays and outputs the display information generated by the control unit 54.
- the display unit 51 includes a display device such as a liquid crystal display or an organic EL display.
- the input unit 52 receives the input of information or instructions by the operator and outputs the received input information or input instructions to the control unit 54.
- the input unit 52 includes an input device such as a keyboard, a mouse, or a touch panel.
- the touch panel may be provided integrally with the display unit 51.
- the storage unit 53 stores various information and programs for causing the control unit 54 to execute a specific function. In addition, the storage unit 53 stores a tomographic image of the organ of the subject or the like generated by the control unit 54.
- the storage unit 53 includes a storage device such as a RAM or a ROM.
- the control unit 54 controls the operation of each component that constitutes the image processing device 1.
- the control unit 54 executes a specific function by reading a specific program.
- the control unit 54 includes, for example, a processor.
- the information input unit 55 receives input of ultrasonic information of an organ or the like acquired by the imaging core unit 21 or a medical instrument or the like located inside the organ or the like. Specifically, the information input unit 55 is electrically connected to the imaging core unit 21 via a signal line 24 extending in the drive shaft 22, and transmits a signal related to ultrasonic information acquired by the imaging core unit 21. Acquire and transmit the signal to the control unit 54. The control unit 54 generates a tomographic image including an organ or the like and a medical instrument located inside the organ or the like based on the input information.
- the imaging core portion 21 includes an ultrasonic vibrator 31 capable of transmitting and receiving ultrasonic waves in the sheath 23, and a housing 32 holding the ultrasonic vibrator 31 in the sheath 23.
- the ultrasonic vibrator 31 includes an ultrasonic transmission / reception surface 31a capable of transmitting / receiving ultrasonic waves.
- the ultrasonic transmission / reception surface 31a faces the radial direction C. That is, the ultrasonic vibrator 31 transmits ultrasonic waves mainly in the radial direction C from the ultrasonic transmission / reception surface 31a. Further, the ultrasonic transmission / reception surface 31a is inclined with respect to the extending direction A so that the distal end is closer to the inner peripheral surface of the sheath 23 than the proximal end. The details will be described later.
- the ultrasonic vibrator 31 transmits ultrasonic waves toward the target portion and receives the ultrasonic waves reflected from the target portion. Based on the time from transmission to reception of this ultrasonic wave, information such as the distance to the target site is acquired.
- the housing 32 holds the ultrasonic vibrator 31. Further, the housing 32 does not block the distal side of the ultrasonic vibrator 31 in the in-plane direction D of the ultrasonic transmitting / receiving surface 31a.
- the "in-plane direction of the ultrasonic wave transmitting / receiving surface” means an arbitrary direction parallel to the ultrasonic wave transmitting / receiving surface. More specifically, the distal end 32a of the housing 32 of the present embodiment is not located distal to the distal end 31e of the ultrasonic transducer 31. The details will be described later.
- the drive shaft 22 is attached to the proximal side of the housing 32 of the imaging core portion 21. Further, the proximal end of the drive shaft 22 is connected to the drive unit 50 described above.
- the drive shaft 22 can be configured by, for example, a multi-layer coil having different winding directions around the shaft. Examples of the coil material include stainless steel and Ni—Ti (nickel / titanium) alloy.
- the sheath 23 is a flexible tubular member that covers the radial C outer side of the imaging core portion 21 and the drive shaft 22.
- the sheath 23 partitions the first lumen 23a in which the imaging core portion 21 and the drive shaft 22 are housed. Further, in addition to the first lumen 23a, the sheath 23 partitions a second lumen 23b into which the guide wire 10 can be inserted.
- FIG. 3 shows a state in which the imaging core portion 21 and the drive shaft 22 are housed in the first lumen 23a, and the guide wire 10 is inserted in the second lumen 23b.
- the diagnostic imaging catheter 20 is inserted into an organ or the like along the guide wire 10.
- the sheath 23 of the present embodiment is a rapid exchange type (RX type) in which the second lumen 23b is partitioned only at the distal end, but is not limited to the RX type, and is, for example, an over-the-wire type (OTW type). There may be.
- RX type rapid exchange type
- OHT type over-the-wire type
- the distal end of the first lumen 23a of the sheath 23 is completely closed by the wall portion 23c.
- the distal end of the first lumen 23a of the sheath 23 is not limited to a completely closed configuration, and is a wall portion having a through hole having a cross section smaller than that of the first lumen 23a and communicating with the outside. May be provided.
- the sheath 23 can be formed of a flexible material.
- the specific material of the sheath 23 is not particularly limited, and for example, styrene-based, polyolefin-based, polyurethane-based, polyester-based, polyamide-based, polyimide-based, polybutadiene-based, transpolyisoprene-based, fluororubber-based, and chlorinated polyethylene-based.
- Various thermoplastic elastomers such as, etc., and one or a combination of two or more of these (polymer alloy, polymer blend, laminate, etc.) can be mentioned.
- FIG. 4 is a side view of the imaging core unit 21.
- FIG. 5 is a top view of the imaging core unit 21.
- FIG. 6 is a cross-sectional view taken along the line I-I of FIG.
- the side view of the imaging core portion 21 of the present embodiment means a plan view seen from a viewpoint in which the ultrasonic wave transmitting / receiving surface 31a looks linear.
- the top view of the imaging core portion 21 of the present embodiment means a plan view of the imaging core portion 21 as viewed from the ultrasonic transmission / reception surface 31a side.
- the imaging core unit 21 includes an ultrasonic oscillator 31 and a housing 32. As shown in FIGS. 3 and 4, the ultrasonic transmission / reception surface 31a of the ultrasonic vibrator 31 is directed with respect to the extending direction A so that the distal end is closer to the inner peripheral surface of the sheath 23 than the proximal end. It is tilted.
- the ultrasonic vibrator 31 may transmit ultrasonic waves from a surface other than the ultrasonic transmission / reception surface 31a, for example, when the output of ultrasonic waves is increased.
- the ultrasonic waves transmitted from the distal end surface 31b of the ultrasonic vibrator 31 are reflected by the wall portion 23c on the distal side of the first lumen 23a of the sheath 23 and received by the ultrasonic transmission / reception surface 31a. May be done.
- the wall portion 23c of the sheath 23 which is an object that is not a target, is reflected as noise in the tomographic image.
- the ultrasonic transmission / reception surface 31a of the ultrasonic vibrator 31 is inclined with respect to the extending direction A so that the distal end is closer to the inner peripheral surface of the sheath 23 than the proximal end. Therefore, even if ultrasonic waves are transmitted from the distal end surface 31b of the ultrasonic vibrator 31, the ultrasonic waves are the first lumen of the sheath 23 as compared with the configuration in which the ultrasonic wave transmitting / receiving surface is parallel to the extending direction A of the sheath. It is difficult to reach the wall portion 23c on the distal side of 23a.
- the ultrasonic wave transmission / reception surface 31a is inclined so as to face the proximal side, so that the ultrasonic wave transmission / reception is performed.
- the surface 31a makes it difficult to receive ultrasonic waves reflected from the wall portion 23c on the distal side of the first lumen 23a of the sheath 23. Therefore, it is possible to prevent the wall portion 23c of the sheath 23, which is a non-target object, from being reflected as noise in the tomographic image.
- the angle of the ultrasonic wave transmitting / receiving surface 31a with respect to the extending direction A is not particularly limited, but is preferably 5 ° to 15 °, more preferably 7 ° to 12 °, for example.
- the housing 32 does not block the distal side of the ultrasonic vibrator 31 in the in-plane direction D of the ultrasonic transmission / reception surface 31a. More specifically, the distal end 32a of the housing 32 of the present embodiment is not located distal to the distal end 31e of the ultrasonic transducer 31. In the present embodiment, the position of the distal end 32a of the housing 32 substantially coincides with the position of the distal end 31e of the ultrasonic transducer 31 in the extending direction A, but the present invention is not limited to this configuration. The distal end 32a of the housing 32 may be located proximal to the distal end 31e of the ultrasonic transducer 31.
- the ultrasonic waves transmitted from the ultrasonic transmission / reception surface 31a and the distal end surface 31b of the ultrasonic transducer 31 are reflected by the housing 32 as an object other than the target, and are super. It is possible to suppress reception of ultrasonic noise as ultrasonic noise on the ultrasonic transmission / reception surface 31a. That is, it is possible to prevent the housing 32 as a non-target object from being reflected as noise in the tomographic image.
- the housing may be located on the distal side of the distal end of the ultrasonic vibrator and only on the back side of the ultrasonic transmission / reception surface of the ultrasonic vibrator (FIGS. 7 (a) and 7 (b)). reference). Even with such a housing, the same effect as described above can be obtained.
- the ultrasonic vibrator 31 receives the ultrasonic wave that becomes noise from the distal side of the ultrasonic wave transmitting / receiving surface 31a in the in-plane direction D. Can be suppressed. That is, it is possible to suppress the reflection of non-target objects as noise on the tomographic image.
- the distal end surface 31b of the ultrasonic vibrator 31 of the present embodiment includes a curved surface.
- the traveling direction of the ultrasonic waves transmitted from the ultrasonic vibrator 31 can be dispersed. That is, it becomes difficult for the ultrasonic waves transmitted from the distal end surface 31b of the ultrasonic vibrator 31 to reach the wall portion 23c of the sheath 23.
- the distal end surface 31b of the present embodiment is a surface substantially orthogonal to the ultrasonic transmission / reception surface 31a. Further, the distal end surface 31b of the present embodiment is a convex surface curved in an arc shape in the top view shown in FIG. However, the shape of the curved surface of the distal end surface 31b is not limited to the shape of the present embodiment.
- the distal end surface 31b may be, for example, a surface that is inclined with respect to the ultrasonic wave transmitting / receiving surface 31a in the side view shown in FIG. 4, or a surface that is curved in the side view shown in FIG. Further, the distal end surface 31b may have irregularities.
- the distal end surface 31b is a surface substantially orthogonal to the ultrasonic wave transmitting / receiving surface 31a as in the present embodiment, and is a convex curved surface that is curved in the top view shown in FIG.
- the top view shape of the ultrasonic vibrator having a distal end surface including such a curved surface include a circular shape, an elliptical shape, a keyhole-shaped tumulus shape, and the like.
- FIG. 7 is a diagram showing an imaging core unit 321 as a modification of the imaging core unit 21 of the present embodiment.
- FIG. 7A is a side view of the imaging core unit 321.
- FIG. 7B is a top view of the imaging core unit 321.
- the housing 32 shown in FIGS. 7 (a) and 7 (b) does not cover the side end surface 331c of the ultrasonic vibrator 331.
- the side end surface 331c of the ultrasonic vibrator 331 includes a curved surface. More specifically, in the ultrasonic vibrators 331 shown in FIGS. 7 (a) and 7 (b), the distal end surface 331b and the side end surface 331c are a continuous series in a top view (see FIG. 7 (b)). Consists of the arc shape of.
- the shape of the side end surface 331c is not limited to the shape shown in FIG. 7.
- the ultrasonic transmission / reception surface 331a is shown as the side end surface 331c shown in FIGS. 7 (a) and 7 (b). It is preferable that the surface is substantially orthogonal to the surface and is a convex curved surface that is curved in a top view.
- the side end surface 31c shown in FIG. 5 which is composed of a plane extending linearly in a top view.
- the distal end surface is also formed of a plane extending linearly in a top view.
- the housing 32 of the imaging core portion 321 shown in FIGS. 7 (a) and 7 (b) is located on the distal side of the distal end 331e of the ultrasonic vibrator 331, and the ultrasonic transmission / reception surface of the ultrasonic vibrator 331. It is located only on the back surface 331d side of 331a. Therefore, it is possible to prevent the housing 32 from being reflected as noise in the tomographic image.
- the imaging core portion 21 of the present embodiment includes a back surface material 33 in addition to the ultrasonic oscillator 31 and the housing 32 described above.
- the ultrasonic oscillator 31 of the present embodiment includes a piezoelectric element and an acoustic matching member.
- the piezoelectric element includes a flat piezoelectric body, a first electrode laminated on at least one side in the thickness direction of the piezoelectric body, and a second electrode laminated on at least the other side in the thickness direction of the piezoelectric body. Consists of.
- the piezoelectric body of the piezoelectric element is composed of, for example, a piezoelectric ceramic sheet.
- the material of the piezoelectric ceramic sheet include piezoelectric ceramic materials such as lead titanate (PZT) and lithium niobate.
- the piezoelectric material may be formed of quartz instead of the piezoelectric ceramic material.
- the first electrode and the second electrode of the piezoelectric element can be formed by laminating as electrode layers on both sides of the piezoelectric body in the thickness direction by, for example, an ion plating method using a mask material, a vapor deposition method, or a sputtering method.
- Examples of the material of the first electrode and the second electrode include metals such as silver, chromium, copper, nickel, and gold, and laminates of these metals.
- One of the first electrode and the second electrode of the present embodiment is composed of a folded electrode. Therefore, as shown in FIG. 5, the signal line 24 is electrically connected to each of the first electrode and the second electrode only on one side in the thickness direction of the piezoelectric element.
- the first electrode and the second electrode may be ordinary electrodes located only on both sides of the piezoelectric element in the thickness direction.
- the acoustic matching member is laminated on one side in the thickness direction of the piezoelectric element.
- the acoustic matching member constitutes an acoustic matching layer that enhances the propagation efficiency of ultrasonic waves.
- the ultrasonic transmission / reception surface 31a of the present embodiment is composed of the acoustic matching member.
- the acoustic matching layer as an acoustic matching member is formed by a method of laminating a sheet material forming the acoustic matching layer to a piezoelectric element, a method of applying a liquid acoustic matching material forming the acoustic matching layer and curing it, or the like. be able to.
- the material of the acoustic matching member include a resin material such as an epoxy resin.
- the acoustic matching member may be composed of a laminate of resin layers made of a resin material.
- the ultrasonic vibrator 31 of the present embodiment is formed by applying a convex curved surface to a rectangular plate-shaped distal surface of 1.5 mm to 2.5 mm in top view.
- the ultrasonic vibrator 331 shown in FIG. 7 described above has an outer diameter of 1.5 mm to 2.5 mm in a top view.
- the output frequency of the ultrasonic waves transmitted from the ultrasonic vibrators 31 (see FIG. 5 and the like) and 331 (see FIG. 7) is 7 MHz to 20 MHz.
- the transmission voltage of the ultrasonic waves transmitted from the ultrasonic vibrators 31 (see FIG. 5 and the like) and 331 (see FIG. 7) is, for example, 10 Vp-p to 100 Vp-p.
- the housing 32 of the present embodiment has a proximal tubular portion 41 arranged coaxially with the drive shaft 22, and an ultrasonic transmitting / receiving surface of the ultrasonic vibrator 31 protruding distally from the proximal tubular portion 41.
- a protruding portion 42 located on the back surface 31d side of the 31a is provided.
- the distal end 32a of the housing 32 of the present embodiment is the distal end of the protrusion 42. Therefore, as shown in FIGS. 3 and 4, in the present embodiment, the distal end of the protrusion 42 is not located distal to the distal end 31e of the ultrasonic transducer 31.
- the housing 32 of the present embodiment it is possible to realize a configuration that does not block the distal side of the ultrasonic vibrator 31 in the in-plane direction D of the ultrasonic transmission / reception surface 31a with a simple configuration.
- the protrusion 42 is distal to the ultrasonic transducer 31 in the entire in-plane direction D and in the entire direction orthogonal to the extending direction A (hereinafter, referred to as “width direction E”). It is preferable not to be located in. That is, the protruding portion 42 of the present embodiment has portions located distal to the ultrasonic vibrator 31 at both ends in the width direction E in the top view of FIG. 5, but there is no such portion. Is preferable. By doing so, it is possible to further suppress the ultrasonic vibrator 31 from receiving the ultrasonic waves that become noise from the distal side. Further, as shown in FIG.
- the protruding portion 42 is located on the distal side of the distal end 331e of the ultrasonic vibrator 331 and only on the back side of the ultrasonic transmission / reception surface 331a of the ultrasonic vibrator 331. You may.
- the housing 32 of the present embodiment has a notch portion notched to the distal end 32a in a side view (see FIG. 4).
- the ultrasonic oscillator 31 is arranged in this notch.
- the protruding portion 42 has a cross section (see FIG. 6) in a direction orthogonal to the central axis direction parallel to the central axis of the proximal tubular portion 41 (in the sheath 23, a direction substantially equal to the extending direction A). It is a concave plate portion that curves in an arc shape.
- the protruding portion 42 of the present embodiment is composed of a semi-cylindrical curved plate portion.
- the central axis of the proximal tubular portion 41 coincides with the central axis of the drive shaft 22, and within the sheath 23, substantially coincides with the central axis of the sheath 23.
- the central axis of the proximal cylinder 41, the central axis of the drive shaft 22, and the central axis of the sheath 23 are all referred to as "central axis O".
- a gap is provided between the inner peripheral surface of the sheath 23 and the outer peripheral surface of the proximal tubular portion 41 of the housing 32, but this gap is practically almost nonexistent. That is, the inner diameter of the first lumen 23a of the sheath 23 is substantially equal to the outer diameter of the proximal tubular portion 41, and the outer peripheral surface of the proximal tubular portion 41 is the sheath at a plurality of locations in the circumferential direction B or the entire circumferential direction B. It is in contact with the inner peripheral surface of 23.
- the position of the ultrasonic vibrator 31 of the present embodiment is inside the outer peripheral surface of the proximal tubular portion 41 in the radial direction (in the sheath 23, a direction substantially equal to the radial direction C). That is, the ultrasonic vibrator 31 of the present embodiment does not project radially outward from the outer peripheral surface of the proximal tubular portion 41. By doing so, even when the outer peripheral surface of the proximal tubular portion 41 slides and rotates with the inner peripheral surface of the sheath 23, the ultrasonic vibrator 31 is unlikely to come into contact with the inner peripheral surface of the sheath 23. That is, it is possible to prevent the ultrasonic vibrator 31 from being damaged by coming into contact with the inner peripheral surface of the sheath 23.
- the end faces 42a on both sides of the concave plate portion as the protruding portion 42 of the present embodiment in the circumferential direction are the central axis in the side view. It is inclined with respect to the direction and extends. The details will be described later.
- the proximal end face of the ultrasonic vibrator 31 is arranged at a position separated from the proximal tubular portion 41 on the distal side in a top view.
- an inclined distal end portion inclined with respect to the extending direction A may be formed at the distal end of the proximal tubular portion 41 in the circumferential region in which the protruding portion 42 is not extended.
- the inclined distal end is inclined so as to approach the protrusion 42 toward the distal side. In this way, the ultrasonic waves transmitted from the ultrasonic transmission / reception surface 31a of the ultrasonic vibrator 31 are less likely to reach the proximal tubular portion 41.
- Examples of the material of the housing 32 include metals such as stainless steel (SUS), nickel-titanium alloy (Ni-Ti), and tungsten.
- the back member 33 is located between the protrusion 42 and the ultrasonic vibrator 31, and supports the ultrasonic vibrator 31 from the back surface 31d side of the ultrasonic transmission / reception surface 31a.
- the backing material 33 is a sound absorbing body made of, for example, rubber or an epoxy resin in which a metal powder such as tungsten powder is dispersed. By providing the back surface material 33, it is possible to absorb a part of ultrasonic waves that cause noise transmitted from the ultrasonic vibrator 31.
- the back surface material 33 of the present embodiment covers the entire back surface 31d of the ultrasonic vibrator 31. As a result, the ultrasonic waves transmitted from the back surface 31d of the ultrasonic vibrator 31 can be absorbed. Further, the back surface member 33 of the present embodiment is located on the proximal side of the ultrasonic vibrator 31, and covers the proximal end face of the ultrasonic vibrator 31. That is, the back surface member 33 of the present embodiment is continuous not only on the back surface 31d side of the ultrasonic vibrator 31 but also inside the proximal cylinder portion 41, and fills the entire inside of the proximal cylinder portion 41. As a result, the ultrasonic waves transmitted from the proximal end face of the ultrasonic vibrator 31 can be absorbed.
- the back material 33 is not limited to the back surface 31d of the ultrasonic vibrator 31, and may cover the distal end surface 31b and the side end surface 31c of the ultrasonic vibrator 31. By doing so, the ultrasonic waves transmitted from the distal end surface 31b and the side end surface 31c of the ultrasonic vibrator 31 can be absorbed by the back material 33. Therefore, a part of the ultrasonic waves that cause noise transmitted from the ultrasonic vibrator 31 can be absorbed more.
- FIG. 8 is a diagram showing an imaging core unit 421 as a modification of the imaging core unit 21.
- the imaging core portion 421 shown in FIG. 8 includes an ultrasonic oscillator 31, a housing 32, and a back surface member 433.
- the back member 433 includes a distal cover portion 433a that covers the distal end surface 31b of the ultrasonic transducer 31.
- the back member 433 shown in FIG. 8 includes a distal cover portion 433a that covers the distal end surface 31b of the ultrasonic transducer 31, but is not limited to this configuration, and in addition to or in place of the distal cover portion 433a, ultrasonic waves are used. It may be a backing material provided with a side end cover portion that covers the side end surface of the vibrator.
- the backing material 433 shown in FIG. 8 contains a scattering agent that scatters ultrasonic waves.
- the scattering agent include glass beads and polystyrene beads.
- the back member 433 does not protrude radially outward from the outer peripheral surface of the proximal tubular portion 41 of the housing 32 regardless of the presence or absence of the scattering agent. By doing so, it is possible to prevent the back surface member 433 from coming into contact with the inner peripheral surface of the sheath 23 (see FIG. 3).
- the imaging core unit 21 of the present embodiment will be described again with reference to FIGS. 4 and 6.
- the end faces 42a on both sides of the concave plate portion as the protruding portion 42 of the present embodiment are inclined and extend in the central axis direction in the side view.
- the back member 33 of the present embodiment is projected from the main body 33c located in the recess 42b of the concave plate portion as the protruding portion 42 of the housing 32 and the main body 33c.
- a flange portion 33d supported by end faces 42a on both sides of the concave plate portion in the circumferential direction is provided.
- the flange 33d of the back member 33 is supported by the end face 42a for positioning. That is, by using the end surface 42a, the back surface member 33 can be easily positioned with respect to the concave plate portion as the protruding portion 42. Further, as described above, the end face 42a is inclined with respect to the central axis direction in the side view. Therefore, the support surface 33b of the back material 33 that supports the ultrasonic vibrator 31 can be tilted with respect to the extending direction A simply by supporting the flange portion 33d of the back material 33 on the end surface 42a and positioning it. it can.
- the ultrasonic wave transmission / reception surface 31a is tilted at a desired angle with respect to the extension direction A. , Can be easily realized. That is, the ultrasonic transmission / reception surface 31a of the ultrasonic vibrator 31 inclined at a desired angle can be easily realized.
- the side of the imaging core portion 21 facing the ultrasonic transmission / reception surface 31a is the upper side, and the opposite side is the lower side.
- the protruding portion 42 is preferably located below the central axis O of the proximal tubular portion 41.
- the rotation of the ultrasonic vibrator 31 can be made more stable.
- the proximal ends of the end faces 42a on both sides of the concave plate portion as the protruding portion 42 in the circumferential direction are lower than the central axis O of the proximal tubular portion 41 in the side view. Located in. Therefore, as described above, the position of the ultrasonic vibrator 31 can be easily aligned with the position of the central axis O of the drive shaft 22.
- the main body 33c does not have to fill all the recesses 42b. However, considering the absorption performance of ultrasonic waves, it is preferable to have a configuration that fills all of the recesses 42b.
- the back surface member 33 includes the above-mentioned flange portion 33d, the end surface 42a of the protruding portion 42 of the housing 32 can be covered with the flange portion 33d. As a result, it is possible to prevent the ultrasonic waves transmitted from the ultrasonic vibrator 31 from being reflected by the end surface 42a of the protruding portion 42 of the housing 32 and being received as ultrasonic noise.
- FIG. 9 shows a diagnostic imaging catheter 20 inserted into the right atrium RA of the heart.
- an operator such as a medical worker passes the diagnostic imaging catheter 20 through the inferior vena cava IVC as a first blood vessel having a diameter smaller than that of the right atrium RA of the subject, and then the right atrium RA. Insert inside.
- the operator inserts the blocken blow needle 80 as a medical device located in the right atrium RA into the right atrium RA via the inferior vena cava IVC through the guiding catheter 84.
- the blocken blow needle 80 is used to open the left atrium LA from the right atrium RA through the foramen ovale H that separates the right atrium RA and the left atrium LA.
- the operator inserts the distal end of the diagnostic imaging catheter 20 into the superior vena cava SVC as a second blood vessel smaller in diameter than the right atrium RA communicating with the right atrium RA. ..
- the guide wire 10 can be first inserted into the superior vena cava SVC, and then the distal end of the diagnostic imaging catheter 20 can be inserted into the superior vena cava SVC along the guide wire 10. As a result, the vibration of the distal end portion of the diagnostic imaging catheter 20 is suppressed.
- the diagnostic imaging catheter 20 since the proximal side of the diagnostic imaging catheter 20 is contained in the inferior vena cava IVC having a diameter smaller than that of the right atrium RA, the diagnostic imaging catheter 20 is contained in the superior vena cava SVC having a diameter smaller than that of the right atrium RA. And the inferior vena cava IVC, and the vibration and movement of the portion of the diagnostic imaging catheter 20 located in the right atrium RA are suppressed.
- the first lumen 23a of the sheath 23 in which the ultrasonic vibrator 31 is housed can be curved.
- the extending direction A of the sheath 23 can be changed, and the position in the right atrium RA where the ultrasonic vibrator 31 moves can be changed. Therefore, for example, it is possible to bring the inner wall surface of an organ or the like closer to a site to be particularly observed (for example, the foramen ovale H of the heart).
- the ultrasonic oscillator 31 moves in the extending direction A while rotating in the circumferential direction B at the first lumen 23a of the sheath 23. During that time, the ultrasonic vibrator 31 transmits ultrasonic waves in the radial direction C and receives the ultrasonic waves reflected on the inner wall surface of the right atrium RA and the like. As a result, the ultrasonic vibrator 31 acquires the position information of the inner wall surface of the right atrium RA as the surrounding information. Further, the ultrasonic vibrator 31 acquires the position information of the Brocken blow needle 80 as a medical instrument located in the right atrium RA as the surrounding information. Then, the control unit 54 generates a tomographic image reflecting the position information of the inner wall surface of the right atrium RA and the position information of the blocken blow needle 80 based on the surrounding information acquired by the ultrasonic vibrator 31. ..
- the ultrasonic vibrator 31 In order to move the ultrasonic vibrator 31 in the sheath 23 while the vibration and movement of the portion of the diagnostic imaging catheter 20 located in the right atriosphere RA are suppressed, the ultrasonic vibrator 31 The rotation in the circumferential direction B and the movement of the ultrasonic vibrator 31 in the extending direction A are stable. Therefore, it is possible to stably acquire surrounding information such as the position information of the inner wall surface of the right atrium RA.
- the storage unit 53 determines the tomographic image generated by the control unit 54 when the ultrasonic vibrator 31 moves in the extending direction A, the position of the ultrasonic vibrator 31 in the extending direction A at that time, and Is associated and memorized at any time.
- the control unit 54 may generate a three-dimensional image of the right atrium RA by superimposing tomographic images using the information stored in the storage unit 53.
- the ultrasonic transducer 31 of the diagnostic imaging catheter 20 is inclined so that the ultrasonic transmission / reception surface 31a (see FIG. 4 and the like) faces the proximal side. Therefore, as shown in FIG. 9, the ultrasonic vibrator 31 is arranged further back than the oviduct H punctured by the blocken blow needle 80, and is proximal to the position of the ultrasonic vibrator 31.
- the ultrasonic wave transmitting / receiving surface 31a see FIG.
- the tip position of the medical instrument inserted into the living body together with the diagnostic imaging catheter 20 can be positioned. It becomes easier to obtain a clear tomographic image. This is not limited to the procedure shown in FIG. 9, and can be similarly applied to any procedure performed in a relatively large space in the living body such as the atrium.
- the right atrium RA of the heart is shown as an example of the lumen of an organ or the like, but the lumen of the organ or the like into which the diagnostic imaging catheter 20 according to the present disclosure is inserted is not particularly limited, for example.
- the diagnostic imaging catheter according to the present disclosure is not limited to the specific structure shown in the above-described embodiment and modification, and can be variously modified or modified as long as it does not deviate from the description of the claims.
- This disclosure relates to a diagnostic imaging catheter.
- Image processing device 10 Guide wire 20: Catheter for diagnostic imaging 21, 321, 421: Imaging core part 22: Drive shaft 23: Sheath 23a: First lumen 23b: Second lumen 23c: Wall part 24: Signal line 31 , 331: Ultrasonic transducer 31a, 331a: Ultrasonic transmitter / receiver surface 31b, 331b: Distal end surface 31c, 331c: Side end surface 31d, 331d: Back surface 31e, 331e: Distal end of ultrasonic transducer 32: Housing 32a: Distal end 33 of the housing 433: Back material 33b: Support surface 33c: Main body 33d: Flange 41: Proximal cylinder 42: Projection 42a: End surface 42b: Recess 50: Drive 51: Display 52: Input Unit 53: Storage unit 54: Control unit 55: Information input unit 59: Pedestal 60: Image processing unit 80: Blocken blow needle 84: Guiding catheter 433a: Distal cover unit A: Sheath extension direction B: Sheath circumference
Abstract
Description
10:ガイドワイヤ
20:画像診断用カテーテル
21、321、421:イメージングコア部
22:駆動シャフト
23:シース
23a:第1ルーメン
23b:第2ルーメン
23c:壁部
24:信号線
31、331:超音波振動子
31a、331a:超音波送受信面
31b、331b:遠位端面
31c、331c:側端面
31d、331d:背面
31e、331e:超音波振動子の遠位端
32:ハウジング
32a:ハウジングの遠位端
33、433:背面材
33b:支持面
33c:本体部
33d:フランジ部
41:近位筒部
42:突出部
42a:端面
42b:凹部
50:駆動部
51:表示部
52:入力部
53:記憶部
54:制御部
55:情報入力部
59:台座
60:画像処理部
80:ブロッケンブロー針
84:ガイディングカテーテル
433a:遠位カバー部
A:シースの延在方向
B:シースの周方向
C:シースの径方向
D:超音波送受信面の面内方向
E:幅方向
O:近位筒部、駆動シャフト及びシースの中心軸線
LA:左心房
RA:右心房
IVC:下大静脈
SVC:上上大静脈
Claims (12)
- 生体内に挿入されるシースと、
前記シース内で超音波を送受信可能な超音波振動子と、
前記シース内で前記超音波振動子を保持するハウジングと、
前記ハウジングの近位側に取り付けられ、前記シース内で回転可能な駆動シャフトと、を備え、
前記超音波振動子における前記シースの径方向に向く超音波送受信面は、近位端よりも遠位端が前記シースの内周面に近づくように、前記シースの延在方向に対して傾斜しており、
前記ハウジングは、
前記超音波送受信面の面内方向において、前記超音波振動子の遠位側を遮らない、画像診断用カテーテル。 - 前記ハウジングの遠位端は、前記超音波振動子の遠位端より遠位側に位置しない、又は、
前記ハウジングは、前記超音波振動子の遠位端より遠位側で、前記超音波振動子の前記超音波送受信面の背面側のみに位置する、請求項1に記載の画像診断用カテーテル。 - 前記超音波振動子の遠位端面は湾曲面を含む、請求項1又は2に記載の画像診断用カテーテル。
- 前記ハウジングは、前記駆動シャフトに対して同軸状に配置される近位筒部と、前記近位筒部から遠位側に突出し、前記超音波振動子の前記超音波送受信面の背面側に位置する突出部と、を備える、請求項1から3のいずれか1つに記載の画像診断用カテーテル。
- 前記突出部の遠位端は、前記超音波振動子の遠位端より遠位側に位置しない、又は、
前記突出部は、前記超音波振動子の遠位端より遠位側で、前記超音波振動子の前記超音波送受信面の背面側のみに位置する、請求項4に記載の画像診断用カテーテル。 - 前記超音波送受信面が向く側を上側とし、その反対側を下側とした場合に、前記突出部は、前記近位筒部の中心軸線よりも下側に位置する、請求項4又は5に記載の画像診断用カテーテル。
- 前記突出部と前記超音波振動子の間に位置し、前記超音波振動子を前記超音波送受信面の背面側から支持する背面材を備える、請求項4から6のいずれか1つに記載の画像診断用カテーテル。
- 前記突出部は、前記近位筒部の中心軸線方向に直交する方向の断面で円弧状に湾曲する凹状板部であり、
前記背面材の少なくとも一部は、前記凹状板部の凹部内に位置している、請求項7に記載の画像診断用カテーテル。 - 前記背面材は、前記超音波振動子の遠位端面を覆う遠位カバー部を備える、請求項7又は8に記載の画像診断用カテーテル。
- 前記ハウジングは、前記超音波振動子の側端面を覆っておらず、
前記超音波振動子の側端面は湾曲面を含む、請求項9に記載の画像診断用カテーテル。 - 前記背面材は、超音波を散乱する散乱剤を含む、請求項7から10のいずれか1つに記載の画像診断用カテーテル。
- 前記超音波振動子の位置は、前記近位筒部の外周面よりも径方向の内側である、請求項4から11のいずれか1つに記載の画像診断用カテーテル。
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CN202310567296.4A CN116584971A (zh) | 2019-03-27 | 2020-03-19 | 图像诊断用导管 |
AU2020248784A AU2020248784B2 (en) | 2019-03-27 | 2020-03-19 | Image diagnosis catheter |
CN202080023578.2A CN113631098B (zh) | 2019-03-27 | 2020-03-19 | 图像诊断用导管 |
JP2021509349A JP7304409B2 (ja) | 2019-03-27 | 2020-03-19 | 画像診断用カテーテル |
US17/484,972 US20220008038A1 (en) | 2019-03-27 | 2021-09-24 | Image diagnosis catheter |
JP2023104140A JP2023123681A (ja) | 2019-03-27 | 2023-06-26 | 画像診断用カテーテル |
AU2023237114A AU2023237114A1 (en) | 2019-03-27 | 2023-09-27 | Image diagnosis catheter |
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JPH0759776A (ja) * | 1993-08-23 | 1995-03-07 | Aloka Co Ltd | 体腔内用超音波探触子 |
JP2006223843A (ja) * | 1994-11-30 | 2006-08-31 | Boston Scientific Ltd | 音響像形成、ドプラーカテーテルおよびガイドワイヤ |
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JP2017056142A (ja) * | 2015-09-18 | 2017-03-23 | テルモ株式会社 | 画像診断用カテーテル |
WO2019004355A1 (ja) * | 2017-06-29 | 2019-01-03 | テルモ株式会社 | 画像診断用カテーテル |
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EP2454998B1 (en) * | 2010-08-06 | 2014-12-31 | Olympus Medical Systems Corp. | Ultrasonic diagnosis device |
JP2017093506A (ja) * | 2015-11-18 | 2017-06-01 | テルモ株式会社 | 画像診断用カテーテル |
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JPH0759776A (ja) * | 1993-08-23 | 1995-03-07 | Aloka Co Ltd | 体腔内用超音波探触子 |
JP2006223843A (ja) * | 1994-11-30 | 2006-08-31 | Boston Scientific Ltd | 音響像形成、ドプラーカテーテルおよびガイドワイヤ |
JP2016019737A (ja) * | 2008-12-08 | 2016-02-04 | シリコンバレー メディカル インスツルメンツ インコーポレイテッド | 画像誘導のためのカテーテルのシステム |
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