CN108635025B

CN108635025B - Laser puncture guiding system

Info

Publication number: CN108635025B
Application number: CN201810818188.9A
Authority: CN
Inventors: 倪建明; 张追阳; 唐平; 陆银春
Original assignee: Wuxi No 2 Peoples Hospital
Current assignee: Wuxi No 2 Peoples Hospital
Priority date: 2018-07-24
Filing date: 2018-07-24
Publication date: 2023-09-05
Anticipated expiration: 2038-07-24
Also published as: CN108635025A

Abstract

The invention discloses a laser puncture guiding system, which comprises the following steps: (1) laser angle selection system vertical zeroing correction; (2) Firstly, on a positioning CT image, determining a puncture point and a sampling target area, and measuring a planned puncture angle and depth; (3) After the projection angle is set, rotating the angle dial of the laser angle selection system to a corresponding angle, and horizontally moving the laser line through the sliding rail to enable the laser line to pass through the marked needle insertion point; (4) When the puncture is performed, the needle point is fixed on the marked puncture point, the needle rod is moved back and forth, and when the needle rod is illuminated by the laser line, a virtual puncture path is established.

Description

Laser puncture guiding system

Technical Field

The invention relates to the field of medical auxiliary equipment and a using method thereof, in particular to a laser puncture guiding system.

Background

Lung cancer is the most common malignancy, and lung is also the site of most metastasis. Because of the lack of specificity in imaging lung tumors, percutaneous lung biopsy under CT guidance remains one of the important diagnostic tools, especially for peripheral tumors, the obtained samples can also be used for gene detection to guide targeted therapies. The percutaneous lung puncture technology is also the technical foundation for Hookwire wire positioning, tumor particle implantation treatment and other treatments before the television thoracoscopy of the lung nodules. Unlike ultrasound real-time guidance, freehand puncture is very time consuming, especially when the lesion is small or deep.

To improve lancing accuracy and efficiency, many students have developed a variety of auxiliary lancing systems: from low cost simple needle holding devices to complex electromechanical systems such as robotic puncture systems, electromagnetic or laser navigation systems, etc., that need to be integrated into the CT scanning hardware and communicate with the system software. In addition to the high price of these systems, the systems disinfect and complex image registration, further complicating the surgical procedure. In addition, the laser navigation system also needs to install a fixed track on the ceiling of the CT room, the requirement of changing the machine room structure is difficult to be accepted by a hospital manager, and the laser positioning device installed on the scanning frame also faces similar problems.

At present, the PTNB under CT guidance is still a bare-handed puncturing technology for the most part, and the control of the puncturing angle is completely dependent on the experience of an operator. Repeated CT scans are often required to help adjust the position of the needle and are therefore time consuming, especially for small and deep lesions or novice. Many scholars have designed various devices to improve the angular control of freehand lancing, significantly// with high lancing efficiency, but they are all based on CT platforms. Compared with the conventional biopsy, which only reaches a focus, the nuclide functional image mediated target area selection needs to accurately deliver the puncture needle to a designated ingestion area, so that the technical requirement on operators is higher.

It has also been devised to measure the angle of access to the needle at the surface of the patient's skin by means of a protractor. However, this requires on the one hand a relatively high level of manipulation by the bare-handed wearer and on the other hand a protractor at the point of penetration, which has a negative effect on the sterility.

Disclosure of Invention

Aiming at the characteristics of a SPECT/CT platform, the research designs a laser navigation auxiliary puncture system (Laser navigation system, LNS) with a simple structure, and performs PTNB verification research based on fusion image mediation on the SPECT/CT platform, and provides a laser navigation auxiliary puncture system which does not need to contact the skin surface of a patient before needle insertion, can conveniently and accurately establish a needle insertion channel, and can accurately grasp the puncture angle and depth even by a novice.

The invention adopts the following technical scheme:

a method of operating a laser piercing guidance system, comprising:

the device comprises a CT machine, a puncture needle, a laser line projector, a rotatable dial, a horizontal slide rail and a base;

the rotary dial is vertically and movably arranged on a horizontal sliding rail, the laser projector is coaxially arranged in the rotary dial, so that a light curtain projected by the laser projector and a rotary plane of the rotary dial are kept vertical, the horizontal sliding rail is fixed on a base provided with a horizontal regulator, the base is opposite to the CT machine (the horizontal sliding rail is opposite to the CT machine, so that the light curtain projected by the laser projector and the CT machine are kept vertical) and is positioned at the position outside the top of the head when a patient lies in the CT machine, the light curtain projected by the laser projector irradiates the foot from the head, the horizontal sliding rail and the bottom surface of the CT scanning bed are kept horizontal (so that the moving track of the laser projector and the rotary dial is kept horizontal with the bottom surface of the CT scanning bed, so that the light curtain projected by the laser projector is kept parallel with a connecting line between the top of the head and the bottom of the foot when the human body lies in the CT scanning bed, and the laser projector can project a plurality of red or green sector light curtains with 400-700 nm;

the operation method comprises the following steps:

1. preliminary design is carried out on the CT result of the chest before operation, the patient lies in the CT machine, the connecting line of the head and the sole of the body is parallel to the longitudinal central line of the CT machine, a metal positioning grid is placed on the skin surface of a preset puncture area for positioning CT scanning, and SPECT image acquisition is carried out; after the SPECT original image is subjected to fault reconstruction by using an Astonish program, the SPECT original image is fused with a CT image, a part with the most obvious radioactive concentration degree and a safe puncture path is taken as a planned sampling target area, a skin puncture point (no important blood vessel, important nerve and bone exist between the puncture point and the planned sampling target area, namely, the puncture needle penetrates from the puncture point and reaches the planned sampling target area), the corresponding puncture angle (the included angle between the connecting line between the skin puncture point and the planned sampling target area and the plumb line) and the depth (the connecting line distance between the skin puncture point and the planned sampling target area) are measured on the CT image; marking skin puncture points on the skin surface of a patient by using a black water-based pen, namely determining the skin puncture points on a CT image, marking the skin puncture points on the skin surface of the patient, wherein the prior art mainly comprises the steps of counting the skin puncture points on the CT image between metal positioning grids (the contrast marks of the metal positioning grids are arranged on the CT image), and then easily finding the skin puncture points on the corresponding metal positioning grids on the skin surface of the patient, namely ordering the patient to keep the position motionless during the period;

2. a laser angle selection system carries out vertical zero-resetting correction;

3. the rotary dial turns the light curtain projected by the laser projector to a corresponding angle (puncture angle), and then horizontally moves the rotary dial through the sliding rail, so that the light curtain projected by the laser projector passes through the marked needle insertion point on the skin (the linear light curtain irradiates on a lying human body from the head, and the linear light curtain passes through the marked needle insertion point on the skin in side view);

4, before puncture is prepared, the needle point of the puncture needle is fixed on the marked puncture point (skin is not required to be punctured), the needle rod is moved back and forth (the needle point is not moved), and when the needle rod is illuminated by a laser line (at the moment, the angle of the puncture needle = linear light curtain angle = puncture angle = the included angle between the line between the puncture point of the skin and the focus and the plumb line), a virtual puncture path is established.

Further, the laser angle selection system in the step (2) is specifically:

2.1, adjusting the horizontal sliding rail to be horizontal by adjusting the height of the base;

2.2, adjusting the light curtain or the light wall to be vertical to zero degrees, and displaying the rotary dial at the moment;

2.3, turning on a CT laser positioning lamp, and displaying a CT laser projection positioning line on a CT scanning bed frame;

2.4 moving the laser projector along the horizontal slide rail to make the projected light curtain or light wall coincide with the longitudinal positioning laser line projected by the CT laser positioning lamp (at this time, when the light curtain projected by the laser projector and the human body lie flat on the CT scanning bed, the connection line of the head top and the foot sole coincide, because when the CT film is manufactured, the longitudinal positioning laser line projected by the CT laser positioning lamp coincides with the connection line of the head top and the foot sole when the human body lies flat on the CT scanning bed.)

Needle penetration is performed according to a standard procedure; CT scanning is carried out after the planned puncture depth is reached, the position of the needle point is confirmed, and biopsy operation is carried out. When the needle is inserted for puncture, the puncture or stepping needle insertion can be determined according to the size and the position of the preset focus.

The invention has the technical effects that:

the operation method of the laser puncture guiding system is flexible and convenient to operate and high in accuracy, and the working efficiency and accuracy of medical staff are greatly improved.

Preliminary research results show that compared with simple bare-handed puncture, the method can reduce the CT guide scanning times by 53 percent, thereby shortening the whole PTNB operation time and reducing the radiation of patients. The reduction of the time of the puncturing operation also means a reduction of the ionizing radiation from the patient himself to which the operator is subjected.

Drawings

The accompanying drawings are included to provide a further understanding of the invention and are incorporated in and constitute a part of this specification, illustrate the invention and together with the embodiments of the invention, serve to explain the invention. In the drawings:

FIG. 1 is a schematic diagram of the placement of the hardware of the laser guidance system of the present invention;

FIG. 2 is a diagram showing the puncturing procedure in example 1 of the present invention;

fig. 3 is a view showing the needle insertion procedure from the head of the patient when the example 1 of the present invention is operated.

Detailed Description

The preferred embodiments of the present invention will be described below with reference to the accompanying drawings, it being understood that the preferred embodiments described herein are for illustration and explanation of the present invention only, and are not intended to limit the present invention.

Example 1:

as shown in fig. 1, the laser puncture guiding system is composed of a laser line projector, a rotary dial, a horizontal slide rail and a base (fig. 1 a). A laser penetration guide system placed at the distal end of the CT scanner bed projects a line of laser light at a predetermined angle to the scanner gantry (fig. 1 b). Before use, the laser line of the laser puncture guiding system is adjusted to be vertical zero degree, a CT laser positioning lamp (figure 1 c) is turned on, and the positions of the base of the laser puncture guiding system and the laser line are adjusted to be completely overlapped with the longitudinal positioning laser line (figure 1 d), so that the vertical zero-resetting correction of the system is realized.

As in fig. 2, 3, lns-assisted SPECT/CT-PTNB. Men, 54 years old. Preoperative enhanced CT shows an upper left lung tumor (fig. 2 a). Supine position 99mTc-MIBISPECT/CT tomosynthesis acquisition, skin puncture points and planned sampling target areas (x) were determined from a metal grid placed on the body surface, and the distances (white lines) and puncture angles of the puncture points to the pleura and the edges of the target areas were measured (fig. 2 b). The LNS is adjusted to the set penetration angle and the laser line (short arrow) is moved through the marked skin penetration point (long arrow, fig. 2 c). The needle tip is pressed against the skin needle insertion point and the needle position is adjusted back and forth, the predetermined angle of penetration being the time the needle is fully illuminated by the red laser line (fig. 2 d). The puncture needle is pushed into a preset depth by adopting a method of one-time needle insertion or stepwise needle insertion. A further partial CT scan is performed (fig. 2 e) and fused with the SPECT image, showing the tip reaching the pre-set target region (fig. 2 f).

Claims

1. A laser penetration guidance system, comprising:

the rotary dial is vertically and movably arranged on a horizontal sliding rail, the laser projector is coaxially arranged in the rotary dial, so that a light curtain projected by the laser projector and a rotary plane of the rotary dial are kept vertical, the horizontal sliding rail is fixed on a base provided with a horizontal regulator, the base is opposite to the CT machine and is positioned at the position outside the top of the head when a patient lies in the CT machine, the light curtain projected by the laser projector irradiates the foot from the head, the horizontal sliding rail and the bottom surface of the CT scanning bed are kept horizontal, the laser projector is driven by a battery, and the laser projector can project a sector light curtain consisting of a plurality of red or green dense laser beams with the wavelength of 400-700 nm;

the system comprises the following steps when in operation:

1, carrying out preliminary design on a chest CT result before operation, keeping parallel to the longitudinal central line of a CT machine and connecting lines of the top and the bottom of a patient lying in the CT machine, positioning CT scanning by arranging a metal positioning grid on the skin surface of a preset puncture area, and then carrying out SPECT image acquisition; after a SPECT original image is subjected to a reconstruction fault by using an Astonish program, fusing the reconstructed fault with a CT image, taking a part with the most obvious radioactive concentration degree and a safe puncture path as a planned sampling target area, determining skin puncture points on the CT image, and measuring corresponding puncture angles and depths on the CT image; marking skin puncture points on the skin surface of a patient by using a black water-based pen, and ordering the patient to keep the position still during the period;

2, vertical zeroing correction of the laser angle selection system;

2.2, adjusting the light curtain to be vertical to zero degrees, and displaying the rotary dial at the moment;

2.4, moving the laser projector along the horizontal slide rail to enable the projected light curtain to completely coincide with the longitudinal positioning laser line projected by the CT laser positioning lamp;

3, rotating the rotary dial to turn the light curtain projected by the laser projector to a puncture angle, and horizontally moving the rotary dial through the sliding rail to enable the light curtain projected by the laser projector to pass through a marked needle insertion point on the skin;

4, fixing the needle point of the puncture needle on the marked puncture point before preparing puncture, and moving the needle rod back and forth, wherein when the needle rod is illuminated by the laser line, a virtual puncture path is established.