CN110559086A - Accurate positioning auxiliary device and method for surgical breast nuclear magnetic resonance examination - Google Patents

Accurate positioning auxiliary device and method for surgical breast nuclear magnetic resonance examination Download PDF

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Publication number
CN110559086A
CN110559086A CN201810567520.9A CN201810567520A CN110559086A CN 110559086 A CN110559086 A CN 110559086A CN 201810567520 A CN201810567520 A CN 201810567520A CN 110559086 A CN110559086 A CN 110559086A
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positioning
breast
cup
accurate positioning
magnetic resonance
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CN110559086B (en
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王传兵
张玲
李大鹏
武晨江
王思奇
吴飞云
施海彬
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Jiangsu Province Hospital First Affiliated Hospital Of Nanjing Medical University
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Jiangsu Province Hospital First Affiliated Hospital Of Nanjing Medical University
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/05Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/055Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves  involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3904Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
    • A61B2090/3908Soft tissue, e.g. breast tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3937Visible markers
    • A61B2090/395Visible markers with marking agent for marking skin or other tissue

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Public Health (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • High Energy & Nuclear Physics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Biophysics (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Magnetic Resonance Imaging Apparatus (AREA)

Abstract

The invention discloses a surgery mammary gland nuclear magnetic resonance examination accurate positioning auxiliary device and a method for performing accurate positioning based on the device, wherein the surgery mammary gland nuclear magnetic resonance examination accurate positioning auxiliary device comprises: a positioning cup with a hole at the center, a back strap and a shoulder strap for connecting the two cups; the positioning cup is circular, the diameter of a central hole is 2-3 cm, a circle of circular interlayer is arranged on the inner ring of the cup, an adjusting belt penetrates through the interlayer, and two ends of the adjusting belt extend out of the interlayer; three marking holes are arranged on the positioning cup, the three small holes are distributed in a regular triangle, and the distance between the small holes is 2 cm. The invention is simple and feasible, economical and practical, does not increase extra pain of patients, reduces the operation time of the operation and ensures the accurate excision of tumors. Can lay a foundation for accurately guiding the positioning in the breast tumor operation and the breast protection operation.

Description

Accurate positioning auxiliary device and method for surgical breast nuclear magnetic resonance examination
Technical Field
The invention belongs to the technical field of surgical clinical medicine, and particularly relates to an auxiliary device for accurate positioning of surgical breast nuclear magnetic resonance examination and an accurate positioning method based on the device.
Background
The mammary gland mainly comprises fat and connective tissue, so the structure is soft, the mammary gland is easy to deform under the action of gravity, the shape change of the mammary gland is large in the supine position and the prone position of a human body, a mammary tumor is often deformed, the mammary gland can not be accurately positioned during a breast conservation operation, and enlarged excision or residual focus is often caused. At present, a positioning guide wire puncture method is adopted conventionally, namely, a preoperative operation is carried out under mammary gland fluoroscopy (X-ray or ultrasonic), a mammary gland focus is positioned, firstly, a doctor in an imaging department puts a guide wire of a mammary gland positioning needle into the mammary gland focus before mammary gland operation, and thus, the part of the mammary gland focus is positioned; then the surgeon can accurately find the focus according to the guide of the guide wire. The disadvantages are: x-rays have ionizing radiation and are harmful to the body. Focal lesions are easily missed by X-ray for dense mammary glands. B-ultrasound is not easy to find focus and cause positioning difficulty for smaller tumors. 4. Both methods of puncturing can cause additional pain and additional expense to the patient. 5. The puncture method can only find the center of the tumor, and cannot accurately locate the edge of the tumor.
Nuclear magnetic resonance is increasingly used in breast examinations due to its lack of ionizing radiation hazard, multi-parameter imaging, and high soft tissue contrast imaging. The conventional mammary gland coil is designed into a prone position examination mode in order to obtain a high-quality mammary gland image, but the position of a mammary gland is in a supine position during B-ultrasonic examination and operation, and the prone position image of magnetic resonance has large change of tumor position in the supine position due to soft texture, so that the operation range cannot be accurately judged by applying the magnetic resonance image. Some scholars use supine magnetic resonance examination to solve this problem, but still suffer from the following disadvantages: 1. the special mammary gland coil for the supine position examination is not available, so the image quality is not high, and the accurate tumor positioning is influenced. 2. The applied surface coil also deforms the breast further by its own weight. 3. The supine position examination is usually standard prone position enhanced coil replacement and body position post-scanning, and the coil replacement needs to take a long time for obvious contrast medium outflow effect, which aggravates the inaccuracy of tumor positioning.
Disclosure of Invention
the invention aims to provide an auxiliary device for accurate positioning of surgical breast nuclear magnetic resonance examination and a method for accurate positioning based on the device, aiming at the defects of the prior art.
In order to achieve the purpose, the invention adopts the following technical scheme: an accurate positioning auxiliary device for surgical breast nuclear magnetic resonance examination comprises: a positioning cup with a hole at the center, a back strap and a shoulder strap for connecting the two cups; the positioning cup is circular, the diameter of a central hole is 2-3 cm, a circle of circular interlayer is arranged on the inner ring of the cup, an adjusting belt penetrates through the interlayer, and two ends of the adjusting belt extend out of the interlayer; three marking holes are arranged on the positioning cup, the three small holes are distributed in a regular triangle, and the distance between the small holes is 2 cm.
Furthermore, two ends of the strap are fixed through the adhesive sheet arranged at the end head.
In one step, the shoulder strap is provided with a eight button for adjusting the length.
In a further step, the positioning cup is made of an elastic composite material with moderate hardness.
In a further step, the auxiliary positioning device is made of a non-ferromagnetic material.
A method for accurately positioning a breast tumor based on an accurate positioning auxiliary device and 3D printing comprises the following steps: (1) the patient wears the accurate positioning auxiliary device, fixes a cod liver oil at the three marking holes of the positioning cup, and carries out nuclear magnetic resonance examination;
(2) After the magnetic resonance examination is finished, sticking positioning labels on the surfaces of the mammary glands corresponding to the three marking holes of the positioning cups;
(3) Introducing the mammary gland nuclear magnetic resonance image into MIMICS software for three-dimensional reconstruction, and reconstructing a cod liver oil image at three positions for locating cod liver oil on the surface of the reconstructed mammary gland;
(4) Introducing the obtained three-dimensional reconstructed breast and tumor and positioning cod-liver oil images into 3-MATIC software for processing, designing a precise positioning device, wherein the shape of the precise positioning device is consistent with that of a breast of a patient, a round hole is formed in the center of the precise positioning device, three identical small holes are formed in the position for positioning the cod-liver oil, 3-5 cylindrical injection holes are formed in the position 5mm away from the edge of the tumor, and the precise positioning device is printed by a 3D printer;
(5) the accurate positioning device is placed at a corresponding breast part of a patient, the positions of the three small holes correspond to the positions of the positioning label marks on the surface of the breast one by one, and after the tumor accurate positioning device is matched with the breast, a disposable syringe is used for injecting methylene blue at a cylindrical injection hole of the accurate positioning device to accurately position the breast tumor.
Further, in the step 1, the accurate positioning auxiliary device worn by the patient exposes the nipple of the patient out of the center hole of the positioning cup; adjusting the circular adjustable band of the inner ring of the cup according to the size of the breast to enable the cup to be attached to the surface of the breast; the length of the shoulder straps on the two sides is adjusted, and the magic tapes of the straps are adjusted to enable the positioning cups to be attached to the body so as to better fix the mammary gland.
Further, step 3 the precise positioning device is provided with two direction marks at the round hole edge, the first direction mark points to the opposite side nipple, the second direction mark points to the xiphoid process
Further, the precise positioning device in step 4 needs to be polished and sterilized before use.
Furthermore, the cylindrical injection hole is made of transparent material, the inner diameter is 5.5mm, and the height is 5 cm; the outer surface of the cylindrical injection hole is provided with a graduated scale, and the graduated scale is marked with a distance from the position corresponding to the cylindrical injection hole to the edge of the tumor; the inner surface of the cylindrical injection hole is provided with a clamping groove.
Firstly, a self-made surgical breast nuclear magnetic resonance examination accurate positioning auxiliary device is used for fixing the shape of a breast of a patient to a certain degree, MIMICS software is used for segmenting the tumor and reconstructing the surface of the breast in three dimensions, and a breast and tumor model is established; 3-MATIC software is applied to design an individualized positioning device according to the three-dimensional breast and tumor model; printing the personalized accurate positioning device by using a 3D printer and carrying out post-treatment such as disinfection; finally, the patient is anesthetized in the operation and provided with a 3D printed accurate positioning device, and methylene blue is injected to the position 5mm away from the edge of the tumor through a cylindrical injection hole of the accurate positioning device so as to mark the edge of the tumor to be cut. According to the technology, cod-liver oil is pasted on three different positions of the surface of a mammary gland and positioning labels are pasted on the surface of the mammary gland at the three same positions during magnetic resonance examination, the three positions where the cod-liver oil is pasted can be displayed when the MIMICS software three-dimensionally reconstructs the surface of the mammary gland, three small holes are respectively designed at the three positions where the cod-liver oil is pasted when the 3-MATIC software processes the surface of the mammary gland, and when a 3D printing positioning device is applied to a patient operation, the 3D printing positioning device is completely pasted with the shape of the mammary gland only by corresponding three marks of a mammary gland surface sign pen to the three small holes. The invention is simple and feasible, economical and practical, does not increase extra pain of patients, reduces the operation time of the operation and ensures the accurate excision of tumors. Can lay a foundation for accurately guiding the positioning in the breast tumor operation and the breast protection operation.
Drawings
Fig. 1 is a schematic structural diagram of an auxiliary device for accurate positioning in breast nmr examination in an embodiment.
fig. 2 is a schematic structural diagram of the precise positioning device according to the embodiment.
Detailed Description
In order to make the technical solutions better understood by those skilled in the art, the technical solutions in the embodiments of the present application will be clearly and completely described below with reference to the drawings in the embodiments of the present application, and it is obvious that the described embodiments are only partial embodiments of the present application, but not all embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present application.
The accurate positioning auxiliary device of (one) surgery mammary gland nuclear magnetic resonance examination includes: a positioning cup 1 with a central hole, a back strap 2 connecting the two cups and a shoulder strap 3. All the used materials are free of ferromagnetic materials, so that the influence on images in magnetic resonance examination is avoided.
Wherein the positioning cup is round, the diameter of the central hole is 3cm, the inner ring of the cup is provided with a circle of round interlayer 4, an adjusting belt 5 is penetrated in the interlayer, and the two ends of the adjusting belt extend out of the interlayer. Three marking holes 6 are arranged on the positioning cup, the three small holes are distributed in a regular triangle, and the distance between the small holes is 2 cm. The positioning cup is made of elastic composite material with moderate hardness.
the two ends of the strap are fixed through the sticking pieces arranged at the ends, and a Ba button 7 for adjusting the length is arranged on the shoulder strap.
(II) manufacturing accurate positioning device
(1) The patient removes all metal from the body in preparation for a conventional breast nmr scan (flat scan plus boost), and then applies a fine positioning aid: the nipple is exposed out of the middle hole of the positioning cup; the adjustable belts in the circular interlayer in the cups are adjusted according to the size of the breast, so that the cups are well attached to the surface of the breast; the length of the shoulder straps on the two sides is adjusted, and the magic tapes of the back straps are adjusted to enable the positioning cups to be well attached to the body so as to better fix the mammary gland.
(2) Three small holes A, B, C of a regular triangle are reserved on the positioning cup, corresponding to the surface of the breast, a sign pen is used for making a cross mark, three cod liver oils are fixed at the three small holes A, B, C, and after the magnetic resonance examination is finished, positioning labels A ', B ' and C ' are pasted at the positions where the sign pen on the surface of the breast is used for making the cross mark, so that the mark can be accurately stored to be applied during the operation.
(3) The patient with the positioning auxiliary device fixed is sent into a magnetic resonance examination room (the breast nuclear magnetic resonance examination is in a prone position conventionally), the positioning cod-liver oil in the magnetic resonance image is also clearly displayed, the obtained DICOM-format magnetic resonance image is led into MIMICS software to carry out tumor segmentation and breast surface three-dimensional reconstruction, and a breast and tumor model is established. The personalized mammary surface of the patient is obtained by applying the functions of MUSK, hollow and the like of 3-MATIC, and the tumor positioning device is completely attached to the mammary model, so that a foundation is laid for accurately positioning the tumor. Three small holes a, b and c are respectively designed at three positions for positioning cod-liver oil A, B, C in the design process of the accurate positioning device in the breast tumor operation. The nipple position of accurate positioner designs for being greater than nipple diameter round hole 8 slightly, and the design has two direction signs on the round hole, and the directional contralateral nipple of first direction sign 9, the directional xiphoid process of second direction sign 10. 3 ~ 5 (according to tumour size, shape determination number) inequality cylinder injection holes 11 of 5mm interval design in patient's tumour edge, the inside diameter design of cylinder injection hole is 5.5mm, height 5cm and the design has the scale of accurate to the millimeter, and cylinder injection hole material is transparent material, and cylinder hole bottom design has draw-in groove 12, and the draw-in groove effect is for doing benefit to fixed syringe position. And saving the STL 3D printing format file after the 3-MATIC design is finished.
(4) The method comprises the steps of selecting a proper 3D printer and printing materials to print an accurate positioning device in the breast tumor operation, and applying the positioning device to an operating room after polishing and disinfection treatment.
(III) method for accurately positioning breast tumor by using accurate positioning device
Particular attention is paid to the application of the precise positioning device in breast tumor surgery to the surface of the breast of a patient: firstly, exposing the nipple out of a middle hole of the accurate positioning device; secondly, the first direction mark of the mammary gland positioning device points to the contralateral nipple, and the second direction mark points to the xiphoid process; thirdly, three small holes a, B and C designed by the mammary gland positioning device correspond to the positions of the positioning labels A ', B ' and C ' at the positions where the cross marks are made by the mammary gland surface sign pen one by one. Therefore, the consistency of the prone position breast shape in the magnetic resonance examination by the auxiliary device and the supine position breast shape of the accurate positioning device in the operation of applying 3D printing to the breast tumor in the operating room is realized, and a foundation is laid for designing and producing the supine position 3D printing tumor accurate positioning device by applying prone position magnetic resonance images.
(1) After the tumor precise positioning device is matched with the breast, a disposable injector is used for injecting methylene blue at a cylindrical injection hole of the precise positioning device, the injection depth is set according to the distance from the breast surface corresponding to each cylindrical hole in the magnetic resonance image to the tumor edge, and the scale on each cylindrical hole can ensure the accuracy of the injection depth.
(2) The surgeon performs the operation, and the part needing to be cut is within the blue display at the edge of the tumor. The method is simple and easy to implement, reduces the pain of a patient, saves the treatment cost of the patient, shortens the treatment period, and most importantly, reduces the false positive and false negative results of tumor resection, greatly reduces the recurrence rate after the operation, and can lay a foundation for accurately guiding the positioning in the breast tumor operation and the breast-conserving operation.
the above description is only a preferred embodiment of the present invention and is not intended to limit the present invention, and various modifications and changes may be made by those skilled in the art. Any modification, equivalent replacement, or improvement made within the spirit and principle of the present invention should be included in the protection scope of the present invention.

Claims (10)

1. The utility model provides a surgery mammary gland nuclear magnetic resonance examination accurate positioning auxiliary device which characterized in that includes: a positioning cup with a hole at the center, a back strap and a shoulder strap for connecting the two cups; the positioning cup is circular, the diameter of a central hole is 2-3 cm, a circle of circular interlayer is arranged on the inner ring of the cup, an adjusting belt penetrates through the interlayer, and two ends of the adjusting belt extend out of the interlayer; three marking holes are arranged on the positioning cup, the three small holes are distributed in a regular triangle, and the distance between the small holes is 2 cm.
2. The precision positioning aid of claim 1, wherein: the two ends of the strap are fixed through the adhesive pieces arranged at the ends.
3. the precision positioning aid of claim 1, wherein: the shoulder strap is provided with eight buckles for adjusting the length.
4. The precision positioning aid of claim 1, wherein: the positioning cup is made of elastic composite materials with moderate hardness.
5. The precision positioning aid of claim 1, wherein: the auxiliary positioning device is made of a non-ferromagnetic material.
6. A method for accurately positioning a breast tumor based on an accurate positioning auxiliary device and 3D printing is characterized by comprising the following steps:
(1) the patient wears the accurate positioning auxiliary device, fixes a cod liver oil at the three marking holes of the positioning cup, and carries out nuclear magnetic resonance examination;
(2) After the magnetic resonance examination is finished, sticking positioning labels on the surfaces of the mammary glands corresponding to the three marking holes of the positioning cups;
(3) Introducing the mammary gland nuclear magnetic resonance image into MIMICS software for three-dimensional reconstruction, and reconstructing a cod liver oil image at three positions for locating cod liver oil on the surface of the reconstructed mammary gland;
(4) Introducing the obtained three-dimensional reconstructed breast and tumor and positioning cod-liver oil images into 3-MATIC software for processing, designing a precise positioning device, wherein the shape of the precise positioning device is consistent with that of a breast of a patient, a round hole is formed in the center of the precise positioning device, three identical small holes are formed in the position for positioning the cod-liver oil, 3-5 cylindrical injection holes are formed in the position 5mm away from the edge of the tumor, and the precise positioning device is printed by a 3D printer;
(5) the accurate positioning device is placed at a corresponding breast part of a patient, the positions of the three small holes correspond to the positions of the positioning label marks on the surface of the breast one by one, and after the tumor accurate positioning device is matched with the breast, a disposable syringe is used for injecting methylene blue at a cylindrical injection hole of the accurate positioning device to accurately position the breast tumor.
7. The method of claim 6, wherein: in the step 1, the accurate positioning auxiliary device worn by the patient exposes the nipple of the patient out of the center hole of the positioning cup; adjusting the circular adjustable band of the inner ring of the cup according to the size of the breast to enable the cup to be attached to the surface of the breast; the length of the shoulder straps on the two sides is adjusted, and the magic tapes of the straps are adjusted to enable the positioning cups to be attached to the body so as to better fix the mammary gland.
8. the method of claim 6, wherein: and 3, arranging two direction marks on the edge of the circular hole by the accurate positioning device, wherein the first direction mark points to the nipple on the opposite side, and the second direction mark points to the xiphoid process.
9. The method of claim 6, wherein: and 4, polishing and disinfecting the accurate positioning device before use.
10. The method of claim 6, wherein: the cylindrical injection hole is made of transparent material, the inner diameter is 5.5mm, and the height is 5 cm; the outer surface of the cylindrical injection hole is provided with a graduated scale, and the graduated scale is marked with a distance from the position corresponding to the cylindrical injection hole to the edge of the tumor; the inner surface of the cylindrical injection hole is provided with a clamping groove.
CN201810567520.9A 2018-06-05 2018-06-05 Surgical mammary gland nuclear magnetic resonance examination accurate positioning auxiliary device and method Active CN110559086B (en)

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CN111317510A (en) * 2020-03-23 2020-06-23 孙志强 Body surface patch assisting in ultrasonic positioning of breast lesions

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Publication number Priority date Publication date Assignee Title
CN111317510A (en) * 2020-03-23 2020-06-23 孙志强 Body surface patch assisting in ultrasonic positioning of breast lesions

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