CN111481221B - Medical X-ray measuring device and storage medium - Google Patents
Medical X-ray measuring device and storage medium Download PDFInfo
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- 239000000725 suspension Substances 0.000 claims abstract description 24
- 238000001514 detection method Methods 0.000 claims description 95
- 238000005259 measurement Methods 0.000 claims description 45
- 208000010392 Bone Fractures Diseases 0.000 claims description 20
- 206010017076 Fracture Diseases 0.000 claims description 20
- 238000003745 diagnosis Methods 0.000 claims description 14
- 238000003384 imaging method Methods 0.000 claims description 12
- 239000013558 reference substance Substances 0.000 claims description 7
- 230000005855 radiation Effects 0.000 abstract description 6
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- 230000037182 bone density Effects 0.000 description 15
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
- A61B6/40—Arrangements for generating radiation specially adapted for radiation diagnosis
- A61B6/4007—Arrangements for generating radiation specially adapted for radiation diagnosis characterised by using a plurality of source units
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
- A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
- A61B6/505—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of bone
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
- A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
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Abstract
The medical X-ray measuring apparatus of the present invention prevents unnecessary X-ray radiation to a subject when measuring bone mineral density. An X-ray image is generated and displayed (S18) between the first irradiation step (S16) and the second irradiation step (S26). A continuation instruction or a suspension instruction is input by an inspector who refers to the X-ray image (S20). And allowing the second irradiation process to be executed when a continuation instruction is input. When the suspension instruction is input, execution of the second irradiation process is suspended.
Description
Technical Field
The present invention relates to a medical X-ray measurement device and a program, and more particularly to the generation of an image representing a two-dimensional distribution of a specific component included in a subject.
Background
DEXA (dual-energy X-ray absorptiometry: dual-energy X-ray absorption method) is a method of generating an image representing a specific component contained in an examinee from 2 kinds of detection data obtained by sequentially irradiating 2 kinds of X-rays having different energies to the examinee. Specifically, an image representing a two-dimensional distribution of the content or content ratio of a specific component contained in the subject is generated. As such an image, a bone density (bone density) image is known. The bone mineral density image is also referred to as a bone mineral content (bone mineral content) image. An image representing a two-dimensional distribution of fat mass, fat percentage, fat free mass, fat free percentage, or the like can also be generated by the DEXA method. The fat-free amount is the amount of the tissue other than fat in the soft tissue, and the fat-free rate is the content of the tissue other than fat in the soft tissue. The DEXA process is also known as DXA process.
When the DEXA method is applied, the measurement time becomes long when a two-dimensional irradiation region is formed by scanning a planar X-ray beam. In contrast, if a two-dimensional irradiation region is formed by using an X-ray beam having a pyramid shape, the measurement time can be shortened.
The following methods are also known: that is, 2 kinds of detection data are obtained by making the energy sensitivity different in the X-ray detection stage on the basis of irradiation of X-rays having a wide range of energy. It is also a way of the DEXA process.
In the medical X-ray measurement apparatus described in patent document 1, an X-ray generation apparatus that generates an X-ray beam having a three-dimensional shape is provided above a subject, and an X-ray detection apparatus (radiographic imaging apparatus) is provided below the subject. The X-ray detection device is provided with a first detector, a radiation restricting member, and a second detector, which are stacked in the vertical direction. 2 kinds of detection data are obtained simultaneously by the first detector and the second detector.
Prior art literature
Patent literature
Patent document 1: japanese patent application laid-open No. 2018-23768
Problems to be solved by the invention
When 2 kinds of detection data are simultaneously obtained by one X-ray irradiation, an examinee is generally irradiated with X-rays having a large energy range. In such a method, it is not possible to judge that the measurement is stopped in the middle of the measurement, and as a result, it is considered that more than necessary radiation is generated to the subject. In such a method, when a stacked structure including the first detector and the second detector is used, a positional error generated between the first detector and the second detector increases as the beam central axis is deviated.
Disclosure of Invention
The invention aims at: so that useless X-ray irradiation to the subject can be avoided.
Alternatively, the object of the present invention is: the problem of position errors between 2 detected data is avoided.
Solution scheme
The medical X-ray measurement device of the present invention is characterized by comprising: an irradiation unit that irradiates a first X-ray beam having a three-dimensional shape with a first energy to an examinee in a first irradiation step, and irradiates the examinee with a second X-ray beam having a three-dimensional shape with a second energy different from the first energy in a second subsequent irradiation step; a detection unit that generates first two-dimensional detection data by detecting X-rays that have passed through the subject in the first irradiation step, and generates second two-dimensional detection data by detecting X-rays that have passed through the subject in the second irradiation step; a main image generating unit that generates a main image representing a two-dimensional distribution of a specific component included in the subject based on the first two-dimensional detection data and the second two-dimensional detection data; and a control unit that allows or stops execution of the second irradiation step in an intermediate step between the first irradiation step and the second irradiation step.
The program of the present invention is characterized by comprising: a function of controlling the execution of the first irradiation process; a function of controlling execution of an intermediate step after the first irradiation step; a function of controlling the execution of the second irradiation step after the intermediate step; and a function of controlling execution of a display process subsequent to the second irradiation process, wherein in the first irradiation process, a first X-ray beam having a first energy and having a three-dimensional shape is irradiated to the examinee, first two-dimensional detection data is generated by detecting the X-ray passing through the examinee, a fracture diagnosis image is generated and displayed based on the first two-dimensional detection data, a continuation instruction or a suspension instruction is received, execution of the second irradiation process is permitted when the continuation instruction is received, execution of the second irradiation process is suspended when the suspension instruction is received, in the second irradiation process, a second X-ray beam having a second energy different from the first energy and having the three-dimensional shape is irradiated to the examinee, second two-dimensional detection data is generated by detecting the X-ray passing through the examinee, and a bone density image is generated and displayed based on the first two-dimensional detection data and the second two-dimensional detection data.
Effects of the invention
According to the present invention, unnecessary X-ray irradiation to the subject can be avoided. Alternatively, according to the present invention, it is possible to avoid a positional error from occurring between a plurality of detection data.
Drawings
Fig. 1 is a diagram showing a medical X-ray measurement apparatus according to an embodiment.
Fig. 2 is a diagram showing data processing.
Fig. 3 is a flowchart showing a first example of operation.
Fig. 4 is a flowchart showing a second example of operation.
Fig. 5 is a flowchart showing a third example of the operation.
Fig. 6 is a flowchart showing a fourth example of the operation.
Fig. 7 is a diagram showing a display example of an X-ray image.
Fig. 8 is a flowchart showing a fifth example of operation.
Fig. 9 is a diagram showing the operation of the projector.
Fig. 10 is a diagram showing a structure of a projector.
Fig. 11 is a view showing a first projection image.
Fig. 12 is a diagram showing a second projection image.
Fig. 13 is a view showing a third projection image.
Fig. 14 is a view showing a fourth projection image.
Fig. 15 is a diagram showing a modification example of the projection method.
Fig. 16 is a view showing a first example of the upper surface of the prosthesis (fantom).
Fig. 17 is a view showing a second example of the upper surface of the prosthesis.
Fig. 18 is a view showing a third example of the upper surface of the prosthesis.
Fig. 19 is a view showing a display example of an X-ray image and a bone mineral density image.
Reference numerals illustrate:
10: a measuring unit; 12: an information processing unit; 18: a photographing table; 20: an inspected person; 22: an irradiation section; 28: a detection unit; 32: an arithmetic unit; 34: a control unit; 40: an X-ray image generation unit; 42: an X-ray image analysis unit; 44: an irradiation condition calculation unit; 46: a bone mineral density image generation unit; 48: a bone mineral density image analysis unit; 50: first two-dimensional detection data; 52: an X-ray image; 54: second two-dimensional detection data; 56: bone mineral density images.
Detailed Description
The embodiments are described below with reference to the drawings.
(1) Summary of the embodiments
The medical X-ray measurement device according to the embodiment includes an irradiation unit, a detection unit, a main image generation unit, and a control unit. The irradiation unit irradiates a first X-ray beam having a three-dimensional shape with a first energy to the subject in a first irradiation step, and irradiates a second X-ray beam having a three-dimensional shape with a second energy different from the first energy to the subject in a second irradiation step thereafter. The detection unit detects the X-rays that have passed through the subject in the first irradiation step to generate first two-dimensional detection data, and detects the X-rays that have passed through the subject in the second irradiation step to generate second two-dimensional detection data. The main image generating unit generates an image representing a two-dimensional distribution of a specific component included in the subject based on the first two-dimensional detection data and the second two-dimensional detection data. The control unit permits or terminates execution of the second irradiation step in an intermediate step between the first irradiation step and the second irradiation step.
According to the above configuration, an intermediate step is provided between the first irradiation step and the second irradiation step, and in the intermediate step, it is determined whether or not the second irradiation step can be executed. In the intermediate step, when it is determined that the second irradiation step should not be performed or the second irradiation step should not be performed, the second irradiation step is not performed, and therefore the amount of irradiation of the subject can be reduced accordingly. The first irradiation step and the second irradiation step are performed stepwise, and therefore the detection unit can be shared between these steps. In other words, even if a member having a special structure is not used as the detection portion. The binding state of the subject can be released as early as possible without performing the second irradiation step, and thus the burden on the subject can be reduced.
The inspector generally determines whether or not the second irradiation process can be performed. In this case, it is desirable to provide the inspector with information for supporting the judgment of the inspector. The control unit generally permits or terminates execution of the second irradiation step in accordance with an instruction from the inspector. However, the control unit may autonomously and automatically determine whether or not the second irradiation step can be executed.
A typical example of the main image is an image representing a two-dimensional distribution of bone density (bone mineral content). The concept of the main image includes an image representing a two-dimensional distribution of fat mass or fat percentage, and an image representing a two-dimensional distribution of fat free mass or fat percentage. The irradiation process may be performed stepwise by 3 or more steps while the energy of the X-rays is varied. In this case, it is desirable to provide an intermediate step between the first irradiation step and the second irradiation step. However, for each of the adjacent 2 irradiation steps, an intermediate step or a step corresponding thereto may be provided therebetween.
The medical X-ray measurement device according to the embodiment comprises: a sub-image generating unit that generates an X-ray image of the subject as a sub-image based on the first two-dimensional detection data in an intermediate step; a display that displays a sub-image in an intermediate process; an input unit that receives a continuation instruction or a suspension instruction in the intermediate step. The control unit permits execution of the second irradiation step when the continuation instruction is received, and terminates execution of the second irradiation step when the suspension instruction is received.
In the above configuration, the sub-image is provided to the inspector, and the inspector determines whether or not the second irradiation process can be performed, and receives a continuation instruction or a suspension instruction as a result of the determination. For example, if the disease can be diagnosed based on the sub-image even if the second irradiation step is not performed, or if the first irradiation step cannot be performed due to the fact that the subject is not included in the sub-image, such as movement of the subject in the first irradiation step, the suspension instruction is input.
In an embodiment, the main image is a bone mineral density image, and the continuation instruction is input to the input device when no fracture site is recognized in the diagnosis target bone image in the sub-image, and the suspension instruction is input to the input device when a fracture site is recognized in the diagnosis target bone image in the sub-image. For example, in the case where a fragile fracture is recognized in the bone image to be diagnosed, osteoporosis can be diagnosed, and in this case, it is not necessarily necessary to perform the second irradiation step. Conversely, the irradiation is preferentially reduced, and the second irradiation step is omitted. The above-described structure can correspond to such a demand. However, the execution of the second irradiation step may be instructed depending on the judgment of the inspector regardless of the contents of the sub-image.
In an embodiment, the control unit controls the opinion input process to be executed when the execution of the second irradiation process is suspended. It records the result of the judgment based on the sub-image, and records the opinion together with the sub-image. Other processes than the opinion input process may be performed.
The medical X-ray measurement device according to the embodiment includes an arithmetic unit that calculates an irradiation condition in the second irradiation step based on the first two-dimensional detection data. According to this configuration, the irradiation conditions in the second irradiation step can be optimized for the subject. In an embodiment, the calculation unit includes a unit for calculating a representative thickness of the subject based on the first two-dimensional detection data, and a unit for correcting the irradiation condition in the second irradiation step based on the representative thickness. For example, the second energy is increased when the average value of the thickness of the subject is large, and the second energy is decreased when the average value of the thickness of the subject is small. Thus, both measurement accuracy and radiation reduction can be achieved.
The medical X-ray measurement device according to the embodiment includes a support information generation unit that generates support information for supporting determination of whether or not to execute the second irradiation process, based on the sub-image, wherein the support information is displayed on a display together with the sub-image. With this configuration, the judgment of the inspector can be supported.
The medical X-ray measurement device according to the embodiment comprises: a photographing table carrying a subject to be inspected; and a projector that projects, onto the imaging table, a projection image that is used when positioning the subject, wherein the projection image is an optical image that indicates a region where the first X-ray beam and the second X-ray beam are irradiated. The size of the area where the X-ray beam is irradiated varies by diaphragm adjustment or the like. The present irradiation region can be recognized from the projection image, and the subject can be accurately positioned in correspondence with the present irradiation region.
In the embodiment, the projection image includes an element used when positioning the correction reference substance. The element functions, for example, as a mark indicating a position or region where the prosthesis including the reference substance for correction is provided. According to this configuration, the calibration standard substance can be easily placed at a correct position. For example, the reference substance for correction can be prevented from being separated from the X-ray beam having a three-dimensional shape.
The operation method (operation control method) of the medical X-ray measurement device according to the embodiment includes a first irradiation step, an intermediate step, a second irradiation step, and a display step. In the first irradiation process, a first X-ray beam having a first energy and having a three-dimensional shape is irradiated to the subject, and first two-dimensional detection data is generated by detecting the X-rays that have passed through the subject. In the intermediate process, a fracture diagnosis image is generated and displayed based on the first two-dimensional detection data, and a continuation instruction or a suspension instruction is accepted. The execution of the second irradiation step is permitted when the continuation instruction is received, and the execution of the second irradiation step is suspended when the suspension instruction is received. In the second irradiation step, a second X-ray beam having a second energy and a three-dimensional shape is irradiated to the subject, and second two-dimensional detection data is generated by detecting the X-rays that have passed through the subject. In the display process, an image of bone mineral density is generated and displayed based on the first two-dimensional detection data and the second two-dimensional detection data.
In an embodiment, the operation method is controlled according to a program. The program is installed in the medical X-ray measurement apparatus or an information processing apparatus provided therein via a removable storage medium or a network.
(2) Details of the embodiments
Fig. 1 shows a medical X-ray measurement device according to an embodiment. The medical X-ray measurement device has an X-ray imaging function, a bone mineral density measurement function, and the like. According to the medical X-ray measuring apparatus, bone mineral density can be measured without using a device dedicated for bone mineral density measurement. In the bone mineral density measurement, the DEXA method was used. Further, the content and the content of fat and the content of fat-free (soft tissue other than fat) can be measured by the medical X-ray measuring device.
In fig. 1, a medical X-ray measuring apparatus is generally composed of a measuring unit 10 and an information processing unit 12. The measurement unit 10 is provided in the inspection chamber 14, and the information processing unit 12 is provided in the control chamber 16. The measuring unit 10 and the information processing unit 12 are connected to each other by a cable. They may also be connected by wireless communication. The information processing unit 12 is constituted by, for example, a computer as an information processing device. The information processing unit 12 may be constituted by a plurality of computers. In which case they are connected to each other via a network. The x-direction is a first horizontal direction, and the z-direction is a vertical direction (vertical direction). The direction orthogonal to the x-direction and the z-direction is the y-direction as the second horizontal direction.
The photographing table 18 is disposed in the examination room 14. In measurement, an examinee (human body) 20 is carried on the imaging table 18. In this case, for example, the subject 20 lies in a supine position on the imaging table 18. In this case, the body axis (central axis of the body trunk) is parallel to the x-direction. Examples of the site to be measured for bone density include lumbar vertebrae and femur.
An irradiation unit 22 is provided above the imaging table 18, that is, above the subject 20. The irradiation unit 22 is supported by the robot mechanism 24. The irradiation unit 22 includes an X-ray generation tube, a diaphragm mechanism, a projector, and the like. In the case of performing X-ray measurement, the irradiation unit 22 generates an X-ray beam 26 having a three-dimensional shape. Specifically, the X-ray beam 26 has a pyramid-like form. It is also called a cone beam of light. The propagation angle θ of the X-ray beam 26 in the xz plane may be the same as or different from the propagation angle Φ of the X-ray beam in the yz plane. However, in the bone mineral density measurement, the irradiation unit 22 is usually positioned at a predetermined height, and the angle θ and the angle Φ are the same predetermined angle. X-ray beams having shapes other than quadrangular pyramid shapes (e.g., conical shapes) may also be used.
The voltage and current of the drive signal supplied to the X-ray generation tube and the supply time of the drive signal are controlled by a control unit 34 described later. Typically, the energy of the generated X-rays is changed by changing the voltage of the drive signal. As described later, in the embodiment, high-energy X-rays are generated in the first irradiation step, and low-energy X-rays having a lower high energy are generated in the second irradiation step. The second energies different from each other are determined in correspondence with the tissue to be measured. In an embodiment, 2 energies suitable for bone densitometry are selected.
A detection unit 28 is disposed below the top plate provided on the imaging table 18, that is, below the subject 20. The detector 28 includes a Flat Panel Detector (FPD) 30, and detects X-rays by the FPD. The FPD30 is constituted by a number of detection elements arranged in the x-direction and the y-direction. Each detection element includes, for example, a scintillator that converts X-rays into light and a circuit that converts light into an electrical signal. The X-rays passing through the subject are detected by the FPD30, whereby two-dimensional detection data is obtained.
In the bone mineral density measurement, first two-dimensional detection data is generated in a first irradiation step, and second two-dimensional detection data is generated in a second irradiation step. These two-dimensional detection data are transferred to the information processing unit 12. The FPD30 of the embodiment is commonly used between 2 irradiation steps. The detection unit 28 does not have a superimposed structure including a plurality of detectors. In the embodiment, no positional error or a difference in magnification occurs between the 2 two-dimensional detection data.
Next, the information processing unit 12 will be described. The information processing unit 12 includes a calculation unit 32, a control unit 34, a storage unit 36, an input unit 37, and a display unit 38. The arithmetic unit 32 and the control unit 34 are configured by a CPU that operates in accordance with a program. They may be constituted by a plurality of processors or by other devices. The storage unit 36 is constituted by a semiconductor memory, a hard disk, or the like. The storage unit 36 stores an operation control program and an arithmetic processing program. The data including the image can also be stored in the storage section 36. The input unit 37 is constituted by a keyboard, a pointing device, or the like. The input unit 37 receives input of a continuation instruction and a suspension instruction, which will be described later. The display unit 38 is configured by a liquid crystal display, an organic EL display, or the like. The X-ray image and the bone mineral density image, which will be described later, are displayed on the screen of the display unit 38.
The control unit 34 controls the generation and detection of X-rays and the data processing in accordance with the operation control program. The bone mineral density measurement process in charge of the operation control program includes, as will be described later, a first irradiation step, an intermediate step, a second irradiation step, a display step, an opinion input step, and the like. Specifically, the control unit 34 performs control for the formation and irradiation of the X-ray beam, the detection of the X-ray beam, the process shift based on the instruction, the image generation, and the like.
The arithmetic unit 32 has a plurality of functions. Among these functions, a plurality of functions associated with bone densitometry are represented by a plurality of modules in fig. 1. Specifically, the computing unit 32 includes an X-ray image generating unit 40, an X-ray image analyzing unit 42, an irradiation condition computing unit 44, a bone mineral density image generating unit 46, and a bone mineral density image analyzing unit 48.
In the intermediate step, the X-ray image generating unit 40 generates an X-ray image as a lunar-ray image based on the first two-dimensional detection data acquired in the first irradiation step. The X-ray image includes a diagnosis target bone image of the inside of the measurement target region. By this observation, the state of the bone to be measured can be grasped before the second irradiation step is performed. The X-ray image is referred to as a sub-image or an auxiliary image from the viewpoint of the relationship with the bone mineral density image described later, and is referred to as an image for fracture diagnosis from the viewpoint of its function.
The X-ray image analysis unit 42 analyzes the X-ray image to determine an abnormal portion. In analyzing an X-ray image, a learning image recognition technique or the like can be used. In the case where the abnormal portion is determined, for example, a painted image or a mark representing the abnormal portion is superimposed on the X-ray image.
The irradiation condition calculation unit 44 calculates the irradiation condition for the second X-ray beam based on the first two-dimensional detection data before the second irradiation step is performed. The irradiation condition calculation unit 44 according to the embodiment calculates an average value or a maximum value of the thickness of the subject based on the first two-dimensional detection data, and optimizes the second energy related to the second X-ray beam based on such representative thickness.
For example, when the representative thickness is the standard value, a predetermined value is set as the second energy, when the representative thickness is larger than the standard value, a value higher than the predetermined value is set as the second energy, and when the representative thickness is smaller than the standard value, a value lower than the predetermined value is set as the second energy. This prevents a decrease in measurement accuracy in the case of measuring a thick subject and an excessive radiation in the case of measuring a thin subject. The calculated irradiation conditions are sent from the irradiation condition calculation unit 44 to the control unit 34.
The bone mineral density image generating unit 46 generates an bone mineral density image based on the first two-dimensional detection data and the second two-dimensional detection data obtained from the subject in accordance with the DEXA method. The bone mineral density image represents a two-dimensional distribution of bone mineral mass within the subject.
In calculating the bone mineral density image, the first irradiation step and the second irradiation step are performed before the subject is placed on the imaging table 18 in order to correct the sensitivity. Thereby, first two-dimensional detection data (first two-dimensional air-coefficient data) and second two-dimensional detection data (second two-dimensional air-coefficient data) are acquired. In the stage of generating the bone mineral density image, these data are referred to as needed. In order to correct the sensitivity, a prosthesis to be described later is also used as needed.
The attenuation amount image may be displayed as an X-ray image. The attenuation amount image is an image generated from the first two-dimensional detection data and the first air-factor data acquired in advance. Specifically, the ratio of the air ratio to the detection data is calculated as a logarithmic value in units of pixels. The logarithmic value corresponds to the amount of attenuation. Further, correction based on the air factor and correction using a prosthesis have been a technique used in the past in bone mineral density measuring devices.
The bone mineral density image analysis unit 48 analyzes the bone mineral density image to determine an abnormal portion. In this case, a learning type image recognition technique can be utilized. When an abnormal portion is determined, a painted image or a mark representing the abnormal portion is displayed superimposed on the bone mineral density image.
In fig. 2, a flow of data processing is shown. By performing the first irradiation process, first two-dimensional detection data 50 is generated. The first two-dimensional detection data 50 is constituted by a plurality of detection values 50a arranged in the x-direction and the y-direction. Each detection value 50a corresponds to each pixel. In an embodiment, an X-ray image 52 is generated from the first two-dimensional detection data 50 and displayed.
By observing the X-ray image 52, the inspector determines whether the second irradiation process can be performed. For example, when a fragile fracture is recognized in the bone to be measured and osteoporosis can be diagnosed at this stage, it is determined that the second irradiation step is not necessary, and a termination instruction is input by the inspector. In addition, when it is found that the first irradiation process is not performed correctly by observing the X-ray image 52, a suspension instruction may be input. In order to support the observation of the X-ray image 52, the analysis result of the X-ray image 52 may be displayed.
On the other hand, when the examiner determines that the bone mineral density image needs to be generated by observing the X-ray image 52, a continuation instruction is input by the examiner. When it is determined that acquisition of an image of bone mineral density is necessary although a fragile fracture is identified, a continuation instruction may be input. The suspension instruction and the continuation instruction are input by the inputter.
When the suspension instruction is input, the second irradiation process is prohibited from being performed, and the second two-dimensional detection data 54 is not acquired. On the other hand, when a continuation instruction is input, a second irradiation process is performed, whereby second two-dimensional detection data 54 is acquired. The second two-dimensional detection data 54 is composed of a plurality of detection values 54a corresponding to a plurality of pixels, similarly to the first two-dimensional detection data 50. The second irradiation condition in the second irradiation step may be calculated from the first two-dimensional detection data 50 or an X-ray image generated based thereon before the second irradiation step. Which is denoted by reference numeral 53.
After the second illumination procedure is performed, an image 56 of bone density is generated from the first 50 and second 54 two-dimensional detection data. From the viewpoint of an X-ray image as a sub-image, it is called a main image. The bone mineral density image is displayed and analyzed as needed.
Next, a first operation example to a fourth operation example of the medical X-ray measurement apparatus shown in fig. 1 will be described with reference to fig. 3 to 6. Each step constituting each operation example is executed under the control of the control unit.
Fig. 3 shows a first example of operation. In S10, the subject information is input to the medical X-ray measurement device. The examinee information is information including an examination number, a name, and the like, for example. The X-ray image and the bone density image obtained from it are correlated with the subject information. In S12, the subject is positioned on the photographing table. The subject is positioned so that the measurement target portion enters the irradiation region. In an embodiment, a high energy is set as the energy of the first X-ray beam. In this case, the energy may be set to be low, but the energy may be insufficient according to the physical constitution of the subject, so that the energy is set to be high. The first irradiation condition may be displayed, and the content thereof may be confirmed by the inspector. S16 is a first irradiation step. In S16, the first X-ray beam is irradiated to the subject, and the X-ray beam passing through the subject is detected. Thereby, the first two-dimensional detection data is acquired.
S18 and S20 constitute an intermediate step. The intermediate step may include S24 described later. In S18, an X-ray image is generated from the first two-dimensional detection data and displayed. The inspector who observes the X-ray image determines whether to continue or stop the measurement. If it is determined to stop the measurement, a stop instruction is input by the inspector in S20. On the other hand, if it is determined to continue measurement, a continuation instruction is input by the inspector in S20.
When the suspension instruction is input in S20, S22 is executed. In S22, an inspector inputs an opinion using an input device. The input opinion information is managed corresponding to the X-ray image. For example, the fracture site position and the fracture degree are input as comments. A diagnostic name may also be entered.
On the other hand, when a continuation instruction is input in S20, the control section sets the second irradiation condition in S24. The second irradiation condition may be displayed, and the content thereof may be confirmed by the inspector. S26 is executed following S24. S26 is a second irradiation step. That is, in S26, the second X-ray beam is irradiated to the subject, and the X-ray passing through the subject is detected. Thereby, second two-dimensional detection data is acquired. S28 is a display step. In S28, an image of bone density is generated from the first two-dimensional detection data and the second two-dimensional detection data according to the DEXA method, and displayed.
According to the above operation example, when the suspension instruction is input in S20, the execution of the second irradiation step is prohibited, and thus, unnecessary radiation to the subject can be avoided. In this case, the subject can be released from the binding state as early as possible.
Further, 3X-rays having 3 or more energies may be irradiated stepwise to generate a plurality of images (for example, bone mineral density image, fat mass image, fat free mass image). In this case, it is desirable to provide an intermediate step between the first irradiation steps. If necessary, a step corresponding to an intermediate step may be provided between the second and subsequent irradiation steps.
Fig. 4 shows a second example of operation. Fig. 4 to 6 show a part of a series of operations. Omitted parts are the same as those shown in fig. 3. In fig. 4 to 6, the same step numbers are given to the steps already described, and the description thereof is omitted.
In the second operation example shown in fig. 4, S30 and S32 are provided after S28. In S30, the bone mineral density image is analyzed, and in S32, the analysis result is displayed. For example, when there are abnormally high portions and abnormally low portions of the bone mineral density values, these are determined as abnormal portions, and symbols or the like representing these are displayed superimposed on the bone mineral density image. According to the second operation example, diagnosis based on the bone mineral density image can be supported.
In the third operation example shown in fig. 5, S34 to S40 are provided before S24. Specifically, in the case where the continuation instruction is input in S20, the second irradiation condition is calculated from the first two-dimensional detection data or the X-ray image in S34. For example, the representative thickness is calculated as described above, and the second energy is adaptively set according to it. In S36, the second irradiation condition is displayed on the screen. Thereby, the second irradiation condition is confirmed by the inspector. In S38, when the inspector inputs the second irradiation condition, S24 is executed. On the other hand, in S38, when the inspector inputs a request to change the second irradiation condition, S40 is executed. In S40, the second irradiation condition is changed by the inspector. Then, S24 is performed. According to the third operation example, the second irradiation condition can be optimized according to the situation.
In the fourth operation example shown in fig. 6, S50 to S54 are provided after S16. Specifically, in S50, an X-ray image is generated from the first two-dimensional detection data. Next, in S52, the X-ray image is analyzed. For example to determine the location of a possible fracture. In S54, an X-ray image is displayed. At this time, the X-ray image analysis result is also displayed. For example, a site where a fracture is likely is marked on an X-ray image. According to the fourth operation example, the inspector can support the determination in the intermediate process.
An X-ray image is illustrated in fig. 7. The illustrated X-ray image contains a plurality of vertebral images. Wherein the paint color represents a particular vertebra that is likely to fracture, as shown by reference numeral 60A.
Fig. 8 shows a fifth example of operation. In S60, it is determined whether the mode selected by the user is the intermediate instruction mode or the continuous mode. When the intermediate instruction mode is selected, S62 is executed, and the processing shown in fig. 3 to 6, that is, the processing including the intermediate step, is executed. On the other hand, in the case where the continuous mode is selected, S64 is executed. In S64, the second irradiation process is continuously performed following the first irradiation process. In this case, the reception of the suspension instruction or the continuation instruction is not performed. In the case where the continuous mode is selected, the X-ray image may be displayed after the first irradiation step is performed. In addition, the second irradiation condition may be calculated from the first two-dimensional detection data. In the fifth operation example, when the second irradiation step is always performed, the continuous mode can be selected, and in this case, the instruction action of the inspector is not required, so that the load of the inspector can be reduced.
Next, the projector and its operation will be described with reference to fig. 9 to 15.
In fig. 9, the subject 20 is carried on the photographing table 18. The irradiation section 22 is disposed above it, and the detection section 28 is disposed below it. The irradiation section 22 includes an X-ray generator 61 and a projector 62. The projector 62 generates a light beam 64 having the same shape as the quadrangular pyramid-shaped X-ray beam, and functions as a projector or collimator.
Fig. 9 shows a prosthesis (dummy) 66 supported by a support mechanism 68. The prosthesis 66, for example, contains a first reference substance that simulates bone and a second reference substance that simulates soft tissue. The prosthesis 66 is supported in an inclined state such that the central axis of the prosthesis 66 coincides with the X-ray emission direction, while the prosthesis 66 is contained in the X-ray beam space. The prosthesis 66 is used to modify the first and second two-dimensional test data, using itself previously. The prosthesis 66 may be supported by the supporting means 68 in a state of being in contact with the upper surface of the imaging table 18, or the prosthesis 66 may be supported by the supporting means 68 in a state of being lifted from the upper surface of the top plate of the imaging table 18. The stand-alone prosthesis may be provided on the top surface of the top plate of the imaging table 18 without using the support mechanism 68.
Fig. 10 shows an example of the structure of the projector 62. An aperture mechanism 62A is provided at the exit of the projector 62. The three-dimensional shape of the X-ray beam 26 is defined by the aperture mechanism 62A. The angle θ and the angle Φ are particularly specified (only the angle Φ is shown in fig. 10). Incidentally, in measuring bone mineral density, the angle θ and the angle Φ are respectively defined as a predetermined angle. Thus, the effect of the projector 62 need not be dynamically variable.
Specifically, the projector 62 includes a light source 70, a first mirror 72, and a second mirror 74 in addition to the diaphragm mechanism 62A. Light emitted from the light source 70 is reflected by the first mirror 72, and the reflected light is further reflected by the second mirror 74. The reflected light constitutes a light beam 64. Beam 64 has a cone-like form that corresponds to the form of X-ray beam 26.
The diaphragm mechanism 62A has an exit, and a light-transmitting member 76 is disposed therein. The pattern of the light-transmitting member 76 is projected onto the top plate (and the subject) of the photographing table. The light-transmitting member 76 has light-shielding properties or includes 2 lines of black. These lines cross in a "+" shape. Thus, 2 lines crisscrossed are included on the shadowgraph image. Further, it is desirable that the reflecting mirror 74 and the light transmitting member 76 be made of a material that hardly attenuates X-rays.
Next, as a modification of the projection image formed by the projector 62, first to fourth projection images will be described with reference to fig. 11 to 15.
The first shadowgraph image is shown in fig. 11. The projection image 80 shows the X-ray irradiation area on the top surface 18A of the top plate, and the outer shape of the two is identical. The projection image 80 is colored by coloring the light-transmitting member 76. The shadowgraph image 80 contains a marker 82, which is made up of 2 lines 84, 86 crisscrossed at the centre of the beam. The X-ray irradiation region can be visually confirmed as a projection region from the projection image 80. In addition, the measurement site can be accurately positioned in the X-ray irradiation region by the marker 82.
A second shadowgraph image is shown in fig. 12. In fig. 12 to 15, the same elements as those shown in fig. 11 are denoted by the same reference numerals, and the description thereof is omitted.
In fig. 12, the projection image 80 includes a line 88 that functions as a reference when the prosthesis 90 is disposed. The thread 88 is produced by applying a thread of a different coloring from the surrounding to the light-transmitting member. Specifically, the prosthesis 90 is provided in a band-like region between the line 88 and the end edge (right-side end edge in fig. 12) of the projection image 80. The line 88 is a marker that functions as an element for positioning the prosthesis. According to the projection image 80 including the line 88, the prosthesis 90 can be reliably and easily set at a position in the angular cone-shaped X-ray beam where no obstacle is generated to the subject. The setting angle of the prosthesis 90 may be determined in advance, or the setting angle of the prosthesis 90 may be optimized by a method described later using a projection image.
A third shadowgraph image is shown in fig. 13. The projection image 80 includes marks 92 and 94 that function as references when the prosthesis 90 is disposed. The 2 marks 92, 94 are generated by adding 2 marks, which are colored differently from the surroundings, to the light-transmitting member. For example, the 2 corners (the left-hand corner in fig. 13) present in the lower portion of the prosthesis 90 are aligned with the 2 marks 92, 94, while naturally optimizing the position at which the prosthesis 90 is disposed. The 2 markers 92 and 94 are markers that function as elements for positioning the prosthesis.
A fourth shadowgraph image is shown in fig. 14. The projection image 80 includes an image 96 indicating the arrangement position of the prosthesis 90. The image 96 has a predetermined color tone. The image 96 is generated by forming a light-transmitting portion having a prescribed color tone on a part of the above-described light-transmitting member. In the fourth projection image shown in the drawing, the image 96 as an element thereof is configured as a figure having a shape identical to or slightly larger than the bottom surface of the prosthesis, for example. If the prosthesis is placed on the image 96, the location where the prosthesis is placed is optimized as a result. It is also possible to project a portion or all of the image 96 onto the upper surface of the prosthesis after the prosthesis has been placed, after which it is confirmed that the prosthesis has been placed in the correct position. This will be further described later using fig. 16 to 18. As described above, the image 96 is a mark functioning as an element for positioning the prosthesis.
Fig. 15 shows a modification. The shadowgraph image 80 may also be formed and a colored or adhesive tape applied to the top plate upper surface 18A to visibly represent the prosthesis placement area 97. Since a projection table is generally used for the image capturing in the ethical field, it is desirable to use the second to fourth projection images when it is desired to avoid special processing of the image capturing table.
Several embodiments are shown in fig. 16-18 in relation to the upper surface of the prosthesis 66. In a first example shown in fig. 16, a rough surface finish is applied to the upper surface 66A of the prosthesis 66. Thereby, reflection of light is suppressed. This can improve the visibility of the projection image. To further improve the visibility of the projection image, coloring or the like may be applied to the upper surface 66A.
In the second example shown in fig. 17, a mark 100 as a logo is depicted on the upper surface 66B of the prosthesis 66. The mark 100 is made up of 2 lines 102, 104 crisscrossed at the center of the upper surface 66B. By referring to the marker 100, the position and orientation of the prosthesis 66 can be easily confirmed from the relationship with the projection image.
In the third example shown in fig. 18, 2 markers 106, 108 are attached to the upper surface 66B of the prosthesis 66. On the other hand, 2 marker images corresponding to them are included in the projection image. By matching the 2 marker images with the 2 markers 106, 108, the position and posture of the prosthesis can be optimized.
According to the above-described configurations, it is easy to accurately position the subject, and it is also easy to accurately position the prosthesis. The problem of the prosthesis coming off the X-ray beam having a three-dimensional shape can be prevented. Further, the load on the inspector in positioning the prosthesis can be reduced. If the positioning of the subject and the prosthesis is optimized, the risk of failure of the measurement due to positioning errors can be reduced.
The configuration shown in fig. 9 to 18 may be adopted in a medical X-ray measuring apparatus or a bone mineral density measuring apparatus that does not perform an intermediate step. For example, the embodiments of fig. 9 to 18 may be adopted for a medical X-ray measurement apparatus capable of acquiring a plurality of two-dimensional detection data corresponding to a plurality of energies by one irradiation, and a medical X-ray measurement apparatus in which a correction substance is provided in an X-ray beam together with an examinee.
From such a viewpoint, the medical X-ray measurement apparatus of the present invention includes: an irradiation unit that irradiates an X-ray beam having a three-dimensional shape to an examinee on a photographing table; a detection unit that detects an X-ray that has passed through the subject and outputs two-dimensional detection data; an image forming unit that forms an image representing the subject based on the X-ray detection data; and a projector that projects a guide image, which is used when at least one of the subject and the calibration reference substance is positioned, onto the projection table. Desirably, the guiding image is an image representing the area where the X-ray beam is irradiated. Preferably, the guide image includes an element that is used when positioning the calibration standard substance. The upper surface of the calibration standard substance or the upper surface of the member containing the calibration standard substance may be subjected to processing or coloring different from that of the other surfaces. The upper surface may be provided with a pattern serving as a reference for positioning when the guide image is irradiated.
Fig. 19 shows an example of an image displayed by the medical X-ray measurement apparatus shown in fig. 1. In the display step after the second irradiation step, the X-ray image 60 and the bone mineral density image 110 are simultaneously displayed. The X-ray image 60 includes a marker image 60A indicating an abnormal portion, and the bone mineral density image 110 also includes a marker image 112 indicating an abnormal portion. By simultaneously observing these images 60 and 110, the bone to be measured can be comprehensively diagnosed.
For reference, an abnormality determination method based on the bone mineral density image is described. For example, when the bone to be measured is the lumbar vertebra, the average bone density may be calculated for each level of the vertebral bone, and when the bone is deviated from the appropriate range, the bone density may be determined to be abnormal. The average bone density may be calculated for a plurality of vertebrae, and if the average bone density deviates from an appropriate range, the average bone density may be determined to be abnormal.
For example, abnormal bone density higher than an appropriate range is generated due to compression fracture, calcification of blood vessels, contrast agent, foreign matter, and the like. It is also possible to determine an abnormality for each pixel and express it by brightness, hue, or the like. For example, in the case where the bone mineral amount is low due to osteoporosis, abnormal bone density lower than the proper range is generated. In this case, abnormality may be determined for each pixel, and expressed by brightness, hue, or the like.
Claims (8)
1. A medical X-ray measuring apparatus is characterized in that,
the medical X-ray measurement device is provided with:
an irradiation unit that irradiates a first X-ray beam having a three-dimensional shape with a first energy to an examinee in a first irradiation step, and irradiates the examinee with a second X-ray beam having a three-dimensional shape with a second energy different from the first energy in a second subsequent irradiation step;
a detection unit that generates first two-dimensional detection data by detecting X-rays that have passed through the subject in the first irradiation step, and generates second two-dimensional detection data by detecting X-rays that have passed through the subject in the second irradiation step;
a main image generating unit that generates a main image representing a two-dimensional distribution of a specific component included in the subject based on the first two-dimensional detection data and the second two-dimensional detection data;
a control unit that allows or stops execution of the second irradiation step in an intermediate step between the first irradiation step and the second irradiation step;
a sub-image generating unit that generates an X-ray image of the subject as a sub-image based on the first two-dimensional detection data in the intermediate step;
A display that displays the sub-image in the intermediate step; and
an input unit for receiving a continuation instruction or a suspension instruction in the intermediate step,
the control unit allows the second irradiation step to be executed when the continuation instruction is received, and suspends the execution of the second irradiation step when the suspension instruction is received,
the above-mentioned main image is an image of bone mineral density,
when no fracture site is recognized in the diagnosis target bone image in the sub-image, the continuation instruction is input to the input unit, and when a fracture site is recognized in the diagnosis target bone image in the sub-image, the suspension instruction is input to the input unit.
2. The medical X-ray measurement apparatus according to claim 1, wherein,
the control unit controls the opinion input process to be executed when the execution of the second irradiation process is suspended.
3. The medical X-ray measurement apparatus according to claim 1, wherein,
the medical X-ray measurement device includes an arithmetic unit that calculates an irradiation condition in the second irradiation step based on the first two-dimensional detection data.
4. The medical X-ray measurement apparatus according to claim 3, wherein,
the arithmetic unit includes:
means for calculating a representative thickness of the subject based on the first two-dimensional detection data; and
and means for correcting the irradiation conditions in the second irradiation step based on the representative thickness.
5. The medical X-ray measurement apparatus according to claim 1, wherein,
the medical X-ray measurement device includes a support information generation unit that generates support information for supporting determination of whether or not the second irradiation step is executed based on the sub-image,
the support information is displayed on the display together with the sub-image.
6. The medical X-ray measurement apparatus according to claim 1, wherein,
the medical X-ray measurement device is provided with:
a photographing table for carrying the subject; and
a projector for projecting a guide image used for positioning the subject to the imaging table,
the guide image indicates a region where the first X-ray beam and the second X-ray beam are irradiated.
7. The medical X-ray measurement apparatus according to claim 6, wherein,
The guide image includes an element used for positioning the calibration reference substance.
8. A storage medium storing a program, characterized in that,
the program includes:
a function of controlling the execution of the first irradiation process;
a function of controlling execution of an intermediate step after the first irradiation step;
a function of controlling the execution of the second irradiation step after the intermediate step; and
a function of controlling the execution of the display process after the second irradiation process,
in the first irradiation step, a first X-ray beam having a three-dimensional shape and having a first energy is irradiated to an examinee, and first two-dimensional detection data is generated by detecting the X-ray having passed through the examinee,
in the intermediate step, an image for fracture diagnosis is generated and displayed based on the first two-dimensional detection data, and a continuation instruction or a suspension instruction is received, execution of the second irradiation step is permitted when the continuation instruction is received, execution of the second irradiation step is suspended when the suspension instruction is received,
in the second irradiation step, a second X-ray beam having a second energy different from the first energy and having the three-dimensional shape is irradiated to the subject, and second two-dimensional detection data is generated by detecting the X-rays having passed through the subject,
In the display step, an image of bone mineral density is generated and displayed based on the first two-dimensional detection data and the second two-dimensional detection data,
the continuation instruction is input when no fracture site is recognized in the diagnosis target bone image in the fracture diagnosis image, and the suspension instruction is input when a fracture site is recognized in the diagnosis target bone image in the fracture diagnosis image.
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