DE102008030891A1 - Method for controlling respirator for artificially respirating patient during examination with medical system, involves respirating artificially patient using respirator and detecting operating condition of medical system - Google Patents

Abstract

The method involves respirating artificially a patient (6) using a respirator and detecting the operating condition of a medical system. The artificial respiration of the patient is automatically interrupted depending on the operating condition of the medical system. The interruption of the artificial respiration is displayed. A starting signal is sent to the medical system for starting the examination to begin the interruption of the artificial respiration. An independent claim is included for a control device for a respirator for artificially respirating a patient during an examination with a medical system.

Description

The The invention relates to a method and a control device for Controlling a ventilator for breathing a patient during an examination with a medical system, in particular in the form of an imaging system.

Imaging Systems of medical technology (also called "modalities") take one today important role in the investigation of patients. The of The imaging systems produced representations of the internal organs and structures of the patient are used to diagnose disease causes, for planning and implementation of operations or even for the preparation of therapeutic measures applied. Examples of such Imaging systems are magnetic resonance systems (also called "MR systems"), Computer tomographs (also called "CT systems"), Ultrasound systems, angiographic and / or cardiac X-ray equipment or positron emission tomographs (also called "PET systems").

One Recording process to generate the patient image data should be included For a relatively fast expire, the profitability of To ensure examination method and the burden on the patient, for example by X-radiation, preferably to keep low. On the other hand, however, a high image data quality is also sought, with it as possible high-quality examination result is ensured. The image data quality, however, is usually through - mostly inevitable - movements the internal organs and structures of the patient during the Recording process impaired. Occasionally, so-called "movement artifacts" arise, ie. H. erroneous representations of the inner caused by the movements Organs and structures. The movements arise among other things through the natural activity the inner organ, for example respiration (respiratory movement) of the examined patient.

First Methods and devices for reducing movement related impairment the image data quality are known. For example, computer tomography becomes a so-called "Respiratory Gating option "through Siemens AG offered, which via a chest strap, the breathing movements of the patient and together with a software component achieved a reduction of respiratory motion artifacts in the image data.

Of the present invention is based on the object, a breathing movement a patient during to reduce a medical examination.

The Task is solved by a method according to claim 1, by a control device according to claim 11 and by a Medical system according to claim 21; advantageous embodiments are the subject of each referenced Dependent claims.

The Invention is based on the basic idea of a respirator, anyway during ventilation of the patient one - in particular diagnostic or therapeutic - examination is used to be controlled so that the breathing movement during the examination with a medical system is interrupted. By the automatic On the one hand, interruption ensures that during the Examining the patient's breathing is reliably prevented, and on the other hand can the interruption of ventilation exactly to the necessary for the examination Limited period become. This is for the health of the examined patient advantageous because no additional examination load - z. B. in the form of a load of X-rays - through a repeat of the investigation, in the case of an imaging examination due to a possible motion blur caused by respiratory motion necessary becomes, and in itself over longer time for the Patient harmful Interruption of ventilation in their duration can be reduced. About that In addition, the medical staff is not familiar with an error-prone manual Interruption of ventilation during filed the examination and can thus other tasks such as z. B. the monitoring from physiological values of the patients connected via one to this Turn to the patient monitor.

In An advantageous embodiment of the invention will be at least one physiological value of the patient, in particular an oxygen partial pressure blood or electrocardiogram (ECG) values, and the interruption of ventilation is suspended depending on this value. Thereby can also resume ventilation before completing the examination if the medical status of the patient is due the respiratory interruption is too severely impaired. The automatic Resuming respiration in this way succeeds more reliably than through a manual condition of the ventilator based on an observation of the patient monitor.

In The following detailed description of the figures are not restrictive Understanding embodiments with their features and other advantages with reference to the schematic drawings discussed. In this show each in a perspective view:

1 a C-arm X-ray device with a control device for a ventilator

in the The invention is based on a diagnostic examination using a medical system in the form of an imaging system explains wherein a movement of the patient during a recording of Image data should be prevented. The invention is however as well on a therapeutic examination using a medical System be applied in the form of a radiation therapy system. Of the In this case, the radiation therapy system should also be equipped with particle therapy systems include. In therapeutic radiation treatment, patient movement during the Irradiation be avoided. In radiotherapy radiotherapy The movement of the patient during the irradiation may cause not only the tumor tissue but also the surrounding healthy tissue the patient is irradiated.

• – die Röntgenanordnung 2 mit einer Verschwenkgeschwindigkeit zwischen einer ersten und einer zweiten Endwinkellage um eine Schwenkachse verschwenkt wird und
• – der Röntgenstrahlungsdetektor 4 bei einer Vielzahl von Winkellagen zu Erfassungszeitpunkten Röntgenprojektionen eines im Bereich der Schwenkachse angeordneten Patienten 6 als Bilddaten aufgezeichnet und zusammen mit den jeweiligen Winkellagen temporär zwischengespeichert werden.

The present invention may, for. In relation to an imaging system in the form of an in 1 X-ray system shown 1 Use find an X-ray arrangement 2 from an X-ray source 3 and an X-ray detector 4 has, which are diametrically opposite each other with respect to the pivot axis. The X-ray system 1 is through an x-ray control 5 so controlled that

• - the X-ray arrangement 2 is pivoted at a pivoting speed between a first and a second end angle position about a pivot axis and
• - The X-ray detector 4 at a plurality of angular positions at detection times X-ray projections of a patient arranged in the region of the pivot axis 6 recorded as image data and temporarily stored together with the respective angular positions.

Such operating methods and X-ray systems 1 are well known. By means of the recorded projections, as a rule, a three-dimensional reconstruction of the examination object takes place, for example. B. an internal organ of the patient 6 ,

The x-ray arrangement is used to record the projections 2 usually pivoted by a pivoting angle of more than 180 °. The pivot angle is for example between 195 ° and 220 °. If the three-dimensional reconstruction of the examination subject is to be determined according to the field-camp-on algorithm which is well known to those skilled in the art, the minimum size of the pivoting angle is 180 ° + β. The angle β is the detection angle of the X-ray detector 4 ,

In an x-ray system 2 In the form of a CT systems, the pivoting of the X-ray arrangement takes place 2 quite fast. Thus, for example, pivoting speeds are achievable in which the X-ray arrangement is pivoted for only 0.1 to 0.2 seconds to the required pivoting angle.

In an x-ray system 2 in contrast, in the form of an angiography system and a C-arm X-ray system, the time required to cover the required pivoting angle is well above one second. Swing times between a few seconds (eg 10 seconds) and a minute and more are typical. The above operating methods are therefore used in these X-ray devices usually only for the detection of projections of static structures. Examples of such static structures are the human brain and the blood vessel system of the brain.

For ventilation of an anesthetized patient 6 are from the state of the art ventilators 7 known from the outside the respiratory tract of the patient 6 Supply air or oxygen. Anesthesia can be both general anesthesia and conscious anesthesia. According to the present invention is a control device 8th for respirator 7 provided that an interface 10 for detecting the operating state of the X-ray system 1 includes as well as a control logic 9 to interrupt the ventilation of the patient 6 during an operating condition for recording X-ray image data 1 , The control device 8th can both in the ventilator 7 be integrated or - as in the illustrated embodiment - be designed as a separate device.

It can be a combination of a ventilator 7 and another separate anesthesia machine. This is especially true for anesthesia with anesthetic gases added by a separate anesthetic machine.

The control device 8th can change the operating status of the X-ray system 1 for example, by a query of the X-ray control 4 to capture. Alternatively, the control device sends 8th Active a start signal to the X-ray system 1 which then carry out the X-ray examination of the patient 6 starts. In this way it is avoided that the operating state of the X-ray machine 1 detected too late and the ventilation is not interrupted in time before the examination begins.

In this embodiment, the control device 8th also set up an injector 11 to control the patient 6 a contrast agent injected. This contrast agent is due to the X-ray system 1 to recognize generated images particularly clearly. The control device 8th controls the injection of the contrast agent as a function of the recording of the image data by the X-ray system 1 , Due to the joint control of both the interruption of ventilation and the injection of contrast medium, these steps of the examination procedure can be particularly well timed to each other.

• 1. der Patienten 6 wird auf einer Patientenliege 12 der C-Bogen-Röntgenanlage 1 positioniert;
• 2. Eine Vollnarkose des Patienten 6 wird eingeleitet;
• 3. Die Beatmung des Patienten 6 mithilfe des Beatmungsgeräts 7 wird gestartet;
• 4. der automatischen Untersuchungsprozedur wird an der Steuervorrichtung 8 ausgelöst;
• 5. die Steuervorrichtung 8 steuert das Beatmungsgerät 7 so, dass die Beatmung unterbrochen wird;
• 6. die Steuervorrichtung 8 sendet über Ihre Schnittstelle 10 ein Startsignal an die Röntgensteuerung 5 der C-Bogen-Anlage 1;
• 7. die C-Bogen-Anlage verschwenkt die Röntgenanordnung 2 mit einem Verschwenkwinkel 270° in 20 Sekunden um den Patienten 6, während der Röntgenstrahlungsdetektor 4 von der Röntgenstrahlungsquelle 3 auf den Patienten 6 projizierte Röntgenstrahlen detektiert und als Bilddaten erfasst;
• 8. die Steuervorrichtung 8 steuert das Beatmungsgerät 7 so, dass die Beatmung wieder fortgesetzt wird;
• 9. die Steuervorrichtung 8 steuert den Injektor 11 so, dass die Injektion des Kontrastmittels gestartet wird;
• 10. die Steuervorrichtung 8 steuert das Beatmungsgerät 7 so, dass die Beatmung erneut unterbrochen wird;
• 11. die Steuervorrichtung 8 sendet über Ihre Schnittstelle 10 ein weiteres Startsignal an die Röntgensteuerung 5 der C-Bogen-Anlage 1;
• 12. die C-Bogen-Anlage verschwenkt die Röntgenanordnung 2 mit einem Verschwenkwinkel 270° in 20 Sekunden in die entgegengesetzte Verschwenkrichtung um den Patienten 6, während erneut Bilddaten des Patienten 6 erfasst werden – diesmal mit injizierten Kontrastmittel;
• 13. die Steuervorrichtung 8 steuert das Beatmungsgerät 7 so, dass die Beatmung wieder fortgesetzt wird;
• 14. die Untersuchung ist abgeschlossen und die Narkose wird beendet.

The following is an example of an X-ray examination using an X-ray machine in the form of a C-arm X-ray machine 1 where:

• 1. the patient 6 is on a patient couch 12 the C-arm X-ray system 1 positioned;
• 2. General anesthesia of the patient 6 Is initiated;
• 3. The ventilation of the patient 6 using the ventilator 7 is started;
• 4. the automatic examination procedure is at the control device 8th triggered;
• 5. the control device 8th controls the ventilator 7 so that the ventilation is interrupted;
• 6. the control device 8th sends over your interface 10 a start signal to the x-ray controller 5 the C-arm system 1 ;
• 7. The C-arm system pivots the X-ray arrangement 2 with a 270 ° swivel angle in 20 seconds around the patient 6 while the X-ray detector 4 from the X-ray source 3 on the patient 6 projected X-rays are detected and detected as image data;
• 8. the control device 8th controls the ventilator 7 so that the ventilation is resumed;
• 9. the control device 8th controls the injector 11 such that the injection of the contrast agent is started;
• 10. the control device 8th controls the ventilator 7 so that the ventilation is interrupted again;
• 11. the control device 8th sends over your interface 10 another start signal to the X-ray control 5 the C-arm system 1 ;
• 12. The C-arm system pivots the X-ray arrangement 2 with a pivoting angle 270 ° in 20 seconds in the opposite direction of pivoting around the patient 6 while re-image data of the patient 6 be detected - this time with injected contrast agent;
• 13. the control device 8th controls the ventilator 7 so that the ventilation is resumed;
• 14. The examination is completed and the anesthesia is terminated.

The Injection of the contrast agent is done so that the contrast agent in the second image data recording in sufficient quantity in is distributed to the examination object. For this purpose, the injection is possibly during the Recording of the image data continued.

The control device 8th is connected to a display device, on which the interruption of ventilation for the information of the medical staff is displayed. This information is for the medical supervision of the examined patient 6 very important. In this embodiment, the time interval becomes 14 the interruption of ventilation graphically displayed.

In addition, a patient monitor 15 for monitoring physiological measurements of the patient 6 provided on the patient 6 arranged physiological sensor 16 be recorded. The medical staff can read the readings from a reading 17 read off. The measured and displayed physiological values include pulse, blood pressure and the respiratory interruption-relevant oxygen partial pressure in the blood of the patient 6 , Such patient monitors are known per se in the art.

The patient monitor 15 transmits the physiological measured values to the control device 8th whose control logic overrides the interruption of ventilation depending on the physiological values. This control, based on current readings, can quickly and reliably reduce the risk of patient health hazards 6 be reduced by too long interruption of ventilation. The oxygen partial pressure for this control a particularly meaningful measure.

If the medical resuscitation resumes automatically, the controller sends 8th simultaneously an abort signal to the X-ray system 1 which then stops the imaging examination. This will result in unnecessary radiation exposure to the patient 6 avoided.

The at least one physiological measurement used to control ventilation need not necessarily be provided by a patient monitor 15 can also be detected directly from the sensor 16 to the control device 8th be transmitted.

In the illustrated embodiment, the time course of the oxygen partial pressure in the form of a graphical curve 18 through the display device 13 displayed. The display of the curve 18 takes place in direct connection with the presentation of the interval 14 the respiratory interruption, so that the medical staff the temporal context can be understood quickly.

Advantageously, the invention finds use in relation to an angiographic and / or cardiac X-ray equipment such as the illustrated C-arm X-ray system 1 , However, the invention can also be used in other X-ray systems, in sonographic systems, in a CT or MR system and in a radiation therapy system.

In addition to merely interrupting the ventilation, additional ventilation parameters may additionally depend on the operating state of the medical system 1 be taxed. By specifically increasing the respiratory rate and / or the respiratory volume before the interruption of ventilation, the oxygen content in the blood of the patient 6 increases and thereby the interval 14 the ventilation interruption be extended.

By means of an editing function, furthermore, the temporal course of the ventilation parameters can be dependent on the operating state of the medical system 1 be varied. As a result, z. B. the start of interruption and the end of the interruption are adjusted, for. B. by setting an additional interruption interval before and / or after the investigation. In addition, a hysteresis for the ventilation process can be defined.

At least one embodiment of the invention can thus be summarized as follows: The ventilation of a patient under general anesthesia 6 gets through a respirator 7 depending on a detected operating state of a medical system 1 automatically interrupted for the duration of a diagnostic or therapeutic examination. The medical system can be both an imaging system 1 as well as a radiation therapy facility. In the case of an imaging system 1 Ventilation is interrupted during acquisition of image data. By the invention, the ventilation is reliably interrupted chen exactly for the duration of the investigation. The medical staff will be relieved in this way in the investigation.

Claims (21)

Method for controlling a ventilator ( 7 ) for ventilating a patient ( 6 ) during an examination with a medical system ( 1 ), comprising the following steps: - ventilation of the patient ( 6 ) using the ventilator ( 7 ), - detecting the operating state of the medical system ( 1 ), - automatic interruption of the ventilation of the patient ( 6 ) depending on the operating state of the medical system ( 1 ). Process according to claim 1, with the following further Step: - Show the interruption of ventilation. Method according to Claim 1 or 2, with the following further step: sending a start signal to the medical system ( 1 ) to start the examination at the beginning of the interruption of ventilation. Method according to one of claims 1-3, with the following further step: - detecting at least one physiological value of the patient ( 6 ), in particular by means of a patent monitor ( 15 ), whereby the interruption of ventilation is canceled depending on the physiological value. The method of claim 4, wherein the physiological value is an oxygen partial pressure of the patient ( 6 ). Method according to Claim 4 or 5, with the following further step: sending an abort signal to the medical system ( 1 ) to discontinue the examination if the interruption of ventilation ceases. The method of any one of claims 1-6, wherein the medical system comprises an imaging system ( 1 ), the examination comprises a recording of image data and the ventilation during an operating state for recording image data with the imaging system ( 1 ) is interrupted. Method according to claim 7 applied to an imaging system in the form of an angiographic and / or cardiac X-ray system ( 1 ). Method according to Claim 7 or 8, with the following further step: controlling an injector ( 11 ) for injecting a contrast agent in response to the recording of the image data. Method according to one of claims 1-6, wherein the medical system is a radiation therapy system, the examination of a radiation of the patient ( 6 ) and the ventilation is interrupted during the irradiation. Control device ( 8th ) for a ventilator ( 7 ) for ventilating a patient ( 6 ) during an examination with a medical system ( 1 ) - with an interface ( 10 ) for detecting the operating state of the medical system ( 1 ) and - with a control logic ( 9 ) for automatically interrupting the ventilation of the patient ( 6 ) depending on the operating state of the medical system ( 1 ). Control device ( 8th ) according to claim 11 with a display means ( 13 ) for visual or audible indication of the interruption of ventilation. Control device ( 8th ) according to claim 11 or 12, wherein the control logic ( 9 ) for sending a start signal to the medical system ( 1 ) is set up for starting examination at the beginning of the interruption of ventilation. Control device ( 8th ) according to any one of claims 11-12, wherein the control logic ( 9 ) for detecting at least one physiological value of the patient ( 6 ) and is set to cancel the interruption of ventilation depending on the physiological value. Control device ( 8th ) according to claim 14 with an interface to a patient monitor ( 15 ) for detecting the physiological value. Control device ( 8th ) according to claim 14 or 15, wherein the physiological value is an oxygen partial pressure of the patient ( 6 ). Control device ( 8th ) according to any one of claims 14-16, wherein the control logic ( 9 ) for sending an abort signal to the medical system ( 1 ) is set to terminate the examination when the suspension of ventilation is canceled. Control device ( 8th ) according to any of claims 11-17, wherein the medical system comprises an imaging system ( 1 ), the examination comprises a recording of image data and the control logic ( 9 ) for interrupting ventilation during an operating state for recording image data with the imaging system ( 1 ) is trained. Control device ( 8th ) according to claim 18, arranged for controlling an imaging system ( 1 ) in the form of an angiographic and / or cardiac X-ray system ( 1 ). Control device ( 8th ) according to claim 18 or 19, wherein the control logic ( 9 ) for controlling an injector ( 11 ) is arranged for injection of a contrast agent in response to the recording of the image data. Medical system ( 1 ) with a control device ( 8th ) according to any of claims 11-20.