DE102011004641A1 - Medical imaging device of C-arm X-ray system, has imaging unit, and injection system for injecting image recording liquids which are controllable by common manually operated pedal - Google Patents

Abstract

The medical imaging device (1) has an imaging unit (2) comprising a display unit (5) for image display and an injection system (6) for injecting image recording liquids through a catheter (8). The imaging unit and injection system are controllable by a common manually operated pedal (10). The imaging unit and injection system are actuated independently or simultaneously using the switch.

Description

The invention is in the field of medical technology, in particular in the field of interventional radiology, and relates to an imaging medical system.

In interventional radiology, minimally invasive medical or therapeutic interventions are performed under image control. Some of these interventions serve purely diagnostic purposes (for example, angiograms) while others serve treatment purposes (for example, angioplasty). Today image control units such as computed tomography, magnetic resonance tomography, angiography or ultrasound systems are commonly used for image control. X-ray angiography is the preferred method for therapeutic purposes. This method has the advantage that with the C-arm devices often used for this purpose, a particularly good access to the patient is given.

During an interventional (radiological) examination, a radiographic image of a vascular structure, such as the lumen of a vessel or atrium, is obtained by injecting (radiographic) contrast material through a catheter into an artery or vein. Subsequently, the corresponding body region in which the contrast material was injected is X-rayed. The x-rays are absorbed by the contrast material, thereby producing a radiographic demolition or image of the contrast material-containing lumen. This serves both to assist the navigation of the materials used (for example, a guide wire, guide catheter, balloons, stents, etc.) and the assessment of the lumen with regard to clinically relevant and therefore treatable defects (for example, vasoconstriction).

The contrast material is injected either manually via a syringe (with hand-held dose per unit time) from an interventionalist or semi-automatically via an injector (at a preset dose per unit time). Both methods have the disadvantage of distracting an examiner from the actual exam by having to either set (set), monitor, and trigger the automatic injection, or have and release a hand to initiate the semi-automatic or manual injection. During an examination, however, the interventionalist should have both hands free so that the materials can be placed (requires one to two hands) and, if necessary, the contrast material flow can be followed with the examination table (requires a hand to release the table brake)

Fundamental to a good reproducibility and a high quality of the examination or the intervention is the temporal coordination, that is the timing, of the contrast material injection and the start of the measurements with the radiographic examination device. The contrast material should always be given at the same time as X-radiation, which is either low-dose (fluoroscopy) or higher-dose (angiography). In most cases, the examination device is actuated by a switch from the interventionalist and the injection is started at the time of actuation by calling an assistant. This requires additional manpower, which increases staff costs and is not available in every catheter lab.

The invention has for its object to provide a medical image recording device, which improves in terms of temporal coordination between an injection of the image recording supportive fluids and the start of image acquisition and in particular is less labor intensive.

This object is achieved by the features of claim 1. Advantageous embodiments and further developments are the subject of the dependent claims.

For this purpose, the image recording device comprises an imaging unit with a display unit for image display, and an injection system for injecting liquids that support the image recording. The imaging unit on the one hand and the injection system on the other hand can be controlled by a jointly manually operable switch. This makes it possible to operate the image recording device by a single person, in particular an interventionalist. Assistants injecting the image-receiving fluids on demand are not required. This advantageously reduces personnel costs and improves the reproducibility and quality of image acquisition.

In an expedient embodiment, the imaging unit is, in particular, a C-arm X-ray system for X-ray angiography and the liquids which assist the image acquisition, in particular a contrast agent. During the examination, for example, the contrast agent delivery is controlled simultaneously with the triggering of the radiation (in fluoroscopy or angiography mode) via the common switch. The coupling of radiation and contrast agent administration is not a problem insofar as contrast administration makes sense only under fluoroscopy or angiography.

In an advantageous embodiment, the common switch of imaging unit and Injection system a footswitch. As a result, a particularly simple handling of the image recording device is possible. Furthermore, the contrast agent can be injected by the interventionalist without the need for a hand.

In a suitable continuation of the switch is formed in several stages with different switching stages. Each such switching stage controls either only the imaging unit or only the injection system or the imaging unit and the injection system together.

In an advantageous embodiment, the different switching stages of the foot switch are realized for example by different pressure points. In particular, in one embodiment as a treadle or as a foot pedal so different examination steps can be successively triggered upon actuation of the footswitch.

In an advantageous embodiment, only the imaging unit is actuated in a first stage of the foot switch and the imaging unit on the one hand and the injection system on the other hand actuated simultaneously or in a timely manner in a second stage. For example, a foot pedal has two stages or pressure points. The first stage alone triggers radiation (fluoroscopy), the second stage triggers radiation and a contrast medium (angiography). The steps are preferably separated by a mechanical resistance, which must first be overcome for the contrast agent by a stronger pressure with the foot.

In an equally preferred embodiment, movement of the imaging unit is controllable by the switch. This is desirable, for example, in rotational angiographies (rotation of the C-arm about the ISO center under continuous radiation) for taking 3-D image data. For this purpose, the first stage may be occupied with fluoroscopy and optional contrast agent administration, and the second stage may be used to initiate rotational angiography with further addition of contrast agent. This has the advantage that the interventionalist recognizes during actuation of the first switching stage, as soon as the vessels are filled with contrast agent and then can start the rotational angiography with the second switching stage. It is also conceivable, however, that - for example, in a computer tomograph as an imager - an examination table, on which the patient lies, is moved when the switch is actuated in the computed tomography system.

In an advantageous continuation, different pulse / frame rates of the imaging unit for fluoroscopy and angiography can be set and controlled by the switch positions of the footswitch. Thus, for example, in digital subtraction angiography (DSA) imaging (with and without stepping), the first switching stage may be configured at a low frame rate. As a result, a patient is advantageously only exposed to a lower radiation dose. Such a low-dose program can be used by the interventionalist, for example, for orientation in the vessel section or for positioning the body region to be examined in the image recording area of the system. The second stage is occupied by a DSA program in combination with contrast agent administration. In this way it is possible for the interventionalist to perform the orientation of the examined region and the subsequent DSA recording with just one foot pedal.

In a preferred embodiment, the injection system is actuated via the switch such that upon actuation a preset dose of contrast agent per unit time is injected into the body of the patient. The amount and the mixing ratio of the respective administration of contrast agent can thus be prepared according to the preferences of the interventionalist before starting the examination. This leads to an advantageous time saving during the examination as well as to a reduction of distractions of the interventionist from the examination. Furthermore, the semiautomatic injection allows a uniform flow of contrast medium in the image result, which ensures good reproducibility and high recording quality.

In an expedient embodiment, data and / or signals, in particular status data, can be transmitted from the imaging unit to the injection system. Preferably, the injection system is designed such that the injection of contrast agent in dependence on the received data and / or signals is controllable. In a suitable embodiment, the contrast agent delivery is coupled directly to the recording program, so that the imaging program of the imaging unit controls the amount of contrast agent. As a result, a particularly simple handling of the image recording device is ensured since a further operating step on the injection system is dispensed with by the coupling of the adjustment of the contrast agent quantity / of the contrast medium mixing ratio to the recording program.

Embodiments of the invention will be explained in more detail with reference to FIGS. Show:

1 in a schematically simplified representation of the image recording device according to the invention with a foot pedal and a patient, and

2 in a schematic representation of the operation of the foot pedal with different stage assignments.

Corresponding parts and sizes are always provided with the same reference numerals in all figures.

1 shows greatly simplified the structure and operation of an image pickup device 1 by way of example with a C-arm X-ray system 2 X-ray angiography of a patient to be examined 3 , The patient 3 lies on a surgical table during a radiological examination or during an interventional procedure 4 , The C-arm X-ray system 2 is signal-wise with a monitor 5 and an injector 6 coupled. The display 5 The image display is used by the C-arm X-ray system 2 recorded examination data. These are from a recording program of the C-arm X-ray system 2 image data 7A to the monitor 5 for image display and status data 7B for controlling the injector 6 Posted.

With the injector 6 is controlled by a liquid substance via a catheter 8th in the body of the patient 3 injected, preferably a contrast agent 9 to improve the representation of structures and functions on the monitor 5 during the procedure. The injector 6 is semi-automatic, that is, before the start of the examination, the interventionalist will determine the amount and mixing ratio of the contrast agent 8th or the contrast medium is set. During the examination, then, when the injector is triggered 6 this preset dose per unit time in the patient 3 injected, ensuring a continuous and constant flow of contrast agent.

Through the recording program of the C-arm X-ray system 2 is the amount of contrast agent administered during the study by the status data 7B controllable. By coupling the adjustment of the amount of contrast agent / the contrast agent mixture ratio to the recording program eliminates a further step on the injector 6 whereby the interventionalist is less distracted during the examination so he can concentrate better.

The C-arm X-ray system 2 and the injector 6 be with a signal technically coupled with them foot pedal 10 controlled. The foot pedal 10 is a two-stage, manually operated footswitch that allows the interventionalist to examine the patient 3 the image pickup device 1 "From the ankle" can control. As a result, the Interventionalist has both hands free, so that he can easily place materials (for example, a stent) or possibly a table brake with one hand 11 can resolve the contrast flow with the operating table 4 to follow.

The foot pedal 10 includes - as in 2 (left) visible - a pedal rocker 12 that have a hinge 13 to a housing 14 is coupled. The housing 14 is wedge-shaped, with an inclined surface 15 as a base plate for the pedal rocker 12 serves. A lever 16 serves the spring return of the pedal rocker 12 , The foot pedal 10 is with a connection cable 17 to the C-arm X-ray system 2 and the injector 6 connected.

By the spring bearing of the adjusting lever 16 Two pressure points are defined. To operate the foot pedal 10 becomes the upper end of the pedal rocker 12 through the toe of a leg 18 depressed by the interventionalist (indicated by a dashed arrow). This will change the relative angle between the pedal rocker 12 and the inclined surface 15 of the housing 14 diminished until the first pressure point of the control lever 16 achieved ( 2 Center).

The first pressure point corresponds to a first switching stage of the foot pedal 10 , At this stage, a C-arm C-arm signal is activated 19 over the connection cable 17 to the C-arm X-ray system 2 Posted. Through the C-arm signal 19 becomes the image pickup device 1 operated in fluoroscopy mode, that is, the patient 3 is irradiated with radiation alone and an empty shot 7A ' that is a picture without contrast 9 who created examined body region.

With a stronger low pressure of the leg 18 becomes the spring resistance of the control lever 16 overcome and the pedal rocker 12 closer to the case 14 pressed until the second pressure point is reached ( 2 right). This second switching stage triggers the angiography mode of the image recording device 1 out. Here are both the C-arm signal 19 as well as an injector signal 20 to the C-arm X-ray system 2 or the injector 6 Posted. Through the injector signal 20 gets from the injector 6 the preset dose of contrast agent 9 per unit of time over the catheter 8th in the patient 3 injected. At the same time the radiation of the C-arm X-ray system becomes 2 triggered, allowing the flow of contrast in the examined body region on the monitor 5 can be tracked.

In angiography mode, the monitor shows 5 the contrast of the vessels studied with the blood flow and thus provides the combination of morphological information about the filling image and functional information about the arrival and flow of the contrast agent 9 as an expression of hemodynamics.

The empty shot 7A ' The fluoroscopy mode is taken from the image data 7A ' Angiography mode of the C-arm X-ray system 2 subtracted and a DSA recording 21 created. Disturbing picture elements on the two of the picture data 7A ' and 7A ' generated images (eg, bones) are thus on the monitor 5 hidden, whereby the evaluation of the recordings is facilitated.

In such a DSA recording 21 In an alternative embodiment, the switching stages are furthermore assigned different image / pulse rates for the fluoroscopy or angiography mode. This is done with the C-arm signal 19 between a fluoroscopy signal 19A and an angiographic signal 19B distinguished, these sub-signals the corresponding switching stages of the foot pedal 10 assigned. The fluoroscopy signal 19A solves a low pulse / frame rate in the C-arm X-ray system 2 out. The patient 3 Thus, it is burdened only with a low radiation dose, while the interventionalist, for example, the operating table 4 and / or the patient 3 align so that the body region to be examined on the monitor 5 is clearly visible. The angiogram signal 19B then triggers a higher pulse / frame rate, so that the contrast medium flow is particularly good resolution.

In another possible switch occupancy, in particular for rotational angiography, the first stage is occupied by fluoroscopy and contrast agent administration. In the second stage, in addition to another contrast agent is a rotation signal 22 to the C-arm X-ray system 2 Posted. By the rotation signal 22 The C-arm rotates for about 8 seconds over an angle of 180 ° around the patient's ISO center 3 , or the examined body region around. During the rotation, radiation is continuously emitted and detected by the C-arm X-ray system, so that 3-D image data 23 the examined body region on the monitor 5 are evaluable. The diagnostic value of the 3-D data 23 is many times higher than conventional angiography. Further, the 3-D data is advantageous, for example, in planning endovascular treatment of cerebral aneurysms.

The invention is not limited to the embodiments described above. Rather, other variants of the invention can be derived therefrom by the person skilled in the art without departing from the subject matter of the invention. In particular, furthermore, all individual features described in connection with the various exemplary embodiments can also be combined with one another in other ways, without departing from the subject matter of the invention.

Claims (9)

Medical image recording device ( 1 ), with an imaging unit ( 2 ) comprising a display unit ( 5 ) for image display and with an injection system ( 6 ) for injecting image-aiding liquids ( 8th ), wherein the imaging unit ( 2 ) on the one hand and the injection system ( 6 ) on the other hand by a common manually operable switch ( 9 ) are controllable. Image recording device ( 1 ) according to claim 1, wherein the switch ( 9 ) is a footswitch. Image recording device ( 1 ) according to claim 1 or 2, wherein the switch ( 9 ) is formed in several stages with different switching stages, wherein such a switching stage either - only the imaging unit ( 2 ) or - only the injection system ( 6 ) or - the imaging unit ( 2 ) and the injection system ( 6 ) controls together. Image recording device ( 1 ) according to one of claims 1 to 3, wherein the switch ( 9 ) - in a first stage only the imaging unit ( 2 ), and - in a second stage, the imaging unit ( 2 ) on the one hand and the injection system ( 6 ) on the other hand simultaneously or promptly operated. Image recording device ( 1 ) according to one of claims 1 to 4, wherein the switch ( 9 ) a movement of the imaging unit ( 2 ) is controllable. Image recording device ( 1 ) according to one of claims 1 to 5, wherein by the switch ( 9 ) different pulse / frame rates of the imaging unit ( 2 ) are controllable. Image recording device ( 1 ) according to one of claims 1 to 6, wherein the injection system ( 6 ) via the switch ( 9 ) is controlled in such a way that upon actuation a preset dose of liquids ( 8th ) is injectable per unit time. Image recording device ( 1 ) according to one of claims 1 to 7, wherein the imaging unit ( 2 ) Data and / or signals ( 7B ), in particular status data, to the injection system ( 6 ) are transferable. Image recording device ( 1 ) according to one of claims 1 to 8, wherein the injection system ( 6 ) is carried out in such a way that the injection of liquids supporting image acquisition ( 8th ) in Dependence on the received data and / or signals ( 7B ) is controllable.

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