JP2003284716A - Radiation diagnostic device and insertion body for therapy - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a radiation diagnostic device which makes catheter insertion operation under radiography simple and easy, and sharply simplifies the operation, with improved throughput of a patient, and catheter top end part tracing function. <P>SOLUTION: The X ray diagnostic device comprises a movable examination table 10 on which, an examinee P is laid; a means (18) composed of a radiographic system having an X ray source 12 and a detector 14, constructed so as to detect the X ray transmitted through the examinee P by the detector 14; a supporting mechanism 6 supporting the radiographic system capable of changing the relative position of the radiographic system and the examinee; a means (18) generating an image of the examinee in which, the distal end part of the catheter 22, having a marker against the X ray, is recognizable, depending on the collection signal of the detector 14; an a means (18) making the supporting mechanism 16 and/or the table (10) move and trace in compliance with the position of the top end part of the catheter 22 in the above image. <P>COPYRIGHT: (C)2004,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a radiation diagnostic apparatus such as an X-ray diagnostic apparatus, and particularly to inserting a hand tool such as a catheter or a biopsy puncture needle into a subject when treating or diagnosing the inside of a blood vessel. TECHNICAL FIELD The present invention relates to a radiation diagnostic apparatus suitable for surgery and medical treatment.

[0002]

2. Description of the Related Art In recent years, when diagnosing or treating the inside of a blood vessel, the work of inserting a catheter into the blood vessel under fluoroscopy by an X-ray diagnostic apparatus has been increasing. This is for inserting a catheter, injecting an X-ray contrast medium, or for treatment with a coil or a stent.

An operator such as a doctor must carefully insert a catheter along a blood vessel while observing an X-ray fluoroscopic image. As the insertion of the catheter progresses, the position of the tip of the catheter on the X-ray fluoroscopic image gradually moves and shifts from the center of the fluoroscopic image. Therefore, in order to maintain the central portion of the catheter where the image can be easily seen, the operator manually operates the switch or the like to mount the holding device or the subject holding the X-ray source and the X-ray detector. The position of the top plate of the bed is moved, and the position is corrected so that the part irradiated with X-rays matches the current catheter tip. As a result, the tip of the catheter comes to be located at the center of the fluoroscopic image.

During the insertion of the catheter, it is often necessary to check the structure of the blood vessel and the surrounding condition where the distal end of the catheter is placed. In this case also, the operator
Through the manual operation, move the holding device or bed top to a position where the insertion direction of the catheter and the surrounding condition of the tip can be understood,
The structure and situation are confirmed from the fluoroscopic images at various angles obtained at this position.

However, in any case, the correction (control) of the positions of the holding device and the bed top as described above requires the operator to manually operate while looking at the see-through screen, and the operation is cumbersome, and the operator is troublesome. There was a problem in that it imposes an operational burden on the. As a result, it has been difficult for doctors to concentrate on treatment and diagnosis. Further, since such an operation requires time and labor, there is a problem that diagnosis and treatment time is prolonged and patient throughput is low.

On the other hand, in the past, Japanese Patent Laid-Open No. 7-19461
The method described in Japanese Patent No. 6 has been proposed. The technique described in this publication has, as one aspect thereof, a bed on which a subject is mounted and which has a movable top, an X-ray tomographic imaging apparatus that obtains a tomographic image of the subject, and the bed is inserted into the subject. A surgical assistance system including an insert such as a catheter, wherein the X-ray tomography apparatus has a scan for scanning a subject while changing a slice width and a slice position. As a result, the X-ray tomographic imaging apparatus moves the tabletop in its longitudinal direction,
The tip of the insert can be traced on the image.

[0007]

However, according to the technique described in the above publication, the only object to be moved when the tip of the insert is tracked is the table top of the bed and the collimator for changing the slice width and slice position. Since the moving direction of tracking is limited to the longitudinal direction of the top plate, that is, the slice direction, the tracking ability of the tip of the insert (catheter or the like) that exhibits three-dimensional movement within the subject, that is, The ability to visualize the tip on the image is low.

Moreover, in the case of the technique described in this publication, no attention is paid to measures for confirming the above-mentioned structure of the blood vessel and the surrounding condition where the distal end portion of the catheter is placed. Even when the system described in the official gazette is used, confirmation during insertion work must be based on manual operation by the operator.

The present invention has been made in order to overcome such a situation, and the insertion work of an insertion body such as a catheter under radioscopy can be performed more easily and easily. It is an object of the present invention to provide a radiation diagnostic apparatus capable of significantly reducing the operation and improving the patient throughput, and significantly improving the tracking ability of the distal end portion of the insert.

In order to achieve the above-mentioned object, the present invention also provides a therapeutic insert having a structure for tracking the distal end portion, which is not present in the insert itself, as another object. And

[0011]

In order to achieve the above object, according to the radiation diagnostic apparatus of the present invention, a movable bed on which a subject is placed, a radiation source for radiating radiation, and detection for detecting radiation. Between the imaging system and the object, and an imaging system configured to detect the radiation, which is exposed from the radiation source and has passed through the object, by the detector. A marker for the radiation is added to the tip and inserted into the subject based on the signal detected by the supporting unit that supports the imaging system so that the positional relationship can be relatively changed. Image generating means for generating an image of the subject capable of recognizing the distal end portion of the insert body, and the supporting means and the supporting means according to the position of the distal end portion of the insert body on the image generated by the image generating means. The above Characterized by comprising a movement control means for moving track at least one platform.

As a result, even if the tip of the insertion body such as a catheter moves three-dimensionally, the moving means and / or the bed are automatically tracked and moved according to this movement, so that the tip is complicated. Tracking movements that deal with movements become possible. Therefore, the insertion work of the insertion body such as a catheter under fluoroscopy can be performed more easily and easily, thereby significantly reducing the operation and improving the patient throughput, and the distal end portion of the insertion body. You can greatly improve your tracking ability.

Further, as a preferable mode based on the above-mentioned structure, the following structure can be adopted. For example, the movement control means is a means for controlling the movement of at least one of the support means and the bed so that the position of the distal end portion of the insertion body is always located at the center of a predetermined range on the image. You may comprise.

The movement control means may include a direction analysis means for analyzing the movement direction of the distal end portion of the insert from the image generated by the image generation means.

Further, there may be provided angling means for angling the supporting means so as to scan from a plurality of perspective angles centered on the position of the distal end portion of the insert.

On the other hand, according to the therapeutic insert of the present invention, a marker for radiation is added to the distal end portion, and the shape of this marker has a shape capable of recognizing the direction of movement of the distal end portion. It is characterized by that. As a result, it is possible to provide an insertion body that has not been available in the past, in which the marker itself has directional information.

[0017]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the radiation diagnostic apparatus of the present invention will be described below with reference to the accompanying drawings. In this embodiment, a mode in which the radiation diagnostic apparatus is an X-ray diagnostic apparatus will be described.

First, FIG. 1 shows a schematic overall configuration of the X-ray diagnostic apparatus of this embodiment.

This X-ray tomography apparatus comprises a bed 10, a high voltage generator 11, an X-ray tube 12, an X-ray detector 14, a support mechanism 16 as a support means, and a controller 18.
An input device 19, a display device 20, and an operation device 21 are connected to the control device 18 so that signals can be transmitted and received.

The bed 10 is provided with a top plate 10a which is slidable in its longitudinal direction. This top plate 10a is a control device 1
It is possible to change the slide position in response to a control signal from 8. The subject P is usually laid on his back on the top 10a, and in this state, X-ray irradiation is performed.

The support mechanism 16 is of a floor-standing type, and has a column portion 16a standing on the floor and the column portion 16a.
It has a C-shaped arm 16b which is three-dimensionally swingably supported by a drive mechanism 16c with respect to a. Drive mechanism 1
A control signal is sent from the control device 18 to 6c, and the drive mechanism 16c operates in response to this control signal. As a result,
Only the C-shaped arm 16b can move three-dimensionally.

The X-ray tube 1 is provided on both ends of the C-arm 16b.
2 and the X-ray detector 14 are arranged so as to face each other.
Therefore, when the C-shaped arm 16b is positioned so as to sandwich the subject P on the bed 10, the X-rays emitted from the X-ray tube 12 are emitted.
The rays can pass through the subject P and enter the X-ray detector 14.

The support mechanism 16 does not necessarily have to be a floor-standing type, but may have a structure in which it is suspended from the ceiling and the C-shaped arm 16b thereof can move three-dimensionally. Further, the shape of the C-shaped arm 16b does not necessarily have to be C-shaped, and may have another shape.

The X-ray tube 12 is connected to a high-voltage generator for generating a high voltage for exposure, and X-rays toward the subject P.
It functions as a radiation source that irradiates rays. X-ray detector 14
Functions as a detector for detecting X-rays. Control device 18
Has components necessary for control and processing such as a memory and a CPU, and is responsible for controlling the overall operation of the X-ray diagnostic apparatus and processing collected data.

The input device 19 is used by the operator to give necessary information and commands to the apparatus. The display 20 displays an X-ray image and an X-ray fluoroscopic image taken by this device.
Further, the operating device 21 is used by an operator to manually move the position of the support mechanism 16 and / or the top 10a of the bed 10.

According to the present embodiment, an operator such as a doctor inserts the catheter 22 into, for example, a blood vessel of the subject P under fluoroscopy by the X-ray diagnostic apparatus and inputs a contrast agent. Various treatments can be performed. Catheter 22
Functions as an insert that is inserted into the subject. In addition to this, the insert may be, for example, a biopsy puncture needle or a linear surgical instrument.

The tip portion 22a of the catheter 22 is shown in FIG.
As shown in (a) to (c), a marker 24 is provided. The tip portion 22a indicates a range having a predetermined dimension from the tip, where the marker 24 is provided.

For the marker 24, a material having a higher X-ray absorptivity than that of the subject P, such as flaky lead, is used. Marker 2
4 is processed into a shape having directionality so that the direction of the distal end portion of the catheter 22 can be recognized, and is attached or embedded on the surface of the distal end portion.

The marker 24 shown in FIG. 2 (a) is composed of a plurality of marker pieces 24a forming a long triangle, and the plurality of marker pieces 24a are separated from each other and become thinner from the catheter proximal side toward the distal side. Is provided. Further, the marker 24 shown in FIG. 6B is composed of a plurality of ring-shaped marker pieces 24b, and the plurality of marker pieces 24b are separated from each other in the catheter axial direction and are hung from the catheter proximal side to the distal side. It is provided so that the width of the piece 24b is narrow. Further, the marker 24 shown in FIG. 7C is composed of a plurality of ring marker pieces 24c and 24d, and the plurality of marker pieces 24c and 24d are provided so as to be separated from each other in the catheter axial direction. Materials having different X-ray absorptivities are used for the plurality of marker pieces 24c and 24d.

Next, the operation of image processing and control of the X-ray diagnostic apparatus according to this embodiment will be described with reference to a catheter operation performed under fluoroscopy.

The control device 18 executes the processing according to the control flow roughly shown in FIG. At the time of starting the insertion of the catheter 22 into the subject P, the control device 18 responds to a manual instruction from the operator, for example, the C-shaped arm 16b and the top plate 10a.
Command the initial position of (step S1).

This initial position is manually designated by the operator using, for example, the operating unit 21 so that the starting position of the catheter 22 is reflected in the central portion of the fluoroscopic image displayed on the display unit 20. Since the three-dimensional positions of the C-shaped arm 16b and the top plate 10a are controlled in response to the command of the initial position, the distal end portion (the portion of the marker 24) of the catheter 22 should be positioned at the center of the fluoroscopic image. Catheter 22
Is reflected in the perspective image. Also, this initial position command may be automatically issued.

The central portion of the fluoroscopic image displaying the distal end portion of the catheter 22 may be the position of the central coordinates of the image itself, or a range within a predetermined diameter centered on the central position. Alternatively, the position or range may be shifted to some extent from the central position.

Then, the controller 18 determines the X-ray transmission image data (including the image data of the shape of the marker 24) detected by the X-ray detector 14, the physical information such as the X-ray absorption rate of the marker 24, and the size. The current two-dimensional positions of a plurality of marker pieces forming the marker 24 are extracted for each sampling time (step S2). The coordinates (X,
Y) is obtained by, for example, thresholding the image data on the perspective image.

Next, the control device 18 determines whether or not there is a direction component of the catheter tip portion 22a also in the depth (front) direction perpendicular to the fluoroscopic image (step S3). For example, when the markers 24 have the arrangement shown in FIG. 2A, this determination is made based on information such as the thickness of the marker pieces by calculating the direction vector orthogonal to the row of the marker pieces. Further, for example, in the case where the markers 24 are arranged as shown in FIG. 2B, the interval between the marker pieces appears so that the catheter tip 22a has a directional component directed in the depth direction (or the front direction) of the fluoroscopic image. You can judge whether or not. An example of the concept of this analysis is shown in FIG. When the distance between the marker pieces of the marker 24 in the real space is A, but the distance between the marker pieces reflected in the perspective image is B, in the case of the example of FIG. 4, θ = cos−1 (B / Since the relationship of A) is established, θ indicating that there is a moving direction component in the depth direction (or the front direction) is obtained from this relational expression. In addition, the marker 24
2C has the arrangement shown in FIG. 2C, the catheter tip 22a is oriented in the depth direction (or the front direction) of the fluoroscopic image due to the difference in the size of the two pieces of the marker having the same size. It can be determined whether or not it has a directional component.

When it is determined by this determination that there is no directional component of the catheter tip 22a in the depth (front) direction perpendicular to the fluoroscopic image (step S3, YES: see FIG. 5), the control device 18 performs the above-mentioned operation. The two-dimensional position of each of the plurality of marker pieces forming the marker 24 obtained as described above is developed on the two-dimensional coordinates, the direction between the plurality of marker pieces (that is, the direction of the tip portion 22a) is analyzed, and the tip portion 22a is analyzed. The amount of movement on the image is analyzed as a difference value from the position information at the time of the previous sampling (step S4). At this time, simply, assuming that the actual distance between the plurality of marker pieces is Xcm, the moving distance and the moving direction may be obtained from the position information of the marker pieces reflected on the image. In addition, the magnifying power of the perspective image can be used for calculating the moving distance and the moving direction.

On the other hand, when it is determined in the above-described step S3 that the direction component of the catheter tip portion 22a is also present in the depth (front) direction perpendicular to the fluoroscopic image (step S3, YES: see FIG. 6). The control device 18 develops the two-dimensional positions of each of the plurality of marker pieces forming the marker 24 on the two-dimensional coordinates, and the developed information and the tip portion 22a.
Based on the information indicating the movement component in the depth (front) direction, the direction of the tip 22a and the amount of movement on the image are analyzed (step S5).

When the moving direction of the tip portion 22a and the moving amount on the image are obtained in this way, the control device 18 then
The amount of movement on the image is converted into the amount of movement in the actual space (step 6).

After this, the control device 18 sets the drive direction 16c of the C-shaped arm 16b and / or the top board 1 of the bed 10 using the moving direction and the actual moving amount obtained as described above as the target values.
0a to execute the movement control (step S
7).

As a result, from the state where the catheter 22 is at a certain position in the blood vessel B as shown in FIG. 7 (a), as shown in FIG. 7 (b), it is + α mm in the longitudinal direction of the subject and in the lateral direction. When moved by + β mm, the C-shaped arm 16b and / or the C-shaped arm 16b and / or the catheter tip end 22a of the destination are located in the center of the fluoroscopic image and the movement direction vector of the catheter tip end 22a and the front surface of the detection system are parallel. Alternatively, the three-dimensional position of the top plate 10a is automatically tracked and controlled. Since the catheter 22 is gradually inserted by the operator, the position of the C-arm 16b and / or the top plate 10a is controlled so as to be tracked almost in real time as the position of the catheter tip 22a advances.

In particular, as shown schematically in FIG. 8, assuming that the insertion of the catheter 22 does not stop within a certain plane but moves three-dimensionally so as to protrude from that plane, the horizontal direction (constant The C-shaped arm 16 and / or the top plate 10a cooperate to cope with the movement in the plane), and control including the operation of tilting the C-shaped arm for the movement in the oblique direction protruding from the certain plane. I can deal with it.

Further, the control device 18 issues a confirmation command for confirming the blood vessel structure in the vicinity of the catheter tip portion 22a, for example, via the operating device 21, during the tracking control for the insertion of the catheter 22 described above. It is determined whether or not it has been output (step S8). If it is determined that the confirmation command has not been issued by this determination, the process directly returns to the process of step S2 described above, and the tracking control to the catheter tip portion 22a described above at each sampling time is performed.

On the contrary, when it is judged in step S8 that the confirmation command is issued, it is then judged from the command information whether the confirmation motion is the pivot motion or the rotation motion (step S9). ).

When it is confirmed by this determination process that the pivot operation is instructed, the C-arm 16b is angled to various positions around the catheter tip 22a.
As one method, as shown in FIG.
The C-shaped arm 16b is pivotally turned 360 ° around 2a (step S10). The pivot operation of the C-shaped arm 16b is continued until the operator issues a stop command via the operation device 21 (step S11). Therefore, an operator such as a doctor can confirm the blood vessel structure in the vicinity of the catheter tip portion 22a, which is seen through the pivot operation, on an image, and use it as a reference for the subsequent catheter insertion operation.

It is also preferable that the operator can give a command for the radius of the pivot turn together with the command for the 360 ° pivot movement. In this case, the control device 18 receives the pivot radius from the operator in the command process of step S10. Then, in response to this reception, the control device 18 angles the C-arm 16b so that the radius from the catheter tip portion 22a matches the reception value, and controls the pivot operation thereof. This allows for more automated pivoting.

On the other hand, if it is confirmed from the determination processing in step S9 that the rotation operation is instructed, the C-shaped arm 16
Another way to angle b at various positions is shown in FIG.
As shown in, the C-arm 16b is rotated around the rotation center axis of the catheter 22 (step S12). This rotation operation of the C-shaped arm 16b is continued until the operator issues a stop command via the operation device 21 (step S13). For this reason, an operator such as a doctor can see the catheter tip 2 through the rotation.
The blood vessel structure near 2a can be confirmed on the image.

After this confirmation, the process is returned to step S2 again, the above-mentioned tracking control is performed for each sampling time, and the confirmation operation is performed as necessary.

Therefore, according to the X-ray diagnostic apparatus of this embodiment, when the catheter 22 is inserted into the subject P under fluoroscopy, the position of the catheter tip 22a is a fluoroscopic image and C-shaped arm 1 so that it enters the center
The position of 6b and / or the bed top 10a is automatically tracked and controlled. This eliminates the need for the operator to manually operate the holding device or the bed top as in the conventional case, and can concentrate on the insertion operation of the catheter 22 and the treatment. Further, such automation enables the catheter 22 to be inserted efficiently and in a short time, so that the examination time and the treatment time can be shortened.

Skilled techniques are required for catheter insertion, and moreover, fluoroscopic images are obtained from various angles in order to grasp the three-dimensional structure of the blood vessel, and the catheter is guided while confirming the blood vessel structure. I can go. According to the present embodiment, such a confirmation operation does not need to be performed by an operator such as a doctor himself, and only one command to that effect is required. In response to such a command, the fluoroscopic image relating to the confirmation operation (pivot operation or rotation operation) can be automatically observed, and the blood vessel structure near the catheter tip portion 22a can be surely confirmed. As a result, the operability for confirming the blood vessel structure is improved, not only the time for inspection and treatment is shortened, but also unnecessary X-ray irradiation is not required.

The present invention is not limited to the configurations of the embodiments and the modifications thereof, and those skilled in the art can appropriately change or modify the embodiments without departing from the scope of the claims. is there.

For example, in the above-described embodiment, the two-dimensional coordinates of each of a plurality of marker pieces obtained from the fluoroscopic image data and the direction of the tip portion obtained from the degree of deformation of the marker pieces reflected in the fluoroscopic image and the degree of deformation of the interval are Based on the above, the catheter tip was automatically tracked. About this, for example,
2 of each of a plurality of marker pieces obtained from fluoroscopic image data
Another one in the direction perpendicular to the perspective image estimated from the degree of deformation of the marker pieces reflected in the dimensional coordinates and the perspective image and the deformation of the interval.
The catheter tip may be automatically tracked based on the dimensional coordinates, that is, based on the three-dimensional coordinate values.

[0052]

As described above, according to the radiation diagnostic apparatus of the present invention, the insertion work of the insertion body such as the catheter under radioscopy can be performed more easily and easily. Thus, it is possible to significantly reduce the operation and improve the patient throughput, and it is possible to greatly improve the tracking ability of the distal end portion of the insert. Further, according to the therapeutic insert of the present invention, the insert itself can have a structure for tracking the distal end portion, which has not been found in the past.

[Brief description of drawings]

FIG. 1 is a functional block diagram showing a schematic configuration of an embodiment of an X-ray diagnostic apparatus as a radiation diagnostic apparatus according to the present invention.

FIG. 2 is a diagram for explaining the shape of a marker attached to the tip of a catheter used under X-ray fluoroscopy in an X-ray diagnostic apparatus.

FIG. 3 is a flowchart showing a schematic process for tracking control and confirmation operation command executed by a controller of the X-ray diagnostic apparatus.

FIG. 4 is a diagram illustrating an example of a geometrical relationship between an actual distance between marker pieces and a distance on an image.

FIG. 5 is a view for explaining an example of the relationship between the marker at the tip of the catheter and the moving direction.

FIG. 6 is a diagram illustrating another example of the relationship between the marker at the tip of the catheter and the moving direction.

FIG. 7 is a diagram illustrating the position of the distal end portion of a catheter inserted into a blood vessel and the insertion state thereof.

FIG. 8: X-ray source 1 for changes in catheter insertion direction
2 is a diagram illustrating an example of position control of the X-ray tube 14 and the X-ray tube 14.

FIG. 9 is a diagram illustrating a confirmation operation by a pivot operation of a C-shaped arm.

FIG. 10 is a view for explaining a confirmation operation by rotating the C-arm.

[Explanation of symbols]

10 sleeper 10a Top plate 12 X-ray source 14 X-ray detector 16 Support mechanism (holding device) 16b C type arm 16c drive mechanism 18 Control device 19 Input device 20 indicator 21 Operation device

Claims (8)

[Claims] 1. A movable bed on which a subject is placed, and an imaging system having a radiation source that emits radiation and a detector that detects radiation, and the radiation is transmitted from the radiation source to pass through the subject. Imaging means configured to detect the radiation by the detector; support means for supporting the imaging system such that the positional relationship between the imaging system and the subject can be relatively changed, An image for generating an image of the subject in which a marker for the radiation is added to the tip and the tip is recognizable with respect to an insertion body inserted into the subject based on a signal detected by a detector. It is provided with a generation means and a movement control means for tracking and moving at least one of the support means and the bed according to the position of the distal end portion of the insertion body on the image generated by the image generation means. Radiation diagnostic device that. 2. The radiation diagnostic apparatus according to claim 1, wherein the movement control unit is configured to support the insertion body so that the position of the distal end portion of the insertion body is always located at the center of a predetermined range on the image. A radiation diagnostic apparatus which is a means for controlling the movement of at least one of the means and the bed. 3. The radiation diagnostic apparatus according to claim 1, wherein the movement control unit includes a direction analysis unit that analyzes a movement direction of a distal end portion of the insertion body from an image generated by the image generation unit. Diagnostic device. 4. The radiation diagnostic apparatus according to claim 1, further comprising angling means for angling the supporting means so as to scan from a plurality of see-through angles centered on the position of the distal end portion of the insert. Radiation diagnostic equipment. 5. A therapeutic insert characterized in that a marker for radiation is added to the distal end portion, and the shape of this marker has a shape capable of recognizing the direction of movement of the distal end portion. 6. The therapeutic insert according to claim 5, wherein at least the tip portion has a cylindrical shape, while the marker has an outer circumference of the tip portion so as to be orthogonal to an axial direction of the tip portion. A therapeutic insert comprising a plurality of ring-shaped marker pieces which are attached to the portion and are formed with different widths toward one of the axial directions. 7. The therapeutic insert according to claim 6, wherein the plurality of ring-shaped marker pieces are made of a plurality of types of materials having different transmissivities with respect to the radiation. 8. The therapeutic insert according to claim 5, wherein at least the distal end portion has a tubular shape, while the marker is provided on the outer peripheral portion of the distal end portion along the axial direction of the distal end portion. A therapeutic insert, which is a plurality of linear marker pieces that are attached and are formed so as to have different widths in one of the axial directions.