JP2007000226A - Medical image diagnostic apparatus - Google Patents

Medical image diagnostic apparatus Download PDF

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Publication number
JP2007000226A
JP2007000226A JP2005181546A JP2005181546A JP2007000226A JP 2007000226 A JP2007000226 A JP 2007000226A JP 2005181546 A JP2005181546 A JP 2005181546A JP 2005181546 A JP2005181546 A JP 2005181546A JP 2007000226 A JP2007000226 A JP 2007000226A
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Japan
Prior art keywords
puncture needle
image
position
puncture
dimensional
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JP2005181546A
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Japanese (ja)
Inventor
Yasuta Aoyanagi
Takehiro Ema
Hitoshi Yamagata
仁 山形
武博 江馬
康太 青柳
Original Assignee
Toshiba Corp
Toshiba Medical System Co Ltd
Toshiba Medical Systems Corp
東芝メディカルシステムズ株式会社
東芝医用システムエンジニアリング株式会社
株式会社東芝
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Priority to JP2005181546A priority Critical patent/JP2007000226A/en
Publication of JP2007000226A publication Critical patent/JP2007000226A/en
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Abstract

PROBLEM TO BE SOLVED: To provide a medical image diagnostic apparatus that enables an operator to easily determine a correction direction of a puncture needle when a puncture needle is inserted into the target site with reference to an image including the target site. .
A medical image diagnostic apparatus used when a puncture needle is inserted into a target site in a subject, and includes a second image display in the vicinity of the puncture needle in addition to the first image display means 14 of the apparatus body. Means 17 is provided, wherein the second image display means displays a cross-sectional image including the target part perpendicular to the insertion direction of the puncture needle to indicate the relative positional relationship between the target part and the puncture needle.
[Selection] Figure 1

Description

  The present invention relates to a medical image diagnostic apparatus used for displaying a three-dimensional image of a target region in a subject and inserting a puncture needle.

  Currently, among the three major diseases in Japan, the mortality rate due to cancer diseases is the only increase, and there is a social demand to suppress the mortality rate not only by diagnosis but also by treatment. Of these cancer diseases, liver cancer accounts for about 10% and unfortunately is increasing.

  For example, liver cancer can be detected at an early stage by diagnosis using a medical image diagnostic apparatus such as an ultrasonic diagnostic apparatus, MRI, or X-ray CT apparatus.

  On the other hand, liver cancer treatment methods include intrahepatic arterial anticancer drug injection, hepatic artery embolization, minimally invasive treatment, and open surgery. Among them, a minimally invasive treatment method is widely practiced because it is easy to operate and has a low burden on patients.

  The minimally invasive treatment method performs treatment by inserting a puncture needle into a living body, and includes, for example, PEIT (Percutaneous Ethanol Injection Technique) and microwave puncture ablation method. Recently, RFA (Radio-Frequency Ablation), which is one of the puncture ablation methods, has started to attract attention, and clinical applications have been considerably advanced. In addition, examinations such as collection of tissue such as cancer using a puncture needle are also performed. Hereinafter, the treatment method and the inspection method using the above-described puncture needle are collectively referred to as puncture.

  By the way, such puncture is generally performed in order to avoid blood vessels that may cause major bleeding due to damage or to reliably puncture a target tissue such as cancer. A medical image diagnostic apparatus such as a sonic diagnostic apparatus is used. For example, a two-dimensional tomographic image is displayed on the display screen of the ultrasonic diagnostic apparatus, and the two-dimensional tomographic image is referred to.

  For example, there is one in which puncture is easily performed by designating a puncture site and a puncture direction by a puncture site marker unit and a puncture direction marker unit (see, for example, Patent Document 1).

  Further, in recent years, an ultrasonic probe (hereinafter referred to as a probe) that mechanically reciprocates ultrasonic transducers arranged one-dimensionally or a probe provided with two-dimensionally arranged ultrasonic transducers. Research and proposals have been made to use an ultrasound diagnostic apparatus that collects volume data of a subject using a child and displays a three-dimensional image such as a stereoscopic image or cross-sectional images in a plurality of directions to support puncture (for example, , See Patent Document 2).

JP-A-5-176922 JP 2000-185041 A

  However, regardless of the image to be referred to, a deviation from the trajectory to the target target site occurs due to bending of the puncture needle or the like. In that case, the operator corrects the insertion direction of the puncture needle while confirming the operation to the puncture needle at hand while looking at the display screen, that is, the operation is performed while repeating the movement of the line of sight. It was not easy to judge. In addition, the repetition of this line-of-sight movement has been a great burden on the operator.

  In addition, it is difficult to intuitively determine the direction to be corrected on the displayed screen in which direction the direction of the puncture needle should actually be corrected. For this reason, it takes time to adjust the position and orientation of the probe, and the puncture needle is often pulled out many times. there were.

  The present invention has been made in view of the above circumstances, and a first object thereof is to provide a medical image diagnostic apparatus capable of reducing the movement of the line of sight from the hand operating the puncture needle. is there.

  A second object is to provide a medical image diagnostic apparatus that allows an operator to easily determine the correction direction of a puncture needle.

  In order to achieve the first object, the invention described in claim 1 is a medical image diagnostic apparatus used when a puncture needle is inserted into a target site in a subject, and the position where the puncture needle is inserted A display means that is movable in the vicinity of the object, a three-dimensional image data generation means for generating three-dimensional image data indicating a three-dimensional image in the subject including at least the target region, and the three-dimensional image data. Display control means for displaying the relationship between the position of the target portion and the position of the puncture needle on the display means.

  The invention according to claim 2 is a medical image diagnostic apparatus for use in inserting a puncture needle into a target site in a subject, and is movable in the vicinity of a position where the puncture needle is inserted. Display means; three-dimensional image data generation means for generating three-dimensional image data indicating the three-dimensional image in the subject including at least the target region; and detection means for detecting the insertion direction of the puncture needle with respect to the subject And display control means for causing the display means to display a first cross-sectional image that is perpendicular to the detected insertion direction and includes the target portion based on the three-dimensional image data. .

  In order to achieve the second object, the invention according to claim 8 is a medical image diagnostic apparatus used when a puncture needle is inserted into a target site in a subject, and includes a display unit, an input unit, A probe for transmitting a reception signal by transmitting / receiving ultrasonic waves to / from the subject, an image reconstruction unit for reconstructing a three-dimensional ultrasonic image over time based on the reception signal, and the input Based on the position input using the means, the position of the target region and the puncture needle insertion schedule for one 3D ultrasound image among the 3D ultrasound images reconstructed over time 3D reconstructed over time following the one 3D ultrasound image based on the marking means for determining the path, the determined position of the target region and the planned insertion path of the puncture needle Position and front of the target site in the ultrasound image The puncture target position tracking means for tracking the planned insertion path of the puncture needle, the puncture needle detection means for detecting the puncture needle in each three-dimensional ultrasound image, and the respective three-dimensional ultrasound images were obtained. Display control means for displaying on the display means the relationship between the position of the target region, the planned insertion path, and the puncture needle detected for each of the three-dimensional ultrasound images.

  According to the medical image diagnostic apparatus of claim 1 or 2, since the display means can be arranged in the vicinity of the position where the puncture needle is inserted, the puncture needle can be operated while checking the image at hand. And there is no need to repeat eye movement.

  According to the medical image diagnostic apparatus of the eighth aspect, since the deviation between the puncture direction and the planned insertion path of the puncture needle can be displayed, the surgeon can easily determine the correction direction.

  Hereinafter, various embodiments of a medical image diagnostic apparatus according to the present invention will be specifically described with reference to the drawings. Further, the same constituent elements are denoted by the same reference numerals in the respective drawings.

[First Embodiment]
(System configuration)
A first embodiment according to the present invention will be described. FIG. 1 is a functional block diagram showing the configuration of the medical image diagnostic apparatus according to the first embodiment. In the present embodiment, an ultrasonic diagnostic apparatus is taken up as a medical image diagnostic apparatus.

  The probe 11 is for collecting volume data of a subject, and includes, for example, a plurality of ultrasonic transducers arranged two-dimensionally. Here, FIG. 2 shows a state of scanning by the probe 11. As shown in FIG. 2, the inside of the subject is scanned three-dimensionally by transmitting ultrasonic waves from the transducer array surface 11a on which the transducers are arranged and receiving reflected waves returning from the subject. To do. For example, the scan range shown in FIG. 2 is scanned. The received reflected wave is sent as an echo signal (received signal) to the image reconstruction unit 12 of the apparatus main body connected via a cable (not shown). As shown in FIG. 2, the probe 11 is equipped with a position detection device 16A as shown in FIG. The position detector 16A has a three-dimensional XYZ coordinate axis as shown in FIG. The probe 11 may be a three-dimensional scan by reciprocating ultrasonic transducers arranged in a one-dimensional manner.

  The puncture needle 18 is inserted into the puncture target 2 (target site) to perform treatment or examination. As shown in FIG. 2, the position detection device 16 </ b> B and the second image display means 17 as the display means in the present invention are fixed to the puncture needle 18 by a fixture 19 as shown in FIG. 2. The position detection device 16B has a three-dimensional UVW coordinate axis as shown in FIG. The display screen 17a is fixed perpendicular to the W axis. The puncture needle 18 is fixed at a predetermined position on the UV plane in parallel with the W axis, and is fixed through the center of the display screen 17a of the second image display means 17. In addition, it is desirable that the display screen 17a be a small and light enough to be handled with one hand using a display screen such as an LCD (Liquid Crystal Display). Further, the position detection device 16B and the second image display means 17 are connected to the apparatus main body via a cable (not shown). Alternatively, they may be connected via radio.

  Returning to FIG. 1 again, the image reconstruction unit 12 performs echo signal logarithmic amplification, envelope detection processing, and the like on the echo signal, converts the signal intensity into luminance data indicating brightness, and converts the luminance data into the obtained luminance data. Based on this, three-dimensional image data is generated. Furthermore, a 3D image data is stored with a memory. The three-dimensional image data is sent to the image display control unit 15. Further, each position in the scan range is indicated by coordinates in the three-dimensional XYZ coordinate space from the relative positional relationship between the scan range of the probe 11 and the three-dimensional XYZ coordinate axes. The three-dimensional image data generation means of the present invention mainly includes a probe 11 and an image reconstruction unit 12.

  The image display control unit 15 has a function as display image data generation means. For example, according to a display format instructed by an operator through an instruction unit (not shown), for example, based on three-dimensional image data, image data for volume rendering display, or MPR (Multi Planar Reconstruction) display axial image, sagittal image, coronal Image data of a cross section of three orthogonal surfaces of the image is generated. Furthermore, the image display control unit 15 has a function as a display control unit, and displays, for example, an image of the generated image data on the first image display unit 14 or the second image display unit 17.

  The first image display means 14 is a so-called monitor that is provided in the apparatus main body and is configured by an LCD or a CRT (Cathode Ray Tube).

  The mark means 13 includes input means such as a trackball and various keys. First, the surgeon determines the position of the puncture target 2 based on an input performed using the input unit while viewing an image displayed on the first image display unit 14, for example, an MPR display. This position is specified by a point or region in the three-dimensional XYZ coordinate space. The mark means 13 receives this input and sends it to the image display control unit 15 as puncture target position information.

  The position detection means 16 (detection means) detects the relative positional relationship of the three-dimensional UVW coordinates of the position detection device 16B with respect to the three-dimensional XYZ coordinates of the position detection device 16A to detect the position and insertion of the puncture needle in the three-dimensional XYZ coordinates. A straight line expression indicating the direction and the coordinates of the tip position of the puncture needle 18 are obtained. Specifically, first, the initial position of the three-dimensional UVW coordinate of the position detection device 16B in the three-dimensional XYZ coordinates of the position detection device 16A in a state where the position detection device 16A and the position detection device 16B are in a predetermined relative positional relationship. Recognize (initial setting). For example, the state is recognized as the initial position of the three-dimensional UVW coordinates in the three-dimensional XYZ coordinates by pressing a button or the like in a state where each is placed on a dedicated table having a predetermined relative positional relationship. Thereafter, when the probe 11 or the puncture needle 18 is moved, a change in the relative positional relationship between the position detection device 16A and the position detection device 16B, that is, a change in the position of the origin coordinate of the position detection device 16B, rotation of the coordinate axis, etc. Is detected to recognize the position and direction of the three-dimensional UVW coordinate with respect to the three-dimensional XYZ coordinate. For example, the position and direction of the three-dimensional UVW coordinate relative to the three-dimensional XYZ coordinate as shown in FIG. 2 can be recognized. Here, as described above, since the puncture needle 18 is fixed in a predetermined position on the UV plane in parallel with the W axis, the puncture needle 18 can be expressed by an expression showing a straight line in the three-dimensional UVW coordinate space. By the coordinate conversion, it can be obtained as a straight line expression indicating the puncture needle 18 in the three-dimensional XYZ coordinate space. This is sent to the image display control unit 15 as puncture needle insertion information. In addition, by indicating the tip position of the puncture needle 18 with coordinates in the three-dimensional UVW coordinate space, the tip position of the puncture needle 18 can be obtained as coordinates in the three-dimensional XYZ coordinate space. This is sent to the image display control unit 15 as puncture needle tip position information.

  Further, the image display control unit 15 further has a function as a plane determining means, and based on the three-dimensional image data, puncture target position information and puncture needle insertion information, the puncture needle 18 as shown in FIG. A plane 31 that is perpendicular to the insertion direction of the puncture needle and includes the puncture target 2 is determined. Specifically, for example, the center of the puncture target 2 is obtained based on the puncture target position information indicating the puncture target in the three-dimensional image data shown in FIG. 3, and the puncture needle is selected from the plane including the center of the puncture target 2. A plane orthogonal to the straight line indicated by the insertion information is selected, and the plane is determined as the plane 31. Further, the image display control unit 15 generates the image data of the cross-sectional image by the plane 31 in the three-dimensional image data and displays it on the second image display means 17.

  Further, the image display control unit 15 displays, for example, the position of the intersection of the plane 31 and the straight line indicating the puncture needle so as to be positioned at the center of the display screen 17a. As a result, when the puncture needle 18 and the puncture target 2 are in a positional relationship as shown in FIG. 4A, the second image display means 17 displays the center of the display screen 17a as shown in FIG. 4B. The puncture target 2 is displayed with a deviation. 5, 6, and 8, similarly to FIG. 4, (a) shows the actual positional relationship between the puncture needle 18 and the puncture target 2, and (b) shows the display screen 17 a in each case. Shows how it is displayed. Further, when the puncture target 2 is in a position that coincides with the insertion direction of the puncture needle 18 as shown in FIG. 5A, the puncture target is displayed at the center of the display screen 17a as shown in FIG. 5B. 2 is displayed. Therefore, the surgeon can grasp the relative positional relationship between the insertion direction of the puncture needle 18 and the puncture target 2.

  Furthermore, the image display control unit 15 has a function as a detecting unit that detects that the position of the tip of the puncture needle 18 indicated by the puncture needle tip position information in the three-dimensional XYZ coordinate space has entered the scan range. Specifically, the fact that the tip position of the puncture needle is within the scanning range of the probe 11 is detected from the coordinates of the tip position of the puncture needle. Then, a plane perpendicular to the straight line indicated by the puncture needle insertion information is selected from the plane including the tip position (actually, the vicinity of the tip on the puncture needle 18 side), and the plane is determined as the plane 32. In the image data, image data of a cross-sectional image by the plane 32 is generated, and the cross-sectional image by the plane 32 is superimposed on the cross-sectional image by the plane 31 and displayed on the second image display means 17.

  For example, as shown in FIG. 5A, when the puncture needle 18 is inserted in a state where the puncture target 2 coincides with the insertion direction of the puncture needle 18 as shown in FIG. When the tip of the needle 18 is bent during the puncture, the tip of the puncture needle 18 is shifted from the intersection of the plane 32 and the insertion direction, so a display screen as shown in FIG. The tip of the puncture needle 18 is displayed with a deviation from the center of 17a. Thereby, the surgeon can grasp that the puncture needle 18 at that time is bent. Moreover, you may make it display the deviation | shift amount of the puncture needle 18 tip and the puncture object 2 at that time. Specifically, a high-luminance data area in the cross-sectional image of the plane 32 is determined as the puncture needle 18, and for example, the distance between the center of the area and the intersection of the plane 32 and a straight line indicating the puncture needle is obtained. The distance is displayed as a deviation amount.

  Further, the image display control unit 15 further selects a plane including a straight line indicated by the puncture needle insertion information from the plane including the center of the puncture target 2 as shown in FIG. decide. The image data of the cross section by the plane 33 is generated and displayed on the second image display unit 17 together with the cross section image by the plane 31, for example. Since the cross-sectional image by the plane 33 includes an image in the length direction of the puncture needle 18, for example, it can be visually confirmed whether or not the tip of the puncture needle 18 has reached the puncture target 2.

  Further, a cross-sectional image by the planes 31 to 33 described above may be displayed on the first display unit 14. However, according to the display on the second display means 17 as described above, the operator can operate the puncture needle 18 while confirming the cross-sectional image at hand, so the first display means 14 There is no need to see. Further, it is not necessary to move the line of sight. Therefore, by displaying on the second display means 17, it is possible to reduce the burden on the operator due to the movement of the line of sight.

  The second display means 17 may be arranged side by side with the puncture needle 18 without penetrating the puncture needle 18. Further, since the insertion position is in the vicinity of the probe 11, the second display means 17 may be provided in the probe 11. In this case, a mark or the like is provided at the center of the display screen 17a so that the positional relationship between the insertion direction of the puncture needle 18 and the puncture target 2 can be grasped from the deviation between the image showing the puncture target 2 and the mark. it can. Moreover, it may be made to include the image which shows a mark in a cross-sectional image instead of the mark of the display screen 17a.

(Puncture procedure)
Next, a procedure of puncture performed using the ultrasonic diagnostic apparatus having the above configuration will be described with reference to FIG. FIG. 9 is a flowchart showing an operation mode of the ultrasonic diagnostic apparatus according to the present embodiment.

  First, an initial setting of the relative position between the position detection device 16A and the position detection device 16B is performed. First, when the operator brings the probe 11 into contact with the subject, the image display control unit 15 displays a three-dimensional image including the puncture target 2 on the first image display unit 14 or the second image display unit 17. (Step S101. Hereinafter, step S101 is abbreviated as S101. Other steps are also abbreviated in the same manner.) Next, the surgeon designates the position of the puncture target 2 while viewing the MPR display, for example, using an input means such as a trackball or various keys. The mark means 13 receives this input (S102, Yes) and sends it to the image display control unit 15 as puncture target position information.

  Here, the puncture needle 18 to which the position detection device 16B and the second image display means 17 are fixed is brought into contact with the subject. Here, for example, the surgeon requests the second image display unit 17 to display a cross-sectional image including the puncture target 2 perpendicular to the insertion direction by the plane 31 using the input unit.

  Upon receiving the request (S103, Yes), the image display control unit 15 determines the puncture needle of the puncture needle 18 based on the puncture target position information and the detection result of the relative position between the position detection device 16A and the position detection device 16B. A cross-sectional image of the plane 31 perpendicular to the insertion direction and including the puncture target 2 is displayed on the second image display means 17 (S104). Here, for example, if the puncture needle 18 is positioned in a direction displaced from the puncture target 2 as indicated by A in FIG. 8A, the second image display means 17 is indicated by A in FIG. 8B. The puncture target 2 is displayed shifted from the center of the screen. Here, as the surgeon changes the direction of the puncture needle 18, the cross-sectional image perpendicular to the direction of the puncture needle 18 including the puncture target 2 is displayed on the second image display means 17. While viewing the cross-sectional image displayed on the second image display means 17, the direction of the puncture needle 18 is changed so that the image showing the puncture target 2 is centered as shown in FIG. 8B. When the image showing the puncture target 2 is located at the center, the insertion direction of the puncture needle 18 is as shown in B in FIG. 8A, and the puncture target 2 is positioned in the insertion direction of the puncture needle 18. become. Then, the surgeon inserts the puncture needle 18.

  Next, for example, when the image display control unit 15 detects from the puncture needle tip position information that the puncture needle tip position has entered the scan range of the probe 11 (S105, Yes), the puncture needle 18 is inserted. The plane 32 perpendicular to the entry direction and including the tip of the puncture needle is determined, cross-sectional image data by the plane 32 is generated, and the cross-sectional image by the plane 32 is superimposed on the cross-sectional image by the plane 31 described above to the second image display means 17. It is displayed (S106). At this time, when the image shown in FIG. 6B is displayed, the surgeon determines that the puncture needle 18 is bent and the tip of the puncture needle 18 is displaced from the puncture target 2, and the tip of the puncture needle 18 is displayed. The puncture needle 18 is retracted until the image of the cross section near the center of the display screen 17a, and the insertion is performed again to correct the insertion.

  As described above, since the shift in the insertion direction and the bending of the puncture needle 18 are displayed at hand, the puncture needle 18 may be moved in the displayed direction. Therefore, the surgeon can easily determine the direction to be corrected.

  In the above-described embodiment, the probe 11 includes the position detection device 16A, and the puncture needle 18 includes the position detection device 16B. The insertion position and the length direction of the puncture needle 18 with respect to the probe 11, that is, the insertion direction. However, when a puncture guide for guiding a puncture needle provided in the probe is used, the position detection means 16 determines the insertion position and the insertion direction from the positional relationship between the probe and the puncture guide. Can be requested. In addition, by using a puncture guide provided in the probe and having a variable puncture needle insertion direction, the insertion direction can be corrected as described above.

  The tip position of the puncture needle is determined so that the position detection means 16 includes a detection means such as a rotary encoder that detects the movement amount of the puncture needle from the insertion position, and the detected movement amount, insertion position, and insertion direction. You may make it ask from.

  In this embodiment, the ultrasonic diagnostic apparatus has been described as the medical image diagnostic apparatus. However, the present invention can be applied to other medical image diagnostic apparatuses such as an X-ray CT apparatus and an MRI.

[Second Embodiment]
In the present embodiment, in the puncture operation, an image to be displayed and a procedure for generating the image will be mainly described in order to enable the operator to easily determine the correction direction of the puncture needle.

(System configuration)
FIG. 10 is a functional block diagram showing a system configuration of the medical image diagnostic apparatus according to the present embodiment. In the present embodiment, an ultrasonic diagnostic apparatus is taken up as a medical image diagnostic apparatus.

  The probe 11 is for collecting volume data of a subject, and includes, for example, a plurality of ultrasonic transducers arranged two-dimensionally. Then, ultrasonic waves are transmitted from the transducer array surface 11a into the subject and the reflected waves returning from the subject are received to scan the inside of the subject three-dimensionally, and the received reflected waves are echo signals (received). Signal) to the image reconstruction unit 12 of the apparatus main body connected via a cable (not shown). The probe 11 may be a three-dimensional scan by reciprocating ultrasonic transducers arranged in a one-dimensional manner.

  The puncture needle 18 is inserted into the puncture target 2 (target site) to perform treatment or examination.

  The image reconstruction unit 12 performs log signal amplification, envelope detection processing, and the like on the echo signal, converts the signal intensity into luminance data indicating brightness, and displays a three-dimensional image based on the obtained luminance data. Reconstruct 3D image data. Furthermore, a 3D image data is stored with a memory. The reconstructed three-dimensional image data is sent to the puncture target tracking means 21, the puncture needle detection means 22 and the image display control unit 15. The image reconstruction unit 12 has a function as reconstruction means of the present invention.

  The image display control unit 15 has a function as display image data generation means. For example, in accordance with a display format instructed by an operator through an instruction means (not shown), based on 3D image data, for example, image data for volume rendering display, or an axial image, sagittal image, coronal image for MPR (Multi Planar Reconstruction) display. Image data of a cross section of three orthogonal surfaces of the image is generated. Furthermore, the image display control unit 15 has a function as a display control unit, and displays an image of the generated image data on the image display unit 24, for example.

  The image display means 24 (display means) is a monitor provided in the apparatus main body, or a display apparatus that performs display at the puncture hand.

  The mark means 13 includes input means such as a trackball and various keys. First, the operator designates the position on the image using the input unit while viewing the image displayed on the first image display unit 14, for example, the MPR display. The mark unit 13 receives this input, determines and stores the position data, and sends it to the puncture target tracking unit 21 and the image display control unit 15. Here, the position data handled in the present embodiment will be described with reference to FIG. FIG. 12 is a diagram showing the scan range of the probe 11, the puncture target 2, and the position data handled in the present embodiment. There are two position data handled in the present embodiment, one is puncture target area representative position data indicating the position of the puncture target 2, and the other is puncture needle puncture indicating the planned puncture route of the puncture needle 18. This is the scheduled route data. The puncture target area representative position data is the coordinates designated as the point P in the puncture target 2 as shown in FIG. 12, and the puncture needle puncture planned path data is the insertion of the scan range as shown in FIG. It consists of the coordinates designated as the point Q of the start position and the coordinates of the point P.

  The puncture target tracking means 21 will be described with reference to FIG. FIG. 13 is a functional block diagram showing the configuration of the puncture target tracking means 21. As shown in FIG. 13, the puncture target tracking means 21 includes a puncture target area determination unit 211, a puncture target area deviation amount determination unit 212, and a puncture target area information storage unit 213.

  The puncture target area determination unit 211 receives the puncture target area representative position data and the puncture needle insertion planned route data sent from the mark unit 13 and the three-dimensional image data sent from the image reconstruction unit 12 and It has a function of determining puncture target area data indicating the target area.

  Here, the function of determining the puncture target area data in the puncture target area determination unit 211 will be described with reference to FIGS. 14 and 15. FIG. 14 is a flowchart showing a procedure for determining puncture target area data, and FIG. 15 is a diagram for explaining a procedure for determining puncture target area data. Further, although it is processing for three-dimensional image data, it is shown in two dimensions for easy viewing in FIG. First, a region with a large luminance (that is, a voxel value) or a region with a low luminance is determined from the three-dimensional image data (S201). The determined area is shown in FIG. This is because a lesion such as a tumor to be punctured has a higher or lower luminance than the surrounding area, and it is determined according to an instruction from an instruction unit (not shown) which luminance is used. In addition, threshold value processing or edge detection can be used for this region determination. Next, an area including the position indicated by the puncture target area representative position data is selected from the obtained areas (S202). The selection result is shown in FIG. Subsequently, the outline of the selected area is determined (S203). The determined contour is shown in FIG. A coordinate group indicating this contour is set as puncture target area data. Then, the puncture target area determining unit 211 collects the puncture target area representative position data, the puncture needle puncture planned path data, and the puncture target area data and sends them to the puncture target area information storage unit 213 as puncture target area information.

  The puncture target region deviation amount determination unit 212 performs three-dimensional image data reconstructed later in time for temporally continuous three-dimensional image data, that is, three-dimensional image data reconstructed sequentially with time. It has a function as a calculation means for calculating the amount of spatial deviation indicating how much the puncture target area for is shifted from the puncture target area for the three-dimensional image data reconstructed earlier in time. Then, the puncture target region is obtained as puncture target region information by obtaining puncture target region representative position data, puncture needle puncture planned route data, and puncture target region data corresponding to the three-dimensional image data reconstructed later in time from the deviation amount. The information is sent to the information storage unit 213.

  A specific operation in the puncture target region deviation amount determination unit 212 will be described with reference to FIGS. 16 and 17. FIG. 16 is a flowchart showing the operation in the puncture target region deviation amount determination unit 212, and FIG. 17 is a diagram for explaining the processing in the puncture target region deviation amount determination unit 212. Also, FIG. 17 is shown in two dimensions for easy viewing as in FIG. First, temporally continuous three-dimensional image data (of these three-dimensional image data, the earlier one in time is referred to as three-dimensional image data (N), and the other as three-dimensional image data (N + 1)). The puncture target area information corresponding to the three-dimensional image data (N) is received (S301). A region including the puncture target region indicated by the puncture target region information, for example, a rectangular parallelepiped region including the puncture target region is set as a region of interest in both three-dimensional image data (S302). FIG. 17A shows a state where the 3D image data (N) is set, and FIG. 17B shows a state where the 3D image data (N + 1) is set. Here, the set region of interest is stored as an initial value. Next, with respect to the three-dimensional image data (N + 1), the position of the region of interest is moved along the coordinate axis, for example, as shown in FIGS. The index value using the voxel value in the region of interest of the three-dimensional image data is calculated at each position. For example, the index value is the sum of squares of the difference between the voxel values in the region of interest between the two three-dimensional image data. According to this, since the position of the region of interest indicating the minimum index value can be regarded as the position of the puncture target region in the three-dimensional image data (N + 1), the region of interest having the minimum index value is selected. (S304). Here, it is determined whether or not the position of the selected region of interest with respect to the puncture target region is the same as before the movement. If they are the same (S305, Yes), for example, as shown in FIG. 17D, if the puncture target region is surrounded by the region of interest as in FIG. 17A, the selected region of interest The difference between the position and the initial value is determined as a deviation amount, and the puncture corresponding to the three-dimensional image data (N + 1) is shifted by the deviation amount determined for each of the puncture target area information corresponding to the three-dimensional image data (N). The target area information is obtained (S306). If not the same (S305, No), the process proceeds to S303. Then, the obtained puncture target area information is sent to the puncture target area information storage unit 213.

  The puncture target area information storage unit 213 stores the puncture target area information, and sends the stored puncture target area information to the puncture needle deviation amount calculation unit 23 and the image display control unit 15.

  The puncture needle detection means 22 has a function of receiving the 3D image data sent from the image reconstruction unit 12 and detecting the position of the puncture needle 18 in the 3D image data. Further, puncture needle position data indicating the detected puncture needle position is sent to the puncture needle deviation amount calculating means 23 and the image display control unit 15. Here, detection of the puncture needle portion in the three-dimensional image data performed by the puncture needle detection means 22 will be described with reference to FIGS. FIG. 18 is a flowchart showing a procedure for detecting the puncture needle portion in the three-dimensional image data, and FIG. 19 is a diagram for explaining Hough transformation used as an example in the detection of the puncture needle portion in the three-dimensional image data. Further, the detection of the puncture needle portion in the present embodiment utilizes the feature that the puncture needle 18 exhibits a large voxel value in the three-dimensional image data and is linear.

  As shown in FIG. 18, when the puncture needle detection means 22 receives the three-dimensional image data, the puncture needle detection means 22 performs threshold processing on the three-dimensional image data, and for the voxel value that exhibits a predetermined threshold value or more, A labeling process often used in image processing is performed (S401). Next, all voxels in all labeled regions are subjected to conversion processing called Hough conversion and mapped to the distance-angle space (S402).

Here, for the sake of simplicity, the Hough transformation in a two-dimensional space will be described. As shown in FIG. 19A, it is assumed that a straight line exists on the orthogonal coordinates. Draw a perpendicular to the straight line from the origin. If the coordinates of the intersection of the perpendicular and the straight line are (x j , y j ), the distance from the origin to the intersection is r, and the angle between the perpendicular and the X axis is θ,
r = x j cos θ + y j sin θ
Can represent this straight line. If r and θ are changed, another straight line passing through (x j , y j ) can be defined. The Hough transform is to convert a point of Cartesian coordinates into a distance-angle space (r-θ space), and one point on the Cartesian coordinates becomes one curve in the r-θ space (FIG. 19 ( b)). When a plurality of points on a straight line are subjected to Hough transform, the curves intersect at one point in the r-θ space. Then, a straight line equation can be obtained by substituting the (r, θ) coordinates of this intersection point into the above-described straight line equation.

  Specifically, for all voxels in all labeled regions, r is calculated while gradually changing the value of θ, and the (r, θ) coordinates in the distance-angle space (r-θ space) are calculated. The process of adding 1 is performed. The initial value of all (r, θ) coordinates in the distance-angle space (r-θ space) is set to 0 (zero).

Among the values of all (r, θ) coordinates in the distance-angle space (r-θ space), the (r, θ) coordinate having the maximum value is selected (S403). This is because it can be considered that these (r, θ) coordinates correspond to the most linear region among the labeled regions. Then, this selected (r, θ) is expressed as r = x j cos θ + y j sin θ
By substituting into, a straight line expression representing a straight line region is obtained (S404).

  However, at this stage it is not specified which of the labeled areas corresponds to this straight line. Therefore, for each labeled region, the sum of squares of the distance from the voxel in the region to the straight line is calculated, and the average value is obtained by dividing by the number of voxels (S405). In the case of a region corresponding to a straight line, since the voxels in the region are distributed close to the straight line, the average value is small. Therefore, the region with the smallest value among the average values obtained for each region is punctured. It selects as a needle | hook area | region (S406).

  Then, the coordinates of each voxel in the selected puncture needle region and the straight line formula obtained as puncture needle position data are sent to the puncture needle deviation amount calculation means 23.

Further, the Hough transform has been described by taking a two-dimensional space as an example for simplicity, but in the case of a three-dimensional space, the coordinates of the intersection of a perpendicular and a straight line are (x j , y j , z j ) from the origin to the intersection. Is r, the angle between the perpendicular and the xy plane is Φ, and the angle between the line segment projected onto the xy plane and the x axis is θ,
r = (x j cos θ + y j sin θ) cos Φ + z j sin Φ
Since a straight line can be represented by (x, y, z), the coordinates in the (x, y, z) space may be converted and mapped to the (r, Φ, θ) space.

  The puncture needle deviation amount calculation means 23 (calculation means) will be described with reference to FIGS. FIG. 20 is a functional block diagram showing the configuration of the puncture needle deviation amount calculation means 23, and FIG. 21 is a flowchart showing the operation of the puncture needle deviation amount calculation means 23.

  As shown in FIG. 20, the puncture needle deviation amount calculation means 23 includes a puncture needle tip position determination unit 231, a plane determination unit 232, and a deviation angle determination unit 233, and is delivered from the puncture needle detection unit 22. A deviation angle between the puncture needle 18 and the planned puncture needle insertion path is calculated using the needle position data and the puncture target area information sent from the puncture target tracking means 21.

  The puncture needle tip position determining unit 231 has a function of obtaining the tip position of the puncture needle 18 from the puncture needle position data and the puncture target region representative position data included in the puncture target region information. The data is sent to the determination unit 232.

  The plane determination unit 232 has a function of determining a plane including the position indicated by the puncture needle tip position data and the position indicated by the puncture target region representative position data, and sends the plane data to the shift angle determination unit 233.

  The deviation angle determination unit 233 has a function of obtaining a deviation angle between the puncture needle 18 and the planned puncture needle insertion path from the puncture planned insertion path data included in the plane data, the puncture needle position data, and the puncture target area information. The puncture needle tip position data, puncture target area information, plane data, displacement angle, and the like are sent to the image display control unit 15.

  Hereinafter, the operation of the puncture needle deviation amount calculation means 23 will be described based on the flowchart shown in FIG.

  The puncture needle deviation amount calculating means 23 receives puncture needle position data and puncture target area information, and the puncture needle tip position determining unit 231 is puncture target area representative position data included in the puncture needle position data and puncture target area information. The puncture needle tip position data is obtained from the above (S501). Specifically, thinning processing is performed on the puncture needle position data to obtain an end point, the distance from the position indicated by the puncture target region representative position data is calculated, and the end point having the closest distance is used as the tip of the puncture needle 18. The coordinates are used as puncture needle tip position data.

  Next, the plane determining unit 232 determines a plane including the position indicated by the puncture needle tip position data and the position indicated by the puncture target area representative position data (S502). Although there are an infinite number of planes including both positions, in this embodiment, the puncture needle position data includes the position indicated by the puncture needle tip position data and the position indicated by the puncture target area representative position data (puncture target area representative position). Is determined to be the plane having the smallest angle with the straight line indicated by.

  Then, the deviation angle determination unit 233 obtains the deviation angle between the puncture needle 18 and the planned puncture needle insertion path (S503). Specifically, the two coordinates of the puncture needle insertion planned route data are projected onto the determined plane, and the coordinates of any two points on the straight line indicated by the puncture needle position data are obtained to determine these coordinates. A line segment formed by projecting two points is regarded as a vector, and an inner product is calculated to obtain an angle formed by the two vectors, which is set as a deviation angle. Then, the puncture needle tip position data, puncture target area information, plane data, and shift angle are sent to the image display control unit 15.

  The image display control unit 15 receives the puncture needle tip position data, puncture target region information, plane data, and the shift angle, and for example, with respect to the plane indicated by the plane data of the three-dimensional image data as shown in FIG. An image of an area having a predetermined thickness, a position indicated by puncture target area representative position data included in the puncture target area information (puncture target area representative position, indicated by a “+” mark in the figure), and puncture target area information Generates a display image including a puncture target area indicated by the puncture target area data included in the puncture needle, a planned puncture needle insertion path data projected on the plane, and a text image indicating a deviation angle. It is displayed on the means 24. Since the puncture needle 18 is included in the region having a predetermined thickness at this time, it is displayed as an image.

  The overall operation of the above-described ultrasonic diagnostic apparatus is controlled by a control unit (not shown).

(Puncture procedure)
Next, a puncture procedure performed using the ultrasonic diagnostic apparatus having the above-described configuration will be described with reference to FIG. FIG. 11 is a flowchart showing an operation mode of the ultrasonic diagnostic apparatus according to the present embodiment.

  First, when the operator brings the probe 11 into contact with the subject, the image reconstruction unit 12 reconstructs the three-dimensional image data, and the image display control unit 15 first creates an image of a predetermined cross section. Is displayed on the image display means 24. The surgeon moves the probe 11 while viewing the image so that the affected area to be punctured is included in the cross-sectional image.

  When the surgeon requests input of a position using, for example, an input unit, the image display control unit 15 displays a predetermined mark superimposed on the cross-sectional image so that the position of the puncture target 2 can be input. The surgeon operates the input means to move the mark position to, for example, the center of the affected part to be punctured, and operates the input means to make a definite input. The mark means 13 acquires the coordinates of the determined position as puncture target area representative position data. Next, the planned puncture route of the puncture needle 18 can be input, the operator similarly determines the position, and the mark means 13 indicates the coordinates of the determined position and the puncture target area representative position data. The coordinates are acquired as puncture needle insertion planned route data (S601). The puncture target tracking means 21 obtains puncture target region data from the acquired puncture target region representative position data, puncture needle puncture planned route data and corresponding three-dimensional image data, and stores them as puncture target region information. Each time the three-dimensional image data is reconstructed, the shift amount of the puncture target region is obtained, and puncture target region information is obtained from the shift amount and stored (S602).

  The surgeon starts inserting the puncture needle 18. When the puncture needle 18 is visible in the displayed image, the start of puncture support is requested using, for example, an input means.

  In response to the request for puncture support (S603, Yes), the puncture target tracking means 21 uses the image reconstruction unit 12 for the most recently reconstructed 3D image data (hereinafter referred to as 3D image data (N)). Then, a deviation amount of the puncture target area is obtained, and puncture target area information corresponding to the three-dimensional image data (N) is obtained from the deviation amount (S604).

  When the image reconstruction unit 12 newly reconstructs the 3D image data (hereinafter referred to as 3D image data (N + 1)) (S605, Yes), the puncture target tracking means 21 uses the 3D image data ( N) is determined with respect to the puncture target area, and puncture target area information corresponding to the three-dimensional image data (N + 1) is obtained from the shift amount (S606).

  Next, the puncture needle detection means 22 determines a puncture needle region from the three-dimensional image data (N + 1) and obtains puncture needle position data (S607).

  Further, the puncture needle deviation amount calculation means 23 obtains the tip position of the puncture needle for the three-dimensional image data (N + 1), determines a plane including the puncture target region representative position and the tip position of the puncture needle 18, and The deviation angle between the direction and the planned puncture needle insertion path is obtained (S608).

  The image display control unit 15 generates an image of a region including the puncture needle 18 having a predetermined thickness with respect to the plane indicated by the plane data of the three-dimensional image data (N + 1), and the three-dimensional image data (N + 1). The corresponding puncture target area representative position, puncture target area, puncture needle insertion planned path, and shift angle are displayed on the image display means 24 (S609).

  Thereafter, when the three-dimensional image data is newly reconstructed (S610, Yes), the process proceeds to S606, and S606 to S609 are repeated. For example, if there is a request to end the puncture support using the input means (S611, Yes) ) End.

  By tracking the puncture target and detecting the puncture needle 18 in this way, the puncture target, the puncture needle, the planned puncture route, and the like can be constantly updated and displayed. Furthermore, the deviation angle between the puncture needle and the planned insertion path can be constantly updated and displayed.

It is a functional block diagram which shows the structure of the ultrasonic diagnosing device of 1st Embodiment. It is a figure which shows the mode of the scan by a probe. It is a figure which shows the plane which is perpendicular | vertical to the insertion direction of a puncture needle and contains a puncture object. (A) shows an example of the actual state of the positional relationship between the puncture needle and the puncture target, and (b) shows an example of an image displayed on the second image display means. (A) shows an example of the actual state of the positional relationship between the puncture needle and the puncture target, and (b) shows an example of an image displayed on the second image display means. (A) shows an example of the actual state of the positional relationship between the puncture needle and the puncture target, and (b) shows an example of an image displayed on the second image display means. It is a figure which shows the straight line which shows the insertion direction of a puncture needle, and the plane containing a puncture object. (A) shows an example of the actual state of the positional relationship between the puncture needle and the puncture target, and (b) shows an example of an image displayed on the second image display means. It is a flowchart which shows the operation | movement aspect of the ultrasonic diagnosing device of 1st Embodiment. It is a functional block diagram which shows the structure of the ultrasonic diagnosing device of 2nd Embodiment. It is a flowchart which shows the operation | movement aspect of the ultrasonic diagnosing device of 2nd Embodiment. It is a figure which shows the scanning range of a probe, the puncture object, and position data. It is a functional block diagram which shows the structure of the puncture object tracking means shown in FIG. It is a flowchart which shows the procedure which determines puncture object area | region data. It is a figure for demonstrating the procedure which determines puncture object area | region data. It is a flowchart which shows operation | movement in the puncture object area | region deviation | shift amount determination part. It is a figure for demonstrating the process in the puncture object area | region deviation | shift amount determination part. It is a flowchart which shows the detection procedure of the puncture needle part in three-dimensional image data. It is a figure for demonstrating Hough transformation used as an example by the detection of the puncture needle part in three-dimensional image data. It is a functional block diagram which shows the structure of the puncture needle deviation | shift amount calculation means shown in FIG. It is a flowchart which shows the operation | movement in the puncture needle deviation | shift amount calculation means. It is a figure which shows an example of the image displayed on an image display means.

Explanation of symbols

DESCRIPTION OF SYMBOLS 2 Puncture object 11 Probe 12 Image reconstruction part 13 Mark means 14 1st image display means 15 Image display control part 16 Position detection means 16A, B Position detection apparatus 17 2nd image display means 18 Puncture needle 21 Puncture target tracking means 22 puncture needle detection means 23 puncture needle deviation amount calculation means 24 image display means

Claims (18)

  1. A medical diagnostic imaging apparatus used when inserting a puncture needle into a target site in a subject,
    Display means capable of moving in the vicinity of a position for inserting the puncture needle;
    Three-dimensional image data generating means for generating three-dimensional image data indicating the in-subject three-dimensional image including at least the target region;
    A medical image diagnostic apparatus comprising: display control means for displaying on the display means a relationship between the position of the target portion and the position of the puncture needle using the three-dimensional image data.
  2. A medical diagnostic imaging apparatus used when inserting a puncture needle into a target site in a subject,
    Display means capable of moving in the vicinity of a position for inserting the puncture needle;
    Three-dimensional image data generating means for generating three-dimensional image data indicating the in-subject three-dimensional image including at least the target region;
    Detecting means for detecting the insertion direction of the puncture needle with respect to the subject;
    And a display control unit that causes the display unit to display a first cross-sectional image that is perpendicular to the detected insertion direction and includes the target region, based on the three-dimensional image data. Diagnostic device.
  3. The detection means further detects the position of the tip of the puncture needle with respect to the subject,
    The medical image diagnosis according to claim 2, wherein the display control unit causes the display unit to display a second cross-sectional image that is perpendicular to the insertion direction and includes the position of the tip on the first cross-sectional image. apparatus.
  4. The three-dimensional image data generation means includes a probe that transmits and receives ultrasonic waves,
    The detection unit includes a detection device provided in each of the probe and the puncture needle, and performs the detection based on a relative positional relationship between the detection devices provided in the probe and the puncture needle, respectively. The medical image diagnostic apparatus according to claim 3.
  5.   The medical image diagnostic apparatus according to claim 1, wherein the display unit is provided integrally with the puncture needle.
  6. The three-dimensional image data generation means includes a probe that transmits and receives ultrasonic waves,
    The medical image diagnostic apparatus according to claim 1, wherein the display unit is provided integrally with the probe.
  7.   The medical image diagnostic apparatus according to claim 1, wherein the display unit includes a liquid crystal display element.
  8. A medical diagnostic imaging apparatus used when inserting a puncture needle into a target site in a subject,
    Display means;
    Input means;
    A probe for transmitting a reception signal by transmitting and receiving ultrasonic waves to the subject; and
    Image reconstruction means for reconstructing a three-dimensional ultrasound image over time based on the received signal;
    Based on the position input using the input means, the position of the target region and the puncture needle of one of the three-dimensional ultrasonic images reconstructed with time are included. A marking means for determining a planned entry route;
    Based on the determined position of the target portion and the planned insertion path of the puncture needle, the target portion in the three-dimensional ultrasonic image reconstructed with time following the one three-dimensional ultrasonic image. A puncture target position tracking means for tracking and determining a position and a planned insertion path of the puncture needle;
    Puncture needle detection means for detecting a puncture needle in each three-dimensional ultrasound image;
    Display control means for displaying on the display means the relationship between the position of the target portion obtained for each of the three-dimensional ultrasound images, the planned insertion path, and the puncture needle detected for each of the three-dimensional ultrasound images. A medical image diagnostic apparatus comprising:
  9. A calculation means for calculating an angle between the detected puncture needle and the planned insertion path for each three-dimensional ultrasonic image;
    The medical image diagnosis apparatus according to claim 8, wherein the display control unit further displays the calculated angle on the display unit.
  10.   The puncture target position tracking means is a three-dimensional ultrasound image reconstructed earlier in time of the three-dimensional ultrasound image continuously reconstructed among the three-dimensional ultrasound images reconstructed with time. Of the three-dimensional ultrasonic image reconstructed later in time based on the amount of deviation. The medical image diagnostic apparatus according to claim 8 or 9, wherein a position of the target portion and a position of a planned insertion path of the puncture needle are obtained.
  11.   The medical image diagnostic apparatus according to any one of claims 8 to 10, wherein the puncture needle detection unit performs the detection using a voxel value indicating the three-dimensional ultrasonic image.
  12.   The medical image diagnostic apparatus according to claim 11, wherein the puncture needle detection unit performs the detection by performing at least a Hough transform on a voxel value indicating the three-dimensional ultrasonic image.
  13.   The display control means includes an image of a region including a position of the target portion obtained for each of the three-dimensional ultrasonic images and a puncture needle detected for the respective three-dimensional ultrasonic images, and each of the three-dimensional ultrasonic images. The medical image diagnostic apparatus according to any one of claims 8 to 12, wherein an image obtained by projecting a planned insertion path obtained for an ultrasonic image onto the image is displayed on the display means.
  14.   The display control means obtains the tip position of the puncture needle from the puncture needle detected for each of the three-dimensional ultrasound images, and the position of the target site obtained for the respective three-dimensional ultrasound images and the The medical image diagnostic apparatus according to claim 13, wherein a plane including a tip position is obtained, and the area is provided with a predetermined thickness with respect to the plane.
  15.   The medical image diagnostic apparatus according to any one of claims 8 to 14, wherein the display means can be disposed in the vicinity of a position where the puncture needle is inserted.
  16.   The medical image diagnostic apparatus according to claim 15, wherein the display unit is provided integrally with the puncture needle.
  17.   The medical image diagnostic apparatus according to claim 15, wherein the display unit is provided integrally with the probe.
  18. The medical image diagnosis apparatus according to claim 15, wherein the display unit includes a liquid crystal display element.

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