JP2009022733A - Apparatus and method for supporting medical diagnosis, and radiological diagnostic apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an apparatus for supporting medical diagnosis and a radiological diagnostic apparatus equipped with the function for simulation before examination/treatment and the function of guidance during examination/treatment. <P>SOLUTION: The device is equipped with an extraction part which extracts image data of blood vessels to be observed from three-dimensional image data acquired by photographing a subject, a display which can display the extracted three-dimensional image of the blood vessels, a display direction-setting part which displays the extracted three-dimensional image of the blood vessels on the display at a display angle set by a user, and a simulation image-generating part which simulates the progress of a catheter when the catheter is inserted into the extracted blood vessels and overlaps a marker indicating a position and traveling direction of the catheter to the three-dimensional image of the blood vessels. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention is a medical diagnosis that improves safety by displaying a simulation image or a guide image to assist the examiner when a catheter is inserted into a subject to examine and treat various diseases. The present invention relates to a support device and a medical diagnosis support method. The present invention also relates to a radiation diagnostic apparatus such as an X-ray CT apparatus and an X-ray cardiovascular diagnostic apparatus to which a medical diagnosis support apparatus is applied.

  Conventionally, in a medical system using an X-ray CT apparatus, an X-ray cardiovascular diagnosis apparatus, etc., image diagnosis is performed by a computer, and diagnosis is performed while referring to image data obtained by imaging a subject, Support for testing and treatment.

  For example, in diagnosis of ischemic heart disease, examination or treatment using a catheter that is less invasive than surgical operation is performed. In catheter examination / treatment, for example, a catheter is inserted into a coronary artery of a subject, a contrast medium is injected, and X-rays are irradiated on the subject while observing a two-dimensional fluoroscopic image of the coronary artery (blood vessel). Stenosis part etc.) is searched.

  And the treatment which expands a stenosis location by indwelling a stent is performed to the searched lesion part. The stent is inserted into a stenosis site in a blood vessel, and the diameter of the blood vessel is maintained by expanding the stent using a catheter with a balloon. Further, the above examination is performed not only at the time of lesion search and treatment, but also at the time of confirming the progress and the progression of the lesion after treatment, and is generally performed a plurality of times.

  However, although it is said that catheter inspection / treatment is less invasive than surgical operation, complications may occur due to catheter operation or stent placement (expansion operation). It is hoped to reduce even a little.

  Moreover, during examination / treatment, a two-dimensional fluoroscopic image is obtained by irradiating X-rays while injecting a contrast medium, and diagnosis is performed while looking at it. However, sufficient information cannot be obtained depending on the irradiation angle. In some cases, it is necessary to change the irradiation direction and re-perspectively see through. For this reason, the examination time becomes longer, and the burden on the patient (subject) due to contrast medium injection or X-ray exposure increases.

  In connection with imaging of blood vessels by administration of a contrast agent, Non-Patent Document 1 describes a blood vessel extraction algorithm for extracting only a coronary artery that is a contrasted blood vessel region from a 3D volume image in an X-ray CT apparatus.

O. Wink, WJ Niessen, MA Viergever, "Fast Delineation and Visualization of Vessels in 3-D Angiographic Images", IEEE Trans. Med. Imaging, Vol. 19, No. 4, p.337-346, Apr., 2000 .

  Conventionally, since catheter examination / treatment may cause complications due to catheter manipulation and stent placement (expansion manipulation), it is desired to reduce the number of examinations as much as possible. During examination / treatment, X-rays are irradiated while injecting a contrast agent to obtain a two-dimensional fluoroscopic image. However, sufficient information may not be obtained depending on the angle, and the irradiation direction is changed each time. Therefore, since it is necessary to perform fluoroscopy again, the examination time becomes longer and the burden on the patient (subject) has increased.

  The present invention has been made in view of the above circumstances. By providing a simulation function before examination / treatment and a guide function during examination / treatment, the safety of catheter examination / treatment is improved, and examination / treatment time is reduced. An object of the present invention is to provide a medical diagnosis support apparatus and a radiation diagnosis apparatus that are shortened and reduce the burden on the subject.

  In order to solve the above-described problems and achieve the object, the medical diagnosis support apparatus according to the present invention provides image data of a blood vessel part to be observed from three-dimensional image data obtained by imaging a subject. An extracting unit for extracting; a display unit capable of displaying a rendered image of the blood vessel part extracted by the extracting unit; and a display for displaying the extracted rendered image of the blood vessel part on the display unit at a display angle specified by a user Simulates the progression of the catheter when a catheter is inserted into the blood vessel extracted by the direction setting unit and the extraction unit, and a marker indicating the position and direction of the catheter is superimposed on the rendered image of the blood vessel And a simulation image generating unit.

  A radiological diagnostic apparatus according to a thirteenth aspect of the present invention is a projection image data generation unit that generates fluoroscopic image data of a subject by an X-ray diagnostic apparatus, and the subject is an X-ray CT apparatus or a magnetic resonance diagnostic apparatus. 3D image data obtained by imaging is obtained, an extraction unit for extracting image data of a blood vessel part to be observed, and a display angle of a rendering image of the blood vessel part extracted by the extraction unit are designated by the user A display direction setting unit that is set based on the display unit, and a display unit that is capable of displaying a rendered image of the blood vessel part at a display angle specified by the user, together with the perspective image of the blood vessel part generated by the projection image data generation unit. It is characterized by having.

  According to the medical diagnosis support method of the present invention described in claim 15, image data of a blood vessel part to be observed is extracted from three-dimensional image data obtained by imaging a subject, and a catheter is attached to the extracted blood vessel part. The progress of the catheter when inserted is simulated to create a marker indicating the position and direction of the catheter, and the extracted three-dimensional image of the blood vessel is displayed on the display at a display angle specified by the user. The marker is superimposed and displayed on a three-dimensional image of the blood vessel part.

  According to the present invention, it is possible to provide the user with information necessary for the examination / treatment before performing the catheter examination / treatment, thereby ensuring the safety of the examination / treatment and reducing the examination / treatment time. Can be achieved.

  Hereinafter, an embodiment of the present invention will be described in detail with reference to the drawings.

  FIG. 1 is a system configuration diagram showing a medical system to which a medical diagnosis support apparatus of the present invention is applied. The medical system of FIG. 1 has modalities such as an X-ray CT apparatus 100 and an X-ray cardiovascular diagnosis apparatus 200 as radiation diagnosis apparatuses. These modalities are connected to a network NW, and a medical image server 300 that stores medical image information (including image data and incidental information) is connected to the network NW. Furthermore, an image observation terminal (viewer) 400, an input / output terminal 500, and the like are connected to the network NW.

  The X-ray CT apparatus 100 and the X-ray circulatory organ diagnosis apparatus 200 capture a subject and generate image data. The image data is stored in the medical image server 300. The image observation terminal 400 captures and processes image data and patient information stored in the medical image server 300 and displays various types of information. The input / output terminal 500 is a PC that logs in to each device on the network NW and inputs / outputs information.

  In the system shown in FIG. 1, a doctor uses the input / output terminal 500 to place an order for, for example, a radiological examination. . Medical image data captured by a modality such as the X-ray CT apparatus 100 is stored in the medical image server 300.

  The medical image data is attached to the medical image server 300 with additional information such as a patient ID, patient name, age, sex, and examination site, and various searches can be performed based on the additional information. Furthermore, the image observation terminal 400 displays various types of information such as image data on the display unit according to, for example, a medical image list / patient list creation process or a request from a user (doctor, engineer, operator, etc.). In addition, a simulation function and a guide function are provided, and an image for support when the user performs examination and treatment is displayed on the display unit.

  FIG. 2 is a configuration diagram showing an embodiment of the X-ray CT apparatus 100 which is a radiation diagnostic apparatus. In FIG. 2, an X-ray CT apparatus 100 has a gantry 11 and a rotating ring 12 is provided in the gantry 11 and is rotated by a rotating mechanism (not shown). An X-ray tube 13 that generates X-rays with respect to the subject P placed in the effective visual field region is attached in the rotating ring 12.

  In addition, a radiation detector 14 is disposed so as to face the X-ray tube 13, the central portion of the rotating ring 12 is opened, and the subject P placed on the couch top 15 is inserted therein. . X-rays transmitted through the subject P are detected by the radiation detector 14 and converted into an electrical signal, amplified by a data collection unit (hereinafter referred to as DAS) 16 and converted into digital data. The portion including the X-ray tube 13 and the radiation detector 14 constitutes an imaging unit.

  The radiation detector 14 is composed of a plurality of detector modules. The detector module includes a plurality of detector element arrays each including a scintillator array and a photodiode array, and the plurality of detector modules are arranged along an arc centered on the focal point of the X-ray tube 13.

  Digital data (projection data) from the DAS 16 is transmitted to the computer system 20 via the data transmission device 17. Further, the gantry 11 is provided with a gantry driving unit 18 and a slip ring 19.

  The computer system 20 is provided in the console, and projection data from the data transmission device 17 is supplied to the preprocessing unit 21. The pre-processing unit 21 performs pre-processing such as data correction on the projection data and outputs it to the bus line 201.

  A system control unit 22, an input unit 23, a data storage unit 24, a reconstruction processing unit 25, an image data processing unit 26, a display unit 27, and the like are connected to the bus line 201.

  The system control unit 22 functions as a host controller, and controls the operation of each unit of the computer system 20 and the gantry driving unit 18 and the high voltage generation unit 28. The data storage unit 24 stores data such as tomographic images, and the reconstruction processing unit 25 reconstructs 3D image data from projection data. The image data processing unit 26 processes the data stored in the data storage unit 24 or the reconstructed image data. The display unit 27 displays an image or the like obtained by image data processing.

  The input unit 23 includes a keyboard, a mouse, and the like. The input unit 23 is operated by a user and performs various settings for data processing. In addition, various information such as the patient's condition and examination method is input.

  The high voltage generator 28 supplies power to the X-ray tube 13 via the slip ring 19 and supplies power (tube voltage and tube current) necessary for X-ray exposure. The X-ray tube 13 generates beam X-rays that spread in two directions: a slice direction parallel to the body axis direction of the subject P and a channel direction perpendicular thereto.

  The bus line 201 is provided with a network interface 29, and the X-ray CT apparatus 100 can be connected to the network NW (FIG. 1). Image data captured by the X-ray CT apparatus 100 and reconstructed images are displayed. The data is stored in the medical image server 300.

  In the X-ray CT apparatus 100, a scan range is set, volume scan (3D scan) is performed, and reconstruction is performed by the reconstruction processing unit 25 to obtain a 3D (three-dimensional) image within the range.

  In the X-ray CT apparatus 100, there is a case in which imaging is performed by administering a contrast medium to a subject for the purpose of observing an organ such as a blood vessel. In imaging of blood vessels by administration of a contrast agent, X-ray CT image data of contrast blood vessels is reconstructed, and 3D image data is created from the X-ray CT image data.

  As a method of creating 3D image data, for example, a maximum value projection method (MIP: Maximum Intensity Projection) that performs projection processing in an arbitrary direction and displays a maximum value in a projection path, or a minimum value projection method that projects a minimum value is used. (Minimum Intensity Projection) and Addition Average Projection (X-ray Projection).

  For observation of contrast blood vessels, 3D images (MIP images) created by MIP are frequently used. In addition, a VR method (Volume Rendering) or an SVR method (Shaded Volume Rendering) that reconstructs and visualizes a stereoscopic image using pixel values (CT values) and opacity (opacity) are also used. The SVR method is suitable for dynamic observation, and can display, for example, a moving image of heart wall motion with a shadow.

  FIG. 3 is a configuration diagram showing an embodiment of an X-ray cardiovascular diagnostic apparatus 200 which is a radiation diagnostic apparatus of the present invention. In FIG. 3, the X-ray cardiovascular diagnostic apparatus 200 two-dimensionally detects and detects an X-ray generator 30 for generating X-rays on the subject P, and X-rays transmitted through the subject P. An X-ray detection unit 40 that generates X-ray projection data based on the result is provided.

  The X-ray generator 30 includes an X-ray irradiator having an X-ray tube 31 and an X-ray restrictor 32, and a high voltage generator having a high voltage controller 33 and a high voltage generator 34. The X-ray tube 31 is a vacuum tube that generates X-rays, and accelerates electrons emitted from a cathode (filament) by a high voltage to collide with a tungsten anode to generate X-rays.

  The X-ray detection unit 40 converts the flat detector 41, the charge / voltage converter 42 that converts charges read from the flat detector 41 into voltage, and the output of the charge / voltage converter 42 into digital signals. An A / D converter 43 and a parallel / serial converter 44 that converts the X-ray projection data read out in parallel in line units from the flat detector 21 and converted into digital data into a time-series signal are provided.

  The X-ray generation unit 30 and the X-ray detection unit 40 are held by an arm (C arm) 50. The arm 50 is movable in the body axis direction of the subject P, for example, and moves around the subject P. It can be rotated. The portion including the X-ray generation unit 30 and the X-ray detection unit 40 constitutes an imaging unit.

  The X-ray circulatory diagnostic apparatus 200 includes a moving mechanism unit 60. The movement mechanism unit 60 includes a diaphragm movement control unit 61 and a mechanism control unit 62. The diaphragm movement control unit 61 performs movement control of the diaphragm blades and the like in the X-ray diaphragm 32, and the mechanism control unit 62 performs measurement of the subject. Movement control of the moving mechanism 63 of the top plate 51 on which P is placed and the photographing system moving mechanism 64 are performed.

  The X-ray cardiovascular diagnostic apparatus 200 further includes an image data generation / storage unit 52, an input unit 53, a system control unit 54, and a monitor 55. The image data generation / storage unit 52 generates and stores perspective image data based on the X-ray projection data from the parallel / serial converter 45, and stores the perspective image data generated in the image data generation / storage unit 52. Displayed on the monitor 55.

  The input unit 53 is used by a user such as a doctor to input various commands. The input unit 53 includes an input interface such as a mouse, a keyboard, a trackball, and a joystick, and an interactive interface including a display panel or various switches. Further, the system control unit 54 comprehensively controls each unit of the X-ray cardiovascular diagnostic apparatus 200 via the bus line 56.

  A network interface 57 is connected to the bus line 56, and the X-ray circulatory diagnosis apparatus 200 can be connected to the network NW (FIG. 1). It can be stored in the image server 300.

  Next, the configuration and function of the main part of the present invention will be described. FIG. 4 is a block diagram showing a medical diagnosis support apparatus 70 having a simulation function. The medical diagnosis support apparatus 70 is provided in the image observation terminal 400, for example, and performs a simulation before catheter examination / treatment.

  In FIG. 4, reference numeral 71 denotes a coronary artery extraction unit which reads three-dimensional (3D) image data stored in the storage device 81 and based on the CT value of the image data (LCA: left coronary artery, RCA: right coronary artery). ). The storage device 81 stores the three-dimensional image data collected and reconstructed by the X-ray CT apparatus 100, and may be the medical image server 300 of FIG.

  A coronary artery core wire calculating unit 72 is connected to the coronary artery extracting unit 71, and the coronary artery core wire calculating unit 72 calculates the core wire of the coronary artery extracted by the coronary artery extracting unit 71. The coronary artery core wire calculation unit 72 is connected to a catheter position management unit 73, and a catheter position / direction calculation unit 74 and a catheter movement determination unit 75 are connected to the catheter position management unit 73.

  The catheter position management unit 73 should advance the current catheter position and the catheter based on information provided from the input unit 82, the coronary artery core line calculation unit 72, the catheter position / direction calculation unit 74, and the catheter movement determination unit 75. Determine the direction. The input unit 82 includes, for example, a mouse and a keyboard, and is operated by a user (doctor, engineer, etc.). In the figure, an example having a mouse 821 is shown.

  When there is a catheter position / direction update request from the input unit 82, the catheter position management unit 73 provides determination information to the catheter movement determination unit 75, and whether the catheter position / direction can be updated from the catheter movement determination unit 75. Get information on whether or not.

  Further, the catheter position management unit 73, when the catheter movement determination unit 75 determines that the catheter position / direction can be updated, or in the initial state where the catheter position / direction has never been set, Calculation information is provided to the catheter position / direction calculator 74, and information on the current catheter position / direction is obtained from the catheter position / direction calculator 74.

  The catheter position / direction calculation unit 74 calculates the position and direction of the catheter based on the information provided from the catheter position management unit 73. The catheter movement determination unit 75 determines whether or not the catheter position / direction can be updated (moved) based on the information provided from the catheter position management unit 73, that is, whether or not the catheter can be advanced.

  Further, the catheter position management unit 73 is connected to the overlay creation unit 76, and the overlay creation unit 76 creates an overlay image to be displayed on the three-dimensional image of the coronary artery. For example, an IP (Intensity Projection) or SVR (Shaded Volume Rendering) image is used as the three-dimensional image, and an arrow (marker) image indicating the position and direction of the catheter is created as the overlay image. The data of these three-dimensional images and overlay images are supplied to the display unit 83 and displayed.

  Thus, the coronary artery core line calculation unit 72, the catheter position management unit 73, the catheter position / direction calculation unit 74, the catheter movement determination unit 75, and the overlay creation unit 76 constitute a simulation image generation unit.

  Further, the medical diagnosis support apparatus 70 is provided with a segment creation unit 77 and an image display direction setting unit 78. The segment creation unit 77 creates segment data to be displayed on the 3D image of the coronary artery based on the information provided from the input unit 82 and the information from the catheter position management unit 73. The image display direction setting unit 78 switches the display angle of the three-dimensional image of the coronary artery by controlling the display unit 83.

  The medical diagnosis support apparatus 70 can display a three-dimensional image of the coronary artery viewed from an arbitrary angle using image data captured by the X-ray CT apparatus 100 in advance for the user. In addition, a catheter insertion simulation is performed before examination and treatment.

  Next, the operation of the medical diagnosis support apparatus 70 will be described with reference to the flowchart of FIG. FIG. 5 shows a procedure for extracting a coronary artery from X-ray CT image data and performing a catheter examination simulation using the extracted coronary artery image.

  The simulation image displays the progress of the catheter according to the situation in the blood vessel, and it advances to the lesioned part (for example, the stenosis part of the blood vessel) while rotating the tip of the catheter, and reaches the lesioned part. And display the segment (stent) at the time.

  In step S1 of FIG. 5, first, in order to collect contrast blood vessel images of the subject, a scan with contrast medium administration is executed in the X-ray CT apparatus 100, and three-dimensional image data of the subject is reconstructed. The reconstructed three-dimensional image data is stored in the storage device 81.

  In step S <b> 2, the three-dimensional image data stored in the storage device 81 is read and a three-dimensional image (3D projection image and 3D volume image) is displayed on the display unit 83. As the 3D projection image, it is possible to switch and display a maximum value projection method (Maximum Intensity Projection), a minimum value projection method (Minimum Intensity Projection), or an addition average projection method (X-ray Projection). These projection methods are collectively called IP (Intensity Projection). On the other hand, as a 3D volume image, a shaded volume rendering image (SVR: Shaded Volume Rendering) is displayed.

  The displayed 3D projection image and 3D volume image include a region to be deleted in the simulation together with the contrasted blood vessel. In addition, the 3D projection image displays an area displayed as a 3D volume image as a projection image. Therefore, when segment processing such as region extraction is performed on the 3D volume image, the display of the 3D projection image is inevitably updated.

  In the next step S3, based on the CT value of the image data, only the coronary artery (LCA: left coronary artery, RCA: right coronary artery) that is a contrasted blood vessel region is extracted from the 3D volume image. The blood vessel extraction algorithm uses, for example, the method described in Non-Patent Document 1.

  In step S4, parameters necessary for performing the simulation are set. An example of a GUI (graphical user interface) for setting each parameter is shown in FIG. The GUI displays an operation screen on the screen and sets various parameters. As parameters to be set, for example, as shown in the left screen of FIG. 6A, the following (a) to (e) There are items listed in.

  (A) Designation of coronary artery: Designates a coronary artery (LCA or RCA) to be simulated.

  (B) Start / end position: Designate a range (start position and end position) to be simulated.

  (C) Discrimination condition (collision angle): A condition for discriminating whether or not the catheter is movable at the time of simulation, and the angle between the catheter tip and the blood vessel inner wall is designated.

  (D) Discrimination condition (category position-inner wall): This is a condition for discriminating whether or not the catheter is movable during simulation, and designates the distance between the catheter and the inner wall of the blood vessel.

  (E) Stent length: The length of the stent to be placed at the lesion (stenosis) is set.

  Next, in step S5, only the designated coronary artery (LCA or RCA) is extracted from the 3D volume image when the coronary artery to be simulated is designated in step S4 (item a).

  In step S6, the extracted coronary artery core line is extracted within the simulation range specified in step S4 (item b). The extracted core wire becomes a movement path of the catheter at the time of simulation. The core line extraction algorithm uses, for example, the method described in Non-Patent Document 1.

  In step S7, the position and direction of the initial catheter are set using the simulation range specified in step S4 (item b) as in step S6 (here, only the start position).

  FIG. 7A is a diagram showing the position and direction of the catheter in the blood vessel. The initial catheter position is the start position o designated in step S4 (item b), and is a core line (dotted line). Located on the top. The catheter direction is a vector q represented by a certain angle θ1 from the core line vector p with the catheter position o as a base point, and means the catheter tip.

  That is, here, the catheter position o is determined on the core line (dotted line) based on the input information. Next, a point P on the core line that is a few cm away from the catheter position is obtained, and a core vector p is calculated. The point P on the core line is searched in the direction from the catheter position o to the simulation end position.

  Further, a vector q inclined by θ1 from the core line vector p is calculated with the catheter position o as a base point. As a result, the calculated vector q is taken as the catheter tip. The angle θ1 can be arbitrarily changed by simulation environment setting or the like.

  When the catheter position / direction is set, in the next step S8, a “standby state” is awaited for a new input (catheter position / direction update request) from the user.

  In step S8, when there is an update request, in step S9, it is determined whether or not the update is possible based on the input information from the mouse of the input unit 82. There are two conditions for this determination, which are performed using the values set in step S4 (item c, item d).

  First, the collision angle set in item c is determined. As shown in FIG. 7B, the collision angle represents an angle θ2 formed by the vector q of the catheter tip and the tangent vector r of the inner wall of the coronary artery, and the angle θ2 formed by the two vectors is more acute than the set angle. In this case, it is determined that the catheter cannot be moved. If the angle is acute, the inner wall of the blood vessel may be damaged by the tip of the catheter, so that the catheter cannot be moved.

  That is, here, a point S on the inner wall several millimeters away from the position where the catheter tip is in contact with the blood vessel inner wall is obtained, and the inner wall vector θ2 is calculated. The point S on the inner wall is searched in the direction of the simulation end position from the position where the distal end of the catheter is in contact with the inner wall.

  When the calculated angle θ2 is more acute than the designated angle, it is determined that the catheter position / direction cannot be updated. The distance from the position where the catheter tip is in contact with the inner wall to the point S on the inner wall and the angle θ2 can be arbitrarily changed by setting the environment of the simulation.

  Next, “category position-inner wall” set in item d is determined. As shown in FIG. 7C, the “cate position-inner wall” indicates that the catheter tip vector set from the catheter position o positioned on the core line of the coronary artery is in contact with the inner wall of the coronary artery even if the vector at the catheter tip is an obtuse angle. Is longer than the set distance, it is determined that the catheter cannot be moved. That is, the catheter is prevented from going from the blood vessel main stream to advance in the tributary direction.

  That is, here, the distance from the catheter position o to the blood vessel inner wall is calculated. As a result, if the calculated distance to the inner wall is longer than the specified length, it is determined that the catheter position / direction cannot be updated. Since the value designated as the categorical position-inner wall is used for the determination of the branch point as shown in FIG. 7C, it can be set in consideration of the branch boundary T (the inner wall when the branch is not branched). desirable.

  If either of the above two conditions is met, the catheter position update request is discarded, and the process returns to step S8.

  The determination process in step S9 is performed only when the input information from the input unit 82 is “catheter position update request”, and when it is “catheter direction update request”, it is unconditionally updated.

  The input unit 82 includes, for example, a mouse 821 (see FIG. 4), and input information from the input unit 82 assumes three types of advance / retreat of the catheter position and rotation in the catheter tip direction. For example, when the left button of the mouse 821 is clicked, the position of the catheter is advanced by one step, and by continuously pressing, the catheter is continuously advanced. Also, clicking the right button of the mouse 821 causes the catheter position to move backward by one step, and by continuing to push it, the catheter is continuously retracted.

  The wheel 822 can indicate the direction of the catheter tip, and by rotating the wheel 822 upward, the catheter tip is rotated leftward about the core wire and rotated downward. The catheter tip is rotated to the right as an axis.

  In addition, it is possible to use not only a mouse but also a GUI that allows a user to specify a movement amount and a rotation angle.

  When “catheter position / direction update is possible” is established in step S9, the updated catheter position / direction is set based on the current catheter position / direction information and input information in step S10.

  When the catheter position / direction is updated in step S10, it is determined in step S11 whether or not the catheter position has reached the end position set in item b of step S4. If the end position has been reached, no subsequent catheter position / direction update request is accepted and the process proceeds to step S12. If the end position has not been reached, the process returns to step S8 to wait for a new update request.

  In step S12, it is assumed that the stent is placed at the lesion (the stenosis portion of the blood vessel) when the catheter position reaches the end position, and the segment data X is determined using the stent length set in item e in step S4. Create

  The segment data X is created as shown in FIG. That is, the length of the segment data to be created corresponds to the stent length set in item e in step S4. The creation position is a position where two points on the core wire are connected by a straight line.

  As shown in FIG. 8A, the two points on the core line are a point U several centimeters before the simulation end position and a point V on the core line separated from the point by the length set in the item e. . The distance from this point U to V is the stent length designated by the user. Segment data X is created at a position where points U and V are connected by a straight line. As a result, it is assumed that the created segment data X is regarded as a stent before expansion, and stent placement is performed.

  Next, assuming that the stent is expanded to treat the lesion (stenosis), the created segment data X is expanded as shown in FIG. 8B based on the user's expansion request. In the segment data X, the two points U-V used when creating the segment data are connected by a straight line and expanded in a direction perpendicular to the straight line.

  As a result, as shown in FIG. 8C, the segment data X is displayed with a thickness substantially equal to the blood vessel diameter, and displayed as if the lesion (stenosis) was treated by the expansion of the stent.

  As for the input information, it is assumed that the expansion request is input through the GUI. However, the input information is not limited to the GUI, and may be input by clicking the button of the mouse 281 or the like.

  It should be noted that the distance from the simulation end position to the point U, the CT value of the segment data X, and the expansion rate can be arbitrarily changed by setting the environment of the simulation. In particular, the CT value is not described because it depends on the image acquisition conditions and the like, but since the present invention is performed on the coronary artery after extraction, the CT value is set to be equal to or higher than the CT value of the coronary artery, and It is necessary to make the transparency with respect to the CT value opaque.

  Next, a method for setting the simulation range (start / end) will be described. Although the parameters necessary for the simulation have been described in step S4 in FIG. 5, the simulation range (start / end) setting method will be described in detail here.

  When the designated coronary artery (LCA or RCA) is extracted from the 3D volume image, a start / end position overlay is displayed on the 3D volume image. The start / end position overlay is represented by a coronary artery core line (dotted line) and a cursor Z (x mark) positioned on the core line as shown in FIG.

  When setting the simulation range, the user drags the cursor Z (FIG. 8A) displayed on the 3D image with the mouse 821, and moves to a position where the simulation is started. When the start button in FIG. 6A is selected, the position where the cursor Z is displayed is set as the simulation start position.

  Similarly, the cursor Z is dragged with the mouse to move to a position where the simulation is ended, and the end button in FIG. 6A is selected. As a result, the position where the cursor Z is displayed is set as the simulation end position. The cursor Z disappears when the setting of the start and end positions is completed. Further, by selecting the clear button in FIG. 6A, the set start / end positions can be discarded.

  Next, the catheter position overlay display will be described.

  When the setting of the simulation range (start / end) is completed, an overlay Y indicating the position and direction of the catheter is displayed on the 3D projection image and the 3D volume image (SVR) as shown in FIG. 9A shows a 3D projection image, and FIG. 9B shows an SVR image that is a 3D volume image.

  The displayed overlay image Y is regarded as the distal end portion of the catheter under examination / treatment, and is displayed while updating the display position / direction each time based on input information from the user. When the catheter position reaches the simulation end position (lesion), the overlay image Y displays the image X of the segment (FIG. 8C) instead of displaying the marker (arrow).

  As an example of displaying the overlay image Y, an arrow-shaped marker indicating the position and direction of the catheter is suitable. However, any shape may be used as long as it can represent the position and direction of the catheter.

  Next, the display direction of the 3D volume image will be described. In the present invention, when a 3D volume image is displayed, a plurality of display angle patterns are prepared in advance, and a 3D image viewed from an arbitrary angle direction can be displayed. The display angle pattern means a 3D image when the subject is viewed from a plurality of angular directions, and a 3D image of the coronary artery viewed from a plurality of angular directions is obtained by reconstruction processing by the X-ray CT apparatus 100. Obtainable.

  The display angle is the same as a general irradiation angle when coronary angiography is performed by the X-ray cardiovascular diagnostic apparatus 200, and information necessary for reproduction of actual catheter examination / treatment can be provided.

  The screen on the right side of FIG. 6A shows a GUI for designating a display angle pattern, and enclosed numerals 1 to 8 show the imaging direction of the subject when designating a coronary artery (LCA). . For example, when the cursor is placed on the number 1, the 3D image when the subject is irradiated with X-rays from the front can be selected.

  FIG. 10 is a schematic explanatory diagram for explaining the X-ray irradiation direction in the X-ray cardiovascular diagnostic apparatus 200. FIG. 10A is a view of the X-ray cardiovascular diagnostic apparatus 200 as viewed from the side of the subject, and FIG. 10B is a view of the subject as viewed from the head side.

  In FIG. 10, the X-ray generation unit 30 and the X-ray detection unit 40 are attached to the arm 50, and the X-ray generation unit 30 and the X-ray detection unit 40 face each other so as to sandwich the bed 51. As shown in FIG. 10A, the subject can rotate in the Cranial (head) direction and Caudal (leg) direction. Further, as shown in FIG. 10B, the periphery of the subject can be rotated in the left and right (LR) direction.

  For example, when the X-ray detector 40 is located at an intermediate position between the Cranial direction and the Caudal direction and at an intermediate position of LR, the position on the reference line A is as shown in FIG. Corresponds to the number 1 point. Further, numeral 2 in FIG. 6A indicates a display angle rotated 30 degrees to the right (R) with respect to the reference line A.

  Similarly, the number 3 rotates 30 degrees to the right (R) and 30 degrees in the Caudal direction, the number 4 rotates 30 degrees in the Caudal direction, and the number 5 indicates a display angle rotated 35 to 40 degrees in the Cranial direction. Yes. Other numbers also show display angles when rotated by a predetermined angle in the LR direction and the Cranial-Caudal direction.

  Further, the screen on the right side of FIG. 6B shows the imaging direction of the subject when the coronary artery (RCA) is designated. The number 9 in FIG. 6B indicates the display angle rotated 50 to 60 degrees to the left (L) with respect to the reference line A, and the number 10 is rotated 30 to 40 degrees in the Cranial direction. Indicates a display angle rotated 30 degrees in the right (R) direction. Therefore, by selecting a display angle (numerals 1 to 11) on the right screens of FIGS. 6A and 6B, a 3D image having a desired angle can be displayed.

  Further, by selecting the rotation button in FIGS. 6A and 6B, it is possible to display each display angle pattern in a direction further rotated by + 90 °. In this case, by selecting each number button while the rotation button is selected, the 3D volume image is rotated to the selected number angle, and then rotated by + 90 ° on the X axis of the screen coordinate system, for example. Can be displayed. Therefore, it is possible to display an overlapping state with respect to the depth direction of the coronary artery, which cannot be obtained from a fluoroscopic image at the time of examination / treatment.

  The display angle of the 3D image shown in FIG. 9 can be specified by the GUI shown in the right screen in FIGS. 6A and 6B, and can be specified by the difference in the coronary artery (LCA or RCA) to be simulated. The display angle is also different. As an actual display screen, the image of FIG. 9A or 9B and the GUI of FIG. 6A or 6B are displayed on the same screen so that the display angle can be easily specified. ing.

  Thus, in the first embodiment of the present invention, the medical diagnosis support apparatus 70 shown in FIG. 4 is provided in the image observation terminal 400, so that the user can use the image data captured in advance by the X-ray CT apparatus 100 to perform an examination. -A catheter insertion simulation can be performed together with a 3D image display before treatment.

  Incidentally, by providing the X-ray CT apparatus 100 with the configuration shown in FIG. 4, a radiation diagnostic apparatus having a simulation function can be provided. In this case, the medical diagnosis support apparatus 70 shown in FIG. 4 is incorporated in the image data processing unit 26 of FIG. 2, and the storage device 81, the input unit 82, and the display unit 83 are the data storage unit 24 and the input unit 23 of FIG. The display unit 27 may also be used.

  The second embodiment of the present invention relates to a radiation diagnostic apparatus having a guide function during catheter examination / treatment, and uses a part of the aforementioned simulation function.

  That is, by providing the medical diagnosis support apparatus 70 shown in FIG. 4 in the X-ray cardiovascular diagnosis apparatus 200, a radiation diagnosis apparatus having a guide function is provided. In this case, the medical diagnosis support device 70 and the storage device 81 shown in FIG. 4 are incorporated in the image data generation / storage unit 52 of FIG. 3, and the input unit 82 and the display unit 83 are the input unit 53 and the monitor 55 of FIG. You can use it together.

  In this embodiment, an actual fluoroscopic image obtained by the X-ray circulatory organ diagnosis apparatus 200 is displayed, and three-dimensional image data collected and reconstructed in advance by the X-ray CT apparatus 100 is read and the image data is read. Based on the CT value, a three-dimensional image of the coronary artery can be displayed at an arbitrary display angle. The three-dimensional image of the coronary artery becomes a guide image at the time of catheter insertion.

  In the second embodiment, the coronary artery extraction unit 71 and the image display direction setting unit 78 shown in FIG. 4 are mainly used. The coronary artery extraction unit 71 reads the three-dimensional image data collected / reconstructed by the X-ray CT apparatus 100 stored in the storage device, and based on the CT value of the image data, the coronary artery (LCA: left coronary artery, RCA: The right coronary artery) is extracted, and a three-dimensional image (for example, SVR: Shaded Volume Rendering) of the coronary artery is displayed on the monitor 55.

  The image display direction setting unit 78 sets so as to display a three-dimensional image of the coronary artery at a display angle designated by the user. The three-dimensional image of the coronary artery is displayed on the display unit 83 together with the fluoroscopic image obtained by the X-ray cardiovascular diagnostic apparatus 200.

  Thus, the user can perform catheter examination / treatment by changing the display angle arbitrarily while viewing the three-dimensional image of the coronary artery. In addition, since an actual fluoroscopic image is also displayed, catheter examination / treatment can be supported.

  FIG. 11 is a flowchart for explaining the operation of the X-ray cardiovascular diagnostic apparatus 200 according to the second embodiment. In step S21 in FIG. 11, first, in order to collect a contrast blood vessel image of a subject, a scan with contrast medium administration is executed by the X-ray CT apparatus 100, and three-dimensional image data of the subject is reconstructed. The reconstructed three-dimensional image data is stored in the storage device 81.

  Next, in step S22, a 3D volume image based on the 3D image data stored in the storage device 81 is displayed. The 3D volume image is assumed to display a shaded volume rendering image (SVR).

  The displayed 3D volume image includes a region to be deleted in the simulation together with the contrasted blood vessel. Therefore, in step S23, only the contrasted blood vessel region (coronary artery (LCA: left coronary artery, RCA: right coronary artery)) is extracted from the 3D volume image based on the CT value of the image data. For the coronary artery extraction algorithm, the method described in Non-Patent Document 1 is used.

  Next, in order to perform the guide function, necessary parameters are set in step S24. Here, the coronary artery (LCA or RCA) to be guided is designated. For designation of the coronary artery (LCA or RCA), either the LCA or RCA item in the GUI (left screen) of FIG. 6 is selected.

  Finally, in step S25, as the coronary artery to be a guide function is designated in step S24, only the designated coronary artery (LCA or RCA) is extracted from the 3D volume image, and the guide during catheter examination / treatment is extracted. Display as an image.

  In the guide function, the display direction of the 3D volume image can be set. The setting of the display direction is performed using the GUI (right screen) in FIG. 6 in the same way as the setting of the display angle of the 3D volume image at the time of simulation (the description here is omitted).

  In this way, the display unit 83 displays both a fluoroscopic image obtained by the X-ray cardiovascular diagnostic apparatus 200 shown in FIG. 12A and a three-dimensional image of the coronary artery shown in FIG.

  Furthermore, a portion (corresponding to the segment data in FIG. 7C) specified as a lesion (stenosis portion) at the time of simulation may be displayed as an overlay image on the 3D volume image at the time of the guide function. Thereby, since the position of a lesioned part is specified beforehand, it becomes easy to grasp | ascertain the path | route which inserts a catheter.

  In addition, this overlay image is not always displayed, but can be displayed / hidden based on user input information, and the shape of the lesion can be grasped and information provided to the user as a guide function Any material that does not significantly reduce the amount may be used.

  In the first embodiment, the simulation using a still image has been described. However, an actual catheter operation is performed while viewing a moving fluoroscopic image because the heart or the like is moving. Therefore, even in the simulation, it is possible to provide a more realistic image by using a moving image instead of a still image.

  Further, during the catheter operation, a contrast medium is injected to make the blood vessels easier to see. Therefore, a more realistic image can be provided by simulating a change in blood vessel image due to the injection of a contrast agent. In the simulation, an MIP image assuming an X-ray fluoroscopic image at the time of catheter operation is also displayed. Therefore, a more realistic image can be provided in the MIP image by simulating the change in the blood vessel image due to the injection of the contrast agent.

  Therefore, in the third embodiment, a medical diagnosis support apparatus capable of providing a more realistic image by using a moving image and simulating contrast agent injection will be described.

  First, the configuration of the medical diagnosis support apparatus according to the third embodiment will be described. FIG. 13 is a block diagram illustrating a configuration of the medical diagnosis support apparatus according to the third embodiment. Here, for convenience of explanation, functional units that play the same functions as the respective units shown in FIG.

  However, the medical diagnosis support apparatus 90 displays a plurality of time-phase SVR images as cine. Therefore, each functional unit of the medical diagnosis support apparatus 90 functions for a plurality of time phase image data. For example, the storage device 81 stores image data of a plurality of time phases, and the coronary artery extraction unit 71 extracts coronary arteries at each time phase of the plurality of time phases.

As illustrated in FIG. 13, the medical diagnosis support apparatus 90 further includes a display control unit 91 and a user interface unit 92 as compared with the medical diagnosis support apparatus 70 illustrated in FIG. 4.
The display control unit 91 repeatedly displays cine (moving image display) the coronary artery images of a plurality of time phases extracted from the image data by the coronary artery extraction unit 71 on the display unit 83. Here, as the image data of a plurality of time phases, image data corresponding to a change in rendering due to one injection of the contrast agent is used. FIG. 14 is a diagram showing a change in visualization due to one injection of contrast medium in correspondence with an electrocardiogram waveform and a change in coronary artery flow velocity. The display control unit 91 repeatedly displays a moving image corresponding to the rendering change shown in FIG.

  Specifically, the display control unit 91 sets opacity (0.0 to 1.0), which is one of the drawing conditions of the SVR image, for each time phase corresponding to the drawing change shown in FIG. In each time phase, only the coronary artery from the current catheter position to the peripheral blood vessel is extracted and displayed. When the contrast medium is injected at the timing of R1 during the operation, the coronary artery is vigorously depicted between R1 and R2 due to the flow velocity of the coronary artery, and the coronary artery is not completely depicted after about 3 heartbeats. This change in visualization by contrast agent is applied to the setting of opacity. For example, assuming that the number of time phase data is 30 time phases (the time phase data number between RR is 10 time phases), the opacity at the time of contrast agent injection (first time phase) is set to the minimum value (0.0 ), The vicinity of the seventh time phase is set to the maximum value (1.0), and the final time phase is set to the minimum value (0.0).

  In this way, the display control unit 91 sets the opacity for each time phase, and in each time phase, extracts only the coronary artery from the current catheter position to the peripheral blood vessel and displays it as a cine, so that the movement of the heart An image reflecting the state of contrast agent injection from the catheter can be displayed.

  Here, the maximum value is set to 1.0, but the maximum value of 1.0 is not fixed and can be arbitrarily changed. In the operation of the catheter, the contrast medium is often injected little by little, and the opacity often does not reach the maximum value. By making the maximum value variable, it is possible to display an image more reflecting the state of contrast agent injection.

Further, when displaying the MIP image assuming an intraoperative fluoroscopic image, the display control unit 91 performs cine display by changing the luminance of the image data of each time phase. Specifically, the brightness is set by the user in the following procedure, and the display control unit 91 sets the brightness of all time phases based on the brightness (maximum value / minimum value) set by the user.
(1) Display the first phase image and set the brightness (minimum value).
(2) Select the minimum luminance button on the parameter setting GUI shown in FIG.
(3) Display the image data near the seventh time phase and set the brightness (maximum value).
(4) Select the maximum brightness button on the parameter setting GUI shown in FIG.

The display control unit 91 displays the overlay created by the overlay creation unit 76 and the segment created by the segment creation unit 77 on the display unit 83. The display control unit 91 switches the display angle of the coronary artery based on an instruction from the display direction setting unit 78.
The user interface unit 92 sets simulation parameters based on user instructions. For example, the user interface unit 92 sets a stent length, a determination condition, and the like.

  Also, as shown in FIG. 16, the user interface unit 92 sets the simulation start / end positions for all time phase images. Specifically, the user sets the start / end positions for the first time phase image by the method described in the first embodiment. Then, the user interface unit 92 determines which blood vessel of the coronary artery is set from the information of the start / end position specified on the image data of the first time phase, and further ends from the start position. By calculating the distance to the position, the start / end positions are set for all time phase image data. In order to determine which vessel of the coronary artery the start / end position is set, details such as the left anterior ventricular branch (LAD) and the left coronary artery rotation branch (LCX) are extracted when the coronary artery is extracted. Can be done.

  Next, the operation of the medical diagnosis support apparatus 90 will be described with reference to the flowchart of FIG. FIG. 17 shows a procedure for extracting a coronary artery from X-ray CT image data and starting a simulation of catheter examination using the extracted image of the coronary artery.

  In step S31 of FIG. 17, first, a scan with contrast medium administration is executed in the X-ray CT apparatus 100 to perform cine display, and three-dimensional image data of a plurality of time phases of the subject is reconstructed. The reconstructed three-dimensional image data of a plurality of time phases is stored in the storage device 81.

  In step S <b> 32, the first time-phase three-dimensional image data stored in the storage device 81 is read, and the first time-phase three-dimensional image (3D projection image and 3D volume image) is displayed on the display unit 83. In the next step S33, based on the CT value of the image data, a coronary artery that is a contrasted blood vessel region is extracted from the 3D volume image of each time phase.

  In step S34, parameters necessary for the simulation, that is, a target coronary artery (LCA or RCA), start / end position, determination condition, stent length, and the like are set. Here, for the start / end positions, the user designates only the first time phase, and the medical diagnosis support apparatus 90 automatically sets the other time phases.

  Next, in step S35, the coronary artery (LCA or RCA) designated as the simulation target in step S34 is extracted at each time phase. In step S36, the core line of the extracted coronary artery is extracted at each time phase in the simulation range specified in step S34. In step S37, the position and direction of the initial catheter are set in each time phase based on the start position of each time phase. Then, a cine display is started and a “standby state” is waited for an input (catheter position / direction update request) from the user.

  As described above, in the third embodiment, since a three-dimensional image of a coronary artery is displayed using a plurality of time phase image data, a more realistic image simulation environment can be provided. In addition, the visualization change due to the contrast agent is expressed using the opacity of the SVR image and the brightness of the MIP image, and only the coronary artery from the position of the catheter to the previous peripheral blood vessel is depicted, so a more realistic image simulation environment Can be provided. It should be noted that a 3D image display such as an SVR image or MIP image can be projected and displayed to obtain a sense closer to that during the operation.

  As described above, in the present invention, sufficient information necessary for the examination (treatment) can be obtained before performing the catheter examination, and examination / treatment is supported by looking at the simulation image or the guide image. Can contribute to the improvement of safety. In addition, the examination / treatment time can be shortened and the burden on the subject can be reduced.

  In the above description, an example in which an image of a coronary artery is extracted has been described. However, an image of another blood vessel part can be extracted to display a simulation image or a guide image. The embodiment of the present invention is not limited to the above description, and various modifications can be made without departing from the scope of the claims.

The block diagram which shows the medical system to which the medical diagnosis assistance apparatus of this invention was applied. 1 is a block diagram showing an example of an X-ray CT apparatus that is a radiation diagnostic apparatus of the present invention. 1 is a block diagram showing an example of an X-ray cardiovascular diagnostic apparatus that is a radiation diagnostic apparatus of the present invention. The block diagram which shows one Embodiment of the medical diagnosis assistance apparatus of this invention. The flowchart explaining operation | movement of the embodiment. Explanatory drawing which shows the GUI screen for parameter setting which concerns on the embodiment. Explanatory drawing explaining the update determination of the position and direction of the catheter which concerns on the same embodiment. Explanatory drawing explaining creation and expansion | swelling of the segment data based on the embodiment. Explanatory drawing which shows the simulation image in the display part which concerns on the same embodiment. Explanatory drawing explaining roughly the operation | movement of the X-ray cardiovascular diagnostic apparatus which is a radiation diagnostic apparatus of this invention. The flowchart explaining operation | movement of other embodiment of the radiation diagnostic apparatus of this invention. Explanatory drawing which shows the guide image in the display part which concerns on the 2nd Embodiment of this invention. The block diagram which shows the structure of the medical diagnosis assistance apparatus which concerns on the 3rd Embodiment of this invention. The figure which represented the visualization change by one injection | pouring of a contrast agent corresponding to the electrocardiogram waveform and the coronary artery flow velocity change. Explanatory drawing which shows the GUI screen for parameter setting which concerns on 3rd Embodiment. The figure which shows the setting of the start / end position with respect to the image data of all the time phases. The flowchart explaining operation | movement of the medical diagnosis assistance apparatus which concerns on 3rd Embodiment.

Explanation of symbols

100 X-ray CT system (radiological diagnosis system)
200 X-ray cardiovascular diagnostic equipment (radiological diagnostic equipment)
300 Medical Image Server 400 Image Observation Terminal 500 PC
70, 90 Medical diagnosis support device 71 Coronary artery extraction unit 72 Coronary artery core wire calculation unit 73 Catheter position management unit 74 Catheter position / direction calculation unit 75 Catheter movement determination unit 76 Overlay creation unit 77 Segment creation unit 78 Display direction setting unit 81 Storage device 82 Input unit 83 Display unit 91 Display control unit 92 User interface unit 821 Mouse 822 Wheel

Claims (15)

An extraction unit for extracting image data of a blood vessel part to be observed from three-dimensional image data obtained by imaging a subject;
A display unit capable of displaying a rendered image of the blood vessel portion extracted by the extraction unit;
A display direction setting unit for displaying the extracted rendered image of the blood vessel on the display at a display angle specified by a user;
A simulation image generation unit that simulates the progression of the catheter when a catheter is inserted into the blood vessel extracted by the extraction unit, and superimposes a marker indicating the position and direction of the catheter on the rendered image of the blood vessel When,
A medical diagnosis support apparatus comprising:   The medical diagnosis support apparatus according to claim 1, wherein the display angle corresponds to an imaging angle when the subject is imaged by the X-ray diagnostic apparatus.   The medical diagnosis support apparatus according to claim 1, wherein the rendered image of the blood vessel portion displayed on the display unit is an X-ray projection image or a 3D volume image.   The medical diagnosis support apparatus according to claim 2, wherein the rendered image of the blood vessel portion displayed on the display unit is an X-ray projection image or a 3D volume image. The three-dimensional image data obtained by imaging the subject consists of data reconstructed from image data collected by an X-ray CT apparatus or a magnetic resonance diagnostic apparatus, and the subject is viewed from a plurality of different angular directions. Including the rendered image
The medical diagnosis support apparatus according to claim 1, wherein the display direction setting unit selects a rendered image of the blood vessel unit at a display angle specified by the user and supplies the selected rendering image to the display unit.   6. The medical diagnosis support apparatus according to claim 5, wherein the plurality of different angular directions correspond to imaging angles when the subject is imaged from a plurality of imaging directions by the X-ray diagnostic apparatus. The simulation image generator is
A core calculation unit for calculating a core of the blood vessel extracted by the extraction unit;
A catheter position / direction calculator for calculating the position and direction of the catheter in the extracted blood vessel,
A catheter movement discriminating unit for discriminating whether or not the catheter can proceed according to the state of the blood vessel unit;
A catheter position management unit that determines the position of the catheter in cooperation with the catheter position / direction calculation unit and the catheter movement determination unit based on the core line information obtained by the core calculation unit and input information from the user;
Based on the information obtained by the catheter position management unit, an overlay creating unit that generates marker information indicating the position and traveling direction of the catheter;
The medical diagnosis support apparatus according to claim 1, further comprising:   The simulation image generation unit is configured to set at least a distance between the distal end of the catheter and the inner wall of the blood vessel, and the catheter with respect to the inner wall of the blood vessel by a GUI (graphical user interface) that sets parameters necessary for performing the simulation. The medical diagnosis support apparatus according to claim 7, wherein a collision angle of a tip can be set by a user, and whether or not the catheter can be advanced is determined based on the set parameter.   A segment creation unit that creates segment data representing a stent when the catheter reaches a lesioned part of the blood vessel based on information obtained by the catheter position management unit and input information from a user; The medical diagnosis support apparatus according to claim 7, wherein an image based on the segment data instead of a marker is displayed by being superimposed on a rendering image of the blood vessel part.   The medical diagnosis support apparatus according to claim 9, wherein the segment creation unit is capable of setting the length of the stent based on input information from a user. The extraction unit extracts image data of a blood vessel part to be observed from three-dimensional image data of a plurality of time phases,
The display unit displays a rendered image of a plurality of time phases as a moving image,
The medical diagnosis support apparatus according to claim 1, wherein the simulation image generation unit superimposes the marker on each of a plurality of time-phase rendered images. Contrast medium simulation image generation for generating a rendering image for simulating the movement of the contrast medium injected from the catheter based on the image data extracted by the extraction unit and the progress of the catheter simulated by the simulation image generation unit Part
The medical diagnosis support apparatus according to claim 11, wherein the display unit displays a moving image of the rendering image generated by the contrast agent simulation image generation unit. A projection image data generation unit for generating fluoroscopic image data of a subject by an X-ray diagnostic apparatus;
An extraction unit for obtaining three-dimensional image data obtained by imaging the subject with an X-ray CT apparatus or a magnetic resonance diagnostic apparatus, and extracting image data of a blood vessel part to be observed;
A display direction setting unit that sets a display angle of a rendering image of the blood vessel portion extracted by the extraction unit based on a user's specification;
A display unit capable of displaying a rendered image of the blood vessel part at a display angle specified by the user, together with the fluoroscopic image of the blood vessel part generated by the projection image data generation unit;
A radiation diagnostic apparatus comprising:   The radiation diagnostic apparatus according to claim 13, wherein a rendering image of the blood vessel part is displayed as a guide image when a catheter is inserted into the blood vessel part of the subject to perform examination or treatment. Extracting the image data of the blood vessel part to be observed from the three-dimensional image data obtained by photographing the subject,
Create a marker indicating the position and direction of the catheter by simulating the progression of the catheter when a catheter is inserted into the extracted blood vessel part,
Displaying the extracted three-dimensional image of the blood vessel part on a display unit at a display angle specified by the user, and displaying the marker superimposed on the three-dimensional image of the blood vessel part;
Medical diagnosis support method including the above.

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