JP2009201701A - Apparatus for supporting surgical tool guided surgery - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To display a specific region (a segmentation) and a surgery access path determined before surgery by superimposing them on an MRI image while following and carrying out continuous imaging of a predetermined cross section of a surgical tool guiding instrument in real time within an MRI apparatus by means of a three-dimensional position detector. <P>SOLUTION: An apparatus for supporting surgical tool guided surgery calculates a surgery access path by using a means for following the position of a surgical tool in real time using a medical image diagnostic apparatus such as an MRI apparatus or the like and the three-dimensional position detector, a means for visualizing a specific region using a 3D volume image obtained by the MRI apparatus, and a 3D volume image obtained by the MRI apparatus. The apparatus includes a means for superimposing the specific region on an MRI image, a means for superimposing the surgery access path on an MRI image, and the function for guiding the surgical tool by displaying the direction and the linear distance to a target on the MRI image. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention uses a three-dimensional position detection device within an MRI to follow a specific cross section of a surgical instrument guiding instrument in real time and continuously image the specific region (segmentation) and surgical access path obtained before surgery on the MRI image. The present invention relates to a surgical instrument guided surgery support device including a means for superimposing and displaying on the surgical tool. However, when the needle is behind or near the needle position, the display color or line type is changed and displayed on the display, so that the three-dimensional information can be visualized. It has a function of matching on a dimensional image.

  Minimally invasive treatment is becoming widespread due to the selection of medical institutions and treatment options by patients, and the surgical procedure is accelerating the transition from large incision surgery to endoscopic surgery. On the other hand, in endoscopic surgery, the limited field of view and surgical space have caused problems such as restrictions on procedures / adaptations and increased operator stress. As a solution, a function (Patent Document 1) for displaying a segmentation specific area on an endoscopic image has been proposed, but information necessary for surgery is insufficient. In general endoscopic surgery for the abdomen, the abdominal organs are deformed and moved during the operation, so it is difficult to always grasp the position of the tumor at the site where direct viewing is impossible, and the surgical tool is guided to the tumor position. It could take a lot of time.

  In recent years, an Interventional MRI (I-MRI) system that uses surgical MRI images to bring a surgical tool such as a puncture needle to the target site has appeared, and several reports have been made. Specifically, a method of displaying an MRI image on a graphical user interface, clicking a button on the screen, and determining the tomographic plane to be imaged next (Magnetic Resonance in Medicine: Real-time interactive MRI on a conventional scanner) AB. Kerr et al., 38, pp.355-367 (1997)) and a method using a three-dimensional mouse (US Pat. No. 5,528,827) have been proposed. In these methods, the position and orientation of the tomographic plane to be imaged must be adjusted and set with an input means such as a mouse, which is cumbersome. As an MRI apparatus, the position and orientation of the tomographic plane to be imaged can be adjusted more easily. It is desirable that it can be set. As such a technique, an MRI apparatus for determining a tomographic plane to be imaged using a tomographic plane indicating device (pointer or the like) such as US Pat. No. 5,365,927 and US Pat. No. 6026315 has been proposed (hereinafter, ISC).

  In US Pat. No. 5,536,927, a light emitting diode is provided on a pointer which is a tomographic surface indicating device, and the position pointed by the operator is detected by an infrared camera, or at the tip of an arm provided with a sensor at a joint. A pointer is provided, the position of the pointer is detected based on the angle of the joint of the arm, and the tomographic plane is automatically adjusted based on the detected position. U.S. Pat. No. 6,026,315 discloses a method for automatically determining and imaging a tomographic plane indicated by using two infrared cameras and a pointer provided with three reflecting spheres.

  For example, there is (International Publication No. WO 03/026505 A1), and the MRI apparatus 1 shown in FIG. 2 is, for example, a vertical magnetic field type 0.3T permanent magnet MRI apparatus 1 and an upper magnet 3 that generates a vertical static magnetic field. And a lower magnet 5, a support 7 for connecting these magnets and supporting the upper magnet 3, a position detecting device 9, an arm 11, a monitor 13, a monitor support unit 15, a reference tool 17, a personal computer 19, a bed 21, and a control unit 23 And so on. A gradient magnetic field generation unit (not shown) of the MRI apparatus 1 generates a gyration magnetic field in a pulse manner, has a maximum gradient magnetic field strength of 15 mT / m, and a slew rate of 20 mT / m / ms. The MRI apparatus 1 further includes an RF transmitter (not shown) for generating nuclear magnetic resonance in the subject 24 in a static magnetic field and an RF receiver (not shown) for receiving a nuclear magnetic resonance signal from the subject 24. Is a 12.8MHz resonant coil.

  The position detection device 9 includes two infrared cameras 25 and a light emitting diode (not shown) that emits infrared light, and detects the position and posture of a pointer 27 that is a tomographic plane indicating device. Further, the position detection device 9 is connected to the upper magnet 3 so as to be movable by the arm 11, and the arrangement relative to the MRI apparatus 1 can be appropriately changed as shown in FIG. As shown in FIG. 2, the monitors 13 and 14 display an image of the tomographic plane of the subject 24 indicated by the pointer 27 held by the operator 29, an image of the surgical instrument 36, and the like. Thus, like the infrared camera 25, it is connected to the upper magnet 3. The reference tool 17 links the coordinate system of the infrared camera 25 and the coordinate system of the MRI apparatus 1, includes three reflecting spheres 35, and is provided on the side surface of the upper magnet 3. The position of the pointer 27 detected and calculated by the infrared camera 25 is transmitted to the personal computer 19 through the RS232C cable 33, for example, as position data. The control unit 23 is composed of a workstation, and controls an RF transmitter, an RF receiver, etc. (not shown). The control unit 23 is connected to the personal computer 19. In the personal computer 19, the position of the pointer 27 detected and calculated by the infrared camera 25 is converted into position data usable by the MRI apparatus 1, transmitted to the control unit 23, and recorded by the video recording apparatus 34. The position data is reflected on the imaging section of the imaging sequence. The image acquired with the new imaging section is displayed on the liquid crystal monitor. For example, when a pointer, which is a tomographic plane indicating device, is attached to a puncture needle or the like and configured so that the position where the puncture needle is located is always an imaging cross section, a cross section always including the needle is displayed on the monitor.

  Here, as part of a surgical simulation function for the purpose of improving surgical treatment accuracy, a method for calculating and rendering a surgical access route (Japanese Patent Laid-Open Nos. 2006-149560, 2002-186588, 2000-113086) And Japanese Patent Laid-Open No. 2003-30624) have also been proposed.

JP 2007-7041 A.

  The surgical instrument following imaging function (hereinafter referred to as ISC) is capable of imaging a free cross-section, and therefore positioning imaging is not required and is effective for surgical treatment support. However, because ISC cannot visualize depth information (three-dimensional information) due to two-dimensional information, and the direction of the surgical tool and the target are aligned on the two-dimensional image, the needle is guided to the target center (center of gravity). was difficult.

  The above problem can be solved by the following means.

According to the present invention, a means for following the position of a surgical tool in real time using a medical image diagnostic apparatus such as MRI and a three-dimensional position detection apparatus, and a specific region using a 3D volume image obtained from the MRI apparatus are rendered. In the surgical instrument guided surgery support device that calculates the surgical access path using the 3D volume image obtained from the means and the MRI device,
Means for superimposing and displaying the specific region on the MRI image;
Means for superimposing and displaying the surgical access route on an MRI image;
A surgical instrument guided surgery support device having a function for displaying a direction and a linear distance to a target on the MRI image and guiding the surgical instrument is provided.

  The present invention uses a three-dimensional position detection device within an MRI to follow a specific cross section of a surgical instrument guiding instrument in real time and continuously image the specific region (segmentation) and surgical access path obtained before surgery on the MRI image. Is displayed in a superimposed manner. However, when the needle is behind or near the needle position, the display color or line type is changed and displayed on the display, so that the three-dimensional information can be visualized. It has a function of matching on a dimensional image. In addition, the method of displaying the direction to the target and the straight line distance is displayed on the screen in conjunction with the position of the surgical instrument, and a value is displayed so as to guide to the surgical access route.

  According to the present invention, a specific area (segmentation) and a surgical access path obtained before surgery are obtained while following and continuously imaging a prescribed cross section of the surgical instrument guide instrument in real time using a three-dimensional position detection device in the MRI. It is to superimpose on the image. However, when the needle is behind or near the needle position, the display color or line type is changed and displayed on the display, so that the three-dimensional information can be visualized. It has a function of matching on a dimensional image. Also, the method for displaying the direction to the target and the straight line distance is displayed on the screen in conjunction with the position of the surgical instrument, and a value is displayed so as to guide it to the surgical access route.

  In other words, the three-dimensional information that is depth information is superimposed (projected) on the two-dimensional image, thereby increasing the information necessary for the operation and improving the surgical accuracy. In addition, it is considered that there is an effect of maintaining the operator's concentration by consolidating all the information necessary for the operation on one display.

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

  The functional flow of the present invention is shown in FIG. As pre-operative work, after the patient is brought into the MRI gantry, 3D imaging by MRI is performed 101, specific area drawing (area calculation to be taken) 102 and access route drawing (pre-operative planning) 103, each surgical device and IVR -Start the ISC device 104. MRI images are continuously displayed on the monitor. When the target is in the front (or left) direction with respect to ISC (needle position), 105, the specific area is displayed in light color 106, and the access route is displayed. Displayed with a solid line (or yellow line) 107. On the other hand, when the target is in the back (or right) direction with respect to the ISC (needle position), 109, the specific area is superimposed and displayed 110, and the access path is displayed with a wavy line (or green line) 111. In either case, the target position information is clearly shown on the display 108 and can be confirmed numerically. If the target is in the center (center of gravity) direction with respect to ISC (needle position) 112, the access route is thick (or blue line) 114, the center (center of gravity) inside the specific area is darkly displayed 115, the operator By adjusting the needle position 116, puncture and treatment are performed 117. If there are a plurality of targets, these processes are repeated and the process ends 118.

  Fig. 3 shows the ISC imaging cross-sectional configuration diagram. A pointer 36 is attached to the surgical instrument 36, and the surgical instrument position detection device detects the surgical instrument position. An imaging section 301, a first orthogonal section 302, and a second orthogonal section 303 including the surgical tool are configured using the detected position information.

  Fig. 4 shows a depiction example when translating by ISC. When the surgical tool is translated 401, 403, 405, 407 from the head direction to the foot direction over the abdomen 409 of the patient 400, the MRI images change their imaging sections in conjunction with the surgical tool position 402, 404, 406, 408, respectively. At this time, the surgical tool is always depicted on the image 410,411,412,413.

  FIG. 5 shows a depiction example at the time of parallel movement by ISC (when a specific area is superimposed). Similar to FIG. 4, when the surgical tool is translated 501, 503, 505, 507 from the head direction to the foot direction over the abdomen 509 of the patient 500, the MRI images change their imaging sections 502, 504, 506, 508 in conjunction with the surgical tool position. At this time, the surgical tool is always drawn on the image 510,511,512,513. Here, by setting the target 520 in advance, the target position is projected and displayed on the image 521,522,523,524. However, when the target position is on the right side of the surgical instrument, only the outline is displayed 521,522, and when the target position is on the left side of the surgical instrument, the interior is displayed lightly 524. If there is no deviation between the target and the surgical tool position, the target 523 is displayed darkly, and the depth information of the target can be displayed in color tone to the surgeon. This display example is a display at the time of initial setting, and the target depiction setting can be freely changed by the user.

  FIG. 6 shows a depiction example during parallel movement by ISC (when access routes are superimposed). Similar to FIG. 4, when the surgical instrument is translated 601, 603, 605, 607 from the head direction to the foot direction over the abdomen 609 of the patient 600, the MRI images are changed in their imaging sections 602, 604, 606, 608 in conjunction with the surgical instrument position. At this time, the surgical tool is always depicted on the image 610, 611, 612, 613. Here, by setting the surgical route in advance, the route relative to the surgical tool is projected and displayed on the image 621,622,623,624. However, if the determined surgical route is on the right side of the surgical instrument, a wavy line is displayed 621,622, and if the target position is on the left side of the surgical instrument, a thin solid line is displayed 624. If there is no deviation between the target and the surgical tool position, the surgical path 623 can be displayed thickly, and the depth information of the target can be displayed in color to the surgeon. This display example is a display at the time of initial setting, and it is assumed that the user can freely change the surgical route depiction setting.

  FIG. 7 shows a depiction example at the time of parallel movement by ISC (when a specific area / access route is superimposed). Similar to FIG. 4, when the surgical tool is translated 701, 703, 705, 707 from the head direction to the foot direction over the abdomen 709 of the patient 700, the MRI images change their imaging cross-sections according to the surgical tool position 702, 704, 706, 708, respectively. At this time, the surgical tool is always depicted on the image 710,711,712,713. Here, by setting the surgical path and target 720 in advance, the path and target position relative to the surgical tool are projected and displayed on the image 721,722,723,724. However, when the calculated target / surgical route is to the right of the surgical tool, the contours 721,722 and wavy lines 731 and 732 are displayed. When the target position / surgical route is to the left of the surgical tool, the interior is thinly 724 / thin solid line 734 to display. If there is no deviation between the target and the surgical tool position, the inside can be visualized by darkening the inside 723 and operating path 733 and displaying the target depth information in color. This display example is a display at the time of initial setting, and the user can freely change the target and surgical route drawing setting.

  FIG. 8 shows a GUI display example of the present invention. On the screen 801, there are an ISC image unit 802 and various information units 803, a function setting unit 840, and a display screen setting unit 850. First, a 3D scan 804 is performed, and a surgical route 805 and a specific region 807 are set. By starting ISC 809, an image, a target 808, a surgical route 806, a surgical instrument position 810, and position information 860 and 861 to the target are displayed on the screen 802, and the three-dimensional position information to the target is visually and numerically displayed. By displaying, 3D information can be added to the 2D screen. The display / non-display of the specific area and the operation route can be selected 851,852, and is reflected in the image. There are also a screen 820 centered on the surgical route and a screen 830 displaying a specific area and needle in three dimensions. However, it is assumed that the surgical tools 822 and 832, the surgical routes 821 and 831, and the targets 823 and 833 displayed here are in the same positional relationship. In addition, there are 834 places to display details of device information, patient information, various function information, and surgical tool information.

  Further, the present invention can be applied to both treatment based on operator confidence (manual) and indirect surgery using a robot / manipulator.

The ISC image superimposition flowchart figure which shows embodiment of this invention. The schematic diagram which shows the IVR-ISC basic composition of this invention. The schematic diagram which shows the ISC imaging sectional drawing in the surgical instrument guide instrument of this invention. The block diagram which shows the example of a display at the time of ISC parallel movement in embodiment of this invention. The block diagram which shows the example 2 of a display at the time of ISC parallel movement in the embodiment of this invention (at the time of a specific area superimposition). The block diagram which shows the example 3 of a display at the time of ISC parallel movement (at the time of access path superimposition) in embodiment of this invention. The block diagram which shows the example 4 of a display at the time of ISC parallel movement in the embodiment of this invention (at the time of a specific area | region / access route superimposition). The GUI display example which shows embodiment of this invention.

Explanation of symbols

  1 MRI equipment, 3 Upper magnet, 5 Lower magnet, 7 posts, 9 Position detection device, 11 Arm, 13 Monitor 1, 14 Monitor 2, 15 Monitor support, 17 Reference tool, 19 Personal computer, 21 Bed, 23 Control , 24 Subject, 25 Infrared camera, 27 Pointer, 29 Operator, 30 Operator monitor, 32 Aperture, 33 Endoscope, 34 Video recording device, 35 Reflecting sphere, 36 Surgical tool

Claims (6)

From means for following a position of a surgical tool in real time using a medical image diagnostic apparatus such as MRI and a three-dimensional position detection apparatus, means for rendering a specific region using a 3D volume image obtained from the MRI apparatus, and the MRI apparatus In a surgical instrument guided surgery support apparatus that calculates a surgical access route using the obtained 3D volume image,
Means for superimposing and displaying the specific region on the MRI image;
Means for superimposing and displaying the surgical access route on the MRI image;
A surgical instrument guided surgery support apparatus having a function for displaying a direction and a linear distance to a target on the MRI image and guiding the surgical instrument.   The means for superimposing and displaying the specific area on the MRI image is superimposed on the relative position on the image including the surgical instrument, and the display color or line is displayed when it is at the back or near to the needle position. 2. The surgical instrument guided surgery support apparatus according to claim 1, wherein the seed is changed and displayed on a display.   The means for superimposing and displaying the surgical access path on the MRI image is superimposed on the relative position on the image including the surgical instrument. 2. The surgical instrument guided surgery support device according to claim 1, wherein the line type is changed and displayed on a display.   2. The surgical instrument guided surgery support apparatus according to claim 1, wherein the superimposed display method when the specific area is depicted on the MRI image is presented clearly by changing the color or density of the specific area and the surgical access route. .   The method for displaying the direction and the straight line distance to the target is displayed in conjunction with the surgical tool position, and displays a value so as to guide to the surgical access route. Surgical tool guided surgery support device.   2. The surgical instrument guided surgery support apparatus according to claim 1, wherein the surgical instrument is applicable to both treatment by an operator's confidence (procedure) and indirect surgery using a robot / manipulator.

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