JP2011167344A - Medical device system for pdt, electronic endoscope system, surgical microscope system, and treatment light irradiation distribution control method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To apply an appropriate quantity of treatment light according to the distribution of concentration of a photosensitive substance. <P>SOLUTION: Excitation light Ld is emitted from a light source 31 for PDD to a tumor affected part within a body cavity where the photosensitive substance is accumulated. Fluorescent light FL is generated from the tumor affected part with the applied excitation light Ld. The light from the body cavity including the fluorescent light FL is captured by a CCD 44, and a fluorescent optical image is generated based on an imaging signal acquired by the CCD 44. A concentration distribution specifying part 55a specifies the concentration distribution of the photosensitive substance accumulated in the tumor affected part from the fluorescent optical image. An irradiation distribution control part 54a controls the irradiation distribution of treatment light Lt based on the concentration distribution of the photosensitive substance. By controlling the irradiation distribution in this way, the treatment light Lt of a large light quantity is applied to a portion where the concentration of the photosensitive substance is high, and the treatment light Lt of a small light quantity is applied to a portion where the concentration of the photosensitive substance is low. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a medical device system for PDT, an electronic endoscope system, a surgical microscope system, and a therapeutic light irradiation distribution control method.

  In the medical field in recent years, many diagnoses and treatments using an electronic endoscope have been performed. The electronic endoscope includes an elongated insertion portion that is inserted into the body cavity of a subject, and an imaging device such as a CCD is built in the distal end of the insertion portion. The electronic endoscope is connected to a light source device that emits broadband light such as white light, and the broadband light from the light source device is applied to the inside of the body cavity from the distal end of the insertion portion. In this manner, the subject tissue in the body cavity is imaged by the imaging element at the distal end of the insertion portion in a state where light is irradiated inside the body cavity. An image obtained by imaging is displayed on a monitor after various processing is performed by a processor device connected to the electronic endoscope.

  In addition, since a tumor affected part or the like formed on the inner wall of the patient's body cavity may be difficult to grasp from a monitor image, in recent years, a tumor affected part is used by using a diagnostic method called PDD (Photo Dynamic Diagnosis). Fluorescent light is generated from the tumor so that the position, size, and range of the tumor site can be easily grasped. According to this PDD, before starting diagnosis, a photosensitive substance such as a hematoporphyrin derivative is administered to a patient to accumulate the photosensitive substance in the tumor affected area. At the time of diagnosis, the distal end portion of the electronic endoscope is inserted into the body cavity, and excitation light having a specific wavelength is irradiated from the distal end portion to the tumor affected area. Thereby, fluorescent light is emitted from the tumor affected part irradiated with excitation light.

  And after an operator grasps | ascertains the position of a tumor affected part, etc. by PDD, the tumor affected part is extinguished using the treatment method called PDT (Photo Dynamic Therapy: Photodynamic therapy). In this PDT, treatment light having a specific wavelength different from that of excitation light is irradiated from the distal end portion of the electronic endoscope to the tumor affected area. By irradiating this therapeutic light, active oxygen is generated from the photosensitive substance accumulated in the tumor affected part. The tumor affected area disappears due to the cell-killing action by the active oxygen.

  Since the treatment light is a substance that generates active oxygen from a photosensitive substance, the amount of light is very large. Therefore, when the tumor affected part is disappearing due to the irradiation of the treatment light, if the treatment light with a large amount of light is continuously applied as it is, the normal part may be damaged. Therefore, when irradiating treatment light, it is necessary to control the light quantity of the treatment light to irradiate according to the treatment condition. On the other hand, in Patent Document 1, a light amount sensor for measuring the light amount of treatment light is attached to the distal end portion of the electronic endoscope, and the amount of treatment light is controlled based on the output of the light amount sensor. The amount of therapeutic light is applied to the affected area of the tumor.

JP 2009-22654 A

  In PDT, the concentration of a photosensitive substance changes with time by irradiation with therapeutic light. Therefore, at the start of irradiation of the treatment light, even if the concentration of the photosensitive substance is high, the concentration of the photosensitive substance gradually decreases by irradiating the treatment light intensively on the part. If the treatment light having the same amount of light as that at the start of irradiation is continuously applied to the portion where the concentration is reduced in this way, there is a possibility that even a normal portion may be damaged. In addition, when only a small amount of treatment light is irradiated to a portion where the concentration of the photosensitive substance is high at the start of treatment light irradiation, it takes a considerable time to extinguish the tumor affected part.

  On the other hand, the invention of Patent Document 1 can be applied. However, the invention of Patent Document 1 is based on the amount of therapeutic light reflected in the body cavity and the amount of therapeutic light to be newly irradiated into the body cavity. The above-mentioned problem cannot be solved because the amount of therapeutic light is not controlled according to the concentration distribution of the photosensitive substance.

  The present invention has been made in view of the above problems, and when irradiating treatment light to a tumor affected part in which a photosensitive substance is accumulated, the therapeutic light is emitted with an appropriate amount of light according to the concentration distribution of the photosensitive substance. An object is to provide a medical device system for PDT, an electronic endoscope system, a surgical microscope system, and a treatment light irradiation distribution control method capable of irradiation.

  The medical device system for PDT of the present invention emits a light source for PDD that emits excitation light for generating fluorescent light from a tumor affected part of a patient in which a photosensitive substance is accumulated, and treatment light for extinguishing the tumor affected part. A light source for PDT, an irradiation means for irradiating the tumor affected area with excitation light or treatment light, an image generating means for generating an image based on an imaging signal generated by receiving light from the tumor affected area, Based on the fluorescent light image obtained when the excitation light is irradiated, the concentration distribution specifying unit for specifying the concentration distribution of the photosensitive substance accumulated in the tumor affected part, and the treatment light based on the concentration distribution of the photosensitive substance in the tumor affected part And an irradiation distribution control unit for controlling the irradiation distribution of the light source.

  The irradiation distribution control unit irradiates a portion having a high photosensitizer concentration in the tumor affected area with a large amount of treatment light, and irradiates a portion with a low photosensitizer concentration with a small amount of treatment light. It is preferable to do. A broadband light source that emits broadband light having a wavelength ranging from a blue region to a red region, and an irradiation light switching unit that switches light irradiated to the tumor affected part in the order of the broadband light, the excitation light, and the treatment light. Is preferred.

  Preferably, the photosensitive substance is photophilin, the therapeutic light has a center wavelength of 630 nm, the excitation light has a center wavelength of 405 nm, and the fluorescent light has one peak at 660 nm.

  An electronic endoscope system according to the present invention includes a PDD light source that emits excitation light for generating fluorescent light from a tumor lesion in a body cavity in which a photosensitive substance is accumulated, and treatment light for extinguishing the tumor lesion. A light source device that emits a PDT light source, irradiation means for irradiating excitation light or treatment light to a body cavity including the tumor affected part, and an imaging element that receives light from the tumor affected part and outputs an imaging signal The concentration distribution of the photosensitive substance accumulated in the tumor affected area is identified from the electronic endoscope having the above, an image generating means for generating an image based on the imaging signal, and a fluorescent light image obtained when the excitation light is irradiated A distribution device that controls the irradiation distribution of the treatment light on the basis of the concentration distribution of the photosensitive substance in the tumor affected area. Characterized in that it comprises.

  The surgical microscope system of the present invention includes a PDD light source that emits excitation light for generating fluorescent light from a tumor affected part in which a photosensitive substance is accumulated in a surgical site, and treatment light for extinguishing the tumor affected part. A light source device having a light source for PDT that emits; an irradiating means for irradiating the surgical site including the tumor affected part with excitation light or treatment light; and an image pickup device that receives the light from the tumor affected part and outputs an imaging signal And an image generation means for generating an image based on the imaging signal, and a concentration distribution specifying unit for specifying the concentration distribution of the photosensitive substance accumulated in the tumor affected part from the fluorescent light image obtained when the excitation light is irradiated. The surgical microscope has an irradiation distribution control unit for controlling the irradiation distribution of the treatment light based on the concentration distribution of the photosensitive substance in the tumor affected part. The features.

  In the therapeutic light irradiation distribution control method of the present invention, when the excitation light for generating fluorescent light is emitted from the tumor affected part of the patient in which the photosensitive substance is accumulated, the light from the tumor affected part is irradiated. Is received by the imaging device, a fluorescent light image is generated based on the imaging signal output from the imaging device, the concentration distribution of the photosensitive substance accumulated in the tumor affected part is identified from the fluorescent light image, and the tumor affected part is extinguished. When the treatment light for irradiating the tumor affected area is irradiated, the irradiation distribution of the treatment light is controlled based on the concentration distribution of the photosensitive substance in the tumor affected area.

  According to the present invention, the concentration distribution of the photosensitive substance accumulated in the tumor affected part is identified from the fluorescent light image obtained when the fluorescent light is emitted from the tumor affected part by the irradiation of the excitation light, and the identified tumor affected part of the tumor affected part is identified. Since the irradiation distribution of the treatment light is controlled based on the concentration distribution of the photosensitive substance, it is possible to irradiate the treatment light with an appropriate amount of light according to the concentration distribution of the photosensitive substance in the tumor affected area.

It is an external view of the electronic endoscope system of the present invention. It is a block diagram which shows the electric constitution of an electronic endoscope system. It is a graph which shows the intensity | strength of excitation light Ld, treatment light Lt, and fluorescence light FL. It is explanatory drawing for demonstrating the imaging surface of CCD which uses R1 pixel, R2 pixel, G pixel, and B pixel as one pixel group. (A) is the spectral transmittance of the R1 pixel, (B) is the spectral transmittance of the R2 pixel, (C) is the spectral transmittance of the G pixel, and (D) is a graph showing the spectral transmittance of the B pixel. is there. It is a flowchart which shows the effect | action of this invention. (A) shows the CCD imaging operation in the normal light image mode, (B) shows the CCD imaging operation in the fluorescent light image mode, (C) shows the CCD imaging operation in the therapeutic light image mode, (D () Is an explanatory diagram for explaining the imaging operation of the CCD in the treatment status confirmation mode. It is an image figure of the treatment light image which shows the irradiation area of treatment light. It is an image figure of the fluorescence light image which shows the tumor affected part of the state which has emitted the fluorescence light. 9A shows the light quantity distribution of fluorescent light in the AA line part of FIG. 9, FIG. 9B shows the concentration distribution of the photosensitive substance in the AA line part of FIG. 9, and FIG. It is a graph which shows irradiation distribution of the treatment light in A line part. It is an external view of the surgical microscope system of the present invention. It is a block diagram which shows the electric constitution of the surgical microscope system of this invention.

  As shown in FIG. 1, an electronic endoscope system 10 of the present invention generates an image of a subject tissue in a body cavity based on an electronic endoscope 11 that images the inside of a patient's body cavity and a signal obtained by the imaging. A processor device 12, a light source device 13 for supplying light for irradiating the body cavity, and a monitor 14 for displaying an image in the body cavity. The electronic endoscope 11 includes a flexible insertion portion 16 to be inserted into a body cavity, an operation portion 17 provided at a proximal end portion of the insertion portion 16, an operation portion 17, a processor device 12, and a light source device 13. And a universal cord 18 for connecting the two.

  A bending portion 19 in which a plurality of bending pieces are connected is formed on the distal end side of the insertion portion 16. The bending portion 19 is bent in the vertical and horizontal directions by operating the angle knob 21 of the operation portion. The distal end side of the bending portion 19 is provided with a distal end portion 16a incorporating an optical system for in-vivo imaging, and the distal end portion 16a is directed in a desired direction in the body cavity by the bending operation of the bending portion 19. It is done.

  A connector 24 is attached to the universal cord 18 on the processor device 12 and the light source device 13 side. The connector 24 is a composite type connector including a communication connector and a light source connector, and the electronic endoscope 11 is detachably connected to the processor device 12 and the light source device 13 via the connector 24.

  As shown in FIG. 2, the light source device 13 includes a broadband light source 30, a PDD light source 31, a PDT light source 32, an irradiation light switching unit 34 that switches light to be irradiated into the body cavity, and an irradiation light switching unit 34. A condensing lens 35 that condenses the switched light toward the light guide 43 of the electronic endoscope 11 is provided. The broadband light source 30 is a xenon lamp, a white LED, or the like, and generates broadband light BB having a wavelength ranging from a red region to a blue region (about 470 to 700 nm). The broadband light source 30 is always lit while the electronic endoscope 11 is in use.

  The PDD light source 31 is a laser diode or the like that is constantly lit while the electronic endoscope 11 is in use, and the PDD light source generates excitation light Ld having a center wavelength of around 400 nm. When this excitation light is applied to the tumor affected part in which the photosensitive substance is accumulated, fluorescent light FL is emitted from the tumor affected part. The PDT light source 32 is a laser diode or the like that is always lit while the electronic endoscope 11 is in use, and generates excitation light Ld having a center wavelength in the range of 620 to 690 nm. By this treatment light irradiation, active oxygen is generated from the portion where the photosensitive substance is accumulated. Due to this active oxygen, the affected area of the tumor gradually disappears.

  The wavelength ranges of the excitation light Ld, the treatment light Lt, and the fluorescence light FL differ depending on the type of photosensitive substance administered to the patient. In this embodiment, photophilin is administered as a photosensitizer. When this photophyllin is administered, as shown in FIG. 3, fluorescent light FL having one peak at 660 nm is obtained by irradiating excitation light Ld having a central wavelength of 405 nm. In this case, the tumor affected part can be eliminated by irradiating the treatment light Lt having a center wavelength of 630 nm.

  In addition, when resafylline is administered as a photosensitizer, fluorescent light having one peak at 660 nm is obtained by irradiation with excitation light having a central wavelength of 405 nm, and the tumor lesion is extinguished by irradiation with treatment light having a central wavelength of 664 nm. be able to. In addition, when bisdyne is administered as a photosensitizer, fluorescent light having one peak at 660 nm is obtained by irradiation with excitation light having a central wavelength of 405 nm, and the tumor lesion is extinguished by irradiation with therapeutic light having a central wavelength of 689 nm. be able to.

  As shown in FIG. 2, the irradiation light switching unit 34 includes first to third mirrors 36, 37, 38 that reflect light from the light sources 30, 31, 32, and first to third mirrors 36, 37, The relay mirror 40 which further reflects the light reflected by 38 toward the condensing lens 39 and a mirror switching unit 41 are provided. The first to third mirrors 36, 37, and 38 are incident positions where light from the light sources 30, 31, and 32 is incident on the light guide 43 via the relay mirror 40 and the condenser lens 35, and the incident positions. The light guides 30, 31, and 32 are retracted from the light guide 43 so that the light from the light sources 30, 31, and 32 is prevented from entering the light guide 43. The mirror switching unit 41 sets one of the first to third mirrors 36, 37, and 38 to the incident position and sets the other mirrors to the retracted position in accordance with a switching signal from the controller 59 in the processor device 12. To do.

  The electronic endoscope 11 includes a light guide 43, a CCD 44, an analog processing circuit 45 (AFE: Analog Front End), and an imaging control unit 46. The light guide 43 is a large-diameter optical fiber, a bundle fiber, or the like. The incident end is inserted into the light source device 13, and the emission end is directed to the irradiation lens 48 provided at the distal end portion 16a. The light emitted from the light source device 13 is guided by the light guide 43 and then emitted toward the two irradiation lenses 48a and 48b. The light incident on the irradiation lenses 48a and 38b is irradiated into the body cavity through the illumination window 49 attached to the end face of the distal end portion 16a.

  The spatial distribution of the light amount of the treatment light Lt out of the light irradiated into the body cavity, that is, the irradiation distribution of the treatment light Lt, is controlled by a spatial light modulator 53 provided between the two irradiation lenses 48a and 48b. The The spatial light modulator 53 is configured by two-dimensionally arranging a plurality of minute light modulation elements, and is controlled by an irradiation distribution control unit 54 connected to a controller 59 in the processor device 12. The therapeutic light irradiation distribution is obtained by the therapeutic light irradiation distribution specifying unit 59 a in the controller 59.

  Light from the body cavity enters the condenser lens 51 through the observation window 50 attached to the end surface of the distal end portion 16a. The CCD 44 receives light from the condensing lens 51 on the imaging surface 44a, photoelectrically converts the received light to accumulate signal charges, and reads the accumulated signal charges as imaging signals. The read imaging signal is sent to the AFE 45. The CCD 44 is a color CCD. As shown in FIG. 4, the image pickup surface 44a has a set of four types of pixels, R1 pixel 70, R2 pixel 71, G pixel 72, and B pixel 73, each having a different light transmittance. A large number of pixel groups are arranged.

  The R1 pixel 70 has a light transmittance as shown in FIG. 5A because the R1 pixel 70 includes a neutral density filter that attenuates the excitation light Ld having a central wavelength of 405 nm in addition to the R color filter. In addition to the R color filter, the R2 pixel 71 includes a neutral density filter that attenuates the intensity of the treatment light Lt having the center wavelength of 630 nm to a certain value. Therefore, the light as shown in FIG. Of transmittance. In addition, since the G pixel 72 includes a G color filter, it has a light transmittance as shown in FIG. Further, since the B pixel 73 includes a B color filter, it has a light transmittance as shown in FIG. The R1 pixel 70 and the R2 pixel 71 are provided with a neutral density filter that weakens the light intensity. Instead, a cut filter that completely blocks the excitation light Ld and the treatment light Lt may be provided.

  As shown in FIG. 2, the AFE 45 includes a correlated double sampling circuit (CDS), an automatic gain control circuit (AGC), and an analog / digital converter (A / D) (all not shown). The CDS performs correlated double sampling processing on the image pickup signal from the CCD 44 to remove noise generated by driving the CCD 44. The AGC amplifies the imaging signal from which noise has been removed by CDS. The A / D converts the imaging signal amplified by the AGC into a digital imaging signal having a predetermined number of bits and inputs the digital imaging signal to the processor device 12.

  The imaging control unit 46 is connected to a controller 59 in the processor device 12, and sends a drive signal to the CCD 44 when an instruction is given from the controller 59. Each pixel of the CCD 44 outputs an imaging signal to the AFE 45 at a predetermined frame rate based on the drive signal from the imaging control unit 46.

  The processor device 12 includes a digital signal processor 55 (DSP (Digital Signal Processor)), a frame memory 56, and a display control circuit 57, and a controller 59 controls each part. The DSP 55 creates image data by performing color separation, color interpolation, white balance adjustment, gamma correction, and the like on the imaging signal output from the AFE 45 of the electronic endoscope.

  In addition, the DSP 55 determines the concentration distribution of the photosensitive substance accumulated in the tumor affected part based on the image data of the fluorescent light image obtained when the fluorescent light FL is emitted from the tumor affected part by the irradiation of the excitation light Ld. A portion 55a is provided. The concentration distribution specifying unit 55a specifies a portion where the light amount of the fluorescent light FL is large in the tumor affected part that generates the fluorescent light FL as a high concentration of the photosensitive material, and specifies a portion where the light amount of the fluorescent light FL is low. Specified as low concentration.

  The frame memory 56 stores the image data created by the DSP 55. The display control circuit 57 reads the image data from the frame memory 56 and displays an image on the monitor 14 based on the image data. An image displayed on the monitor 14 is switched by a mode switching SW 61 connected to the controller 59.

  The mode switching SW 61 switches to one of a normal light image mode, a fluorescent light image mode, a treatment light image mode, and a treatment status confirmation mode. Here, the normal light image mode is a mode for displaying a normal light image when the broadband light BB is irradiated into the body cavity. The fluorescent light image mode is a mode in which the fluorescent light image is displayed when the excitation light Ld is irradiated into the body cavity and the fluorescent light FL is emitted from the tumor affected part. The treatment light image mode is a mode for displaying a treatment light image when the treatment light Lt is irradiated into the body cavity. The treatment status confirmation mode is a mode in which the normal light image, the fluorescent light image, and the treatment light image are all displayed on the monitor 14. In the treatment status confirmation mode, the fluorescent light image and the treatment light image may be displayed separately, or may be displayed in a superimposed manner.

  Next, the operation of the present invention will be described with reference to the flowchart of FIG. First, photophilin which is a photosensitive substance is administered to a patient. Thereby, a photosensitive substance accumulates in the tumor affected part of the patient. Then, the mode switching SW 61 is operated to switch the image mode to the normal light image mode. In accordance with the switching to the normal light image mode, the mirror switching unit 41 sets the first mirror 36 at the incident position based on an instruction from the controller 59. Accordingly, the broadband light BB is irradiated from the distal end portion 16 a of the electronic endoscope 11.

  Further, the imaging control unit 46 controls the CCD 44 to perform the operation shown in FIG. 7A based on an instruction from the controller 59. In the normal light image mode, a step of photoelectrically converting the broadband light BB received by each of the R1 pixel 70, the G pixel 72, and the B pixel 73 of the CCD 44 to accumulate signal charges (hereinafter referred to as “charge accumulation step”); Thereafter, a total of two operations including a step of reading the accumulated signal charge as an imaging signal (hereinafter referred to as “signal reading step”) are performed in an acquisition period of one frame. This operation is repeated while the normal light image mode is set. On the other hand, in the R2 pixel 71, signal charge accumulation and signal charge readout are not performed.

  As a result, a color normal light image is displayed on the monitor 14 based on the imaging signal of the R1 pixel 70, the imaging signal of the G pixel 72, and the imaging signal of the B pixel 73. This normal light image is not an R2 pixel imaging signal provided with a treatment light attenuation filter that greatly affects the red color reproduction, but is a reduction for excitation light that hardly affects the red color reproduction. Since it is generated based on the image pickup signal of the R1 pixel provided with the optical filter, the normal light image is excellent in color reproducibility.

  When the normal light image is displayed on the monitor 14, the distal end portion 16a of the electronic endoscope 11 is inserted into the body cavity of the patient. Then, while confirming the normal light image on the monitor 14, the distal end portion 16a is gradually brought closer to the tumor affected area. When the distal end portion 16a reaches the tumor affected area, the mode switching SW 61 is operated to switch the image mode to the fluorescent light image mode. In accordance with the switching to the fluorescent light image mode, the mirror switching unit 41 returns the first mirror 36 to the retracted position and sets the second mirror 37 to the incident position based on an instruction from the controller 59. As a result, the excitation light Ld is emitted from the distal end portion 16 a of the electronic endoscope 11. When this excitation light Ld is irradiated to the tumor affected area, fluorescent light FL is emitted from the tumor affected area.

  Further, the imaging control unit 46 controls the CCD 44 to perform the operation shown in FIG. 7B based on an instruction from the controller 59. In this fluorescent light image mode, a total of two operations of a charge accumulation step based on the fluorescent light FL received by the R1 pixel 70 of the CCD 44 and a subsequent signal reading step are performed in an acquisition period of one frame. This operation is repeated while the fluorescent light image mode is set. On the other hand, in the R2 pixel 71, the G pixel 72, and the B pixel 73, the charge accumulation step and the signal readout step are not performed. Accordingly, a red fluorescent light image is displayed on the monitor 14 based on the imaging signal of the R1 pixel 71. In this fluorescent light image, since the excitation light Lt is removed by the neutral density filter of the R1 pixel 70, halation due to the excitation light does not occur.

  Then, the surgeon confirms the fluorescence state of the tumor affected part from the fluorescent light image displayed on the monitor 14, thereby accurately grasping the position, size, and range of the tumor affected part. After grasping the position and the like of the tumor affected part, the mode switching SW 61 is operated to switch the image mode to the treatment light image mode. In accordance with the switching to the therapeutic light image mode, the mirror switching unit 41 returns the second mirror 37 to the retracted position and sets the third mirror 38 to the incident position based on an instruction from the controller 59. Accordingly, the treatment light Lt is emitted from the distal end portion 16a of the electronic endoscope 11. By this irradiation with the treatment light Lt, the tumor affected part gradually disappears.

  Further, the imaging control unit 46 controls the CCD 44 to perform the operation shown in FIG. 6C based on an instruction from the controller 59. In this treatment light image mode, a total of two operations, a charge accumulation step based on the fluorescent light received by the R2 pixel 71 of the CCD 44 and a subsequent signal readout step, are performed in one frame acquisition period. This operation is repeated while the therapeutic light image mode is set. On the other hand, in the R1 pixel 70, the G pixel 72, and the B pixel 73, the charge accumulation step and the signal readout step are not performed.

  As a result, a red therapeutic light image is displayed on the monitor 14 based on the imaging signal of the R2 pixel 71. In this therapeutic light image, since the intensity of the therapeutic light is weakened by the neutral density filter of the R2 pixel 71, halation due to the therapeutic light does not occur. Further, since the R2 pixel 71 does not completely block the treatment light, the irradiation state of the treatment light can be reliably grasped from the treatment light image.

  Then, the surgeon confirms the disappearance state of the tumor affected part from the treatment light image displayed on the monitor 14. In addition, as shown in FIG. 8, when it is confirmed that a part of the tumor affected part 110 is out of the irradiation area 111 of the treatment light Lt, the part of the tumor affected by the treatment light Lt also hits the part out of the irradiation area 111. Then, the angle knob 21 is operated to move the tip portion 16a. Therefore, in the case of FIG. 8, the entire tumor affected part 110 is included in the irradiation area 112 of the treatment light Lt by moving the distal end portion 16 a to the left.

  Next, in order to confirm how the concentration distribution of the photosensitive substance and the disappearance state of the tumor affected part change with time, the mode switching SW 61 is operated to switch the image mode to the treatment state confirmation mode. According to the switching to the treatment status confirmation mode, the mirror switching unit 41 switches the mirrors to be set at the incident position in the order of the first to third mirrors 36 to 38 for each frame period based on an instruction from the controller 59. .

  By switching the first to third mirrors 36 to 38 in this way, light is irradiated into the body cavity in the order of the broadband light BB, the excitation light Ld, and the treatment light Lt. This light irradiation is repeated while the treatment status confirmation mode is set. By repeating the irradiation of the excitation light Ld and the treatment light Lt in this manner, the tumor affected area is extinguished by the irradiation of the therapeutic light Lt, and the irradiation of the excitation light Ld to the tumor affected area causes the fluorescence light from the extinct tumor affected area. FL can be generated.

  Further, the imaging control unit 46 controls the CCD 44 to perform the operation shown in FIG. 6D based on an instruction from the controller 59. In this treatment status confirmation mode, the total of the charge accumulation step based on the broadband light BB received by the R1 pixel 70, the G pixel 72, and the B pixel 73 of the CCD 44 and the subsequent signal readout step during the irradiation of the broadband light BB. Two operations are performed in an acquisition period of one frame. Then, during the subsequent irradiation with the excitation light Ld, a total of two operations of a charge accumulation step based on the fluorescent light FL received by the R1 pixel 70 of the CCD 44 and a subsequent signal reading step are performed in an acquisition period of one frame, The R2 pixel 71, G pixel 72, and B pixel 73 do not perform these two operations. Then, at the time of the subsequent irradiation of the treatment light Lt, a total of two operations of the charge accumulation step based on the treatment light Lt received by the R2 pixel 71 of the CCD 44 and the subsequent signal readout step are performed in an acquisition period of one frame, The R1 pixel 70, the G pixel 72, and the B pixel 73 do not perform these two operations. The operations for the acquisition period of these three frames are repeatedly performed while the treatment status confirmation mode is set.

  As a result, the monitor 14 displays three images: a color normal light image, a red fluorescent light image, and a red treatment light image. Thus, by displaying not only the normal light image and the treatment light image but also the fluorescence light image on the monitor 14, the progress of the PDT treatment can be confirmed by the change in the concentration of the photosensitive substance. Each image is shifted in time by one frame. However, by shortening the frame acquisition period, each image can appear to be captured at the same time. For example, the acquisition period of 3 frames is preferably 33 msec.

  In the treatment status confirmation mode, the irradiation distribution of the treatment light Lt is controlled according to the change in the concentration of the photosensitive substance. The irradiation distribution of the treatment light Lt is controlled after generating image data of a fluorescent light image. First, when the image data of the fluorescent light image is generated, the density distribution specifying unit 55a in the DSP 55 obtains the light amount distribution of the fluorescent light FL emitted from the tumor affected part based on the image data of the fluorescent light image. Then, the concentration distribution of the photosensitive substance in the tumor affected part is obtained from the light quantity distribution of the fluorescent light FL.

  For example, when fluorescent light FL having a light amount distribution as shown in FIG. 10 (A) is emitted from the AA line portion of the tumor affected part 114 as shown in FIG. 9, the light on the AA line The concentration distribution of the sensitive substance is the same as the light quantity distribution of the fluorescent light FL on the line AA, considering that the light quantity of the fluorescent light FL increases as the concentration of the photosensitive substance increases. Therefore, the concentration distribution shown in FIG. Then, the concentration distribution of the photosensitive substance in the whole tumor affected area is obtained by obtaining the light quantity distribution of the fluorescent light in the same manner for the lines other than the AA line. When the concentration distribution of the photosensitive substance in the entire tumor affected area is obtained, concentration data regarding the concentration distribution of the photosensitive substance is sent to the controller 59.

  Next, the therapeutic light irradiation distribution specifying unit 59a of the controller obtains the irradiation distribution of the therapeutic light Lt irradiated to the tumor affected part based on the concentration distribution of the photosensitive substance. The irradiation distribution control unit 54 controls the spatial light modulator 53 based on the irradiation distribution of the treatment light Lt obtained by the treatment light irradiation distribution specifying unit 59a. Accordingly, the treatment light Lt is emitted according to the irradiation distribution obtained by the treatment light irradiation distribution specifying unit 59a.

  Here, in the part where the concentration of the photosensitive substance is high, the extinction of the tumor affected part can be accelerated by increasing the amount of the treatment light Lt. On the other hand, when the concentration of the photosensitive substance is low, the therapeutic light Lt can be prevented from being excessively applied to the tumor affected part that is disappearing by reducing the light amount of the therapeutic light Lt.

  For example, in the case where the concentration distribution of the photosensitive substance on the AA line in the tumor affected part 114 of FIG. 9 is as shown in FIG. 10B, the treatment light having a large light amount is applied to the central part where the concentration of the photosensitive substance is high. Lt is irradiated, and the peripheral portion where the concentration of the photosensitive substance is low is irradiated with a small amount of therapeutic light Lt. Therefore, the treatment light Lt is irradiated with the irradiation distribution as shown in FIG.

  In the above embodiment, the present invention is applied to an electronic endoscope system. However, the present invention can also be applied to a surgical microscope system 80 as shown in FIG. The surgical microscope system 80 is provided above a patient placed on a surgical base 81, and has a surgical microscope 82 that images and displays a surgical site, a support stand 83 that supports the surgical microscope, and a surgical microscope. And a light source device 84 that supplies various types of light to the microscope 82.

  The support stand 83 includes two arms 88 and 89 that are rotatably connected by a shaft 86. Since one arm 88 is attached to the surgical microscope 82, the surgical microscope 82 can move in the horizontal direction about the shaft 86. The other arm 89 is attached to the column 83a of the support stand 83 so as to be movable in the vertical direction. Therefore, the surgical microscope 82 can move in the vertical direction as the arm 89 moves in the vertical direction.

  The surgical microscope 82 includes a surgical site imaging unit 91 that images a surgical site, a microscope main body 92 that generates an image of the surgical site based on a signal obtained by imaging, and a finder 93 that displays an image of the surgical site. I have. As shown in FIG. 12, the light source device 84 is substantially the same as the light source device 13 of the present embodiment, and the broadband light BB from the broadband light source 30, the excitation light Ld from the PDD light source 31, and the treatment light from the PDT light source 32. Issue Lt. The light from each of the light sources 30, 31, 32 is made uniform in light quantity distribution by the light homogenizer 94. The light having a uniform light quantity distribution is supplied to the light guide 95 that optically connects the light source device 84 and the surgical site imaging unit 91 via the relay mirror 40 and the two condenser lenses 35.

  In the surgical site imaging unit 91, the light from the light guide 95 is reflected by the dichroic mirror 97 and enters the objective lens 98. The light incident on the objective lens 98 is irradiated to the surgical site of the patient through the objective window 100. When the broadband light BB, the excitation light Ld, and the treatment light Lt are irradiated to the surgical site, some of them are reflected and returned to the surgical microscope. Further, when the excitation light Ld is irradiated to the tumor affected part in which the photosensitive substance is accumulated in the surgical site, the fluorescent light FL is generated from the tumor affected part. In addition, the spatial distribution of the light amount of the treatment light Lt out of the light irradiated to the surgical site, that is, the irradiation distribution of the treatment light Lt is caused by the spatial light modulator 53 provided between the light guide 95 and the dichroic mirror 97. Be controlled. The spatial light modulator 53 is the same as that of this embodiment.

  Light from the surgical site is collected by the objective lens 98 through the objective window 100. The light condensed by the objective lens 98 passes through the dichroic mirror 97 as it is. The light from the dichroic mirror 97 is further condensed by the condenser lens 102 and then enters the imaging surface 44 a of the CCD 44.

  As in the present embodiment, a large number of pixel groups, each having one set of four types of R1 pixel 70, R2 pixel 71, G pixel 72, and B pixel 73, each having a different light transmittance, are arranged on the imaging surface 44a. (See FIGS. 4 and 5). An imaging signal obtained from each pixel of the CCD 44 is digitized by the AFE 45 and then input to the microscope main body 92. The output of the imaging signal to the AFE 45 is controlled by the imaging control unit 46 connected to the CCD 44. This imaging control unit 46 is the same as the imaging control unit of the electronic endoscope system of the present embodiment, and is driven based on various instructions from the controller 59 in the microscope main body 92.

  The microscope main body 92 corresponds to the processor device 12 of the present embodiment, and creates image data by performing image processing such as color separation on the DSP 55 with respect to the imaging signal output from the AFE 45 of the microscope main body 92. To do. This image data is stored in the frame memory 56. The image data stored in the frame memory 56 is read by the display control circuit 57. The display control circuit 57 displays an image on the finder 93 based on the read image data. An image displayed on the finder 93 is switched by a mode switching SW 61 connected to the controller 59. The mode switching SW 61 switches the image mode to any one of the normal light image mode, the fluorescent light image mode, the treatment light image mode, and the treatment state confirmation mode, as in the present embodiment.

  In the normal light image mode, a normal light image generated based on the imaging signal of the R1 pixel 70, the imaging signal of the G pixel 72, and the imaging signal of the B pixel 73 is displayed on the finder 93. This normal light image is not an imaging signal of the R2 pixel 71 provided with a neutral density filter for treatment light that greatly affects the red color reproduction, but is used for excitation light cut that hardly affects the red color reproduction. Since it is generated based on the imaging signal of the R1 pixel 70 provided with the neutral density filter, the color reproducibility is excellent.

  In the fluorescent light image mode, a fluorescent light image generated based on the imaging signal of the R1 pixel 70 is displayed on the finder 93. In the fluorescent light image, since the excitation light Ld is attenuated by the neutral density filter of the R1 pixel 70, no halation occurs. In the treatment light image mode, a treatment light image generated based on the imaging signal of the R2 image 71 is displayed on the finder 93. In the therapeutic light image, since the therapeutic light Lt is attenuated by the neutral density filter of the R2 pixel 71, no halation occurs.

  In the treatment status confirmation mode, the normal light image, the fluorescent light image, and the treatment light image are displayed on the viewfinder 93, so how the concentration distribution of the photosensitive substance and the disappearance state of the tumor affected part change over time. Can be confirmed. In the treatment status confirmation mode, similarly to the present embodiment, after generating image data of a fluorescent light image, the irradiation distribution of the treatment light Lt is controlled in accordance with the concentration change of the photosensitive substance.

  In controlling the irradiation distribution of the treatment light Lt, first, the concentration distribution specifying unit 55a in the DSP obtains the concentration distribution of the photosensitive substance accumulated in the tumor affected part, and based on the obtained concentration distribution of the photosensitive substance, The therapeutic light irradiation distribution specifying unit 59a obtains the irradiation distribution of the therapeutic light Lt irradiated to the tumor affected part. The irradiation distribution control unit 54 controls the spatial light modulator 53 based on the obtained irradiation distribution of the treatment light Lt.

  Thereby, since the therapeutic light Lt with a large light quantity is irradiated to the part with a high density | concentration of a photosensitive substance among tumor affected parts, extinction of a tumor affected part can be accelerated. On the other hand, since the treatment light Lt having a small light amount is irradiated to the portion where the concentration of the photosensitive substance is low, the treatment light Lt is not excessively applied to the tumor affected part that is disappearing.

  In this embodiment, the example in which the image mode is switched in the order of the normal light image mode, the fluorescent light image mode, the treatment light image mode, and the treatment status confirmation mode has been described. However, the order of switching the image modes is not limited to this. .

  The present invention can be applied not only to an electronic endoscope system and a surgical microscope system but also to other medical device systems using PDT.

DESCRIPTION OF SYMBOLS 10 Electronic endoscope system 11 Electronic endoscope 30 Broadband light source 31 Light source for PDD 32 Light source for PDT 34 Irradiation light switching unit 44 CCD
53 Spatial Light Modulator 54 Irradiation Distribution Control Unit 55 DSP
55a Concentration distribution specifying unit 59 Controller 59a Treatment light irradiation distribution specifying unit 80 Operating microscope system 82 Operating microscope

Claims (7)

A light source for PDD that emits excitation light for generating fluorescent light from a tumor affected part of a patient in which a photosensitive substance is accumulated;
A light source for PDT that emits treatment light for extinguishing the tumor affected area;
Irradiation means for irradiating the tumor affected area with excitation light or treatment light;
An image generating means for generating an image based on an imaging signal generated by receiving light from the tumor affected area;
From the fluorescent light image obtained when the excitation light is irradiated, a concentration distribution specifying unit for specifying the concentration distribution of the photosensitive substance accumulated in the tumor affected part, and
A medical device system for PDT, comprising: an irradiation distribution control unit that controls the irradiation distribution of the treatment light based on the concentration distribution of the photosensitive substance in the tumor affected part.   The irradiation distribution control unit irradiates a portion having a high photosensitizer concentration in the tumor affected area with a large amount of treatment light, and irradiates a portion with a low photosensitizer concentration with a small amount of treatment light. The medical device system for PDT according to claim 1. A broadband light source that emits broadband light whose wavelength ranges from the blue region to the red region;
The medical device system for PDT according to claim 1, further comprising: an irradiation light switching unit that switches light irradiated to the tumor affected part in the order of the broadband light, the excitation light, and the treatment light. .   The photosensitizer is photophilin, the therapeutic light has a central wavelength of 630 nm, the excitation light has a central wavelength of 405 nm, and the fluorescent light has one peak at 660 nm. The medical device system for PDT of 1 thru | or 3. A light source device having a light source for PDD that emits excitation light for generating fluorescent light from a tumor affected part in a body cavity in which a photosensitive substance is accumulated, and a light source for PDT that emits therapeutic light for extinguishing the tumor affected part; ,
An electronic endoscope having irradiation means for irradiating excitation light or treatment light to a body cavity including the tumor affected part, and an imaging element that receives light from the tumor affected part and outputs an imaging signal;
A processor having image generation means for generating an image based on an imaging signal, and a concentration distribution specifying unit for specifying the concentration distribution of the photosensitive substance accumulated in the tumor affected part from a fluorescent light image obtained when the excitation light is irradiated With the device,
The electronic endoscope is:
An electronic endoscope system comprising an irradiation distribution control unit that controls the irradiation distribution of the therapeutic light based on a concentration distribution of a photosensitive substance in the tumor affected part. A light source device having a light source for PDD that emits excitation light for generating fluorescent light from a tumor affected part in which a photosensitive substance is accumulated in a surgical site, and a light source for PDT that emits treatment light for extinguishing the tumor affected part When,
An irradiation unit that irradiates the surgical site including the tumor affected part with excitation light or treatment light, an image sensor that receives light from the tumor affected part and outputs an imaging signal, and generates an image based on the imaging signal A surgical microscope having an image generation means and a concentration distribution specifying unit for specifying the concentration distribution of the photosensitive substance accumulated in the tumor affected part from the fluorescent light image obtained when the excitation light is irradiated;
The surgical microscope is
A surgical microscope system comprising: an irradiation distribution control unit that controls the irradiation distribution of the treatment light based on a concentration distribution of a photosensitive substance in the tumor affected part. When irradiating the tumor affected part with excitation light for generating fluorescent light from the tumor affected part of the patient in which the photosensitive substance is accumulated, the light from the tumor affected part is received by the imaging device,
Based on the imaging signal output from the imaging device, generate a fluorescent light image,
Identify the concentration distribution of the photosensitive substance accumulated in the tumor affected area from the fluorescent light image,
When irradiating the tumor affected part with treatment light for eliminating the tumor affected part, the treatment light irradiation is controlled based on the concentration distribution of the photosensitive substance in the tumor affected part. Distribution control method.

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