JP2013043026A - Blood flow estimation system for puncture target organ, temperature distribution estimation system, analyzer, and program for analyzer - Google Patents

Blood flow estimation system for puncture target organ, temperature distribution estimation system, analyzer, and program for analyzer Download PDF

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JP2013043026A
JP2013043026A JP2011184322A JP2011184322A JP2013043026A JP 2013043026 A JP2013043026 A JP 2013043026A JP 2011184322 A JP2011184322 A JP 2011184322A JP 2011184322 A JP2011184322 A JP 2011184322A JP 2013043026 A JP2013043026 A JP 2013043026A
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blood flow
temperature
target organ
puncture
temperature distribution
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JP5845536B2 (en
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Masakatsu Fujie
正克 藤江
Hiroshi Kobayashi
洋 小林
Hiroki Watanabe
宏樹 渡辺
Nozomi Yamazaki
望 山崎
Makoto Hashizume
誠 橋爪
Takeshi Ohira
猛 大平
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Waseda University
Kyushu University NUC
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Kyushu University NUC
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Abstract

PROBLEM TO BE SOLVED: To contribute to the estimation of a blood flow in a puncture target organ and to obtain the temperature distribution of the puncture target organ from the blood flow and the change in the temperature distribution.SOLUTION: A temperature distribution estimation system 10 includes: a heating means 14 which applies a constant amount of heat to the insertion site of an electrode needle 12; a temperature sensor 15 which is capable of measuring the temperature change in the proximity to the heating means 14 after the amount of heat is applied; a blood flow estimation means 19 which estimates the blood flow of the puncture target organ based on the measurement value of the temperature sensor 15; and a temperature distribution estimation means 20 which estimates the temperature distribution in the puncture target organ based on the blood flow. In the blood flow estimation means 19, the temperature rise rate to time is calculated from the measurement value of the temperature sensor 15, and the blood flow is calculated based on the temperature rise rate. In the temperature distribution estimation means 20, the temperature distribution is calculated from the blood flow and the amount of heat applied from an electrode 12A to the puncture target organ.

Description

本発明は、穿刺対象臓器の血流量推定システム、温度分布推定システム、解析装置、及び解析装置用プログラムに係り、更に詳しくは、穿刺対象臓器の病変部分を穿刺によって焼灼する際における穿刺対象臓器の血流量を推定し、当該血流量が影響を与える穿刺対象臓器内の温度分布の把握に寄与する穿刺対象臓器の血流量推定システム、温度分布推定システム、解析装置、及び解析装置用プログラムに関する。   The present invention relates to a blood flow volume estimation system, a temperature distribution estimation system, an analysis device, and an analysis device program for a puncture target organ. More specifically, the present invention relates to a puncture target organ at the time of cauterizing a lesion portion of the puncture target organ by puncture. The present invention relates to a blood flow estimation system, a temperature distribution estimation system, an analysis apparatus, and an analysis apparatus program for a puncture target organ that estimates blood flow and contributes to grasping a temperature distribution in a puncture target organ affected by the blood flow.

近時の医療において、患者への負担の少ない低侵襲治療が求められているが、その中でも、臓器の患部に針を刺して治療する穿刺治療法が知られている。この穿刺治療法としては、例えば、肝臓がんの治療等に用いられるRFA(ラジオ波焼灼療法)が挙げられる。このRFAは、腫瘍の一部分に電極針を刺し、当該電極針から発せられるジュール熱で腫瘍を加熱することにより、腫瘍を焼灼して凝固壊死させる療法である。RFAに用いられる電極針としては、その先端に温度センサを設けて、当該先端部分の温度をモニタリング可能なものがある(例えば、特許文献1参照)。   In recent medical treatment, there is a demand for minimally invasive treatment with less burden on the patient. Among them, a puncture treatment method is known in which an affected part of an organ is punctured and treated. Examples of this puncture treatment method include RFA (radiofrequency ablation therapy) used for the treatment of liver cancer and the like. This RFA is a therapy in which an electrode needle is inserted into a part of a tumor and the tumor is heated by Joule heat emitted from the electrode needle to cauterize the tumor and coagulate necrosis. As an electrode needle used for RFA, there is one that can be provided with a temperature sensor at the tip thereof to monitor the temperature of the tip portion (see, for example, Patent Document 1).

特開2011−98211号公報JP 2011-98211 A

しかしながら、前記従来の電極針にあっては、臓器の刺入部位の温度管理しかできないため、医師は、術中に、焼灼対象となる腫瘍或いは臓器全体の温度分布及び当該温度分布の経時的な変化を把握することができず、次の不都合を招来する。   However, since the conventional electrode needle can only control the temperature of the site where the organ is inserted, during the operation, the doctor can determine whether the temperature distribution of the tumor or whole organ to be ablated and the temperature distribution over time. Cannot be grasped, causing the following inconvenience.

一般的に、RFAは、超音波画像下で医師の目視によって行われるが、超音波画像はモノクロであるため、腫瘍と焼灼部分の境界が不明瞭で目視しにくい。   Generally, RFA is performed by a doctor's visual observation under an ultrasonic image. However, since the ultrasonic image is monochrome, the boundary between the tumor and the cauterized part is unclear and difficult to view.

また、電極針から臓器に所定の熱量を付与した際に、当該臓器の血流量が多いと血流に熱が奪われ易くなり、腫瘍への伝熱率が低下して焼灼範囲が意図した範囲よりも小さくなる。逆に、臓器の血流量が少ないと腫瘍への伝熱率が高くなり、焼灼範囲が意図した範囲よりも大きくなる。血流量は、術中の患者の状態によって変化することから、刺入部位の温度をモニタリングし、電極針から臓器に与えられるジュール熱の熱量を所望の値に維持していても、血流量の変化によって臓器内の焼灼範囲の大きさが変わることになる。このため、電極針からのジュール熱の出力調整は、医師の経験や勘に依存しており、治療成績にばらつきが生じ易い。   In addition, when a predetermined amount of heat is applied to the organ from the electrode needle, if the blood flow in the organ is large, heat is easily taken away by the blood flow, the heat transfer rate to the tumor is reduced, and the ablation range is the intended range Smaller than. Conversely, when the blood flow in the organ is small, the heat transfer rate to the tumor increases, and the ablation range becomes larger than the intended range. Since blood flow varies depending on the condition of the patient during the operation, even if the temperature of the insertion site is monitored and the amount of Joule heat given from the electrode needle to the organ is maintained at a desired value, the change in blood flow The size of the ablation area in the organ changes. For this reason, the output adjustment of the Joule heat from the electrode needle depends on the experience and intuition of the doctor, and the treatment results tend to vary.

以上により、臓器の焼灼範囲を正確にコントロールするには、術中、血流量によって変わる臓器の温度分布及びその変化に関する情報を逐次取得することが重要となる。従って、電極針の刺入部位の温度管理をしていても、焼灼対象となる腫瘍或いは臓器全体の温度分布とその変化を術中に正確に把握できなければ、正確な範囲で焼灼することができず、腫瘍の未焼灼領域の残留や正常組織への焼灼過多を招来する虞がある。   As described above, in order to accurately control the ablation range of the organ, it is important to sequentially acquire information on the temperature distribution of the organ that changes depending on the blood flow volume and the change thereof during the operation. Therefore, even if the temperature of the insertion site of the electrode needle is controlled, if the temperature distribution of the tumor or organ to be ablated and the changes in the temperature cannot be accurately grasped during the operation, it can be cauterized within the correct range. Therefore, there is a risk of remaining unburned areas of the tumor and excessive cauterization of normal tissues.

本発明は、このような不都合に着目して案出されたものであり、その目的は、穿刺対象臓器内の血流量を推定し、当該血流量から穿刺対象臓器の温度分布とその変化を把握することに寄与する穿刺対象臓器の血流量推定システム、温度分布推定システム、解析装置、及び解析装置用プログラムを提供することにある。   The present invention has been devised by paying attention to such inconveniences, and its purpose is to estimate the blood flow volume in the puncture target organ and grasp the temperature distribution of the puncture target organ and its change from the blood flow volume. An object of the present invention is to provide a blood flow volume estimation system, a temperature distribution estimation system, an analysis apparatus, and an analysis apparatus program that contribute to the puncture target organ.

前記目的を達成するため、本発明は、穿刺対象臓器における穿刺針の刺入部位に一定の熱量を付与したときのその近傍の温度の計測値から、予め記憶された数式により、時間に対する前記近傍の温度上昇率を算出し、当該温度上昇率に基づいて前記血流量を算出する血流量推定手段を備えた点に主たる特徴を有する。   In order to achieve the above object, the present invention relates to the vicinity of time according to a mathematical formula stored in advance from a measured value of the temperature in the vicinity of the puncture needle in the puncture target organ when a certain amount of heat is applied. The main feature is that it includes a blood flow rate estimating means for calculating the blood flow rate based on the temperature rise rate.

本発明によれば、穿刺術中において、穿刺対象臓器内における血流量を経時的に推定することができ、当該血流量に左右する穿刺対象臓器の温度分布の推定を経時的に行うことができる。これにより、この温度分布に関する情報を医師に提示可能になる他、当該情報に基づいて、穿刺対象臓器を加熱する電極からの出力エネルギーを自動的に制御することができ、患者の術中の血流量の変化に拘らず、所望の範囲の焼灼をより正確に行うことができる。   According to the present invention, during the puncture, the blood flow volume in the puncture target organ can be estimated over time, and the temperature distribution of the puncture target organ that depends on the blood flow volume can be estimated over time. This makes it possible to present information regarding this temperature distribution to the doctor, and based on this information, the output energy from the electrode that heats the puncture target organ can be automatically controlled, and the patient's intraoperative blood flow In spite of the change of the above, the desired range of cauterization can be performed more accurately.

本実施形態に係る温度分布推定システムの概略構成図。The schematic block diagram of the temperature distribution estimation system which concerns on this embodiment.

以下、本発明の実施形態について図面を参照しながら説明する。   Hereinafter, embodiments of the present invention will be described with reference to the drawings.

図1には、本実施形態に係る温度分布推定システムの概略構成図が示されている。この図において、前記温度分布推定システム10は、穿刺対象臓器の腫瘍部分に穿刺針としての電極針12を刺し、当該電極針12に供給されるラジオ波によるジュール熱で腫瘍部分を焼灼するRFA(ラジオ波焼灼療法)時に、穿刺対象臓器の温度分布を推定するシステムである。   FIG. 1 shows a schematic configuration diagram of a temperature distribution estimation system according to the present embodiment. In this figure, the temperature distribution estimation system 10 inserts an electrode needle 12 as a puncture needle into a tumor portion of an organ to be punctured, and RFA (causes the tumor portion with Joule heat generated by radio waves supplied to the electrode needle 12. This system estimates the temperature distribution of the puncture target organ during radiofrequency ablation.

この温度分布推定システム10は、図示しないラジオ波発生装置からの高周波電流が通電する電極12Aを有する電極針12にそれぞれ内蔵された加熱手段14及び温度センサ15と、温度センサ15の計測値に基づき、穿刺対象臓器内の温度分布を経時的に求める解析装置17とを備えている。   This temperature distribution estimation system 10 is based on the heating means 14 and temperature sensor 15 incorporated in the electrode needle 12 having the electrode 12A through which a high-frequency current from a radio wave generator (not shown) is passed, and the measured value of the temperature sensor 15. And an analysis device 17 for obtaining a temperature distribution in the puncture target organ over time.

前記加熱手段14は、図示しない電源に接続され、電極12Aとは別の加熱用細線からなり、電極12Aからのラジオ波エネルギーによる刺入部位の加熱とは別個独立して、当該刺入部位の周囲に一定の熱量を継続して供給するようになっている。なお、加熱手段14としては、加熱用細線に限定されず、腫瘍部分の凝固壊死させるための電磁波による熱エネルギーの付与とは別に、刺入部位の周囲に一定の熱量を継続して供給できる限りにおいて種々のものを採用することができる。   The heating means 14 is connected to a power source (not shown) and is composed of a thin heating wire different from the electrode 12A. The heating means 14 is independent of heating the insertion site by radio wave energy from the electrode 12A, and A constant amount of heat is continuously supplied to the surroundings. The heating means 14 is not limited to the heating thin wire, and as long as a constant amount of heat can be continuously supplied around the insertion site, apart from the application of thermal energy by electromagnetic waves for causing coagulation necrosis of the tumor part. Various types can be employed.

前記温度センサ15は、加熱手段14の近傍の温度、すなわち、刺入部位の近傍の電極針12の温度を計測可能になっており、当該計測値に対応する電気信号が経時的に逐次、解析装置17に送信される。つまり、術中、加熱手段14から穿刺対象臓器に一定熱量が与えられ、それによって生じる温度上昇が温度センサ15で経時的に計測される。   The temperature sensor 15 can measure the temperature in the vicinity of the heating means 14, that is, the temperature of the electrode needle 12 in the vicinity of the insertion site, and the electrical signal corresponding to the measured value is sequentially analyzed over time. Transmitted to the device 17. That is, during the operation, a constant amount of heat is applied from the heating means 14 to the puncture target organ, and the temperature rise caused by the heat is measured over time by the temperature sensor 15.

前記解析装置17は、CPU等の演算処理装置及びメモリやハードディスク等の記憶装置等からなるコンピュータによって構成され、当該コンピュータを以下の各手段として機能させるためのプログラムがインストールされている。   The analysis device 17 is configured by a computer including an arithmetic processing device such as a CPU and a storage device such as a memory and a hard disk, and a program for causing the computer to function as the following units is installed.

この解析装置17は、温度センサ15の計測値に基づき、穿刺対象臓器の血流量の推定値を経時的に求める血流量推定手段19と、血流量推定手段19で求めた血流量に基づき、穿刺対象臓器内での各部位の温度の推定値を経時的に求める温度分布推定手段20とを備えている。   This analysis device 17 is based on the measurement value of the temperature sensor 15, the blood flow rate estimation means 19 for obtaining an estimated value of the blood flow volume of the puncture target organ over time, and the puncture based on the blood flow volume obtained by the blood flow rate estimation means 19. Temperature distribution estimating means 20 for obtaining an estimated value of the temperature of each part in the target organ over time.

前記血流量推定手段19では、予め記憶された以下の式(1)により、温度センサ15の計測値(温度T)から、加熱手段14による継続した加熱の開始時からの経過時間tにおける電極針12の温度上昇率Uが算出され、当該温度上昇率Uから血流量Fが算出される。

Figure 2013043026
なお、温度上昇率Uと血流量Fの関係は、本発明者らが鋭意、実験研究を行った結果、式(1)として導出されたものであり、同式(1)中、a、bは、数値解析に基づくシミュレーションによる実験等の実験研究によって特定された定数となる。
また、式(1)は、加熱手段14からの発熱量のうち、血流量が多い場合、血流に吸収される熱量が多くなって電極針12の温度上昇量が小さくなる一方、血流量が少ない場合、血流に吸収される熱量が少なくなって電極針12の温度上昇量が大きくなる点に着目し、実験研究により導出されたものである。 In the blood flow rate estimating means 19, the electrode needle at the elapsed time t from the start of continuous heating by the heating means 14 from the measured value (temperature T) of the temperature sensor 15 according to the following formula (1) stored in advance. The temperature increase rate U of 12 is calculated, and the blood flow rate F is calculated from the temperature increase rate U.
Figure 2013043026
The relationship between the temperature increase rate U and the blood flow rate F was derived as a formula (1) as a result of earnest researches by the present inventors, and in the formula (1), a, b Is a constant specified by an experimental study such as a simulation based on numerical analysis.
Further, in the formula (1), when the blood flow amount is large among the calorific values from the heating means 14, the amount of heat absorbed in the blood flow is increased and the temperature rise of the electrode needle 12 is reduced, while the blood flow rate is In the case where the amount is small, the amount of heat absorbed by the blood flow is reduced, and the temperature rise amount of the electrode needle 12 is increased.

前記温度分布推定手段20では、前記経過時間tにおける血流量Fと、電極12Aから穿刺対象臓器に与えられるジュール熱の熱量Q(P)とが、予め記憶された次式(2)の熱伝導方程式に代入され、当該方程式を解くことで、穿刺対象臓器の温度分布が算出される。ここで、温度分布は、穿刺対象臓器内の適当な基準位置に設定された座標系から見た任意要素に対する位置ベクトルBと、経過時間tとで表される関数θ(B,t)の形で求められる。また、ジュール熱の熱量Q(P)は、電極12Aへの供給電力量Pと肝臓の電気伝導率によって求まる関数であり、経過時間tにおける前記供給電力量Pの入力によって特定される。

Figure 2013043026
上式(2)において、ρは穿刺対象臓器の密度、cは穿刺対象臓器の比熱、λは穿刺対象臓器の熱伝導率、ρは血液の密度、cは血液の比熱、θは血液の温度であり、これら数値ρ,c,λ,ρ,c,θは、定数として予め記憶されている。 In the temperature distribution estimation means 20, the blood flow F at the elapsed time t and the Joule heat quantity Q (P) given from the electrode 12 </ b> A to the puncture target organ are stored in advance in the following equation (2). By substituting into the equation and solving the equation, the temperature distribution of the puncture target organ is calculated. Here, the temperature distribution is in the form of a function θ (B, t) represented by a position vector B with respect to an arbitrary element viewed from a coordinate system set at an appropriate reference position in the puncture target organ and an elapsed time t. Is required. The amount of heat Q (P) of Joule heat is a function determined by the amount of power supplied to the electrode 12A and the electrical conductivity of the liver, and is specified by the input of the amount of power supplied P at the elapsed time t.
Figure 2013043026
In the above equation (2), ρ is the density of the puncture target organ, c is the specific heat of the puncture target organ, λ is the thermal conductivity of the puncture target organ, ρ b is the blood density, c b is the specific heat of blood, and θ b is This is the blood temperature, and these numerical values ρ, c, λ, ρ b , c b , and θ b are stored in advance as constants.

すなわち、ここでは、経過時間t毎の温度関数θ(B,t)が求められ、穿刺対象臓器の座標系における各位置の温度が経過時間t毎に特定され、同一となる温度部分毎に肝臓を領域分けした温度分布が経時的に得られる。ここで得られた温度分布のデータは、図示しない表示装置に表示することでRFAを行う医師に提示し、或いは、電極12Aからのジュール熱の発熱量の自動制御に用いることができる。   That is, here, the temperature function θ (B, t) for each elapsed time t is obtained, the temperature at each position in the coordinate system of the puncture target organ is specified for each elapsed time t, and the liver is determined for each temperature portion that is the same. Can be obtained over time. The temperature distribution data obtained here can be presented to a doctor performing RFA by displaying it on a display device (not shown), or can be used for automatic control of the amount of generated Joule heat from the electrode 12A.

なお、前記実施形態では、加熱手段14と温度センサ15を電極針12に内蔵した場合を説明したが、本発明はこれに限らず、これらを電極針12と別に設けることも可能である。   In the above-described embodiment, the case where the heating unit 14 and the temperature sensor 15 are built in the electrode needle 12 has been described. However, the present invention is not limited thereto, and these can be provided separately from the electrode needle 12.

また、前記温度分布推定システム10は、穿刺対象臓器の血流量を推定する血流量推定システムを含んで構成されているが、本発明では、前記温度分布推定手段20を設けずに、血流量推定システムのみの構成とすることもできる。   The temperature distribution estimation system 10 is configured to include a blood flow estimation system that estimates the blood flow of a puncture target organ. In the present invention, the blood flow estimation is performed without providing the temperature distribution estimation means 20. A system-only configuration can also be adopted.

更に、本発明は、RFAの際の適用のみならず、マイクロ波凝固療法(PMCT)等の他の穿刺術を行う際の適用も可能となる。   Furthermore, the present invention can be applied not only to RFA but also to other puncture procedures such as microwave coagulation therapy (PMCT).

その他、本発明における装置各部の構成は図示構成例に限定されるものではなく、実質的に同様の作用を奏する限りにおいて、種々の変更が可能である。   In addition, the configuration of each part of the apparatus in the present invention is not limited to the illustrated configuration example, and various modifications are possible as long as substantially the same operation is achieved.

10 温度分布推定システム
12 電極針(穿刺針)
12A 電極
14 加熱手段
15 温度センサ
17 解析装置
19 血流量推定手段
20 温度分布推定手段
10 Temperature distribution estimation system 12 Electrode needle (puncture needle)
12A Electrode 14 Heating means 15 Temperature sensor 17 Analyzing device 19 Blood flow rate estimating means 20 Temperature distribution estimating means

Claims (6)

穿刺針が刺入される穿刺対象臓器の血流量を推定するシステムであって、
前記穿刺針の刺入部位に一定の熱量を付与する加熱手段と、
前記熱量の付与後における前記加熱手段の近傍の温度変化を測定可能な温度センサと、
前記温度センサの計測値に基づき前記血流量を推定する血流量推定手段とを備え、
前記血流量推定手段では、予め記憶された数式により、前記温度センサの計測値から時間に対する温度上昇率を算出し、当該温度上昇率に基づいて前記血流量を算出することを特徴とする穿刺対象臓器の血流量推定システム。
A system for estimating blood flow of a puncture target organ into which a puncture needle is inserted,
Heating means for applying a certain amount of heat to the puncture site of the puncture needle;
A temperature sensor capable of measuring a temperature change in the vicinity of the heating means after the application of the heat quantity;
Blood flow estimation means for estimating the blood flow based on the measurement value of the temperature sensor,
The blood flow rate estimating means calculates a temperature increase rate with respect to time from a measurement value of the temperature sensor by using a mathematical formula stored in advance, and calculates the blood flow rate based on the temperature increase rate Blood flow estimation system for organs.
前記加熱手段と前記温度センサは、前記穿刺針に一体的に設けられていることを特徴とする請求項1記載の血流量推定システム。   The blood flow estimation system according to claim 1, wherein the heating means and the temperature sensor are integrally provided on the puncture needle. 前記穿刺針は、電磁波による熱エネルギーを前記刺入部位に付与するための電極を有する電極針であり、前記加熱手段による加熱は、前記電極による加熱と別個独立に行われることを特徴とする請求項1又は2記載の血流量推定システム。   The puncture needle is an electrode needle having an electrode for applying thermal energy by electromagnetic waves to the insertion site, and heating by the heating means is performed separately from heating by the electrode. Item 3. A blood flow estimation system according to item 1 or 2. 請求項3記載の血流量推定システムを備えた温度分布推定システムであって、
前記血流量に基づき、前記穿刺対象臓器内での温度分布を推定する温度分布推定手段を更に備え、
前記温度分布推定手段では、予め記憶された熱伝導方程式に、前記血流量と、前記電極から前記穿刺対象臓器に与えられた熱量とを代入することで、前記温度分布を算出することを特徴とする穿刺対象臓器の温度分布推定システム。
A temperature distribution estimation system comprising the blood flow estimation system according to claim 3,
A temperature distribution estimating means for estimating a temperature distribution in the puncture target organ based on the blood flow,
In the temperature distribution estimation means, the temperature distribution is calculated by substituting the blood flow rate and the heat amount given from the electrode to the puncture target organ into a heat conduction equation stored in advance. A temperature distribution estimation system for an organ to be punctured.
穿刺針が刺入された穿刺対象臓器の状態を解析する解析装置において、
前記穿刺針の刺入部位に一定の熱量を付与したときのその近傍の温度変化に基づき、前記穿刺対象臓器の血流量を推定する血流量推定手段を備え、
前記血流量推定手段は、予め記憶された数式により、時間に対する前記近傍の温度上昇率を算出し、当該温度上昇率に基づいて前記血流量を算出することを特徴とする穿刺対象臓器の解析装置。
In the analysis device for analyzing the state of the puncture target organ into which the puncture needle is inserted,
A blood flow rate estimating means for estimating a blood flow rate of the puncture target organ based on a temperature change in the vicinity thereof when a certain amount of heat is applied to the puncture site of the puncture needle;
The puncture target organ analysis apparatus characterized in that the blood flow rate estimation means calculates a rate of temperature rise in the vicinity with respect to time by using a mathematical formula stored in advance, and calculates the blood flow rate based on the rate of temperature rise .
穿刺針が刺入された穿刺対象臓器の状態を解析する解析装置のコンピュータを機能させるプログラムにおいて、
前記穿刺針の刺入部位に一定の熱量を付与したときのその近傍の温度の計測値から、予め記憶された数式により、時間に対する前記近傍の温度上昇率を算出し、当該温度上昇率に基づいて前記血流量を算出する血流量推定手段として前記コンピュータを機能させることを特徴とする穿刺対象臓器の解析装置用プログラム。
In a program for operating a computer of an analysis apparatus that analyzes a state of a puncture target organ into which a puncture needle is inserted,
Based on the measured value of the temperature in the vicinity of the puncture needle when a certain amount of heat is applied, the temperature increase rate in the vicinity with respect to time is calculated according to a previously stored mathematical formula, and based on the temperature increase rate A puncture target organ analysis apparatus program that causes the computer to function as blood flow estimation means for calculating the blood flow.
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