JP2013188327A - X-ray radiography system, catheter, and control program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To generate image data effective for treatment effect determination of stent graft indwelling operation.SOLUTION: An X-ray radiography system 100 for generating image data by performing X-ray radiography using a contrast medium to the affected area of a patient where a stent graft is implanted includes: a timing signal generation part 11 for generating the timing signal of contrast medium injection to the affected area and the timing signal of X-ray irradiation to the affected area on the basis of biological signals detected from the patient; an X-ray radiography part 1 for performing the X-ray radiography to the affected area where the contrast medium is injected, on the basis of the timing signal of the X-ray irradiation; an image data generation part 8 for generating image data on the basis of projection data obtained by the X-ray radiography; and a display part 9 for displaying the image data.

Description

  Embodiments described herein relate generally to an X-ray imaging system, a catheter, and a control program capable of accurately grasping a therapeutic effect on a diseased part such as an aortic aneurysm in which stent graft placement is performed.

  Medical image diagnosis using an X-ray diagnostic apparatus, an X-ray CT apparatus, etc. has made rapid progress with the development of computer technology and has become indispensable in today's medical care. In particular, the X-ray imaging diagnosis of the circulatory region, which has been progressing with the development of the catheter technique, is intended for the entire arteriovenous system including the cardiovascular system. This is done by observing image data collected by line imaging.

  For example, an X-ray diagnostic apparatus for the purpose of diagnosing the circulatory region includes an X-ray generation unit and an X-ray detection unit (hereinafter collectively referred to as an imaging system), a C arm that holds the imaging system, and the like. An X-ray from an optimum direction with respect to the imaging region of the patient by moving the imaging system attached to the top plate and the holding unit in a desired direction, including a holding unit and a top plate on which the patient is placed. Shooting is possible.

  By the way, in recent years, in the treatment of an aortic aneurysm or the like, so-called stent graft placement has been used in which an artificial blood vessel having a spring-like metal called a stent graft is used to stop blood flow to the aneurysm. Since this method can be performed from within the blood vessel without opening the abdomen, the burden on the patient can be greatly reduced. However, there is a gap at the junction between the blood vessel wall and the stent graft or at the overlapping portion of the stent graft. If this occurs, blood may flow into the aneurysm and a sufficient therapeutic effect may not be obtained.

  For this reason, a medical worker (hereinafter referred to as an operator) in charge of the treatment is placed on a diseased part (that is, a blood vessel having an aneurysm on its wall surface) into which contrast medium injection has been injected after the stent graft placement. On the other hand, X-ray imaging was performed, and the presence or absence of blood leakage to the aneurysm was confirmed by observing the image data obtained at this time.

JP 2004-201873 A

  It has become possible to determine the quality of stent graft placement by X-ray imaging of a diseased part into which a contrast medium has been injected. However, in particular, when X-ray imaging is performed while injecting a contrast medium into a large blood vessel having a large blood flow such as an aorta, it is necessary to inject a large amount of contrast medium within a unit time. For this reason, when the burden on the kidney of the patient is taken into account, the amount of contrast medium injected and the number of imaging must be limited, which makes it difficult to sufficiently observe the diseased part.

  The present disclosure has been made in view of such conventional problems, and the purpose of the present disclosure is to provide a contrast medium with little or no blood flow leakage to a diseased part such as an aortic aneurysm in which stent graft placement is performed. An object is to provide an X-ray imaging system, a catheter, and a control program that can be accurately and easily grasped by injection.

  In order to solve the above-described problems, the X-ray imaging system of the present disclosure is an X-ray imaging system that generates image data by performing X-ray imaging using a contrast medium on a diseased part of a patient in which a stent graft is placed. A contrast medium injection timing signal generating means for generating a contrast medium injection timing signal for the diseased part based on the biological signal detected from the patient; and an X-ray irradiation timing for the diseased part based on the biological signal X-ray irradiation timing signal generating means for generating a signal, X-ray imaging means for performing X-ray imaging of the diseased part into which a contrast medium has been injected based on the timing signal of X-ray irradiation, and the X-ray imaging. Image data generating means for generating image data based on the projection data received, and display means for displaying the image data, To have.

1 is a block diagram illustrating an overall configuration of an X-ray imaging system according to an embodiment of the present disclosure. The block diagram which shows the specific structure of the X-ray imaging part with which the X-ray imaging system of this embodiment is provided. The block diagram which shows the specific structure of the timing signal generation part with which the X-ray imaging system of this embodiment is provided. The figure for demonstrating the electrocardiogram waveform which the biological signal measurement part of this embodiment measures, and the contrast agent injection | pouring timing signal and X-ray irradiation timing signal which a timing signal generation part produces | generates based on this electrocardiogram waveform. The figure which shows the specific example of the catheter for contrast agent injection | pouring used for this embodiment. The flowchart which shows the production | generation / display procedure of the image data for treatment effect determination in this embodiment.

  Hereinafter, embodiments of the present disclosure will be described with reference to the drawings.

(Embodiment)
In the X-ray imaging system according to the embodiment of the present disclosure, first, X-ray imaging (X-ray fluoroscopy) in the first imaging mode is performed on an imaging region of the patient including a diseased part where a stent graft is previously placed, and the distal end of the catheter Positioning image data is generated and displayed for the purpose of setting the position of the part and optimizing the imaging direction, and then a contrast medium injection catheter (hereinafter referred to as a catheter) is placed at a suitable position in the diseased part. X-ray imaging in the second imaging mode is performed on the imaging area in which the distal end portion is arranged to generate and display therapeutic effect determination image data.

  The configuration and functions of the X-ray imaging system according to this embodiment will be described with reference to FIGS. FIG. 1 is a block diagram showing the overall configuration of the X-ray imaging system in the present embodiment. FIGS. 2 and 3 are specific examples of the X-ray imaging unit and the timing signal generation unit provided in the X-ray imaging system. It is a block diagram which shows a structure.

  An X-ray imaging system 100 shown in FIG. 1 irradiates an imaging region of a patient 150 that moves relative to an imaging system having an X-ray generation unit 2 and an X-ray detection unit 3 described later, An X-ray imaging unit 1 that detects X-rays transmitted through the imaging region and generates projection data, a holding unit (not shown) that holds the above-described imaging system, a top plate 6 on which a patient 150 is placed, and an imaging system Projection unit before and after contrast agent administration generated in the X-ray imaging unit 1 and a moving mechanism unit 7 for moving the holding unit to which the patient is mounted and the top plate 6 on which the patient 150 is placed in a predetermined direction. The image data generation unit 8 that generates image data based on the above, the display unit 9 that displays the obtained image data, and the biological signal measurement unit 10 that measures the electrocardiographic waveform of the patient 150 are obtained. Based on the electrocardiogram waveform, the contrast medium injection timing signal and A timing signal generation unit 11 that generates an X-ray irradiation timing signal, and a contrast medium injection unit (injector) that injects a contrast medium using a catheter 15 whose distal end portion is located near the diseased part of the patient 150 in accordance with the contrast medium injection timing signal. ) 12, an input unit 13 for inputting patient information, setting X-ray imaging conditions, and the like, and a system control unit 14 for comprehensively controlling each unit described above.

  As shown in FIG. 1, the X-ray imaging unit 1 includes an X-ray generation unit 2 and an X-ray detection unit 3, a projection data generation unit 4, and a high voltage generation unit 5 that constitute an imaging system, and passes through a patient 150. A function of generating projection data based on the measured X-ray dose.

  FIG. 2 is a block diagram illustrating a specific configuration of each of the above-described units included in the X-ray imaging unit 1. The X-ray generation unit 2 is an X-ray tube that irradiates the imaging region of the patient 150 with X-rays. 21 and an X-ray restrictor 22 that forms an X-ray weight (cone beam) with respect to the X-rays emitted from the X-ray tube 21. The X-ray tube 21 is a vacuum tube that generates X-rays. The thermoelectrons generated from a heated cathode (filament) are accelerated by a DC high voltage supplied from the high voltage generator 5 and collide with a tungsten anode to cause X-rays. Is generated. On the other hand, the X-ray restrictor 22 is used for the purpose of reducing the exposure dose to the patient 150 and improving the image quality of the image data, and restricts the X-rays radiated from the X-ray tube 21 to a predetermined irradiation region (upper part). Blades), lower blades that reduce scattered radiation and leakage dose by moving in conjunction with diaphragm blades, and compensation filters that selectively reduce X-rays that pass through a medium with a small amount of absorption to prevent halation (Not shown).

  As shown in FIG. 2, the X-ray detector 3 detects a flat detector 31 that detects X-rays transmitted through the patient 150, and a drive signal for reading out the X-rays detected by the flat detector 31 as signal charges. A gate driver 32 is provided to supply to the flat detector 31.

  The flat detector 31 is configured by two-dimensionally arranging minute detection elements in a column direction and a line direction. Each of the detection elements includes a photoelectric film that senses X-rays and generates a signal charge according to an incident X-ray dose. And a charge storage capacitor for storing the signal charge generated in the photoelectric film, and a TFT (thin film transistor) (not shown) for reading out the signal charge stored in the charge storage capacitor at a predetermined timing.

  The projection data generation unit 4 includes, for example, a charge / voltage converter 41 that converts signal charges read in parallel in units of line direction into voltages from the flat panel detector 31 and an output of the charge / voltage converter 41. Are converted into digital signals (data elements of projection data), and a parallel / serial converter 43 that converts the digitally converted data elements into time-sequential data elements. The time-series data elements output from the parallel / serial converter 43 are supplied to the image data generation unit 8.

  On the other hand, the high voltage generator 5 includes a high voltage generator 52 that generates a high voltage to be applied between the anode and the cathode in order to accelerate the thermoelectrons generated from the cathode of the X-ray tube 21, and the system controller 14. The tube current, tube voltage, application time, application timing, application repetition period, etc. in the high voltage generator 52 are controlled based on the X-ray irradiation conditions supplied from the X-ray and the X-ray irradiation timing signal supplied from the timing signal generator 11. An X-ray control unit 51 is provided. The X-ray controller 51 emits X-rays having a predetermined irradiation energy from the X-ray tube 21 in a predetermined heartbeat time phase of the patient 150.

  Returning to FIG. 1, the moving mechanism unit 7 is a holding unit moving mechanism that rotates or moves a holding unit (not shown) to which the X-ray generation unit 2 and the X-ray detection unit 3 (imaging system) are attached around the patient 150. 71, a top plate moving mechanism 72 for moving the top plate 6 in the body axis direction of the patient 150 (z direction in FIG. 1) and in the direction orthogonal to the body axis (x direction and y direction in FIG. 1), and holding unit movement A moving mechanism control unit 73 that controls the mechanism 71 and the top plate moving mechanism 72 is provided.

  The movement mechanism control unit 73 supplies the movement control signal generated based on the imaging system movement instruction signal supplied from the input unit 13 via the system control unit 14 to the holding unit movement mechanism 71, and the imaging system is attached. By rotating or moving the holding unit around the patient 150, the X-ray imaging position and direction are set.

  The movement mechanism control unit 73 supplies the movement control signal generated based on the table movement instruction signal supplied from the input unit 13 via the system control unit 14 to the table movement mechanism 72, The center of the imaging region is set by translating the patient 150 in the body axis direction or in a direction perpendicular to the body axis.

  On the other hand, the image data generation unit 8 includes a projection data storage unit and an image processing unit (not shown). The projection data storage unit generates projection data in X-ray imaging for the patient 150 before and after contrast medium administration. The data elements of the projection data output in time series from the parallel / serial converter 43 of the unit 4 are sequentially stored in correspondence with the line direction and the column direction of the detection elements, thereby forming two-dimensional projection data. Next, the image processing unit generates positioning image data based on the projection data supplied from the projection data storage unit in the first photographing mode. The image processing unit performs predetermined processing on the projection data before contrast medium administration and the projection data after contrast medium administration supplied from the projection data storage unit in the second imaging mode to perform mask image data and contrast DSA (digital subtraction angiography) image data (hereinafter referred to as therapeutic effect determination) for the purpose of determining therapeutic effects by generating subtraction processing (subtraction processing) between the obtained mask image data and contrast image data. Called image data).

  The display unit 9 includes a display data generation unit, a data conversion unit, and a monitor (not shown). The display data generation unit generates positioning image data and second imaging in the first imaging mode generated by the image data generation unit 8. The mode treatment effect determination image data is converted into a predetermined display format, and additional information such as patient information and X-ray imaging conditions is added to generate display data. Next, the data conversion unit performs conversion processing such as D / A conversion and television format conversion on the display data generated by the display data generation unit and displays the display data on the monitor.

  The biological signal measurement unit 10 includes an electrocardiogram waveform measurement unit (not shown) that measures the electrocardiogram waveform of the patient 150. The electrocardiogram waveform measurement unit includes a measurement electrode attached to the body surface of the patient 150, an amplifier that amplifies the electrocardiogram waveform measured by the measurement electrode to a predetermined amplitude, and digitally converts the amplified electrocardiogram waveform. An A / D converter (none of which is shown) for converting into a signal is provided.

  Next, the timing signal generation unit 11 includes an R wave detection unit 111, a contrast medium injection timing signal generation unit 112, and an X-ray irradiation timing signal generation unit 113 as shown in FIG. The generation time of the R wave is detected by comparing the electrocardiogram waveform of the patient 150 supplied from the electrocardiogram waveform measurement unit of the signal measurement unit 10 with a predetermined threshold value α0.

  On the other hand, the contrast agent injection timing signal generation unit 112 is a timing signal for injecting the contrast agent into the diseased part of the patient 150 at a time delayed by a predetermined time Δβ from the R wave generation time detected by the R wave detection unit 111. (Contrast medium injection timing signal) is generated. Further, the X-ray irradiation timing signal generation unit 113 is a timing signal (X-ray irradiation timing signal) for irradiating the imaging region of the patient 150 with X-rays at a time delayed by a predetermined time Δγ from the R-wave detection time. ) Is generated.

  Next, the electrocardiogram waveform of the patient 150 measured by the biological signal measurement unit 10 and the contrast agent injection timing signal and the X-ray irradiation timing signal generated by the timing signal generation unit 11 based on the electrocardiogram waveform will be described with reference to FIG. I will explain.

  4A shows the relationship between the electrocardiogram waveform Ec measured by the electrocardiogram waveform measurement unit of the biological signal measurement unit 10 and the arterial pressure waveform Ap in the diseased part, and FIG. 4B shows the timing signal. The R wave generation time t10 detected by the R wave detection unit 111 of the generation unit 11 by comparing the electrocardiogram waveform Ec with the predetermined threshold value α0 is shown. On the other hand, FIG. 4C shows a contrast agent injection timing having a contrast agent injection timing at time t11 delayed by Δβ from the R wave generation time t10 generated by the contrast agent injection timing signal generation unit 112 of the timing signal generation unit 11. 4D shows an X-ray irradiation timing signal Sg2 having an X-ray irradiation timing at time t12 delayed by Δγ from the R wave generation time t10 generated by the X-ray irradiation timing signal generation unit 113. Respectively.

  The delay time Δβ described above is determined based on the time from the R wave generation time t10 to the time when the arterial pressure of the diseased part takes the maximum value, as shown in FIG. 4C. On the other hand, when an aneurysm and an artery overlap in the imaging direction, the artery injected with the contrast medium and the aneurysm having a blood leak are identified in the therapeutic effect determination image data collected by X-ray imaging immediately after the contrast medium injection. It becomes extremely difficult to do. For this reason, as shown in FIG. 4 (d), the delay time Δγ is set larger than the delay time Δβ, and the contrast medium injected into the artery near the diseased part flows out downstream and flows into the aneurysm with blood. By performing X-ray imaging of the diseased part at the timing when only the contrast agent remains, it is possible to accurately grasp the presence or absence of blood flow leakage to the aneurysm.

  Returning to FIG. 1 again, the contrast agent injection unit 12 is supplied with contrast agent injection conditions such as the contrast agent injection amount and injection rate supplied from the system control unit 14 and the contrast agent injection timing signal supplied from the timing signal generation unit 11. Accordingly, a predetermined amount of contrast medium is injected at a predetermined timing through the catheter 15 whose tip is disposed in the vicinity of the diseased part of the patient 150.

  The input unit 13 is an interactive interface having input devices such as a display panel, a keyboard, a trackball, a joystick, and a mouse. The input unit 13 inputs patient information, sets X-ray imaging conditions including X-ray irradiation conditions, and generates image data. Setting of conditions and image data display conditions, setting of threshold value α0, setting of delay times Δβ and Δγ, setting of contrast medium injection conditions, input of various instruction signals, etc. are performed using the above-described display panel and input device.

  The system control unit 14 includes a CPU and a storage circuit (not shown), and the above-described various information input or set in the input unit 13 is stored in the storage circuit. Then, the CPU comprehensively controls the above-described units of the X-ray imaging system 100 based on these pieces of information, and in the imaging region of the patient 150 where the catheter tip portion is inserted or the contrast medium is injected. Collection of projection data and generation and display of image data based on the projection data are executed.

  Next, the catheter 15 used in the injection of the contrast agent will be described with reference to FIG. As the catheter 15 used in the present embodiment, for example, as shown in FIG. 5A, the distal end portion is arranged in an annular shape along the artery wall BW, and the contrast agent injected from the contrast agent injection portion 12 is circular. A first method of ejecting from a plurality of holes provided on the side surface of the annular tip toward the aneurysm AN (particularly, the contact surface between the aneurysm AN and the stent-graft SG in which blood leakage is a concern), As shown in FIG. 5 (b), each of the tip portions branched into a plurality of portions is arranged at or near the contact surface between the artery wall BW and the stent graft SG, and the contrast agent injected from the contrast agent injection portion 12 is added to the tip portion. The second method of ejecting from the hole to the aneurysm AN is suitable.

  In this case, the hole of the arterial wall BW connected to the aneurysm AN is closed by a cylindrical stent graft SG having a spring-like metal. Then, by using the first-type catheter 15a or the second-type catheter 15b described above, a predetermined amount of the contrast agent supplied from the contrast agent injecting section 12 is applied to the stent graft SG that closes the hole of the artery wall BW. Therefore, the blood flow leakage in the stent graft SG (that is, blood flow leaking from the joint between the stent graft SG and the blood vessel) can be evaluated using a relatively small amount of contrast agent.

  Further, when the contrast agent is ejected in the direction of the aneurysm AN using the catheter 15b having a plurality of branched tip portions, the ejection direction of the contrast agent is set by attaching a metal marker to each of the tip portions. It can be accurately captured in the therapeutic effect determination image data.

(Procedure for generating / displaying therapeutic effect judgment image data)
Next, a procedure for generating / displaying therapeutic effect determination image data according to the present embodiment will be described with reference to the flowchart of FIG.

  Here again, the purpose is to optimize the position of the catheter tip and the imaging direction by performing X-ray imaging in the first imaging mode on the imaging region of the patient 150 including the diseased part where the stent graft is previously placed. Then, the image data for positioning is generated, and then X-ray imaging in the second imaging mode is performed on the imaging region in which the catheter tip is disposed at a suitable position of the diseased part, thereby preventing blood flow leakage to the aneurysm. The case of generating therapeutic effect determination image data (DSA image data) for the purpose of evaluation will be described.

  Prior to the generation of positioning image data, the operator of the X-ray imaging system 100 inputs patient information at the input unit 13, and then sets X-ray imaging conditions including X-ray irradiation conditions, image data generation conditions, and image data. Setting of display conditions, setting of threshold value α0, setting of delay times Δβ and Δγ, setting of contrast medium injection conditions, etc. are performed, and these input information and setting information are stored in the storage circuit of system control unit 14 (FIG. 6 step S1).

  When the above initial setting is completed, the operator inputs the imaging system movement instruction signal and the top board movement instruction signal at the input unit 13, whereby the imaging system and the ceiling of the X-ray generation unit 2 and the X-ray detection unit 3 are input. The plate 6 is moved, and the imaging system is arranged at a predetermined position of the patient 150 placed on the top plate 6. Next, a start instruction signal for the first imaging mode for the purpose of generating and displaying positioning image data is input at the input unit 13, and this start instruction signal is supplied to the system control unit 14, whereby the patient 150 X-ray imaging in the first imaging mode is started (step S2 in FIG. 6).

  The X-ray controller 51 of the high voltage generator 5 that has received the X-ray irradiation conditions and the start instruction signal from the system controller 14 controls the high voltage generator 52 based on the X-ray irradiation conditions to generate X-rays. A high voltage is applied to the X-ray tube 21 of the unit 2. The X-ray tube 21 to which a high voltage is applied performs X-ray irradiation for a predetermined irradiation time on the imaging region of the patient 150, and X-rays transmitted through the imaging region are X-rays provided behind the X-ray tube. It is detected by the flat detector 31 of the detector 3. At this time, the photoelectric film of the detection elements arranged two-dimensionally in the flat detector 31 receives the X-rays that have passed through the imaging region, and accumulates signal charges proportional to the amount of transmission in the charge storage capacitor.

  When the above X-ray irradiation is completed, the gate driver 32 of the X-ray detector 3 supplies the drive pulse generated based on the clock pulse supplied from the system controller 14 to the TFT of the flat detector 31. Then, the signal charges stored in the charge storage capacitor are sequentially read out.

  The read signal charges are converted in voltage by the charge / voltage converter 41 of the projection data generation unit 4 and further converted into a digital signal by the A / D converter 42, and then converted by the parallel / serial converter 43. Once stored in the buffer memory as a data element of the projection data. Next, the parallel / serial converter 43 serially reads out the data elements stored in its own buffer memory in units of lines, and sequentially stores them in the projection data storage unit of the image data generation unit 8 to thereby obtain two-dimensional projection data. Generate.

  When the collection of projection data for the imaging region of the patient 150 is completed, the image processing unit of the image data generation unit 8 performs affine transformation processing, filtering processing, and gamma correction processing on the two-dimensional projection data read from the projection data storage unit. Etc. are performed to generate positioning image data, and the obtained positioning image data is displayed on the monitor of the display unit 9 (step S3 in FIG. 6).

  On the other hand, the operator repeats the above-described step S3 and observes the positioning image data displayed in real time on the display unit 9, for example, the tip of the catheter 15 inserted from the groin of the patient 150 into the artery. (Step S4 in FIG. 6). Then, if it is recognized by observation of the positioning image data that the distal end portion of the catheter 15 is disposed at a suitable position with respect to the diseased portion, the insertion of the catheter 15 is stopped, and the imaging system attached to the holding portion A suitable imaging direction is set for the aneurysm and the stent graft by continuously generating and displaying the positioning image data while moving the image in an arbitrary direction (step S5 in FIG. 6).

  When the setting of the catheter tip and the setting of the imaging direction under observation of the positioning image data is completed, the operator attaches the measurement electrode of the biological signal measurement unit 10 to the predetermined body surface of the patient 150 and inputs the input unit. In step 13, a start instruction signal for the second shooting mode is input (step S6 in FIG. 6).

  Then, the X-ray imaging unit 1 that has received the start instruction signal via the system control unit 14 performs X-ray imaging on the patient 150 before the contrast medium administration by the same procedure as in step S3 described above, and performs projection data. The image data generation unit 8 stores the mask image data generated based on the obtained projection data in its own image data storage unit (not shown) (step S7 in FIG. 6).

  Next, the R wave detection unit 111 of the timing signal generation unit 11 detects the R wave generation time by comparing the electrocardiogram waveform of the patient 150 supplied from the biological signal measurement unit 10 with a predetermined threshold value α0 (FIG. 6). In step S8), the contrast agent injection timing signal generation unit 112 injects the contrast agent into the diseased part of the patient 150 at a time delayed by a predetermined time Δβ from the R wave generation time supplied from the R wave detection unit 111. A contrast medium injection timing signal is generated (step S9 in FIG. 6).

  Next, the contrast agent injecting unit 12 follows the contrast agent injecting conditions such as the injection amount and the injection speed supplied from the system control unit 14 and the above-described contrast agent injecting timing signal supplied from the timing signal generating unit 11. A predetermined amount of contrast medium is injected through the catheter 15 disposed in the vicinity of the diseased part of the patient 150 (step S10 in FIG. 6).

  On the other hand, the X-ray irradiation timing signal generation unit 113 of the timing signal generation unit 11 images the patient 150 to which the contrast medium is administered at a time delayed by a predetermined time Δγ from the R wave generation time supplied from the R wave detection unit 111. An X-ray irradiation timing signal for irradiating the region with X-rays is generated (step S11 in FIG. 6).

  The X-ray control unit 51 included in the high-voltage generation unit 5 of the X-ray imaging unit 1 uses the X-ray irradiation conditions supplied from the system control unit 14 and the X-ray irradiation timing signal supplied from the timing signal generation unit 11. Based on this, an X-ray control signal for controlling a tube current, a tube voltage, an application time, an application timing, an application repetition period and the like in the high voltage generator 52 is generated, and the high voltage generator 52 is supplied from the X-ray control unit 51. Based on the X-ray control signal, a high voltage is supplied to the X-ray tube 21 of the X-ray generator 2 to irradiate the imaging region of the patient 150 with X-rays.

  Then, the image data generation unit 8 performs the same image processing as in step S3 described above on the projection data after contrast agent administration collected by X-ray imaging synchronized with the above-described X-ray irradiation timing signal, thereby producing a contrast image. Data is generated (step S12 in FIG. 6), and further, therapeutic effect determination image data is generated by subtraction processing between the mask image data read from the own image data storage unit and the above-described contrast image data, and the display unit 9 Is displayed on the monitor (step S13 in FIG. 6).

  According to the embodiment of the present disclosure described above, it is possible to accurately and easily grasp the presence or absence or degree of blood flow leakage to a diseased part such as an aneurysm in which stent graft placement has been performed by injecting a small amount of contrast medium. Become.

  In particular, since the contrast agent injection timing and X-ray irradiation timing (X-ray imaging timing) for the diseased part are determined according to the maximum time phase of the arterial pressure where blood leakage is most likely to occur, less contrast agent is effectively used. It can be used, and the burden on the patient in determining the therapeutic effect of stent graft placement can be reduced.

  In addition, the use of a contrast medium injection catheter capable of selectively ejecting a contrast medium to a diseased part makes it possible to further reduce the amount of contrast medium used for determining the therapeutic effect. In addition, when a contrast medium is ejected to a diseased part using a catheter having a plurality of branched end parts, the position and direction of the contrast medium ejection can be treated by attaching a metal marker to each of the front end parts. The image data for determination can be accurately captured.

  Furthermore, according to the above-described embodiment, the X-ray irradiation timing is delayed by a predetermined time from the contrast agent injection timing, and the contrast agent injected into the artery in the vicinity of the diseased part flows out in the downstream direction together with the blood inside the aneurysm. By performing X-ray imaging of the diseased part at the timing when only the contrast medium that has flowed in remains, it is possible to accurately determine the presence or absence of blood flow leakage to the aneurysm without being affected by the contrast medium in the artery. .

  As mentioned above, although embodiment of this indication has been described, this indication is not limited to the above-mentioned embodiment, and it can change and carry out. For example, in the above-described embodiment, a case has been described in which the presence or absence of blood flow leakage in a stent graft placed on an artery wall having an aneurysm is determined based on image data collected by X-ray imaging. It may be a determination of blood flow leakage in a stent graft placed in relation to the same.

  In addition, the case where blood flow leakage is determined in stent graft placement based on the therapeutic effect determination image data collected by one X-ray imaging in the second imaging mode has been described. Contrast agent injection and X-ray imaging may be performed a plurality of times, and the blood flow leakage may be determined based on a plurality of pieces of therapeutic effect determination image data collected at this time. In this case, according to the above-described embodiment, a relatively small amount of contrast agent is used for one X-ray imaging, and thus a large amount of image data for determination of therapeutic effect is collected without imposing a heavy burden on the patient 150. And a highly accurate determination result can be obtained.

  On the other hand, in the above-described embodiment, the case where the contrast medium injection timing signal and the X-ray irradiation timing signal are generated based on the R wave of the electrocardiographic waveform measured from the patient 150 has been described. However, the present invention is not limited to this. For example, the contrast agent injection timing signal and the X-ray irradiation timing signal may be generated based on a biological signal such as a blood pressure waveform measured from the patient 150.

  In addition, the X-ray imaging system 100 including the biological signal measuring unit 10, the contrast medium injection unit 12, and the catheter 15 has been described. Any one of these units is provided independently of the X-ray imaging system. It doesn't matter.

  Each unit included in the X-ray imaging system 100 of the present embodiment can be realized by using, for example, a computer including a CPU, a RAM, a magnetic storage device, an input device, a display device, and the like as hardware. it can. For example, the system control unit 14 that controls each unit of the X-ray imaging system 100 can realize various functions by causing a processor such as a CPU mounted on the computer to execute a predetermined control program. In this case, the above-described control program may be installed in advance in the computer, or may be stored in a computer-readable storage medium or installed in the computer of the control program distributed via the network. .

  Although several embodiments of the present invention have been described above, these embodiments are presented as examples and are not intended to limit the scope of the invention. These novel embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the scope of the invention. These embodiments and modifications thereof are included in the scope and gist of the invention, and are included in the invention described in the claims and equivalents thereof.

DESCRIPTION OF SYMBOLS 1 ... X-ray imaging part 2 ... X-ray generation part 21 ... X-ray tube 22 ... X-ray aperture 3 ... X-ray detection part 4 ... Projection data generation part 5 ... High voltage generation part 6 ... Top plate 7 ... Moving mechanism part 71 ... Holding unit moving mechanism 72 ... Top plate moving mechanism 73 ... Moving mechanism control unit 8 ... Image data generating unit 9 ... Display unit 10 ... Biological signal measuring unit 11 ... Timing signal generating unit 111 ... R wave detecting unit 112 ... Contrast agent Injection timing signal generation unit 113 ... X-ray irradiation timing signal generation unit 12 ... contrast medium injection unit 13 ... input unit 14 ... system control unit 15 ... catheter 100 ... X-ray imaging system

Claims (12)

In an X-ray imaging system for generating image data by performing X-ray imaging using a contrast medium for a diseased part of a patient in which a stent graft is placed,
A contrast medium injection timing signal generating means for generating a contrast medium injection timing signal for the diseased part based on a biological signal detected from the patient;
X-ray irradiation timing signal generating means for generating a timing signal of X-ray irradiation for the diseased part based on the biological signal;
X-ray imaging means for performing X-ray imaging for the diseased part into which a contrast agent has been injected based on the timing signal of the X-ray irradiation;
Image data generating means for generating image data based on the projection data obtained by the X-ray imaging;
An X-ray imaging system comprising display means for displaying the image data.   2. The X-ray imaging according to claim 1, wherein the contrast medium injection timing signal generating unit generates the contrast medium injection timing signal corresponding to a heartbeat time phase in which an intravascular pressure in the diseased part is maximized. system.   2. The X-ray imaging system according to claim 1, wherein the X-ray irradiation timing signal generating means generates the X-ray irradiation timing signal with a predetermined time delay from the contrast agent injection timing signal.   2. The contrast medium injection timing signal generation unit and the X-ray irradiation timing signal generation unit generate respective timing signals based on an electrocardiogram waveform or a blood pressure waveform collected from the patient. X-ray imaging system.   A contrast medium injection catheter and a contrast medium injection means are provided, and the contrast medium injection means performs the contrast medium injection for the disease area using the catheter, the tip of which is disposed in the vicinity of the disease area. The X-ray imaging system according to claim 1, wherein the X-ray imaging system is performed based on a timing signal of the agent injection.   The distal end portion of the catheter is arranged in an annular shape along the blood vessel wall of the diseased part, and has a plurality of holes on the side surface for ejecting contrast medium to the diseased part. The X-ray imaging system according to claim 5.   6. The X-ray imaging according to claim 5, wherein the catheter has a plurality of branches, and a distal end portion of each of the branches has a hole portion for ejecting a contrast medium to the diseased portion. system.   The X-ray imaging system according to claim 7, wherein a tip of the branch includes a metal marker effective for X-ray imaging.   A catheter that injects a contrast medium into a diseased part of a patient in which a stent graft is placed, and has a plurality of holes at its distal end, and can selectively inject the contrast medium into the diseased part Catheter.   The distal end portion is arranged in an annular shape along a blood vessel wall of the diseased portion, and has a plurality of holes on its side surface for ejecting a contrast medium to the diseased portion. The catheter described.   The catheter according to claim 9, wherein the catheter has a plurality of branches, and a tip of the branch includes a hole for ejecting a contrast medium to the diseased part. For an X-ray imaging system that generates image data by performing X-ray imaging using a contrast agent for a diseased part of a patient in which a stent graft is placed,
A contrast agent injection timing signal generation function for generating a contrast agent injection timing signal for the diseased part based on a biological signal detected from the patient;
An X-ray irradiation timing signal generation function for generating an X-ray irradiation timing signal for the diseased part based on the biological signal;
An X-ray imaging function for performing X-ray imaging of the diseased part into which a contrast agent has been injected based on the timing signal of the X-ray irradiation;
An image data generation function for generating image data based on projection data obtained by the X-ray imaging;
A control program for executing a display function for displaying the image data.

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