JP2013541370A - 形成外科手術のための穿通枝皮弁の位置確認及び分析 - Google Patents
形成外科手術のための穿通枝皮弁の位置確認及び分析 Download PDFInfo
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Abstract
Description
1)ICGが結合した血液がどれだけ多く組織内にあるのだろうか?
2)それはどれだけ長い間組織内に留まるのであろうか?
3)それはどれだけ高速に組織を通過するのであろうか?
4)ボーラスが注入された後、各解剖学的領域がどの順序で明るくなるのであろうか?
・ピクセル単位で時間積算された蛍光を判定する。
・時間積算された蛍光を経過時間で割ることにより平均蛍光を計算する。
・蛍光の増加/流失の速度を判定する。
・ピーク蛍光に到達するまでの経過時間を判定する。
吻合開存性、及び、動脈及び静脈の血流を検証すること。これは、潜在的に結果を改善し、皮弁不全を減らす。皮弁不全は、乏しい動脈血流及び不適切な潅流、並びに鬱血をもたらす乏しい静脈還流量の結果として起こり得るものである。
完全な組織潅流を視覚化して確認すること(皮弁全体及び天然組織に対する微小血管潅流は、皮弁が生き残る上で極めて重要であるので)。
1)時間ウインドウに亘って、画像シーケンス中の全画像の全ピクセルの蓄積輝度が計算される。
2)選択されたラベル領域(例えば、5x5ピクセルの正方形マトリクス)に亘って蓄積輝度が平均化される。
3)平均輝度が、画像全体における蓄積輝度の最大値に対して正規化される。
4)正規化された平均輝度がスケーリングされ、変換関数の最大値が100%を表す。
●臨床医は一般的に、問題の組織(suspect tissue)の潅流と、よく流れている「良好な」組織の潅流との、一貫的な比較を行うことを望む。上述した元の技術を用いてこれを行う1つの方法は、よく流れている組織のラベルが100%に達するまでカラーマッピング範囲をマニュアルで調整するという面倒なプロセスを経ることである。ここ時点で、このラベルは、「良好な」組織のリファレンスとして使用可能である。
●臨床医は一般的に、良好な組織に比べて何パーセントかの相対的な蓄積輝度を示す組織が、壊死してしまうか否かを識別することを望む。カメラの本来的なノイズ、照明及び表面反射率の変化し得る状態、及び患者の残留ICGの存在により、比率が一貫していることを保証することが困難になる。
●カラーマッピングが変化してもラベルの比率は一定に保たれるが、臨床医は、プロセスにおいてラベル値自体が変化することが混乱を生じると考える。
L=100*(Alabel−A0)/(A100−A0)
ここで、
●Alabelは、ラベルの下の領域における蓄積輝度を表す。
●A0は、「0マーカー」の下の領域における背景の蓄積輝度を表す。
●A100は、「100マーカー」の下の領域における参照の蓄積輝度を表す。
L=100*(Alabel−A0)/(A100−A0)
を用いて算出される。
●独立した「0マーカー」が明示的には配置されない場合、「0マーカー」の値は、ICGボーラスの到着に先立って取得された最初のフレーム中にある蓄積輝度を平均することにより、導出可能である。そして、平均の蓄積輝度は、最初のフレームの値にシーケンス中のフレーム数を乗じることにより、計算される。
●或いは、独立した「0マーカー」が存在しない場合、「0マーカー」の値は、どのピクセルが組織を表すかを最初に自動的に判定し、次いで、これらの組織ピクセルについてのみ平均背景輝度を算出するために最初のフレームを試験することにより、導出可能である。変化するピクセルは、ICGを伴う血液を受けるものである。これらの組織ピクセルの位置を確認するために、ソフトウェアは、事前決定された閾値を超えて輝度が変化するピクセルの位置を確認する。変化しないピクセルは、無視される。
●既知の近赤外反射率を持つ物理的な参照基準又はパッチを視野の中に配置してもよい。これらの物理的なパッチの幾つかは、可視スペクトルにおいて既知の反射率を持つ様々な皮膚トーンをシミュレートするために提供されることになる。そして、「0マーカー」は、ICGを帯びた血液が流れていない組織の下の蓄積輝度を近似するために、これらのマーカーの上に明示的に配置され得る。これにより、手術室の様々な照明条件に対する正規化が可能になる。
Claims (16)
- 穿通枝血管の潅流を評価する方法であって、
血流中へのICGボーラスの適用に続く組織からの蛍光応答を検出するステップと、
所定時間に亘って前記蛍光応答の時間的な画像シーケンスを取得するステップと、
前記画像におけるピクセル値に関する、時間積算された輝度、又は輝度の時間微分を生み出すために、前記画像シーケンスを処理するステップと、
前記時間積算された輝度、又は前記輝度の時間微分を、カラー画像又は白黒画像として表示するステップと、
を備えることを特徴とする方法。 - 前記画像シーケンスは、各ピクセルの時間積算された輝度値をICGボーラス注入後の経過時間で割ることにより、処理される
ことを特徴とする請求項1に記載の方法。 - 前記画像シーケンスは、ICGボーラス注入後、各ピクセルの時間積算された蛍光輝度がピーク値に到達するまでの経過時間を判定することにより、処理される
ことを特徴とする請求項1に記載の方法。 - 前記画像シーケンスは、各ピクセルの蛍光輝度のピーク値を判定することにより、処理される
ことを特徴とする請求項1に記載の方法。 - 前記時間積算された輝度、又は前記輝度の時間微分に対して、コントラスト変換関数を適用するステップを更に備える
ことを特徴とする請求項1に記載の方法。 - 前記コントラスト変換関数は、前記時間積算された輝度、又は前記輝度の時間微分をオーバレイ画像に変換する線形関数又は非線形関数を表し、前記オーバレイ画像は異なる潅流特徴を異なる色で表す
ことを特徴とする請求項5に記載の方法。 - 前記コントラスト変換関数は、異なる傾斜の領域を持つ非線形関数であり、
前記異なる傾斜、及び、前記異なる傾斜間の変化は、血管の潅流を評価する手順の間に調整される
ことを特徴とする請求項5に記載の方法。 - 実質的に潅流していない組織の背景輝度を表す0マーカー、及び良く潅流している組織の輝度を表す100マーカーを前記オーバレイ画像の中に表示するステップを更に備える
ことを特徴とする請求項6に記載の方法。 - 前記0マーカーは、前記実質的に潅流していない組織の上に配置された非蛍光オブジェクトに関連する
ことを特徴とする請求項8に記載の方法。 - 前記0マーカーは、組織に前記ICGボーラスが到達する前の当該組織からの蛍光応答から導出される
ことを特徴とする請求項8に記載の方法。 - 前記時間積算された輝度、又は前記輝度の時間微分の数字で表した値を前記オーバレイ画像の中に表示するステップを更に備える
ことを特徴とする請求項7に記載の方法。 - 前記時間積算された輝度、又は前記輝度の時間微分を、前記0マーカーと前記100マーカーとの間の範囲に正規化するステップと、
前記時間積算された輝度、又は前記輝度の時間微分の正規化されて数字で表した値を前記オーバレイ画像の中に表示するステップと、
を更に備えることを特徴とする請求項8に記載の方法。 - 前記時間積算された輝度、又は前記輝度の時間微分の正規化されて数字で表した値は、解剖学的特徴に関する異なる画像領域それぞれについて算出される
ことを特徴とする請求項8に記載の方法。 - 前記時間積算された輝度、又は前記輝度の時間微分の正規化されて数字で表した値は、
全ピクセルについて前記時間積算された輝度、又は前記輝度の時間微分を算出するステップと、
前記画像中の所定領域に亘って前記時間積算された輝度、又は前記輝度の時間微分を平均化するステップと、
前記平均化された前記時間積算された輝度、又は前記輝度の時間微分を、画像全体における前記時間積算された輝度、又は前記輝度の時間微分の最大値に対して正規化するステップと、
前記正規化され平均化された前記時間積算された輝度、又は前記輝度の時間微分を、前記コントラスト変換関数の最大値を用いてスケーリングするステップと、
により算出される
ことを特徴とする請求項9に記載の方法。 - 穿通枝血管の潅流を評価する方法であって、
血流中へのICGボーラスの適用に続く組織からの蛍光応答を検出するステップと、
所定時間に亘って前記蛍光応答の時間的な画像シーケンスを取得するステップと、
前記画像におけるピクセル値に関する、時間積算された輝度、又は輝度の時間微分を生み出すために、前記画像シーケンスを処理するステップと、
前記穿通枝血管に皮弁とは異なる天然組織に関連する第1の参照ラベル、及び、所定の潅流を達成している組織に関連する第2の参照ラベルを特定するステップと、
少なくとも1つの追加ラベルを、前記第1の参照ラベル及び前記第2の参照ラベルによって確立される範囲に正規化するステップと、
前記時間積算された輝度、又は前記輝度の時間微分を、カラー画像又は白黒画像として表示するステップと、
前記第1の参照ラベル、前記第2の参照ラベル、及び前記少なくとも1つの追加ラベルを前記画像の上に表示するステップと、
を備えることを特徴とする方法。 - 穿通枝血管の潅流を評価する装置であって、
血流中へのICGボーラスの適用に続く組織からの蛍光応答を検出する手段と、
所定時間に亘って前記蛍光応答の時間的な画像シーケンスを取得する手段と、
前記画像におけるピクセル値に関する、時間積算された輝度、又は輝度の時間微分を生み出すために、前記画像シーケンスを処理する手段と、
前記時間積算された輝度、又は前記輝度の時間微分を、カラー画像又は白黒画像として表示する手段と、
を備えることを特徴とする装置。
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US20070122344A1 (en) | 2005-09-02 | 2007-05-31 | University Of Rochester Medical Center Office Of Technology Transfer | Intraoperative determination of nerve location |
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US10219742B2 (en) | 2019-03-05 |
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EP2618737A4 (en) | 2014-02-26 |
EP3056149A3 (en) | 2016-11-09 |
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CN103491874A (zh) | 2014-01-01 |
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JP6535717B2 (ja) | 2019-06-26 |
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