JP2014204904A - Medical guide system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical guide system which guides a medical device to a position in which appropriate treatment can be performed.SOLUTION: A medical guide system has: an ultrasound endoscope 2; a coil 21b which detects a position and direction of the ultrasound endoscope 2; an abdomen sensor (coil 10 for body surface detection) which acquires position information on the basis of the vibration of a subject; and a position detection device 3B which calculates a phase on the basis of the position in the actual space and temporal change in the coil 10 for body surface detection. On the basis of a position calculation result and phase calculation result of the position detection device 3B, position information on a predetermined object in a phase within a predetermined range is calculated, and the ultrasound endoscope 2 is guided to a guide position and in a guide direction on the basis of a calculation result.

Description

  The present invention relates to a medical guide system, and more particularly to a medical guide system that can visually indicate a three-dimensional position and orientation of a tissue structure of a human body.

  Endoscopes that can acquire an optical image of a subject, and intracavity probes such as an ultrasonic endoscope that can acquire a tomographic image of a subject are digestive tract, bronchus, bile pancreatic duct, blood vessel, etc. It has a structure that can be inserted into a cavity and an abdominal cavity, and has been widely used in the past when observing and diagnosing the lumen and surrounding organs.

  Further, when it is difficult to advance the body cavity probe to a desired part of the lumen only by the information of the optical image and the tomographic image, for example, the distal end portion of the body cavity probe easily reaches the desired part. In order to be able to do so, a system for guiding the observation position of the ultrasonic observation apparatus has been proposed.

  As an example of such a guide system, Patent Documents 1 and 2 disclose a technique for constructing three-dimensional organ data from pre-operative CT images and displaying ultrasonic observation positions on the three-dimensional data. .

  On the other hand, in recent years, this type of ultrasonic observation apparatus has been used not only for image diagnosis but also when performing ultrasonic guided puncture or ultrasonic guided treatment (stent placement, etc.). At that time, while drawing the puncture target or the treatment target with the ultrasonic image, the puncture route of the puncture needle or the treatment instrument is searched or planned and executed.

JP 2008-6108 A JP 2010-69018 A

  However, when performing ultrasound-guided puncture or ultrasound-guided treatment (stent placement, etc.) in the ultrasonic observation apparatus, movement of the puncture target or treatment target due to breathing or heartbeat of the subject becomes a problem. .

  That is, since the ultrasonic image has only plane information, there is a possibility that the target disappears from the ultrasonic image when the puncture target or the treatment target moves. Moreover, even if the target exists on the ultrasonic image, there is a possibility that the target moves outside the puncturable range. In particular, when a tumor, a thin tube, or the like is a puncture target, there is a risk of puncture success or failure.

  The present invention has been made in view of the above-described circumstances, and an object thereof is to provide a medical guide system that guides a medical device to a position where an accurate treatment can be performed.

  The medical guide system according to one aspect of the present invention includes an ultrasonic image acquisition unit that irradiates a subject with ultrasonic waves and acquires an ultrasonic image based on a reflected wave from the subject, and the ultrasonic image acquisition unit. Position and direction detection means for detecting the position and direction of the object, reference position information acquisition means for acquiring position information based on vibration of the subject, and a predetermined object on the image acquired by the ultrasonic image acquisition means. On the other hand, in the position calculation means for calculating the position in the real space based on the coordinates of the pixel on the ultrasonic image and the position and direction information acquired by the position and direction detection means, and in the reference position information acquisition means A phase calculation unit that calculates a phase based on a change over time, and a previous phase in a predetermined range based on the calculation result of the position calculation unit and the phase calculation unit. Guide position information calculation means for calculating position information of a predetermined object, and guide information generation for generating position and direction guide information to be presented to the medical device based on the calculation result of the guide position information calculation means Means.

  According to the medical guide system of the present invention, it is possible to provide a medical guide system that guides the medical device to a position where an appropriate treatment can be performed.

FIG. 1 is a diagram showing an overall configuration of a medical guide system according to a first embodiment of the present invention. FIG. 2 is a perspective view showing a puncture needle that is inserted through the ultrasonic endoscope in the medical guide system of the first embodiment. FIG. 3 is a diagram illustrating an overall configuration of the medical guide system in a state where the puncture needle is inserted through the ultrasonic endoscope in the medical guide system of the first embodiment. FIG. 4 is a graph showing changes over time of one cycle of subject vibration by the breathing sensor in the medical guide system of the first embodiment. FIG. 5 is a diagram showing a display example on the monitor of the graph shown in FIG. 4 in the medical guide system of the first embodiment. FIG. 6 is a graph showing the relationship between the breathing phase of the subject at the timing for designating the position of the puncture target and the position of the puncture target at the timing in the medical guide system of the first embodiment. FIG. 7 is a diagram showing a display example on the monitor of the graph shown in FIG. 6 in the medical guide system of the first embodiment. FIG. 8 is a graph showing the relationship between the breathing phase of the subject at another timing for designating the position of the puncture target and the position of the puncture target at the timing in the medical guide system of the first embodiment. FIG. 9 is a diagram showing a display example on the monitor of the graph shown in FIG. 8 in the medical guide system of the first embodiment. FIG. 10 is a graph showing the position variation of the puncture target estimated from the position of the puncture target and the amplitude variation of the respiration sensor in the medical guide system of the first embodiment. FIG. 11 is a diagram showing a display example on the monitor of the graph shown in FIG. 10 in the medical guide system of the first embodiment. FIG. 12 is a graph showing the speed change of the puncture target obtained by differentiating the graph based on the position variation information shown in FIG. 10 with respect to time in the medical guide system of the first embodiment. FIG. 13 is a diagram showing a display example on the monitor of the graph shown in FIG. 12 in the medical guide system of the first embodiment. FIG. 14 is a graph showing position variation information of a puncture target and a puncture timing position range in the medical guide system of the first embodiment. FIG. 15 is a diagram showing a display example on the monitor of the graph shown in FIG. 12 in the medical guide system of the first embodiment. FIG. 16 is a diagram illustrating a notification example of puncture timing in the medical guide system according to the first embodiment. FIG. 17 is a diagram showing an overall configuration of a medical guide system according to the second embodiment of the present invention. FIG. 18 is a diagram illustrating a state when the distal end of the bronchovideoscope is inserted into the bronchus in the medical guide system according to the second embodiment. FIG. 19 is a diagram showing a state when an ultrasonic probe is inserted from the bronchial videoscope to the vicinity of a lesioned part in the medical guide system of the second embodiment. FIG. 20 is a diagram illustrating a state in which a respiratory phase is specified in a state where an ultrasonic probe is inserted from the bronchial videoscope to the vicinity of a lesioned part in the medical guide system of the second embodiment. FIG. 21 is a diagram illustrating an overall configuration when the ultrasonic probe is removed from the medical guide system according to the second embodiment. FIG. 22 is a view showing a guide sheath when the ultrasonic probe is removed from the medical guide system according to the second embodiment. FIG. 23 is a diagram showing an overall configuration when a biopsy forceps is inserted from the bronchial videoscope to the vicinity of a lesioned part in the medical guide system of the second embodiment. FIG. 24 is a diagram showing a state when a biopsy forceps is inserted from the bronchial videoscope to the vicinity of a lesioned part in the medical guide system of the second embodiment.

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

(First embodiment)
FIG. 1 is a diagram showing an overall configuration of a medical guide system according to a first embodiment of the present invention.

  As shown in FIG. 1, the medical guide system 1 of the present embodiment includes an ultrasonic endoscope 2 as a medical device, an antenna unit 3A, a position detection device 3B having a function as a detection unit, and an ultrasonic diagnosis. The apparatus 4, the image processing apparatus 5, an operation instruction unit 6 capable of giving various instructions related to the operation of the medical guide system 1, a monitor 7, and a plurality of body surface detection coils 10 are principal parts. And is configured.

  The ultrasonic endoscope 2 includes a distal end portion 21 that can be inserted into the body cavity of the subject 100, an elongated insertion portion 22 that is connected to the rear end side of the distal end portion 21, and the rear end side of the insertion portion 22. And a cable 24 in which a plurality of signal lines for inputting and outputting various signals are provided.

  Here, the ultrasonic endoscope 2 serves as an ultrasonic image acquisition unit that acquires an ultrasonic image based on a reflected wave from the subject.

  The tip portion 21 includes a convex scanning (or radial scanning) ultrasonic transducer 21a, a coil 21b that outputs an electric signal in accordance with a magnetic field applied from the outside, and an optical observation (not shown) that is configured by a cover glass. A window, a lens (not shown), a CCD (charge coupled device) camera (not shown), and an illumination light irradiation window (not shown) for irradiating illumination light into the body cavity are provided.

  The image of the body cavity surface is formed on the CCD camera from the optical observation window via the lens, and the CCD signal from the CCD camera is output to the optical observation device via the signal line.

  Here, the coil 21b serves as a position / direction detection means for detecting the position and direction of the ultrasonic endoscope 2.

  The ultrasonic transducer 21a is driven based on a drive signal from the ultrasonic diagnostic apparatus 4, and emits an ultrasonic beam into the living body. The ultrasonic transducer 21 a receives a reflected wave reflected by the ultrasonic beam in the living tissue inside the living body, and outputs an echo signal corresponding to the reflected wave to the ultrasonic diagnostic apparatus 4.

  In the insertion portion 22, a plurality of coils 22 a that output an electric signal in accordance with a magnetic field applied from the outside are arranged along the longitudinal direction.

  The operation unit 23 includes a switch (not shown) that can give various instructions related to the operation of the medical guide system 1.

  One end of the cable 24 extends from the operation unit 23, and a connector 24 a that can be connected to the ultrasonic diagnostic apparatus 4 is provided on the other end. Further, inside the connector 24a, a scope ID storage unit 24b configured by, for example, a memory, in which various information related to the ultrasonic endoscope 2 is stored, is provided.

  In the scope ID storage unit 24b of the present embodiment, as various information related to the ultrasound endoscope 2, for example, the shape information of the array of the ultrasound array provided in the ultrasound transducer 21a, and the ultrasound It is assumed that information such as mounting position orientation information for the insertion portion 22 of the acoustic wave array is stored.

  When the connector 24a is connected to the ultrasonic diagnostic apparatus 4, the scope ID storage unit 24b transmits various information related to the ultrasonic endoscope 2 (hereinafter referred to as ultrasonic scanning information) to the ultrasonic The sound is output to the sonic diagnostic apparatus 4.

  The ultrasonic endoscope 2 is formed with a forceps channel 25 formed so as to form a tunnel structure with a hollow tube along the longitudinal direction from the operation portion 23 to the distal end portion 21. In the forceps channel 25, a forceps channel port 25 a is opened at the distal end portion 21, and a forceps channel port 25 b is opened at the operation portion 23.

  Further, a treatment instrument such as a puncture needle can be inserted into the forceps channel 25.

  The forceps channel port 25a of the forceps channel 25 has an opening having a central axis that forms a predetermined angle with respect to the insertion axis so that a puncture needle 29 (see FIG. 2) as a treatment tool protrudes into the ultrasonic scanning range. It is comprised so that.

  FIG. 2 is a perspective view showing a configuration of a puncture needle that is inserted through an ultrasonic endoscope in the medical guide system of the present embodiment.

  As shown in FIG. 2, the puncture needle 29 is a treatment tool that can be inserted into a living body, and has a hollow inside, and has a structure capable of sucking cells or the like or injecting ethanol or the like. In the hollow portion of the puncture needle 29, a stylet 29a that is a treatment instrument configured as a needle having a sharp tip is inserted.

  FIG. 3 is a diagram illustrating an overall configuration of the medical guide system in a state where the puncture needle is inserted through the ultrasonic endoscope in the medical guide system of the first embodiment.

  As shown in FIG. 3, the distal end portion (stylet 29a) of the puncture needle 29 protrudes from the forceps channel port 25a of the forceps channel 25 into the ultrasonic scanning range of the ultrasonic transducer 21a and is not shown in the drawing. It is designed to be inserted into a predetermined place.

  As shown in FIGS. 1 and 3, the plurality of body surface detection coils 10 are arranged at different locations one by one on the body surface of the subject 100. Specifically, the body surface detection coil 10 includes, for example, the xiphoid process, the upper left anterior iliac spine, the upper right anterior iliac spine, and the lumbar vertebrae, which are four locations on the body surface of the subject 100. One each is arranged at a position corresponding to the spinous process.

  Here, each of the plurality of body surface detection coils 10 has a configuration similar to that of the coil 21b or the coil 22a, and outputs an electrical signal in accordance with a magnetic field applied from the outside. Also serves as a respiration sensor as reference position information acquisition means for acquiring position information based on vibration of the subject (respiration of the subject, etc.).

  The antenna unit 3 </ b> A includes a magnetic field radiation antenna 31 that radiates a magnetic field toward the outside, and an antenna driving unit 32 that drives the magnetic field radiation antenna 31.

  The position detection device 3B performs calculation for specifying the position where the coil 21b exists and the orientation of the coil 21b based on the electrical signal from the coil 21b, and thereby the tip position / orientation data corresponding to the calculation result. Are generated sequentially.

  Further, the position detection device 3B performs an operation for specifying the position where each coil 22a exists and the orientation of each coil 22a based on the electrical signal from each coil 22a, thereby inserting according to the operation result. The part position / orientation data is sequentially generated.

  Further, the position detection device 3B performs an operation for specifying the position where each body surface detection coil 10 is present based on the electrical signal from each body surface detection coil 10, so that the position detection device 3B corresponds to the calculation result. Inspector position / orientation data is sequentially generated.

  As described above, the position detection device 3B constitutes the position direction detection means and the reference position information acquisition means for calculating the tip position / orientation in the real space based on the electrical signal acquired by the coil 21b and the like. .

  Then, the position detection device 3B outputs the generated tip portion position / orientation data, insertion portion position / orientation data, and subject position / orientation data to the image processing device 5 together. Further, the position detection device 3B supplies power required for driving the antenna unit 3A to the antenna drive unit 32.

  The ultrasonic diagnostic apparatus 4 generates and outputs a drive signal for driving the ultrasonic transducer 21a. Further, the ultrasonic diagnostic apparatus 4 sequentially generates an ultrasonic image as a tomographic image of the living body based on the echo signal from the ultrasonic transducer 21a at a frame rate corresponding to the ultrasonic scanning information in the scope ID storage unit 24b. To do. Then, the ultrasonic diagnostic apparatus 4 sequentially outputs the generated ultrasonic image to the image processing apparatus 5.

  Furthermore, the ultrasonic diagnostic apparatus 4 is based on the ultrasonic scanning information output from the scope ID storage unit 24b, the mounting position orientation information for the insertion unit 22 of the ultrasonic array provided in the ultrasonic transducer 21a, and the ultrasonic transducer. Information on the emission direction of the ultrasonic beam emitted from the ultrasonic wave 21a, scanning range shape information (angle of view information) by the ultrasonic beam emitted from the ultrasonic vibrator 21a, and an ultrasonic beam that can be emitted simultaneously from the ultrasonic vibrator 21a The scanning state is composed of the information on the number of the laser beam, the information on the number and position of the focus of the ultrasonic beam emitted from the ultrasonic transducer 21a, and the information on the frame rate corresponding to the ultrasonic beam emitted from the ultrasonic transducer 21a. Detect data.

  On the other hand, when an instruction signal related to various instructions is input from the operation instruction unit 6, the ultrasound diagnostic apparatus 4 emits the ultrasound beam emitted from the ultrasound transducer 21a and the ultrasound transducer 21a. Control for appropriately changing the scanning range shape (angle of view) by the emitted ultrasonic beam and the number of ultrasonic beams simultaneously emitted from the ultrasonic transducer 21a is performed on the ultrasonic transducer 21a. Then, the ultrasonic diagnostic apparatus 4 outputs the changed scanning state data to the image processing device 5 while reflecting the above-described control contents in the scanning state data.

  In addition, when an instruction signal related to image output to the monitor 7 (image display on the monitor 7) is input from the operation instruction unit 6, the ultrasound diagnostic apparatus 4 outputs the instruction signal to the image processing apparatus 5.

  The image processing apparatus 5 includes a control unit 51, a storage unit 52 having a function as a data holding unit, a guide image generation unit 53, a display image generation unit 54, and a timing calculation unit 55.

  The control unit 51 controls the guide image generation unit 53 to generate an ultrasonic tomographic image marker in which the scanning state of the ultrasonic transducer 21 a is visualized based on the scanning state data output from the ultrasonic diagnostic apparatus 4. Against.

  Further, the control unit 51 controls to change the state of image output to the monitor 7 (image display on the monitor 7) based on the instruction signal from the operation instruction unit 6 input via the ultrasonic diagnostic apparatus 4. Is performed on the guide image generation unit 53, the display image generation unit 54, and the timing calculation unit 55.

  The storage unit 52 is configured by a hard disk drive or the like, and is, for example, an X-ray three-dimensional helical CT device or a three-dimensional device via a network line 8 as a communication line for communicating with other devices than the image processing device 5. It is connected to a three-dimensional tomographic image generation device 9 composed of an MRI apparatus or the like. As a result, the storage unit 52 obtains a three-dimensional tomographic image obtained by performing in advance a scan using the three-dimensional tomographic image generation device 9 on the subject 100 to be observed by the ultrasonic endoscope 2. Are respectively input and stored via the network line 8.

  Further, in the storage unit 52, the state in which the body axis direction data for indicating the head and foot direction and the dorsoventral direction of the subject 100 as the acquisition target of the three-dimensional tomographic image is associated with the three-dimensional tomographic image. Is entered as

  The timing calculation unit 55 is controlled by the control unit 51, and based on the tip position / orientation data and the subject position / orientation data output from the position detection device 3B, timing data suitable for puncture of the target site In other words, data of a guide position such as a time range that is a phase range suitable for puncture and a puncture timing position range, and mid-calculation data until the timing data is calculated are generated.

  And the timing calculating part 55 is controlled by the control part 51, and outputs the said timing data and the said calculation middle data to a guide image generation part.

  In this way, the timing calculation unit 55 calculates the position of the puncture target site in the real space based on the coordinates of the puncture target site on the ultrasound image and the tip position / orientation information acquired by the position detection device 3B. It serves as a position calculation means.

  In addition, the timing calculation unit 55 serves as a phase calculation unit that calculates the phase of the position change of the puncture target site due to the vibration of the subject based on the subject position / orientation data.

  Furthermore, the timing calculation unit 55 serves as a guidance position information calculation unit that calculates position information of a target part in a phase within a predetermined range based on the calculation results of the position calculation unit and the phase calculation unit.

  The guide image generation unit 53 generates insertion shape data for indicating the insertion shape of the ultrasonic endoscope 2 based on the distal end portion position / orientation data output from the position detection device 3B and the insertion portion position / orientation data. Generate.

  In addition, the guide image generation unit 53 visualizes the scanning state of the ultrasonic transducer 21a based on the control of the control unit 51 and the tip position / orientation data output from the position detection device 3B. A scope distal end marker that images the configuration of the distal end portion 21 including the image marker and the ultrasonic transducer 21a is generated.

  Further, the guide image generation unit 53 generates three-dimensional biological tissue model data of a tissue structure such as an organ group existing inside the subject 100 based on the three-dimensional tomographic image accumulated in the storage unit 52.

  Further, the guide image generation unit 53 has a function as an index generation unit, and generates subject model image data corresponding to the three-dimensional biological tissue model data based on the body axis direction data read from the storage unit 52. .

  On the other hand, the guide image generation unit 53 generates guide image information based on the calculation intermediate data output from the timing calculation unit 55 and the timing data. That is, the guide image generation unit 53 serves as a guide information generation unit that generates guide image information of a position and a direction to be presented to the ultrasonic image acquisition unit based on the calculation result of the timing calculation unit 55. Fulfill.

  Based on the control of the control unit 51, the guide image generation unit 53 inserts the insertion shape data, the ultrasonic tomographic image marker, the scope tip marker, the three-dimensional biological tissue model data, and the subject model image data. By combining the guide image information, various guide images are generated and output to the display image generation unit 54.

  The display image generation unit 54 generates a composite image obtained by combining the ultrasound image output from the ultrasound diagnostic apparatus 4 and the guide image output from the guide image generation unit 53 based on the control of the control unit 51. A video signal based on the composite image is generated and output to the monitor 7.

  The operation instruction unit 6 is displayed on a screen of a monitor 6 and a keyboard 6a that outputs an instruction signal related to a character input instruction and an instruction to execute a predetermined function (for example, left-right reversal of an ultrasonic image). And a mouse 6b for outputting an instruction signal relating to an instruction for operating the pointer.

  The monitor 7 displays various images on the screen according to the video signal from the image processing device 5.

  Next, the operation of the medical guide system 1 of the present embodiment will be described. In the following, a description will be mainly given of a case where the ultrasonic transducer 21a is a convex scanning type.

  First, the surgeon or the like turns on each part of the medical guide system 1 to activate each part.

  Thereafter, the surgeon and the like refer to the three-dimensional tomographic image from the three-dimensional tomographic image generation device 9 and input four images to the subject 100 while referring to the three-dimensional tomographic image. Each position of the three-dimensional tomographic image corresponding to the position where the body surface detection coil 10 is attached is designated.

  Then, the designation result of the position where the body surface detection coil 10 is attached in the three-dimensional tomographic image is input to the image processing device 5 as the three-dimensional tomographic image body surface detection coil coordinates.

  The ultrasonic transducer 21a is driven when the ultrasonic diagnostic apparatus 4 is activated, emits an ultrasonic beam to the inside of the living body, and then receives a reflected wave reflected by the living body tissue inside the living body. And outputs an echo signal corresponding to the reflected wave.

  The ultrasonic diagnostic apparatus 4 sequentially generates an ultrasonic image as a tomographic image of a living body based on an echo signal from the ultrasonic transducer 21a at a frame rate corresponding to the ultrasonic scanning information in the scope ID storage unit 24b. Then, the ultrasonic diagnostic apparatus 4 sequentially outputs the generated ultrasonic image to the image processing apparatus 5.

  On the other hand, the coil 21b, each coil 22a, and each body surface detection coil 10 detect a magnetic field applied by the antenna unit 3A, and output an electrical signal corresponding to the detected magnetic field to the position detection device 3B.

  The position detection device 3B performs a calculation for specifying the position where the coil 21b and each coil 22a exist and the orientation of the coil 21b and each coil 22a based on the electrical signal from the ultrasonic endoscope 2.

  Then, the position detection device 3B outputs the tip portion position / orientation data and the insertion portion position / orientation data obtained by the above-described calculation to the image processing device 5.

  In addition, the position detection device 3B performs a calculation for specifying the position where each body surface detection coil 10 exists based on the electrical signal from each body surface detection coil 10, thereby detecting the test according to the calculation result. The person position / orientation data is output to the image processing device 5.

  Here, the subject position / orientation data changes with time due to vibration of the subject due to respiration or pulsation of the subject.

  Next, the process of generating the guide image information in the medical guide system of this embodiment will be described.

  FIG. 4 is a diagram illustrating a change over time of one cycle of subject vibration by the respiratory sensor in the medical guide system of the first embodiment.

  In the present embodiment, first, under the control of the control unit 51, the timing calculation unit 55 is based on vibration information from the body surface detection coil 10 that is a respiration sensor (vibration information due to breathing of the subject). Information for one cycle of the temporal change in the specimen position is extracted and output to the guide image generation unit as mid-calculation data.

  Next, the guide image generating unit 53 is controlled by the control unit 51 and includes guide image information including guidance image information for displaying on the monitor 7 information for one cycle of the temporal change in the subject position, which is calculation-in-progress data. Is output to the display image generation unit 54.

  The display image generation unit 54 is controlled by the control unit 51, generates a composite image based on the received guide image, and outputs it to the monitor 7.

  FIG. 5 is a diagram showing a display example on the monitor of the graph shown in FIG. 4 in the medical guide system of the first embodiment.

  Here, a real-time ultrasonic image is displayed on the monitor 7 at a designated frame rate via the display image generation unit 54 in the image processing apparatus 5. That is, on the screen of the monitor 7 on which the ultrasonic image displayed in real time is displayed, as shown in FIG. 4, information for one cycle of the temporal change of the subject position, which is data during calculation, is displayed. It has become.

  As described above, the medical guide system of the present embodiment displays on the monitor 7 a graph as shown in FIGS. 4 and 5 for one cycle of the change in the subject signal detected by the body surface detection coil 10 over time.

  In addition, a marker 201 indicating the current phase is displayed on a graph (see FIG. 5) of the change over time of the body surface detection coil 10 (respiration sensor) on the monitor 7. The position of the marker 201 changes in real time with time.

  In the present embodiment, the graph of the change with time of the position detected by the body surface detection coil 10 is displayed on the monitor 7 for displaying an ultrasonic image. You may display on a monitor.

  Further, here, in order to simplify the description, it is assumed that the change over time of the body surface detection coil 10 (respiration sensor) is a sine wave.

  Next, a process of designating a predetermined puncture target position on the ultrasonic image will be described.

  FIG. 6 is a diagram showing the relationship between the breathing phase of the subject at the timing when the first position of the puncture target is designated and the position of the puncture target at the timing in the medical guide system of the first embodiment. FIG. 7 is a diagram showing a display example on the monitor of the graph shown in FIG. 6 in the medical guide system of the first embodiment.

<Specifying the first point>
As described above, the ultrasonic diagnostic apparatus 4 converts an ultrasonic image as a tomographic image of the living body based on the echo signal from the ultrasonic transducer 21a to a frame rate corresponding to the ultrasonic scanning information in the scope ID storage unit 24b. Are sequentially generated, and the generated ultrasonic images are sequentially output to the image processing apparatus 5.

  As described above, the real-time ultrasonic image is displayed at the designated frame rate on the monitor 7 via the display image generation unit 54 in the image processing apparatus 5 (state in FIG. 5). .

  In this state, the surgeon operates the ultrasonic endoscope 2 and the puncture target whose position shifts with time on the ultrasonic image displayed in real time on the monitor 7 is also displayed on the ultrasonic image even during a part of the time. The ultrasonic endoscope 2 is arranged at a position to be drawn.

  Next, the operator uses a pointing device such as a keyboard 6a or a mouse 6b connected to the ultrasonic diagnostic apparatus 4 to ultrasonically determine the position of the puncture target at the timing when the puncture target is drawn on the ultrasonic image. It is designated on the image (this time is set to t1).

  When the puncture target is designated here, the timing calculation unit 55 in the image processing device 5 performs the position and direction of the ultrasonic endoscope 2, the coordinates of the pixel at the designated position on the ultrasonic image, Based on the range information of the sound image, the position p1 = (x1, y1, z1) of the puncture target in the real space is calculated.

  Note that, as described above, the scope ID storage unit 24b of the ultrasonic endoscope 2 according to the present embodiment is provided with, for example, the ultrasonic transducer 21a as various pieces of information regarding the ultrasonic endoscope 2. In addition to information such as the shape information of the array of the ultrasonic array and the mounting position orientation information for the insertion portion 22 of the ultrasonic array, display range information of a selectable ultrasonic image is included.

  The surgeon can select a display range by using a predetermined instruction switch unit or the operation instruction unit 6 in the operation unit 23.

  As described above, the position of the puncture target is designated on the ultrasonic image by the operator, and at the same time, the timing calculation unit 55 uses the body surface detection coil based on the subject position / orientation data at time t1. The phase (φ1) at time t1 in the time-dependent change of 10 (respiration sensor) (here, sine wave is used as described above) is calculated.

  Based on the phase (φ1) information (calculation halfway data) at time t1 calculated by the timing calculation unit 55, the guide image generation unit 53 performs a puncture target newly displayed on the monitor 7, as shown in FIG. A guide image including image information of the marker 301 at the puncture target position p1 at time t1 is generated so as to be displayed at the position of the phase φ1 in the position graph. Then, the guide image is transferred to the display image generation unit 54, and the display image generation unit 54 displays the guide image including the marker 301 on the monitor 7.

  Although FIG. 6 shows only the x coordinate as a representative diagram, the y coordinate and the z coordinate may be displayed similarly. Further, only coordinates having a large position change may be displayed.

  Further, in the graph of the position of the puncture target on the monitor 7 (see FIG. 7), the marker 201 indicating the current phase is displayed as described above.

<Specifying the second point>
FIG. 8 shows the phase of breathing of the subject at a timing different from the first point where the second position of the puncture target is designated and the position of the puncture target at the timing in the medical guide system of the first embodiment. FIG. 9 is a diagram showing a display example on the monitor of the graph shown in FIG. 8 in the medical guide system of the first embodiment.

  Thereafter, the operator operates the ultrasonic endoscope 2 again, and on the ultrasonic image displayed in real time on the monitor 7, the puncture target whose position shifts with time is depicted on the ultrasonic image even during a part of the time. The ultrasonic endoscope 2 is moved to “another position”.

  Then, the surgeon confirms the time-dependent graph (see FIG. 5) of the body surface detection coil 10 (respiration sensor) displayed on the monitor 7 or the graph of the position of the puncture target (see FIG. 7). It can be confirmed that the phase at the timing when the puncture target is displayed on the sound wave image is different from the phase φ1.

  That is, as described above, the marker 201 indicating the current phase that changes in real time is displayed on the graph of the temporal change of the body surface detection coil 10 (respiration sensor) and the graph of the position of the puncture target.

  Thereafter, the operator designates the position of the puncture target on the ultrasonic image using a pointing device similar to the above at the timing when the puncture target is drawn on the ultrasonic image (this time is assumed to be t2; FIG. 8). reference).

  When the puncture target is designated here, the timing calculation unit 55 determines the position and direction of the ultrasonic endoscope 2, the coordinates of the pixel at the designated position on the ultrasonic image, and the range information of the ultrasonic image. Based on the above, the target position p2 = (x2, y2, z2) in the real space is calculated.

  At the same time, the timing calculation unit 55, based on the subject position / orientation data at time t1, at time t2 in the time-dependent change of the body surface detection coil 10 (respiratory sensor) (also referred to as a sine wave here). Is calculated (see FIG. 8).

  The control unit 51 also determines that the difference between the phases φ1 and φ2 is equal to or smaller than a threshold value stored in advance in the storage unit 52 in the image processing apparatus 5, or the target position p1 (marker 301) in the real space. Similarly, when it is determined that the distance between p2 (marker 302) is equal to or less than the threshold value stored in advance in the storage unit 52, the timing calculation unit 55 and the display image generation unit 54 are controlled. Then, the operator is notified to acquire another point on the monitor 7.

<Estimation of position variation of puncture target>
Next, the process for estimating the position variation of the puncture target on the ultrasound image will be described.

  FIG. 10 is a graph showing the position variation of the puncture target estimated from the position of the puncture target and the amplitude variation of the respiration sensor in the medical guide system of the first embodiment, and FIG. 11 is a diagram illustrating the first embodiment. 11 is a diagram showing a display example on the monitor of the graph shown in FIG. 10 in the medical guide system of FIG.

  First, the timing calculation unit 55 approximates the amplitude variation of the respiration sensor with a mathematical expression. In the present embodiment, since the amplitude variation of the respiration sensor is described as being a sine wave, x = 35 sin (φ).

  Next, assuming that the position variation of the puncture target is also correlated with the amplitude variation of the respiratory sensor, x = x0 + ax sin (φ). Here, the amplitude (a = (ax, ay, az)) and the position p0 = (x0, y0, z0) at phase 0 are unknowns.

 Further, the amplitude (a = (ax, ay, az)), which is an unknown number, and the position p0 = (x0, y0, z0) at phase 0 are calculated from the above p1, p2, φ1, and φ2.

That is,
x1 = x0 + ax sin (φ1)
x2 = x0 + ax sin (φ2)
X0 and ax are calculated by solving the simultaneous equations, and Equation 1 is estimated as a position variation.

x = x0 + ax sin (φ) (1)
The position fluctuation in the y direction and the position fluctuation in the z direction are estimated in the same manner.

  Then, under the control of the control unit 51, the guide image generation unit 53 creates a guide image based on the position variation information of the puncture target specified by the timing calculation unit 55 as described above.

  That is, the guide image generation unit 53 generates a guide image including the guide image information as illustrated in FIG. 10 in which the curve of the position variation information (calculation midway data) is added to the graph illustrated in FIG. 8, and the display image generation unit The information is displayed on the monitor 7 via 54.

  FIG. 10 is a diagram showing the position variation of the puncture target estimated as described above in addition to FIG. 8 in the medical guide system of the first embodiment.

<Calculation of low speed position>
FIG. 12 is a graph showing the speed change of the puncture target obtained by differentiating the graph based on the position variation information shown in FIG. 10 with respect to time in the medical guide system of the first embodiment. FIG. 13 is a diagram showing a display example on the monitor of the graph shown in FIG. 12 in the medical guide system of the first embodiment.

  FIG. 14 is a graph showing position variation information and a puncture timing position range of the puncture target in the medical guide system of the first embodiment, and FIG. 15 is a graph showing the position of the puncture timing position in the medical guide system of the first embodiment. It is the figure which showed the example of a display in the monitor of the graph shown in FIG.

  Next, the timing calculation unit 55 calculates the range of the phase φ in which the moving speed of the puncture target is equal to or less than a predetermined speed threshold value.

  Specifically, the moving speed is obtained by differentiating Equation 1 with respect to time, and punctures the range of phase φ in which the differential value is a predetermined speed threshold value (for example, 0.5 mm / sec or less). The timing phase range is calculated (see FIG. 12).

  Further, the timing calculation unit 55 further calculates the puncture symmetric position range in the phase range as the puncture timing position range (see FIG. 14).

  The time range that is the puncturing timing phase range and the puncturing timing position range are the “timing data” described above, and are output from the timing calculation unit 55 to the guide image generation unit 53.

  Next, a specific creation process of the guide image by the guide image generation unit 53 will be described.

  The guide image generation unit 53 calculates the guide destination of the ultrasonic endoscope 2 by the following selection methods using the puncture timing data resulting from the above, and creates a guide image.

  The surgeon first selects which of these selection methods is to be employed using the keyboard 6a or the like. Hereinafter, it demonstrates concretely for every selection method.

<Selection method of ultrasonic endoscope guide (method 1)>
Method 1 shown below is the most preferred example.

  When the method 1 is selected by the surgeon, the guide image generation unit 53 causes all the positions of the puncture target in all phases including the puncture timing position range to be in a puncturable region on one ultrasonic image. As depicted, the position and direction that are the guidance destination of the ultrasonic endoscope 2 are calculated, and a guidance image for guiding the ultrasonic endoscope 2 is created.

  Here, the puncturable region with respect to the distal end position of the ultrasonic endoscope 2 can be calculated from the position of the forceps channel port 25a, the angular range in which the forceps raising base can be operated, the thickness and hardness ranges of the puncture needle 29, and the like. It is.

<Selection method of ultrasonic endoscope guide (method 2)>
Although the method 1 described above is the best, since the posture and the tip position that the ultrasonic endoscope 2 can take in the body cavity are limited, it can be assumed that the guidance by the method 1 is difficult.

  Therefore, as a modification of the present embodiment, several conditions are prepared as follows, and the ultrasonic endoscope 2 is set based on a combination of conditions selected by the operator or a priority order specified by the operator. It is also possible to guide.

  Method 2a) A guidance image for guiding the puncture timing position range to be depicted in the punctureable region is created.

  As an effect of the method 2a), since the moving speed of the puncture target is slow and a position where puncture is easy can be guided to a position where an ultrasonic image can be drawn, it can be expected to lead to an improvement in the success rate of puncture.

  Method 2b) A guidance image for guiding the puncture timing position range to a position close to the forceps channel port 25a is created.

  As an effect of the method 2b), in addition to the effect of the method 2a, since the puncture distance is shortened, even if the puncture needle is bent during the puncture, the effect is small, and it is expected to lead to an improvement in the success rate of the puncture. it can.

  In addition, since the puncture distance is shortened, the probability and amount of deformation of the puncture target during puncture are reduced, and it can be expected to lead to an improvement in the success rate of puncture.

  Method 2c) A guide image is generated for guiding so that an angle difference between a straight line connecting two positions in a plurality of puncture timing position ranges and an ultrasonic image plane is reduced.

  As an effect of this method 2c), there is an advantage that the puncture target moves on the ultrasonic image for a long time and is visible for a long time.

<Create guidance image>
Note that the following example is also conceivable as the guide image in the present embodiment.

  a) An image in which the current position and posture of the endoscope tip and the position and posture of the guide end of the endoscope are displayed on a three-dimensional space and projected onto a two-dimensional plane.

  b) An image indicating numerically the push / pull amount, bending amount, twist amount, etc. of the endoscope for moving from the current tip position and posture to the position and posture of the endoscope tip as the guidance destination .

  Then, the guide image generation unit 53 may create either one of these guide images or both.

<Puncture timing display after guidance>
In the present embodiment, the guide image generation unit 53 outputs the timing data output from the timing calculation unit 55 when the position of the body surface detection coil 10 (respiration sensor) is within the time range within the puncture timing phase range. Based on this, some display mode of the guide image is changed to notify the puncture timing.

  FIG. 16 is a diagram illustrating a notification example of puncture timing in the medical guide system according to the first embodiment.

  For example, FIG. 11 is a diagram showing an example of an image displayed on the monitor created by the display image generation unit. When such an image is displayed, for example, as shown in FIG. The operator is notified of the puncture timing by changing the color of the ultrasonic tomographic image marker on the image.

  For example, the puncture timing is notified to the surgeon by changing the color of the marker indicating the current phase on the guide image as shown in FIG.

  Further, for example, as shown in FIG. 16, the surrounding frame of the ultrasonic image is highlighted to notify the operator of the puncture timing. This method is useful because the surgeon gazes at the ultrasound image at the time of puncture, and the timing is displayed around the ultrasound image, so that the surgeon can grasp the timing without moving his / her line of sight.

  In this embodiment, when the puncture target is relatively large, the difference between the two specified points tends to be large, but since the target is originally large, even if the calculation is somewhat inaccurate, it is acceptable. On the other hand, when the puncture target is relatively small, the difference between the two specified points is small, so that the calculation is accurate.

  In the medical guide system of this embodiment, the puncture target is specified at two points as described above, and the movement amplitude of the puncture target and the position at phase 0 are based on the position information of the target at these different times. Although it is calculated, the present invention is not limited to this. For example, the position of the puncture target in the amplitude and phase 0 may be obtained by adding velocity information such as Doppler to one point (or two points) of designation information. .

  Further, the position detection means of the ultrasonic endoscope 2 is not only magnetic type but also optical type, robot arm type, optical fiber type or motion sensor type combining geomagnetic sensor, acceleration sensor or gyro, etc. As long as the direction and direction can be detected, anything is acceptable.

  Furthermore, a preoperative image such as CT is stored, a three-dimensional image is created from the preoperative image, the three-dimensional image is aligned with the real space, and ultrasonic endoscopic observation is performed on the three-dimensional image. The current tip position and posture of the mirror 2 and the position and posture of the leading endoscope tip may be displayed as a guide image.

  As described above, according to the medical guide system 1 of the present embodiment, even when the puncture target moves with time due to breathing or pulsation of the subject, the medical guide system 1 is suitable for puncture where the movement speed of the puncture target is slow. At the timing, it is possible to easily extract the puncture target into the puncturable range of the ultrasonic image, thereby achieving an effect that accurate puncture can be performed.

(Second Embodiment)
FIG. 17 is a diagram showing an overall configuration of a medical guide system according to the second embodiment of the present invention.

  In the first embodiment described above, the medical device to which the “position and direction guidance information” generated by the guidance information generation unit is presented is irradiated with ultrasonic waves to the reflected wave from the subject. Whereas the ultrasonic endoscope 2 is an “ultrasonic image acquisition unit” that acquires an ultrasonic image based on the second embodiment, the present second embodiment provides a presentation destination of the “position and direction guidance information” The medical device is not an “ultrasonic image acquisition unit” but a treatment tool such as a biopsy forceps or a cytodiagnosis brush that performs a predetermined treatment on a subject.

  As shown in FIG. 17, the medical guide system 101 of this embodiment includes a bronchial videoscope 102, an ultrasonic probe 122 as a medical device that can be inserted into the bronchial videoscope 102, an antenna unit 3A, and a detection unit. A position detection device 103B having a function, an ultrasonic diagnostic device 104, an image processing device 105, an operation instruction unit 6 capable of giving various instructions relating to the operation of the medical guide system 101, a monitor 7, and a plurality of And the body surface detection coil 10 as a main part.

  It should be noted that here, only the differences from the first embodiment will be described, and a detailed description of the same configuration and operation as in the first embodiment will be omitted.

  The bronchial videoscope 102 has an objective lens 124 at the distal end, and inputs the subject image received by the objective lens to the CCD 126 disposed on the proximal side via the image fiber 127 and the relay lens 125. It is like that.

  Further, the image pickup signal of the CCD 126 is input to an image processing circuit 56 in an image processing apparatus 105 to be described later, and is appropriately subjected to image processing and then output to the monitor 7.

  A forceps insertion opening 102a is formed in the vicinity of the operation portion 102b of the bronchial videoscope 102, and a channel opening 102d is formed at the distal end of the bronchial videoscope 102. The forceps insertion opening 102a and the channel opening 102d are formed. A forceps channel 102c that communicates with each other is formed.

  The ultrasonic probe 122 and the guide sheath 123 are inserted into the forceps channel 102c from the forceps insertion opening 102a. The ultrasonic probe 122 inserted from the forceps insertion opening 102a passes through the forceps channel 102c. It protrudes from the channel opening 102d via.

  Further, a medical device such as a biopsy forceps described later can be inserted into the forceps channel 102c.

  The ultrasonic probe 122 includes a distal end portion 121 that can be inserted into the body cavity of the subject 100 via the forceps channel 102c, and acquires an ultrasonic image based on a reflected wave from the subject. Acts as an acquisition means.

  The tip 121 includes an ultrasonic transducer 121a and a coil 121b that outputs an electric signal in accordance with a magnetic field applied from the outside.

  Here, the coil 121b serves as position / direction detection means for detecting the position and direction of the ultrasonic probe 122.

  The ultrasonic transducer 121a is driven based on a drive signal from the ultrasonic diagnostic apparatus 104 and emits an ultrasonic beam into the living body. Further, the ultrasonic transducer 121 a receives a reflected wave reflected by the ultrasonic beam in the living tissue inside the living body, and outputs an echo signal corresponding to the reflected wave to the ultrasonic diagnostic apparatus 104.

  In the insertion portion 122, a plurality of coils 122a that output an electrical signal in accordance with a magnetic field applied from the outside are arranged along the longitudinal direction.

  As shown in FIG. 17, the plurality of body surface detection coils 10 are arranged at different locations on the body surface of the subject 100, similarly to the first embodiment, and the vibration ( It serves as a respiration sensor as reference position information acquisition means for acquiring position information based on the respiration of the subject.

  In the second embodiment, the position detection device 103B also specifies the position where the coil 121b exists and the orientation of the coil 121b based on the electrical signal from the coil 121b at the tip of the ultrasonic probe 122. By performing the calculation, tip position / orientation data corresponding to the calculation result is sequentially generated.

  In addition, the position detection device 103B performs an operation for specifying the position where each coil 122a exists and the orientation of each coil 122a based on the electrical signal from each coil 122a, so The insertion portion position / orientation data of the acoustic probe 122 is sequentially generated.

  Furthermore, the position detection device 103B performs the calculation for specifying the position where each body surface detection coil 10 exists based on the electrical signal from each body surface detection coil 10, and thereby the first embodiment and Similarly, subject position / orientation data corresponding to the calculation result is sequentially generated.

  As described above, the position detection device 103B constitutes a position direction detection unit and a reference position information acquisition unit that calculate the tip position / orientation in the real space based on the electrical signal acquired by the coil 121b and the like. .

  As in the first embodiment, the position detection device 103B combines the generated tip portion position / orientation data, insertion portion position / orientation data, and subject position / orientation data together with the image processing device 105. Output to.

  In the second embodiment, the ultrasound diagnostic apparatus 104 generates and outputs a drive signal for driving the ultrasound transducer 121a. The ultrasound diagnostic apparatus 104 sequentially generates ultrasound images as a tomographic image of the living body at a predetermined frame rate based on the echo signal from the ultrasound transducer 121a. Then, the ultrasonic diagnostic apparatus 104 sequentially outputs the generated ultrasonic image to the image processing apparatus 105.

  The image processing apparatus 105 is the same as that of the first embodiment except that it includes an image processing circuit 56 that inputs an image pickup signal of the CCD 126 and appropriately performs image processing and then outputs the image processing circuit 56. Detailed description of is omitted.

  Next, the operation of the medical guide system 101 of the second embodiment will be described.

  FIG. 18 is a diagram illustrating a state in which the distal end of the bronchial videoscope in the medical guide system of the second embodiment is inserted into the bronchus, and FIG. 19 is a bronchial videoscope of the medical guide system of the second embodiment. It is the figure which showed the mode at the time of inserting an ultrasonic probe to the lesioned part vicinity more.

  First, the surgeon or the like turns on each part of the medical guide system 101 to activate each part.

  Thereafter, the surgeon and the like refer to the three-dimensional tomographic image from the three-dimensional tomographic image generation device 9 and input four images to the subject 100 while referring to the three-dimensional tomographic image. Each position of the three-dimensional tomographic image corresponding to the position where the body surface detection coil 10 is attached is designated.

  Then, the designation result of the position where the body surface detection coil 10 is attached in the three-dimensional tomographic image is input to the image processing apparatus 105 as the three-dimensional tomographic image body surface detection coil coordinates.

  Next, the surgeon or the like inserts the distal end of the bronchial videoscope 102 into the bronchus 131 as shown in FIG.

  Here, as shown in FIG. 18, the bronchus 131 includes a thin bronchus 131a and a bronchus 131b into which the bronchial videoscope 102 cannot be inserted, and a lesion 130 to be treated is located a few branches ahead of the thin bronchus 131b. Shall.

  In the present embodiment, even if the lesioned part 130 to be treated is present in a thin bronchial portion where the bronchial videoscope 102 cannot be inserted, the ultrasonic probe 122 in the second embodiment can be used. Useful when reachable.

  In this case, the operator inserts the ultrasonic probe 122 into the guide sheath 123 once, and inserts them into the forceps channel 102c from the forceps insertion port 102a of the bronchovideoscope 102.

  Thereafter, the insertion is further advanced, and, as shown in FIG. 19, the distal end portion 121 of the ultrasonic probe 122 reaches the vicinity of the lesioned portion 130 by projecting from the channel opening portion 102d.

  Next, a process of generating guide image information in the medical guide system of the second embodiment will be described.

  Also in the second embodiment, the process of generating the guide image information is basically the same as in the first embodiment.

  First, under the control of the control unit 51, the timing calculation unit 55 determines whether the subject position has changed over time based on vibration information from the body surface detection coil 10 that is a respiration sensor (vibration information due to breathing of the subject). Information for one period is extracted and output to the guide image generation unit as mid-calculation data.

  In addition, one cycle of the temporal change of the subject signal detected by the body surface detection coil 10 is displayed on the monitor 7 as a graph as shown in FIGS. 4 and 5 in the first embodiment.

  Next, a step of designating a predetermined puncture target position on the ultrasound image in the second embodiment will be described.

<Specifying the first point>
FIG. 20 is a diagram illustrating a state in which a respiratory phase is specified in a state where an ultrasonic probe is inserted from the bronchial videoscope to the vicinity of a lesioned part in the medical guide system of the second embodiment.

  Similar to the first embodiment, the ultrasonic diagnostic apparatus 104 sequentially generates and generates ultrasonic images as a tomographic image of a living body at a predetermined frame rate based on an echo signal from the ultrasonic transducer 121a. Ultrasonic images are sequentially output to the image processing apparatus 105.

  As described above, a real-time ultrasonic image is displayed on the monitor 7 through the display image generation unit 54 in the image processing apparatus 105 at a designated frame rate.

  In this state, the surgeon causes the distal end portion 121 of the ultrasonic probe 122 to reach the vicinity of the lesioned portion 130 and then operates the ultrasonic probe 122 so that an ultrasonic image displayed in real time on the monitor 7 is displayed on the lesioned portion 130. The position of the ultrasonic probe 122 is adjusted so as to match.

  When the surgeon adjusts the ultrasound image by the ultrasound transducer 121a to match the lesioned part 130, the surgeon moves the pointing device such as the keyboard 6a or the mouse 6b connected to the ultrasound diagnostic apparatus 104. The position of the treatment target is designated on the ultrasonic image at the timing when the ultrasonic image matches the lesioned part 130 (this time is set as t1).

  The other first point designation processing is the same as in the first embodiment.

  As described above, also in the second embodiment, the timing calculation unit 55 at the time t1 is adjusted by the operator so that the ultrasonic image is adjusted to match the lesioned part 130 by the ultrasonic transducer 121a. Based on the subject position / orientation data, the phase (φ1) at time t1 in the time-dependent change of the body surface detection coil 10 (respiration sensor) is calculated.

  That is, the respiratory phase of the subject 100 at time t1 when the ultrasound image by the ultrasound transducer 121a matches the lesioned part 130 is φ1 (FIG. 20A).

<Specifying the second point>
Thereafter, when the position of the lesioned part 130 and the ultrasound image shift due to the subject's respiratory fluctuation (see FIG. 20B), the operator operates the ultrasound probe 122 again and displays it on the monitor 7 in real time. The position of the ultrasonic probe 122 is adjusted again so that the ultrasonic image to be matched with the lesioned part 130.

  Then, when the surgeon adjusts the ultrasound image by the ultrasound transducer 121a again so as to match the lesioned part 130, the surgeon again has the keyboard 6a or the mouse 6b connected to the ultrasound diagnostic apparatus 104, or the like. The position of this treatment target is designated on the ultrasound image at the timing when the ultrasound image matches the lesioned part 130 using this pointing device (this time is assumed to be t2).

  Note that the other second designation process is the same as in the first embodiment.

  As described above, also in the second embodiment, the timing calculation unit 55 performs the time t2 at a timing at which the operator again adjusts the ultrasonic image to match the lesioned part 130 by the ultrasonic transducer 121a. The phase (φ2) at time t2 in the time-dependent change of the body surface detection coil 10 (respiration sensor) is calculated based on the subject position / orientation data.

  That is, the respiratory phase of the subject 100 at time t2 when the ultrasonic image by the ultrasonic transducer 121a matches the lesioned part 130 is φ2 (FIG. 20C).

  Also in the second embodiment, the subsequent “position variation estimation process for the puncture target” and “guide image creation process” are the same as those in the first embodiment.

  Next, the “guidance information presenting step” in the second embodiment will be described.

  As described above, according to the second embodiment, the medical device to which the “position and direction guidance information” is presented performs a predetermined treatment on the subject instead of the “ultrasonic image acquisition unit”. For example, it is a treatment tool such as a biopsy forceps.

  FIG. 21 is a diagram illustrating an overall configuration when the ultrasonic probe is extracted from the medical guide system of the second embodiment, and FIG. 22 is an illustration of extracting the ultrasonic probe from the medical guide system of the second embodiment. It is the figure which showed the guide sheath at the time of doing.

  As shown in FIG. 21 and FIG. 22, after obtaining the respiratory phases φ1 and φ2 of the subject 100, the operator removes only the ultrasonic probe 122 with the guide sheath 123 remaining in the vicinity of the lesioned part 130. To do.

  Thereafter, the operator inserts, for example, the biopsy forceps 142 into the guide sheath 123 inserted through the forceps channel 102c from the forceps insertion opening 102a of the bronchial videoscope 102 with the guide sheath 123 left. .

  FIG. 23 is a diagram showing an overall configuration when a biopsy forceps is inserted from the bronchial videoscope to the vicinity of a lesioned part in the medical guide system of the second embodiment, and FIG. 24 is a medical view of the second embodiment. It is the figure which showed the mode at the time of inserting biopsy forceps to the lesioned part vicinity from the bronchial videoscope in a guide system.

  As shown in FIGS. 23 and 24, the biopsy forceps 142 is applied to the distal end portion 141 that can be inserted into the body cavity of the subject 100 via the forceps channel 102c and the forceps 141a for performing predetermined treatment and the outside. A coil 141b that outputs an electrical signal in response to the generated magnetic field is provided.

  In addition, a plurality of coils 142 a that output an electrical signal in accordance with a magnetic field applied from the outside are disposed in the insertion portion of the biopsy forceps 142 along the longitudinal direction.

  The coil 141b and the coil 142a are both connected to the position detection device 103B, and the position detection device 103B is based on the electrical signals from the coil 141b and the coil 142a, and the tip portion position / orientation data and the insertion portion position / orientation data. Is supposed to generate.

  In the second embodiment, first, the bronchial videoscope 102 is inserted into the ultrasonic probe 122 including a sensor (such as the coil 121a) for obtaining position information, and after obtaining the above-described predetermined guidance information, the bronchial video is obtained. The ultrasonic probe 122 is removed from the scope 102 and a treatment tool such as a biopsy forceps 142 including a sensor (coil 141a or the like) for obtaining position information is inserted, and the guidance information is transmitted to the treatment tool such as the biopsy forceps 142. It is characterized by presenting.

  Specifically, the biopsy position range and the biopsy timing phase range are presented, the biopsy forceps are guided to the biopsy position range, and the biopsy timing is notified.

  In the configuration example in the second embodiment, the biopsy forceps is employed as the medical device to which the “position and direction guidance information” is presented. However, the present invention is not limited thereto, and the “position and direction guidance” is not limited thereto. A cytodiagnosis brush or a suction biopsy needle may be employed as the medical device to which information is presented.

  In this case, the creation process of “position and direction guidance information” is the same as in the case of the biopsy forceps.

  As described above, according to the medical guide system of the second embodiment, even when the treatment (biopsy) target moves with time due to breathing or pulsation of the subject, the biopsy target is detected as an ultrasonic image. It can be easily positioned within the treatment possible range, and a biopsy can be performed at an appropriate timing according to the movement over time, so that an accurate biopsy can be performed.

  Further, in the biopsy method using the guide sheath as in the second embodiment, since the biopsy target cannot be imaged at the time of biopsy, conventionally, biopsy is performed blindly. However, according to the second embodiment, the biopsy forceps can be guided to the position of the biopsy target, and further the biopsy timing can be notified, so that the effect of improving the biopsy success rate is great.

  Note that the present invention is not limited to the above-described embodiments, and various modifications and applications can be made without departing from the spirit of the invention.

1: Medical guide system 2: Ultrasound endoscope 3A: Antenna unit 3B: Position detection device 4: Ultrasound diagnosis device 5: Image processing device 6: Operation instruction unit 7: Monitor 10: Coil for body surface detection 51: Control Unit 52: Storage unit 53: Guide image generation unit 54: Display image generation unit 55: Timing calculation unit 100 Subject

Claims (14)

Ultrasonic image acquisition means for irradiating the subject with ultrasonic waves and acquiring an ultrasonic image based on a reflected wave from the subject;
Position and direction detection means for detecting the position and direction in the ultrasonic image acquisition means;
Reference position information acquisition means for acquiring position information based on vibration of the subject;
Based on the coordinates of the pixel on the ultrasonic image and the position and direction information acquired by the position / direction detection unit in a predetermined object on the image acquired by the ultrasonic image acquisition unit, in real space Position calculating means for calculating a position;
A phase calculating means for calculating a phase based on a change with time in the reference position information acquiring means;
Guided position information calculating means for calculating position information of the predetermined object in a phase within a predetermined range based on the calculation results of the position calculating means and the phase calculating means;
Based on the calculation result of the guide position information calculation means, guide information generation means for generating guide information of position and direction to be presented to the medical instrument;
A medical guide system comprising:   The medical guide system according to claim 1, wherein the medical instrument is the ultrasonic image acquisition unit. An insertion guide mechanism formed in the ultrasonic image acquisition means;
Puncture range calculation means for calculating a puncture possible range of a puncture needle inserted through the insertion guide mechanism from the position and direction of the ultrasonic image acquisition means;
Further comprising
The medical guide system according to claim 1, wherein the guide information generating unit further generates the guide information based on the puncturable range.   The guidance information generation unit presents at least one of a push-pull amount, a bending amount, and a twist amount as the guidance information to the ultrasonic image acquisition unit. The medical guide system according to item 1.   The medical guide system according to claim 1, wherein the medical instrument is a biopsy forceps. Further comprising biopsy forceps position direction detecting means for detecting the position and direction of the biopsy forceps,
The medical guide system according to claim 5, wherein the guide information generation unit generates the guide information based on a detection result by the biopsy forceps position direction detection unit.   The medical guide system according to claim 1, wherein the medical instrument is a cytodiagnosis brush. Cytodiagnosis brush position direction detection means for detecting the position and direction of the cytodiagnosis brush is further provided,
The medical guide system according to claim 7, wherein the guidance information generation unit generates the guidance information based on a detection result by the cytodiagnosis brush position direction detection unit.   The medical guide system according to claim 1, wherein the medical instrument is a suction biopsy needle. A suction biopsy needle position direction detecting means for detecting the position and direction of the suction biopsy needle;
The medical guide system according to claim 9, wherein the guidance information generation unit generates the guidance information based on a detection result by the suction biopsy needle position / direction detection unit. The guidance position information calculating means calculates a plurality of position information of the predetermined object,
The said guidance information production | generation means produces | generates the said guidance information based on these several positional information which is the calculation result of the said guidance position information calculation means, The any one of Claims 1-10 characterized by the above-mentioned. Medical guide system.   The medical guide system according to any one of claims 1 to 10, wherein the guidance position information calculation unit calculates position information related to a position at which the moving speed of the predetermined object is zero.   The motion estimation means for estimating the motion of the subject based on the detection results of the subject position at different times in the phase calculation means. Medical guide system as described in.   The medical guide system according to any one of claims 1 to 10, further comprising notification means for notifying a timing at which the moving speed of the predetermined object becomes zero.