JP2016195748A - Diagnostic device and diagnostic method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a diagnostic device, etc., capable of evaluating a state of feces inside the large intestine using information of an ultrasonic echo signal obtained from the large intestine using an ultrasonic wave, and to also provide a diagnostic device, etc., capable of evaluating a state of soft feces using an ultrasonic image.SOLUTION: A diagnostic device 1 is a diagnostic device for evaluation a state of feces inside the large intestine. A probe unit 3 can generate an ultrasonic wave and detect an echo signal from the large intestine, and a state-of-feces evaluation unit 7 can distinguish normal feces, hard feces, feces with gas accumulation, and soft feces using the echo signal. Furthermore, a soft feces evaluation unit 25 can evaluate whether or not the feces are soft feces using an ultrasonic image generated by an image generation unit 5.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a diagnostic apparatus and a diagnostic method, and more particularly to a diagnostic apparatus that evaluates the state of feces in the large intestine.

  Defecation control is frequently performed as care for the elderly and the caregivers, and both the judgments of the medical staff such as nurses are directly linked to the care. For example, many elderly people complaining of constipation need medication such as laxatives and enemas.

  Although the state of the large intestine itself may be confirmed with ultrasound for diagnosis of colorectal cancer, the state of feces staying in the large intestine is not visualized in the clinic. Currently, palpation and auscultation are performed as methods for judging the indication, but there is no index that can quantitatively evaluate the internal state of the large intestine for judging the indication. It depends.

  The state of the large intestine can be broadly divided into four categories: 1) normal stool, 2) hard stool (rectal constipation), 3) gas accumulation, and 4) loose stool (relaxing constipation). The inventors analyze an ultrasonic image and evaluate hard stool by attenuation of luminance value (Non-patent Document 1), and normal evaluation by gas accumulation and luminance change amount by autocorrelation function (Non-Patent Document 1). 2) was proposed.

Matsuo, Tanabe, Hatanaka, Sakurai, Hara “Quantitative Evaluation Method for Elderly Constipation Using Ultrasound Images”, 70th Annual Meeting of the Japanese Society of Radiological Technology, April 10-13, 2014 Tanabe, Sakanaka, Matsuo, Sakurai, Hara "Initial study of ultrasonic image analysis for quantitative evaluation of large intestine contents", Japanese Society of Radiological Technology 70th Annual Meeting, April 10-13, 2014

  However, it is expected that the state of the stool inside the large intestine can be accurately evaluated by obtaining the state of the stool inside the large intestine not only from the ultrasound image but also from wider information. In addition, by evaluating the state of loose stool using an ultrasonic image, the state inside the large intestine can be classified.

  Therefore, a diagnostic apparatus and the like that can evaluate the state of stool inside the large intestine using information of ultrasonic echo signals obtained from the large intestine using ultrasonic waves is proposed. It is another object of the present invention to propose a diagnostic apparatus that can evaluate the state of loose stool using an ultrasonic image.

  A first aspect of the present invention is a diagnostic apparatus for evaluating a state of stool inside a large intestine, which detects an echo signal from the large intestine by generating an ultrasonic wave having a propagation direction in the large intestine. Means, and after performing statistical processing on the echo signal in a direction perpendicular to the propagation direction, whether or not the state of the stool inside the large intestine is hard stool using a coefficient of an approximate line with respect to the propagation direction After the evaluation and / or statistical processing of the echo signal in the direction perpendicular to the propagation direction, whether or not the stool inside the large intestine is gas accumulation due to the presence or absence of echoes periodically repeated in the propagation direction And / or performing a Fourier transform on the echo signal in the echo signal to confirm a high frequency component, and / or the size and / or size of the stay in the large intestine. Young By detecting the number, internal flights state of the large intestine are those with a stool state evaluating means for evaluating whether a loose stool.

  A second aspect of the present invention is the diagnostic apparatus according to the first aspect, wherein the stool state evaluating means performs statistical processing on the echo signal in a direction perpendicular to the propagation direction, and then approximates the propagation direction. When the line is attenuated more than the hard stool determination line, the stool inside the large intestine is evaluated as hard stool, and / or after the echo signal is subjected to statistical processing in a direction perpendicular to the propagation direction, The presence of echoes periodically repeated between the echo signal detecting means and the gas in the propagation direction evaluates the feces in the large intestine as gas accumulation.

  According to a third aspect of the present invention, there is provided a diagnostic apparatus for evaluating a state of stool inside the large intestine, the image acquisition means for obtaining the ultrasonic image data of the large intestine using the echo signal, and the ultrasonic image data , The two-dimensional Fourier transform is performed on the part including the large intestine of the ultrasonic image, the high frequency component is confirmed rather than the soft stool determination value, and / or the size and / or number of the retained matter inside the large intestine And / or in the ultrasonic image data, a movement of the large intestine is detected to evaluate whether the state of the stool in the large intestine is soft or not. Is.

  A fourth aspect of the present invention is the diagnostic apparatus according to the third aspect, wherein the stool state evaluating means performs binarization processing on a portion including the large intestine of the ultrasonic image, and expansion and contraction processing By carrying out the process, particulate retention exceeding the reference number is detected.

  According to a fifth aspect of the present invention, there is provided a diagnostic method for a diagnostic apparatus for evaluating a state of stool inside the large intestine, wherein an echo signal detecting means provided in the diagnostic apparatus detects an echo signal from the large intestine. The stool condition evaluation means included in the diagnostic device performs statistical processing on the echo signal in a direction perpendicular to the propagation direction, and then performs information processing for the propagation direction, whereby the state of the stool inside the large intestine is hardened. It is determined whether or not it is a stool and / or gas accumulation, and / or an ultrasonic image or video obtained using the echo signal and / or using the echo signal Using to evaluate whether it is soft stool.

  Note that the present invention may be regarded as a program for causing a computer to function as a diagnostic apparatus according to any one of the first to fourth aspects. Further, the present invention may be regarded as a computer-readable recording medium that regularly records this program.

  According to the present invention, it is possible to evaluate stool and / or gas stagnation using an echo signal, and simplification and improvement in accuracy can be achieved. That is, the echo signal is first processed while paying attention to the direction perpendicular to the propagation direction, and then the propagation direction is focused. Hard stool is a solid substance with a small amount of water and almost uniform acoustic characteristics, and the attenuation of sound waves during propagation is severe compared to soft stool and normal stool. For this reason, a significant difference is seen in the attenuation coefficient, and estimation is possible. Moreover, since the acoustic impedance of gas is significantly different from that of living tissue, most sound waves are reflected at the boundary of the living tissue before the gas and do not propagate inside the gas. Therefore, the attenuation inside the gas cannot be measured and can be distinguished from hard stool. The sound wave reflected at the gas front boundary generates multiple reflections at the boundary between the probe and the gas front. Such a phenomenon is a unique phenomenon in the vicinity of the large intestine and can be estimated. For example, multiple reflections occur in bones or large limes, but their cross-sectional area is smaller than that of the large intestine. Therefore, if the average is taken perpendicular to the propagation direction as in the large intestine, the influence of the multiple reflections is reduced. In addition, soft stool uses, for example, Fourier transform, detects the presence or size of granular stagnants, and uses echo signals that are continuously detected to analyze, for example, moving images or multiple still images. Thus, estimation is possible by detecting high-speed movement.

  Further, according to the third aspect of the present invention, by detecting loose stool from an ultrasonic image, it is possible to detect loose stool in addition to hard stool and gas retention, and the state of stool inside the large intestine. It becomes possible to classify.

It is a schematic block diagram which shows an example of a structure of the diagnostic apparatus which is an example of embodiment of this invention. It is a 1st flowchart which shows an example of operation | movement of the diagnostic apparatus 1 of FIG. It is a 2nd flowchart which shows an example of operation | movement of the diagnostic apparatus 1 of FIG. It is a figure for demonstrating an example of the nursing care by the state of a large intestine. It is a figure which shows an example of the soft stool determination process using an echo signal. It is a figure which shows an example of the two-dimensional Fourier transform of ultrasonic image data.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. The present invention is not limited to this embodiment.

  FIG. 1 is a schematic block diagram showing an example of the configuration of a diagnostic apparatus that is an example of an embodiment of the present invention. 2 and 3 are flowcharts showing an example of the operation of the diagnostic apparatus 1 of FIG. In the present invention, the diagnostic apparatus 1 obtains echo signals of feces accumulated in the large intestine with an ultrasonic device, extracts a plurality of features, classifies them by a neural network, and performs quantitative evaluation inside the large intestine. It is.

  FIG. 4 is a diagram for explaining an example of nursing care based on the state of the large intestine. (A) is flaccid constipation and shows a state in which movement of the entire large intestine is reduced. In this case, nursing care is usually performed using an internal lozenge. (B) is rectal constipation and shows a state in which stool cannot be accumulated in the rectum. In this case, nursing care such as an enema or a suppository type laxative or stool is usually performed. However, at the present time, in order to judge the adaptation of nursing care, the index that evaluates the state of the large intestine depends on the skill level of the caregiver, not the current time.

  The state of the large intestine can be broadly divided into four categories: 1) normal stool, 2) hard stool (rectal constipation), 3) gas accumulation, and 4) loose stool (relaxing constipation). The diagnostic apparatus 1 quantitatively evaluates the state of stool inside the large intestine. The diagnostic device 1 includes a probe unit 3 (an example of an “echo signal detection unit” in the claims of the present application), an image generation unit 5 (an example of an “image acquisition unit” in the claims of the present application), and a stool state evaluation unit 7 (an application of the present application). An example of “stool condition evaluation means” in the claims, and a display unit 9.

  The probe unit 3 emits an ultrasonic wave toward the large intestine and detects an echo signal from the large intestine. The probe 3 includes a convex (deep part) probe part 11 and a linear (surface part) probe part 13. The deep probe unit 11 uses, for example, an ultrasonic wave of about 3 MHz. The superficial portion probe portion 13 uses, for example, an ultrasonic wave of about 7 to 10 MHz. The examination apparatus 1 may be made portable, the deep probe 11 may be provided at one end, and the surface probe 13 may be provided at the other end.

  The image generation unit 5 generates ultrasonic image data from the echo signal detected by the probe unit 3. Specifically, the descending colon and the sigmoid colon are visualized in a uniaxial direction using ultrasonic waves from the probe unit 3.

  The inventors have described an example in Non-Patent Documents 1 and 2 for detecting the state of stool or gas accumulation from ultrasonic image data. The stool state evaluation unit 7 included in the diagnostic apparatus 1 detects the state of hard stool or gas accumulation from the echo signal, and further detects the state of soft stool from the ultrasonic image data, thereby setting the normal stool as the state inside the large intestine. Hard stool (rectal constipation), gas accumulation, and loose stool (relaxed constipation) can be detected. The display unit 9 is a touch panel that displays an image and an echo signal on a monitor, displays the evaluation result of the stool state evaluation unit 7, and inputs a user.

  The stool state evaluation unit 7 includes a stool evaluation unit 21, a gas accumulation evaluation unit 23, a soft stool evaluation unit 25, and a normal stool evaluation unit 27. The stool evaluation unit 21, the gas accumulation evaluation unit 23, and the loose stool evaluation unit 25 evaluate whether the internal state of the large intestine is stool, gas accumulation, and loose stool, respectively. The normal stool evaluation unit 27 evaluates normal stool when neither hard stool nor gas accumulation nor soft stool is present. With reference to FIG. 2, an example of operation | movement of the stool evaluation part 21, the gas accumulation evaluation part 23, and the soft stool evaluation part 25 is demonstrated.

  With reference to Fig.2 (a), an example of operation | movement of the stool evaluation part 21 is demonstrated. The stool evaluator 21 obtains an attenuation coefficient in the propagation direction from the echo signal as a feature quantity, and evaluates whether or not it is a hard stool. First, a hard stool determination line for determining whether or not it is hard stool is obtained by learning from a large number of stool state and non-hard stool echo signals in advance (step STK1). And the large intestine part used as evaluation object is made into a region of interest, and the echo signal from a region of interest is detected (step STK2). Subsequently, the echo signal of the region of interest is averaged in a direction perpendicular to the propagation direction (step STK3). Then, a quadratic approximate curve is obtained using the least square method with respect to the propagation direction, and the coefficient of the approximate curve is used as a feature amount (step STK4). Whereas when using an echo signal, an approximate curve of a second order polynomial is used.) Compared with other states, the hard stool state has a stronger reflection intensity at the large intestine wall and is more attenuated when propagating through the stool. For this reason, the coefficient of the approximate curve is significantly increased. Therefore, the approximate curve is compared with the hard stool determination line, and it is determined whether or not the coefficient is significantly increased (step STK5). If it becomes significantly larger, it is evaluated as hard stool (step STK6). Otherwise, it is evaluated that it is not hard stool (step STK7).

  An example of the operation of the gas accumulation evaluation unit 23 will be described with reference to FIG. The gas accumulation evaluation unit 23 obtains an autocorrelation function in the propagation direction from the echo signal as a feature quantity, and evaluates whether or not the gas is accumulated. The large intestine portion to be evaluated is set as a region of interest, and an echo signal from the region of interest is detected (step STG1). Subsequently, the echo signal of the region of interest is averaged in the direction perpendicular to the propagation direction (step STG2). Then, edge extraction is performed with respect to the propagation direction, and an autocorrelation function is calculated (step STK4). Since gas has a greatly different acoustic impedance from that of living tissue, most sound waves are reflected before the gas. The returned sound wave is reflected again by the probe, and multiple reflection occurs between the probe and the gas. It is determined whether or not this periodically repeated echo is detected (step STG4). If detected, gas accumulation is evaluated (step STG5). Otherwise, it is evaluated that there is no gas accumulation (step STG6).

  With reference to Fig.3 (a), an example of operation | movement of the loose stool evaluation part 25 is demonstrated. First, a soft stool determination value is obtained by learning using two-dimensional Fourier transform of image data in a soft stool state and a non-soft stool state in advance (step STS1). Then, the image generation unit 5 generates ultrasonic image data (step STS2), and the stool evaluation unit 25 performs a two-dimensional Fourier transform on the ultrasonic image data to calculate the frequency spectrum of the image (step STS3). In the loose stool state, there are a plurality of small-sized granular stays. Therefore, it is determined whether or not it is confirmed as a higher frequency component than the loose stool evaluation value (step STS4). FIG. 6 shows processing when two-dimensional Fourier transform is performed. If the high frequency component is confirmed, it is evaluated as loose stool (step STS5). Otherwise, it is not evaluated as soft stool (step STS6). Similarly, it can be evaluated as soft stool by using the echo signal to determine the presence or absence of small-sized granular retention.

  With reference to FIG.3 (b), another example of operation | movement of the loose stool evaluation part 25 is demonstrated. The image generation unit 5 generates ultrasonic image data (step STR1). The soft stool evaluation unit 25 binarizes this ultrasonic image data (step STR2). Then, the expansion / contraction process (here, the expansion process is a process of expanding the figure in the binarized black and white image by one pixel, and the contraction process is a process of contracting by one pixel, and the expansion / contraction process is These steps are repeated to remove noise), and a particulate stay is extracted (step STR3). It is determined whether or not there are more than the reference number of granular stays (step STS4). Here, the reference number is a predetermined number. If more than the reference number of granular stays are confirmed, it is evaluated as soft stool (step STS5). Otherwise, it is not evaluated as soft stool (step STS6). Similarly, it can be evaluated as soft stool by using the echo signal to determine the presence or absence of granular staying.

  FIG. 5 is a diagram showing an echo image and an image after the processing of FIG. FIG. 5A is an echo image in a normal case, and FIG. 5B is a processed image. FIG. 5C shows the case of hard stool, and FIG. 5D shows the result after processing. FIG. 5E shows the case of gas. FIG. 5 (f) is after processing. FIG. 5G shows the case of loose stool, and FIG. 5H shows the result after processing. In FIGS. 5B, 5D, and 5F, no granular stay is detected, whereas in FIG. 5H, a granular stay is detected.

  With reference to FIG.3 (c), an example of operation | movement of the loose stool evaluation part 25 is demonstrated. First, a soft stool determination value is obtained by learning in advance using moving images of a soft stool state and a non-soft stool state (step STD1). Then, the image generation unit 5 generates ultrasonic image data (step STD2), and the stool evaluation unit 25 calculates a change (and / or speed) inside the large intestine from the consecutive ultrasonic images before and after (step STD2). Step STD3). In the soft stool state, since there is a lot of water, small-sized granular stays move faster than normal stool, large intestine, and the tissue in front of it, and move randomly in various directions. Therefore, it is determined whether or not the speed is confirmed to be higher than the soft stool evaluation value (step STD4). If high-speed movement is confirmed, it is determined as soft stool. Otherwise, it is not evaluated as loose stool.

  According to the present embodiment, it is possible to quantify the defecation state by an ultrasonic image in addition to palpation and auscultation during home-visit nursing, and it is possible to perform treatment and constipation care such as a more suitable oral medication or enema.

  DESCRIPTION OF SYMBOLS 1 Diagnosis apparatus, 3 probe part, 5 image generation part, 7 stool state evaluation part, 9 display part, 11 deep part probe part, 13 superficial part probe part, 21 stool evaluation part, 23 gas accumulation evaluation part, 25 stool evaluation Part, 27 Normal stool evaluation part

Claims (5)

A diagnostic device for evaluating the state of stool inside the large intestine,
Echo signal detecting means for detecting an echo signal from the large intestine by generating an ultrasonic wave having a propagation direction in the large intestine;
After performing statistical processing on the echo signal in a direction perpendicular to the propagation direction, it is evaluated whether the state of the stool inside the large intestine is hard stool using a coefficient of an approximate line with respect to the propagation direction, And / or
After performing statistical processing on the echo signal in a direction perpendicular to the propagation direction, it is evaluated whether or not the stool inside the large intestine is gas accumulation by the presence or absence of echo periodically repeated in the propagation direction, and Or
In the echo signal, Fourier transform is performed on a portion including the large intestine to confirm a high-frequency component, and / or by detecting the size and / or the number of accumulated substances in the large intestine, A diagnostic apparatus provided with a stool state evaluating means for evaluating whether or not the state of the stool inside is soft. The stool state evaluation means includes:
After the echo signal is subjected to statistical processing in a direction perpendicular to the propagation direction, the stool inside the large intestine is evaluated as stool when the approximate line with respect to the propagation direction is attenuated more than the stool determination line. And / or
After statistical processing of the echo signal in a direction perpendicular to the propagation direction, there is an echo periodically repeated between the echo signal detection means and the gas in the propagation direction. The diagnostic apparatus according to claim 1, wherein the evaluation is gas accumulation. A diagnostic device for evaluating the state of stool inside the large intestine,
Image obtaining means for obtaining ultrasonic image data of the large intestine using the echo signal;
In the ultrasonic image data, a two-dimensional Fourier transform is performed on a part including the large intestine of the ultrasonic image, a high frequency component is confirmed than a stool determination value, and / or a staying matter inside the large intestine is confirmed. A stool that detects the size and / or the number and / or detects the movement of the large intestine in the ultrasonic image data and evaluates whether the state of the stool in the large intestine is soft or not. A diagnostic apparatus comprising state evaluation means.   The stool state evaluation means performs binarization processing on a portion including the large intestine of the ultrasonic image, and detects granular staying more than a reference number by performing expansion and contraction processing. Diagnostic equipment. A diagnostic method in a diagnostic device for evaluating the state of stool in the large intestine,
An echo signal detecting means provided in the diagnostic device detects an echo signal from the large intestine;
The stool state evaluation means provided in the diagnostic device performs statistical processing on the echo signal in a direction perpendicular to the propagation direction and then performs information processing for the propagation direction, thereby making the state of the stool in the large intestine hard And / or gas accumulation, and / or using the echo signal and / or using an ultrasound image or moving image obtained using the echo signal A diagnostic method comprising the step of evaluating whether or not the stool is soft.