JP2017086819A - Medical image diagnostic apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical image diagnostic apparatus which can display an optical real-time image of a subject and a puncture plan in a superimposition manner at the time of puncture.SOLUTION: A medical image diagnostic apparatus includes: a volume data acquisition part for acquiring volume data of a subject; an input part for setting a puncture path connecting a puncture starting point of a puncture needle on a subject surface with a puncture target in the subject to the volume data; an optical imaging part imaging an optical image at a position corresponding to the acquisition position of the volume data of the subject from at least two directions to the subject; and a display part displaying a puncture guide image including a plurality of optical images and information showing the puncture path corresponding to the imaging directions of the plurality of optical images.SELECTED DRAWING: Figure 1

Description

  Embodiments described herein relate generally to a medical image diagnostic apparatus.

  A medical diagnostic imaging device (for example, an X-ray CT (Computed Tomography) device) scans a subject using X-rays and processes the collected data with a computer, thereby imaging the inside of the subject. It is a kind of device.

  The X-ray CT apparatus acquires volume data in the subject and renders the volume data in an arbitrary cross section to perform MPR (Multi Planer Reconstruction) display. The MPR-displayed cross-sectional image (hereinafter referred to as “MPR image”) includes, for example, an axial image showing a cross-section orthogonal to the body axis, a sagittal image showing a cross-section of the subject along the body axis, There is a coronal image showing a cross-section across the subject along the axis. Furthermore, an oblique image obtained by reconstructing a cross section having an arbitrary angle other than the cross sections of the axial image, the sagittal image, and the coronal image in the volume data is also included in the MPR image.

  This X-ray CT apparatus is used in the case of treatment under CT fluoroscopy in which a puncture treatment is performed while scanning with the X-ray CT apparatus in addition to a normal examination. Usually, an X-ray CT apparatus can measure the distance between the puncture target and the tip of the puncture needle and the puncture angle of the puncture needle on the MPR image under CT fluoroscopy. The operator sets up a puncture plan consisting of the puncture angle and puncture depth of the puncture needle before the puncture treatment. Thus, the operator can take an image of volume data during puncturing, and can grasp whether or not the puncturing plan planned in advance matches the current puncture needle position.

  In addition, along with recent technological development of X-ray CT apparatuses, it has become possible to capture volume data of a subject with a single imaging. By using the volume imaging function of this X-ray CT apparatus, planning the insertion path of the puncture needle with an angle in the body axis direction of the subject and monitoring the puncture needle with an angle in the body axis direction Is becoming possible.

JP2013-162951A

  However, when the insertion angle of the puncture needle also includes an angle in the body axis direction, it is difficult for the operator to accurately grasp the angle of the puncture needle to be inserted three-dimensionally. For example, in order to puncture the puncture target in the subject, the puncture angle of the puncture needle is perpendicular to the body surface direction on the abdominal side or back side of the subject with respect to the body axis direction. It is necessary to grasp the final insertion angle by combining two directions of the body side direction. In such a method, it is difficult for the operator to grasp the insertion angle of the puncture needle toward the puncture target with reference to only the MPR image. Therefore, it is a burden on the operator to refer to the MPR image and correct the puncture angle of the puncture needle when there is a deviation between the current tip position of the puncture needle and the puncture route. Therefore, an object of the embodiment is to provide a medical image diagnostic apparatus in which an operator can easily grasp the position of a puncture needle.

  In order to achieve the above object, a medical image diagnostic apparatus according to an embodiment includes a volume data acquisition unit that acquires volume data of a subject, a puncture start point of a puncture needle on a subject surface, and a subject for the volume data An input unit for setting a puncture path connecting the puncture target in the optical imaging unit, and an optical imaging unit configured to photograph an optical image at a position corresponding to the acquisition position of the volume data of the subject from at least two directions And a display unit that displays a puncture guide image including a plurality of optical images and information indicating a puncture route corresponding to the imaging direction of the plurality of optical images.

1 is a block diagram showing a schematic configuration of a medical image diagnostic apparatus according to a first embodiment. The figure which shows an example of the attachment position of the optical imaging device which concerns on 1st Embodiment. The flowchart which shows the flow of the puncture treatment using the medical image diagnostic apparatus which concerns on 1st Embodiment. The figure which shows an example of the display screen of the MPR image which concerns on 1st Embodiment. The figure which shows an example of the superimposition display screen of the puncture plan to the optical real-time image which concerns on 1st Embodiment. The block diagram which shows schematic structure of the processing circuit which concerns on 2nd Embodiment. The figure which shows an example of the superimposition display screen of the MPR image on the optical real-time image which concerns on 2nd Embodiment. The block diagram which shows schematic structure of the processing circuit which concerns on 3rd Embodiment. The figure which shows an example of the superimposition display screen of the segment display image on the optical real-time image which concerns on 3rd Embodiment. The block diagram which shows schematic structure of the processing circuit which concerns on 4th Embodiment. The flowchart which shows the flow of the warning display at the time of puncture treatment using the medical image diagnostic apparatus which concerns on 4th Embodiment. The figure which shows an example of the warning display screen at the time of the puncture treatment by the medical image diagnostic apparatus which concerns on 4th Embodiment.

(First embodiment)
A first embodiment will be described with reference to the drawings.

<Device configuration>
FIG. 1 is a block diagram illustrating a configuration of a medical image diagnostic apparatus according to an embodiment. A medical image diagnostic apparatus 100 in FIG. 1 includes a gantry device 10, a bed device 30, and a console device 40.

[Mounting device]
The gantry device 10 (gantry unit) is an apparatus that irradiates the subject P with X-rays and collects detection data of the X-rays that have passed through the subject P. The gantry device 10 includes an X-ray generator 11, an X-ray detector 12, a rotating body 13, a high voltage generator 14, a gantry driver 15, a collimator 16, a diaphragm driver 17, and a data acquisition circuit. 18 and an optical photographing device 19.

  The X-ray generator 11 (X-ray generator) includes an X-ray tube (for example, a vacuum tube that generates a cone-shaped or pyramid-shaped X-ray beam (not shown)) that generates X-rays. The generated X-rays are exposed to the subject P.

  The X-ray detector 12 (X-ray detection unit) includes a plurality of X-ray detection element arrays in which a plurality of X-ray detection elements are arranged in the channel direction along one arc centered on the focal point of the X-ray tube. . The X-ray detector 12 detects X-rays that have passed through the subject P. Specifically, the X-ray detection element in the X-ray detector 12 detects the intensity of the X-ray that has passed through the subject P, and outputs a current signal corresponding to the X-ray intensity to the data collection circuit 18. As the X-ray detector 12, for example, an X-ray detector (surface detector) in which a plurality of detection elements are arranged in two directions (slice direction and channel direction) orthogonal to each other is used. The plurality of X-ray detection elements are provided in 320 rows along the slice direction, for example. As described above, by using a multi-row X-ray detector, a three-dimensional imaging region having a width in the slice direction can be imaged by one rotation scan (volume scan). The slice direction corresponds to the body axis direction of the subject P, and the channel direction corresponds to the rotation direction of the X-ray generator 11.

  The data acquisition circuit 18 (data acquisition unit) (DAS: Data Acquisition System) collects current signals obtained from the X-ray detection elements of the X-ray detector 12 and generates detection data indicating an X-ray intensity distribution. Circuit. The data collection circuit 18 converts the generated detection data into a voltage signal, periodically integrates and amplifies the voltage signal, and converts it into a digital signal. Then, the data collection circuit 18 transmits the detection data converted into the digital signal to the console device 40. The rotating body 13 is a frame that supports the X-ray generator 11 and the X-ray detector 12 so as to face each other with the subject P interposed therebetween. The rotating body 13 has an opening region 13a penetrating in the slice direction.

  The high voltage generator 14 (high frequency generator) is a voltage generator circuit that applies a high voltage to the X-ray generator 11. (Hereinafter, “voltage” means the voltage between the anode and the cathode in the X-ray tube). The X-ray generator 11 generates X-rays with the high voltage from the high voltage generator 14.

  The gantry driving device 15 (gantry driving unit) is configured by a power source such as a plurality of motors, and has a function of rotating the rotating body 13.

  The collimator 16 (collimator unit) is a device in which an actuator for moving a lead plate is attached to a lead plate that shields X-rays. A plurality of the lead plates are combined and attached immediately below the X-ray tube, and a gap (slit) formed by the plurality of lead plates is an X-ray irradiation range. The X-ray irradiation range can be adjusted by driving the lead plate by the actuator of the collimator 16 and changing the slit width.

  The aperture driving device 17 (aperture driving unit) is an electric circuit that outputs an operation signal for operating an actuator attached to the lead plate of the collimator 16 so that an X-ray irradiation range has a predetermined shape.

  The optical imaging device 19 (optical imaging unit) is an imaging device that optically images a body surface image of the subject P in real time, and includes a video camera or the like. A real-time optical image (hereinafter referred to as an optical real-time image) of the body surface of the subject P photographed by the optical photographing device 19 is obtained by photographing from two directions of the body surface and the body side surface of the subject P. Therefore, for example, the optical imaging device 19 is attached to the ceiling surface and one side surface of the opening region 13a of the gantry device 10 shown in FIG. The optical imaging device 19 is attached to an opening region 13 a in the vicinity of the rotating body 13 including the X-ray generator 11, the X-ray detector 12, and the data acquisition circuit 18. With the configuration attached to the opening region 13a of the gantry device 10, the imaging region of the optical real-time image captured by the optical imaging device 19 can correspond to the scan position by the X-ray CT apparatus. The captured optical real-time image is displayed on the display device 42. The optical imaging device 19 may have a configuration integrated with the gantry device 10, or may have a configuration arranged separately from the gantry device 10. When the optical imaging device 19 is configured separately from the gantry device 10, the optical imaging device 19 may have a configuration in which the positional relationship between the optical imaging device 19 and the gantry device 10 is fixed. For example, the optical imaging device 19 is attached to the ceiling of an examination room. May be. When the subject P in the gantry device 10 is imaged from outside the gantry device 10 and the puncture is performed in the vicinity of the gantry device 10, the subject P is imaged from an oblique direction. At this time, the captured optical real-time image is subjected to trapezoidal correction by the display control function 447 and puncture information such as the puncture route L is superimposed.

  In the medical image diagnostic apparatus 100, an X-ray tube and an X-ray detector 12 are integrally rotated around a subject P. Rotate / Rotate-Type, and a large number of X-ray detection elements arrayed in a ring shape. Are fixed, and there are various types such as Stationary / Rotate-Type in which only the X-ray tube rotates around the subject P, and any type is applicable to the present embodiment.

[Bed equipment]
The bed apparatus 30 (bed section) is an apparatus that places and moves the subject P to be imaged. The couch device 30 includes a base 31, a couch driving device 32, and a couch top plate 33. The base 31 is a housing having a motor or an actuator that can move the bed top 33 in the vertical direction (direction orthogonal to the body axis direction of the subject P) by the bed driving device 32. The couch driving device 32 is a motor or an actuator that inserts and removes the couch top 33 on which the subject P is placed with respect to the opening region 13 a of the rotating body 13. The couch top 33 is a couch for placing the subject P that can be moved by the couch driving device 32 in the body axis direction of the subject P and in the direction orthogonal to the body axis direction.

[Console device]
The console device 40 (console unit) is used for operation input to the medical image diagnostic apparatus 100. Further, the console device 40 has a function of reconstructing CT image data (tomographic image data and volume data) representing the internal form of the subject P from the detection data collected by the gantry device 10. In addition, the console device 40 has a function of setting a puncture route L to a puncture target using the reconstructed MPR image. The console device 40 includes a storage circuit 41, a display device 42, an input device 43, and a processing circuit 44.

  The storage circuit 41 (storage unit) is configured by a semiconductor storage device such as a RAM or a ROM. The storage circuit 41 stores detection data, projection data obtained by performing pre-processing described later on the detection data, CT image data after reconstruction processing, an optical real-time image acquired by the optical imaging device 19, and the like.

  The display device 42 (display unit) includes an arbitrary display device such as an LCD (Liquid Crystal Display) or a CRT (Cathode Ray Tube) display. For example, the display device 42 displays an MPR image obtained by rendering volume data and an optical real-time image of the subject P photographed by the optical photographing device 19.

  The input device 43 (input unit) is used as an input device that performs various operations on the console device 40. The input device 43 is composed of, for example, a keyboard, a mouse, a trackball, a joystick, and the like. Further, a GUI (Graphical User Interface) can be used as the input device 43.

  The processing circuit 44 (processing unit) executes various processes on the detection data transmitted from the data collection circuit 18. The processing circuit 44 includes a preprocessing function 441, a reconstruction processing function 442, a rendering processing function 443, a puncture information superimposing function 444, a system control function 445, a scan control function 446, and a display control function 447. Consists of.

  The system control function 445 (system control unit) performs overall control of the medical image diagnostic apparatus 100 by controlling the operations of the gantry device 10, the couch device 30, and the console device 40.

  The pre-processing function 441 (pre-processing unit) creates projection data by performing pre-processing such as logarithmic conversion processing, offset correction, sensitivity correction, and beam hardening correction on the detection data detected by the X-ray detector 12. To do.

  The reconstruction processing function 442 (reconstruction processing unit) creates CT image data (tomographic image data and volume data) based on the projection data created by the preprocessing function 441. The tomographic image data is image data of a specific tomographic plane of the subject P, and the volume data is three-dimensional image data of the subject P constructed by an aggregate of tomographic image data. For reconstruction of tomographic image data, any method such as a two-dimensional Fourier transform method, a convolution / back projection method, a successive approximation reconstruction method, or the like can be employed. Volume data is created by interpolating a plurality of reconstructed tomographic image data. For the reconstruction of volume data, for example, any method such as a cone beam reconstruction method, a multi-slice reconstruction method, an enlargement reconstruction method, or the like can be adopted. The reconstruction processing function 442 is an example of a volume data acquisition unit. Further, the volume data acquisition unit is not limited to the reconstruction processing function 442. For example, when reading the volume data acquired in advance by the storage circuit 41, the storage circuit 41 has a function of a volume data acquisition unit. Further, a reconstructed image of the axial plane may be created from each tomographic image data.

  The rendering processing function 443 (rendering processing unit) creates an MPR image by performing rendering processing on volume data in a desired direction. The MPR image is an image showing a desired cross section in the subject P. MPR images include an axial image, a sagittal image, and a coronal image that are three orthogonal cross sections. Alternatively, the rendering processing function 443 may create an oblique image indicating an arbitrary cross section other than the acquired cross section of an axial image, a sagittal image, and a coronal image as an MPR image. Further, a reconstructed image of the axial plane may be used instead of the MPR image of the axial plane.

  The puncture information superimposing function 444 (puncture information superimposing unit) has a function of superimposing the puncture target, the puncture start point, and the puncture route L set by the operator with reference to the MPR image with the optical image captured by the optical imaging device 19. . (Hereinafter, the superimposed image is referred to as a puncture guide image.) In more detail, the operator refers to the MPR image displayed on the display device 42 and inputs the puncture target site, the puncture start point, and the puncture route L. 43 is set. The puncture information superimposing function 444 reads the information from the input device 43 and the optical image photographed by the optical photographing device 19, and corresponds to the puncture route L set on the MPR image of the coronal surface set by the operator and the floor surface. Information on the angle α formed by the body axis and the puncture needle PN on the plane is superimposed on the optical image of the coronal surface (first optical real-time image 54). Similarly, the puncture information superimposing function 444 includes a puncture path L set on the first MPR image of the sagittal surface set by the operator, and a body axis and a puncture needle with respect to the depth direction in the subject P body. Information relating to the angle β is superimposed on the optical image of the sagittal surface (second optical real-time image 55). The generated puncture guide image is stored in the storage circuit 41. At this time, the puncture information superimposing function 444 aligns the first MPR image created by the rendering processing function 443 and the optical real-time image photographed via the optical photographing device 19. When the optical imaging device 19 is installed in the gantry device 10 in advance, since the position coordinates of the gantry device 10 and the optical imaging device 19 are known, these positions correspond to each other. Further, when the image sizes of the first MPR image and the optical real-time image are different from each other, enlargement / reduction is performed on each image, and the pixel size of the image is adjusted. When the image center of the first MPR image is shifted from the center of the FOV (Field Of View), the position of the first MPR image and the optical real-time image is determined from the difference between the FOV center and the center of the first MPR image. Can be combined. Further, image processing for alignment may be performed even when the subject P is displaced from the center of the FOV due to body movement or the like.

  The scan control function 446 (scan control unit) controls various operations related to the X-ray scan. For example, the scan control unit 446 applies a high voltage to the X-ray generator 11 and controls the high voltage generator 14 to generate X-rays. In the scan control function 446, the gantry driving device 15 is controlled so as to rotationally drive the rotating body 13. Further, the scan control function 446 controls the bed driving device 32 so that the bed top plate 33 is moved into the gantry device 10 at the time of executing the scan.

  A display control function 447 (display control unit) performs various controls related to image display. For example, control is performed to display the MPR image created by the rendering processing function 443, the optical real-time image of the subject P, the superimposed image of the optical real-time image and the puncture route L on the display device 42. The display control function 447 switches the puncture route L on the superimposed image. Specifically, the display control function 447 reads information input by the operator via the input device 43, and switches whether to display the puncture route L displayed on the superimposed image. For example, when the display of the puncture route L is deleted from the superimposed image, only the optical real-time image is displayed on the display device 42. As a result, only the body surface of the subject P and the puncture needle PN can be displayed. Further, the optical image displayed on the display device 42 may be updated at a predetermined time interval including updating in real time. Alternatively, the display control function 447 may update the optical image by reading input information from the operator.

  In addition, the components of the processing circuit 44, the preprocessing function 441, the reconstruction processing function 442, the rendering processing function 443, the puncture information superimposing function 444, the system control function 445, the scan control function 446, and the display control function 447 are performed. The processing functions are recorded in the storage circuit 41 in the form of a program that can be executed by a computer. The processing circuit 44 is a processor that realizes a function corresponding to each program by reading and executing the program from the storage circuit. In other words, the processing circuit 44 in a state where each program is read has each function shown in the processing circuit 44 of FIG. In FIG. 1, a single processing circuit 44 uses a preprocessing function 441, a reconstruction processing function 442, a rendering processing function 443, a puncture information superimposing function 444, a system control function 445, a scan control function 446, and a display control function 447. However, it is also possible to configure the processing circuit 44 by combining a plurality of independent processors and to implement the functions by executing a program by each processor.

<Operation>
Next, the operation of the medical image diagnostic apparatus 100 according to the present embodiment will be described with reference to the flowchart of FIG. Here, the flow when creating a puncture route L using the first volume data, displaying the puncture route L superimposed on the optical real-time image of the subject P, and performing puncture along the puncture route L will be described. To do. In this flow, an example in which the optical imaging device 19 is attached to the opening region 13a of the gantry device 10 as shown in FIG. 2 and puncturing is performed by the operator in the gantry device 10 will be described as an example.

  First, in step S <b> 10, the scan control function 446 performs an X-ray scan on the subject P via the gantry device 10. In the embodiment, an X-ray scan performed before puncturing the subject P is referred to as a first scan. Specifically, the X-ray generator 11 irradiates the subject P with X-rays. The X-ray detector 12 detects X-rays that have passed through the subject P and acquires the detection data. Detection data detected by the X-ray detector 12 is collected by the data collection circuit 18 and processed by the preprocessing function 441. At this time, the bed top plate 33 is located in the gantry device 10.

  Next, in step S11, the preprocessing function 441 performs preprocessing on the detection data acquired in S11 to create projection data.

  In step S12, the reconstruction processing function 442 creates a plurality of tomographic image data with different slice positions using the projection data created in S11. A plurality of tomographic image data having different slice positions is acquired by executing a helical scan that rotates the rotating body 13 while moving the bed top 33 and scans the subject P in a spiral shape, for example. Or you may acquire by performing the non-helical scan which rotates the rotary body 13 with the position of the subject P fixed, and scans the subject P in a circular orbit. Next, the reconstruction processing function 442 creates volume data by interpolating a plurality of tomographic image data. Hereinafter, the volume data shot before puncturing is referred to as first volume data.

  In step S13, the rendering processing function 443 creates an MPR image by rendering the first volume data created in S12 in an arbitrary direction. In the embodiment, the MPR image generated based on the first volume data obtained before puncturing the subject P is referred to as a first MPR image. The system control function 445 reads information input by the operator via the input device 43 and designates the first MPR image including the tip of the puncture needle PN from the first MPR image. The display control function 447 displays on the display device 42 an orthogonal three-section image (axial image, sagittal image, coronal image) of the designated first MPR image. A display example of the first MPR image on the display device 42 of the orthogonal three-section image will be described in detail with reference to FIG.

  Next, in step S14, the system control function 445 first displays the first MPR image on the display device. Next, the system control function 445 reads the puncture route L and the puncture start point E set by the operator via the input device 43. The puncture target T, puncture path L, and puncture start point E on the first MPR image are stored in the storage circuit 41 via the system control function 445.

  In step S15, the optical imaging device 19 reads information input by the operator via the input device 43 from the system control function 445, and optical real-time images of the subject P are obtained from the body surface side and the body side surface of the subject P. Take a picture. The captured optical real-time image is stored in the storage circuit 41.

  In step S16, the puncture information superimposing function 444 displays on the display device 42 an image in which the optical real-time image of the subject P imaged by the optical imaging device 19 and the puncture route L created in S14 are superimposed. The puncture information superimposing function 444 aligns the position coordinate system of the first MPR image created in S13 and the optical real-time image photographed in S15. The display device 42 displays an image in which the puncture route L is superimposed on the first optical real-time image 54 and the second optical real-time image 55 that are different in the photographing direction. Next, the gantry driving device 15 reads a signal from the system control function 445, pulls out the couch top 33 on which the subject P is lying, from the gantry device 10, and the operator performs puncture.

  In step S <b> 17, the scan control function 446 performs X-ray scanning again via the gantry device 10 in order to confirm that the puncture needle PN has reached the puncture target T. In the embodiment, an X-ray scan performed after puncturing the subject is referred to as a second scan. The gantry driving device 15 reads a signal from the system control function 445 and moves the couch top 33 on which the subject P is lying down into the gantry device 10 again. The processing required for the second scan is the same as the processing required for the first scan. The X-ray detector 12 detects X-rays that have passed through the subject P, and the data acquisition circuit 18 acquires detection data. Detection data detected by the X-ray detector 12 is collected by the data collection circuit 18 and processed by the preprocessing function 441. Further, the second scan may be performed any number of times at the timing desired by the operator during puncturing.

  Next, in step S18, the preprocessing function 441 performs preprocessing on the detection data acquired in S17 to create projection data.

  In step S19, the reconstruction processing function 442 creates a plurality of tomographic image data having different slice positions using the projection data created in S18. Next, the reconstruction processing function 442 creates volume data by interpolating a plurality of tomographic image data. Hereinafter, the volume data shot after puncturing is referred to as second volume data.

  In step S20, the operator designates an orthogonal three-section image of the second MPR image including the tip of the puncture needle PN from the MPR image (second MPR image) obtained by rendering the second volume data. . The display control function 447 displays an MPR image of three orthogonal cross sections in the designated second MPR image on the display device 42.

  Next, in step S21, the operator confirms whether the puncture needle PN has reached the puncture target T. When the puncture needle PN has not reached the puncture target T, an input signal to that effect is input via the input device 43 by the operator, and the system control function 445 receives the input signal. The system control function 445 again displays a notification that the puncture route L is created on the display device 42. When the notification on the display device 42 is confirmed by the operator, the process returns to S14 again and the puncture route L is created by the operator. The operator moves the puncture needle PN toward the puncture target T again after matching the puncture direction of the puncture route L and the puncture needle PN that are created again. When the operator confirms that the puncture needle PN has reached the puncture target T, the puncture is terminated (S22).

<Screen display>
FIG. 4 is a diagram illustrating an example of a screen configuration of the display device 42 that displays an orthogonal three-section image corresponding to the first MPR image constructed from the first volume data. On the display screen of the display device 42, for example, a coronal image 51, an axial image 52, and a sagittal image 53 of the first MPR image are displayed side by side. The operator refers to the orthogonal three cross-sectional images of the subject P displayed on the display device 42, sets the puncture target T via the input device 43, and punctures an organ other than the puncture target T while referring to the screen display. A puncture route L can be created so as to avoid contact with the needle PN, and the puncture route L that is a line segment connecting the puncture target T and the puncture start point E can be displayed. A point where the puncture path L intersects the body surface is displayed as a puncture start point E. Further, a reconstructed image of the axial surface of the first volume data may be displayed in place of the first MPR image of the axial surface among the three orthogonal cross-sectional images corresponding to the first MPR image.

  Next, the first optical real-time image 54 and the second optical real-time image 55 displayed on the display device 42 will be described with reference to FIG. The first optical real-time image 54 and the second optical real-time image 55 are optical real-time images photographed by the optical photographing device 19 described above, and are viewed from two directions on the body surface side and the body side surface, which are above the subject P. Taken. In the first optical real-time image 54 and the second optical real-time image 55, the puncture start point E, the puncture target T, and the puncture route L shown in FIG. 5 are displayed. You may have the structure which an operator can select.

  The operator can perform puncturing by referring to the puncture start point E, the puncture target T, and the puncture route L superimposed on the first optical real-time image 54. The operator first sets the puncture needle PN to the puncture start point E with reference to the first optical real-time image 54 and the second optical real-time image on which the puncture route L displayed on the display device 42 is superimposed. Next, the operator refers to the first optical real-time image 54 obtained by photographing the subject P displayed on the display device 42 from above, along the puncture path L, the angle α in the body surface direction with respect to the body axis. The insertion angle (hereinafter referred to as the first insertion angle) is adjusted so as to match. Further, the operator refers to the second optical real-time image obtained by photographing the subject P displayed on the display device 42 from the side surface, and the insertion angle so as to match the deviation angle β in the body side surface direction with respect to the body axis. (Hereinafter, the second insertion angle) is adjusted. After adjusting the puncture needle PN to the puncture start point E, the first puncture angle, and the second puncture angle, the operator advances the puncture needle PN toward the puncture target T. In addition to the puncture start point E, the puncture target T, and the puncture route L, the information displayed on the display device 42 includes the first and second puncture angles and the distance from the puncture start point E to the puncture target T. Numerical information regarding the insertion depth to be shown may be included.

(Second Embodiment)
In the second embodiment, in addition to the puncture start point E, the puncture target T, and the puncture route L superimposed on the optical real-time image in the first embodiment, the first MPR image including the puncture target T is superimposed and displayed. The case where it carries out is demonstrated using FIG. 6 and FIG. In the second embodiment, the medical image diagnostic apparatus 100 includes a processing circuit 44b in place of the processing circuit 44 of the first embodiment. The processing circuit 44 b has a configuration in which a puncture needle tip position calculation function 448 is added to the processing circuit 44.

  FIG. 6 is a block diagram excerpting the processing circuit 44b of the medical image diagnostic apparatus 100 according to the second embodiment.

  The puncture needle tip position calculation function 448 (puncture needle tip position calculation unit) reads information on the tip position of the puncture needle PN by analyzing the optical real-time image acquired from the optical imaging device 19 and outputs the information to the display control function 447. To do. Specifically, the position of the puncture needle PN can be specified by performing line extraction processing on the first optical real-time image 54 and the second optical real-time image 55 acquired by the optical imaging device 19. . In the line extraction process, when there is a linear range having the same pixel value on the optical image, the puncture needle tip position calculation function 448 detects the range as the puncture needle PN. The insertion depth of the puncture needle PN into the subject P on the optical real-time image is calculated by analyzing the length of the puncture needle PN exposed outside the subject P. In addition, instead of using the optical imaging device 19 for specifying the tip position of the puncture needle PN, position information sensors attached to both ends of the puncture needle PN are used to calculate the position and angle of the puncture needle PN. May be.

  FIG. 7 shows a coronal image 56 of a first MPR image of a cross section including the puncture target T on the first optical real-time image 54, and a first MPR of a cross section including the puncture target T on the second optical real-time image 55. It is a figure which shows an example of the display of the display apparatus 42 on which the sagittal image 57 of the image was superimposed and displayed. The medical image diagnostic apparatus 100 of the embodiment displays the coronal image 56 and the sagittal image 57 of the first MPR image of the cross section including the puncture target T in the first and second optical real-time images, and the first MPR image The display may be maintained until the puncture is completed. Alternatively, the tip position of the puncture needle PN may be read by the puncture needle tip position calculation function 448 and displayed so as to follow the cross-sectional position of the first MPR image so that the tip position of the puncture needle PN is included. Further, instead of the coronal image of the first MPR image including the puncture target T, the first MPR image of the oblique surface including the puncture start point E and the puncture target T may be displayed separately.

(Third embodiment)
In the third embodiment, in addition to the puncture start point E, the puncture target T, and the puncture route L that are superimposed on the optical real-time image in the first embodiment, a segment display image including the puncture target T is superimposed and displayed. This will be described with reference to FIGS. In the third embodiment, the medical image diagnostic apparatus 100 includes a processing circuit 44c instead of the processing circuit 44 of the first embodiment. The processing circuit 44 c has a configuration in which a puncture needle tip position calculation function 448 and a segmentation function 449 are added to the processing circuit 44.

  FIG. 8 is a block diagram excerpting the processing circuit 44c of the medical image diagnostic apparatus 100 according to the third embodiment.

  The segmentation function 449 (segmentation unit) performs processing for specifying the region of the object for the volume data designated by the operator. When the segmentation function 449 receives an instruction to execute the segmentation process (area specification) from the input device 43, it reads the volume data from the storage circuit 41 and executes the segmentation process on the volume data. By performing the segmentation process, it is possible to specify only the puncture target or non-puncture target biological organ region in the subject P. Next, an example of threshold processing executed by the segmentation function 449 will be described. First, the segmentation function 449 extracts the voxel having the highest voxel value among the voxels in each region as a seed point (feature point). Alternatively, the operator designates a seed point via the input device 43. Then, the segmentation function 449 is connected to the seed point, and region growing (Region) that sequentially repeats extracting voxels satisfying the condition that the voxel value is larger than the threshold value of the voxel value of the volume data corresponding to each region. The segmentation process is executed by extracting only a specific area using the Growing method. As a result, a specific area is specified from the areas displayed by the volume data, that is, the areas that can be observed by the operator. As a result, it is possible to display on the display device 42 a volume rendering image in which only the region of the puncture target T or the non-puncture target biological organ in the subject P is specified.

  9 superimposes a coronal image 58 of a segment display image including the puncture target T on the first optical real-time image 54 and a sagittal image 59 of the segment display image including the puncture target T on the second optical real-time image 55. It is a figure which shows an example of a display screen structure of the made display apparatus 42 made. The medical image diagnostic apparatus 100 according to the embodiment displays the coronal image 56 and the sagittal image 57 of the cross section including the puncture target T on the first and second optical real-time images, as in the case where the MPR image is superimposed and displayed. The display may be continued until the puncture is completed. Alternatively, the tip position of the puncture needle PN may be read by the puncture needle tip position calculation function 448, and the position of the cross section of the segment image may be updated and displayed so that the tip position of the puncture needle PN is included. Further, instead of the coronal image of the segment display image including the puncture target T, the segment display image of the oblique surface including the puncture start point E and the puncture target T may be displayed separately.

(Fourth embodiment)
In the fourth embodiment, with respect to the case where the operator is warned when the position of the puncture needle PN deviates from the puncture path L or when puncture is started from a position different from the puncture start point E, FIG. This will be described with reference to FIGS. In the fourth embodiment, the medical image diagnostic apparatus 100 includes a processing circuit 44d instead of the processing circuit 44 of the embodiment. The processing circuit 44d has a configuration in which a puncture needle tip position calculation function 448 and a warning function 450 are added to the processing circuit 44. The processing circuit 44b of the second embodiment will be described as a configuration in which a puncture needle tip position calculation function 448 and a warning function 450 are added, but the puncture needle tip position calculation function 448 and the warning function 450 are added to the third embodiment. It may be done.

  FIG. 10 is a block diagram excerpting the processing circuit 44d of the medical image diagnostic apparatus 100 according to the fourth embodiment.

  The warning function 450 (warning unit) is displayed when it is determined from the first optical real-time image 54 and the second optical real-time image 55 that there is a deviation between the puncture path L and the current puncture needle PN. A warning screen is displayed on the device 42. More specifically, the puncture needle tip position calculation function 448 reads information related to the tip position of the puncture needle PN obtained by analyzing the optical imaging device 19. The warning function 450 receives information related to the tip position of the puncture needle PN, and issues a warning when there is a deviation between the puncture path L and the tip position of the puncture needle PN. As a warning method, a warning screen may be displayed on the display device 42 or a voice warning may be given. Further, the degree of coincidence between the puncture needle PN and the puncture route L may be notified by a change in sound. For example, the volume of the voice may be changed in proportion to the magnitude of the deviation between the puncture needle PN and the puncture path L, and the voice is notified even when the positions of the puncture needle PN and the puncture path L are not shifted. Alternatively, when a deviation occurs, the voice may be increased to notify the positional deviation.

  Next, the operation of the medical image diagnostic apparatus 100 according to the fourth embodiment will be described with reference to the flowchart of FIG. Here, a warning screen is displayed on the display device 42 when it is determined from the first optical real-time image 54 and the second optical real-time image 55 that there is a deviation between the puncture route L and the current puncture needle PN. The flow when displaying is described.

  Steps S30 to S34 are the same as steps S12 to S16 described above.

  In step S35, the puncture needle tip position calculation function 448 detects a deviation between the current tip position of the puncture needle PN displayed on the first optical real-time image 54 and the second optical real-time image 55 and the puncture route L. . If the puncture angle or the puncture depth of the puncture needle PN deviates from the puncture path L, a warning is given in the next step S36.

  In step S36, when the puncture needle tip position calculation function 448 detects a deviation between the puncture needle PN and the puncture route L in step S35, the warning function 450 displays a warning screen on the display device.

  In step S37, the puncture needle tip position calculation function 448 detects whether or not the deviation between the puncture needle PN and the puncture path L has been corrected. When the correction of the deviation is confirmed, the warning function 450 transmits a command for deleting the warning display from the display screen of the display device 42 to the display device 42. If the correction of the deviation is not confirmed, the warning display continues to be displayed.

  Steps S38 to S42 are the same as steps S17 to S22 described above.

  FIG. 12 is a diagram showing an example of a display format when the display device 42 displays a warning display. For example, a warning mark such as a warning display 61 is output to a part of the display device 42 as shown in FIG. The warning mark format is not limited to the format of the warning display 61, but may be displayed on the screen with characters such as “puncture error”, or may be in the format of warning by voice as described above. Good. As long as the operator is notified that there is a deviation between the puncture needle PN and the puncture route L, the present invention is not limited to the listed formats. Further, when the deflection angles are γ and δ with respect to the first insertion angle α and the second insertion angle β, the information on the displacement angle is an image such as a numerical value and an arrow as shown in FIG. The information may be displayed on the display device 42 in the form of information.

  The method for detecting the deviation between the puncture needle PN and the puncture route L is not limited to the configuration in which the puncture information superimposing function 444 of the processing circuit 44 reads and detects the optical image described in S38. For example, CT images are taken over time at the time of puncture, an MPR image including the puncture needle PN is read, and the difference between the puncture needle PN and the puncture path L is calculated using the MPR image information. 448 may detect it. Alternatively, a sensor for detecting position information may be attached to the puncture needle PN, and the sensor information may be read so that the puncture needle tip position calculation function 448 detects a deviation between the puncture needle PN and the puncture path L. .

  In the fourth embodiment, by using the optical real-time image from the optical imaging device 19 to grasp the position of the puncture needle PN, the puncture position of the puncture needle PN can be detected without exposing X-rays. It becomes possible. This makes it possible to increase the efficiency of inspection and reduce the exposure dose.

  In the present embodiment, the medical image diagnostic apparatus for the X-ray CT apparatus has been described. However, the present embodiment is not limited to the X-ray CT apparatus shown in the block diagram of FIG. For example, it may be applied to dental CT. The present embodiment can also be applied to other modalities such as C-arm type X-ray diagnostic apparatus, MR apparatus, and ultrasonic diagnostic apparatus. Alternatively, image data acquired by other modalities may be stored in an external server or the like, and puncture route L, puncture start point E, puncture target T, and the like may be set using the image data. In addition, when acquiring volume data with a C-arm X-ray diagnostic apparatus, volume data is generated by performing reconstruction processing on the X-ray projection data sequentially output by rotating the C-arm. Then, the volume data is stored in the storage circuit 41. The entire process in this workflow may be a volume data acquisition unit, or a component related to a series of processes from imaging until the reconstruction process may be a volume data acquisition unit, or a component that performs the reconstruction process May be a volume data acquisition unit. Furthermore, a component related to a process of reading volume data from the storage circuit 41 may be used as a volume data acquisition unit. In the MR apparatus, volume data is generated by performing reconstruction processing such as Fourier transform on MR data acquired by MR imaging, and the volume data is stored in the storage circuit 41. The entire process in this workflow may be a volume data acquisition unit, or a component related to a series of processes from imaging until the reconstruction process may be a volume data acquisition unit, or a component that performs the reconstruction process May be a volume data acquisition unit. Furthermore, a component related to a process of reading volume data from the storage circuit 41 may be used as a volume data acquisition unit. In the ultrasound diagnostic apparatus, volume data is generated by reconstructing an image from a plurality of two-dimensional ultrasound images and data relating to the acquisition position. Volume data generated by each process is stored in the storage circuit 41. The entire process in these workflows may be a volume data acquisition unit, or a component related to a series of processes up to the reconstruction process may be a volume data acquisition unit, and a component that performs the reconstruction process is a volume A data acquisition unit may be used. Furthermore, a component related to a process of reading volume data from the storage circuit 41 may be used as a volume data acquisition unit. In the present embodiment, the case where a single puncture needle PN is used and optical real-time images are captured from two different directions has been described, but optical real-time images may be captured from two or more directions. For example, in a configuration having a plurality of puncture needles PN, the puncture needle PN for which puncture is currently being executed is designated via the input device 43 by the operator. Input information from the input device 43 is received by the system control function 445, and a signal for adjusting the focal position to the puncture needle PN designated by the operator is transmitted to the optical imaging device 19. The designation method of the puncture needle PN that is performing the puncture may be designated by the operator. In the second embodiment, the third embodiment, and the fourth embodiment, the puncture needle tip position calculation function 448 may detect the puncture needle PN being punctured. Further, an optical real-time image may be taken from two or more different directions depending on the position of the puncture needle PN. For example, the configuration having the first puncture needle PN1 and the second puncture needle PN2 may be configured to have a plurality of optical imaging devices 19 that perform imaging for each puncture needle. You may make it image | photograph by aligning a focus position to 1st puncture needle PN1 and 2nd puncture needle PN2 in order from the same direction.

  Further, in the present embodiment, the description has been made on the assumption that the couch top 33 on which the subject P is lying is positioned in the gantry device 10 only at the time of volume data acquisition, but the puncture may be performed in the gantry device 10. . This makes it possible to display not only an optical real-time image of the subject P at the time of puncturing but also an MPR image corresponding to the tip position of the puncture needle PN.

  According to the embodiment described above, the operator punctures the subject P by superimposing the puncture plan on the optical real-time image from at least two directions of the subject P instead of the reference image such as the MPR image. Referring to the images from two directions, the insertion angle of the puncture needle PN can be determined from the two directions, and the tip position of the puncture needle PN and the puncture route L can be easily aligned. is there. Also, when the tip position of the puncture needle PN is shifted from the puncture path L during puncture, the correction of the puncture angle is performed in two directions with reference to the optical real-time image, compared with the case of referring to the MPR image. Since only adjustment is required, it is possible to reduce the burden on the operator. This makes it possible to reduce the inspection time and the exposure dose.

  Note that the components described as “units” in this embodiment may be realized by hardware, software, or hardware and software. It may be realized by a combination.

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

  DESCRIPTION OF SYMBOLS 10 ... Mount apparatus, 11 ... X-ray generator, 12 ... X-ray detector, 13 ... Rotating body, 13a ... Opening area, 14 ... High voltage generator, 15 ... Mount drive apparatus, 16 ... Collimator, 17 ... Diaphragm drive Device: 18 ... Data collection circuit, 19 ... Optical imaging device, 30 ... Couch device, 31 ... Base, 32 ... Couch driving device, 33 ... Couch top plate, 40 ... Console device, 41 ... Memory circuit, 42 ... Display device 43 ... Input device 44 ... Processing circuit 44b ... Processing circuit 441 ... Preprocessing function 442 ... Reconstruction processing function 443 ... Rendering processing function 444 ... Specific function 445 ... System control function 446 ... Scan control Functions: 447: Display control function, 448: Puncture needle tip position calculation function, 449: Segmentation function, 450: Warning function, 51: Coronal image, 52: Axial image, 53 ... Digital image 54 ... first optical real-time image 55 ... second optical real-time image 56 ... MPR image coronal image 57 ... MPR image sagittal image 58 ... segment image coronal image 59 ... segment image Sagittal image, 61 ... warning display, 100 ... medical image diagnostic apparatus

Claims (15)

A volume data acquisition unit for acquiring volume data of the subject;
For the volume data, an input unit for setting a puncture path connecting a puncture start point of a puncture needle on the subject surface and a puncture target in the subject;
An optical imaging unit that images an optical image of a position corresponding to the position of the volume data in the subject from at least two directions with respect to the subject;
A display unit for displaying a puncture guide image including the plurality of optical images and information indicating the puncture route corresponding to the imaging direction of the plurality of optical images;
A medical image diagnostic apparatus. A puncture needle tip position calculating unit for calculating position information of the puncture needle tip;
A warning unit that detects a positional deviation from the puncture path based on the position information of the puncture needle calculated by the puncture needle tip position calculation unit, and controls a warning display or the like based on the information about the positional deviation;
The medical image diagnostic apparatus according to claim 1, further comprising: A rendering processing unit that creates an MPR image that is a cross-sectional image of the subject based on the volume data;
The medical image diagnostic apparatus according to claim 1, wherein the puncture path is set based on an MPR image generated from the volume data. A reconstruction processing unit for creating a reconstruction image of the axial surface of the volume data;
The medical image diagnostic apparatus according to claim 1, wherein the puncture path is set based on the reconstructed image. A processing unit for receiving input information from the input device;
The medical image diagnostic apparatus according to claim 2, wherein the puncture guide image is an image in which the MPR image is further superimposed and displayed in addition to the puncture route and the optical image by the processing unit. A segmentation unit that creates a segment image by performing extraction of a contour part of the part excluding the puncture target or the puncture target based on the volume data;
A processing unit for receiving input information from the input device;
The medical image diagnostic apparatus according to claim 2, wherein the puncture guide image is an image in which the segment image is further superimposed and displayed in addition to the puncture route and the optical image by the processing unit.   The medical image diagnostic apparatus according to claim 5, wherein a cross section of the MPR image superimposed as the puncture guide image is set at a position including the tip of the puncture needle detected by the puncture needle tip position calculation unit.   The medical image diagnostic apparatus according to claim 6, wherein a cross section of the segment image superimposed as the puncture guide image is set at a position including a tip of the puncture needle detected by the puncture needle tip position calculation unit. A processing unit for receiving input information from the input device;
When there are a plurality of puncture needles to be inserted into the subject at the time of puncturing, the processing unit performs the optical imaging so that a focal position is adjusted to any one of the puncture needles. The medical image diagnostic apparatus according to claim 1, wherein the plurality of puncture needles are imaged by controlling a unit.   The processing unit controls the optical imaging unit to adjust a focal position to the puncture needle selected by the operator via the input unit among the plurality of puncture needles. The medical image diagnostic apparatus described.   A puncture needle tip position calculation unit that calculates position information of the puncture needle tip, wherein the puncture needle tip position calculation unit detects the puncture needle on which puncture is being performed among a plurality of previous puncture needles; The medical image diagnostic apparatus according to claim 10, wherein the positions are adjusted. A processing unit for receiving input information from the input device;
When there are a plurality of the puncture needles to be inserted into the subject at the time of puncturing, the processing unit images the plurality of puncture needles from the same direction with the same optical imaging unit, and the optical imaging unit The medical image diagnostic apparatus according to claim 1 or 2, wherein the plurality of puncture needles are photographed by sequentially switching a focal position. A processing unit for receiving input information from the input device;
The medical image diagnostic apparatus according to claim 1 or 2, wherein the processing unit switches whether to display the puncture route displayed in the puncture guide image based on input information from the input unit. A processing unit for receiving input information from the input device;
The medical image diagnosis apparatus according to claim 1, wherein the optical image is updated at predetermined time intervals by the processing unit and displayed on the display unit. A processing unit for receiving input information from the input device;
The medical image diagnostic apparatus according to claim 1, wherein the optical image is updated based on input information from the input unit and displayed on the display unit by the processing unit.

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