JP2021109050A - Medical information processing device, medical image diagnostic device, and medical information processing method - Google Patents

Abstract

To realize planning and re-planning with the high correctness and objectivity compared to a conventional technique in a medical treatment using a puncture needle such as ablation.SOLUTION: A medical information processing device according to an embodiment comprises a first generation unit and a display control unit. The first generation unit generates planning information about a medical treatment of a treatment target region using at least a three-dimensional image acquired by imaging a region including the treatment target region of a subject, the first information including the type, number, puncture route, puncture depth of a puncture needle used in the medical treatment of the treatment target region and the second information indicating a treatable region of the puncture needle. The display control unit displays the planning information on a display unit.SELECTED DRAWING: Figure 3

Description

The embodiments disclosed in the present specification and the like relate to a medical information processing device, a medical diagnostic imaging device, and a medical information processing method.

In recent years, as one of the cancer treatments, a treatment method by radio ablation under the guidance of a medical diagnostic imaging apparatus has become widespread. This ablation is, for example, a treatment method in which a cauterizing needle (electrode needle, puncture needle) is inserted into a cancer cell and a high frequency is applied to cauterize the cancer cell by radio waves to cause necrosis. In addition to ablation, cancer that causes cancer cells to die by inserting a puncture needle into the subject and supplying heat, energy, vibration, etc., such as cauterization with a microwave and freezing with a needle ice bowl. There is a cure.

In the treatment method using these puncture needles, in the actual pretreatment planning, the treatment target area is specified using the three-dimensional image acquired by the X-ray computer tomographic imaging device or the magnetic resonance imaging device and used for the treatment. It is necessary to determine the type, number, puncture angle, puncture route, etc. of the puncture needle.

However, conventionally, these matters are left to the experience and intuition of the surgeon. Therefore, it can be said that there is a limit to improving the accuracy of puncture. In addition, when treatment different from planning is performed as a result, there is no means for promptly and objectively performing replanning (recovery) during treatment.

Japanese Unexamined Patent Publication No. 2018-534984

One of the problems to be solved by the embodiments disclosed in the present specification and the like is that in treatment using a puncture needle such as ablation, more accurate and objective planning and replanning can be realized as compared with the conventional case. Is to do so.

The medical information processing apparatus according to the embodiment includes a first generation unit and a display control unit. The first generation unit is a three-dimensional image acquired by imaging a region including a treatment target region of a subject, and a type, number, puncture route, and puncture of a puncture needle used for treatment of the treatment target region. At least the first information including the depth to be treated and the second information indicating the treatable area of the puncture needle are used to generate planning information regarding the treatment of the treatment target area. The display control unit causes the display unit to display the planning information.

FIG. 1 is a diagram showing a configuration of a treatment system S in which the medical information processing device 2 according to the embodiment is used. FIG. 2 is a diagram showing a configuration of a medical information processing device 2 according to an embodiment. FIG. 3 is a flowchart showing the flow of processing in the pretreatment planning process. 4 (a) and 4 (b) are views showing an example of the cauterization target region set in step S2. FIG. 5 shows an example of a three-dimensional image in which the cauterable regions R2, R3, R4 and the insertion paths L2, L3, and L4 are arranged for each cautery needle with respect to the cauterization target region R1. FIG. 6 is a diagram showing an example of planning information displayed on the display circuit 24, in which the cauterable regions R5 and R6 and the insertion paths L5 and L6 for each cauterization needle are arranged with respect to the ablation target region R1. An example of a three-dimensional image is shown. FIG. 7 is a flowchart showing the flow of processing in the planning process during treatment. FIG. 8 is a block diagram for explaining the configuration of the medical information processing apparatus 2 according to the second embodiment. FIG. 9 is a flowchart showing the flow of the ablation information generation process executed by the medical information processing apparatus 2. FIG. 10 is a diagram showing an example of the tumor region R7 set in the pre-ablation treatment image or the post-ablation treatment image. FIG. 11 is a diagram for explaining the acquisition of the difference region in step S23. FIG. 12 is a diagram for explaining the acquisition of the difference region in step S23. FIG. 13 is a diagram for explaining the acquisition of the difference region in step S23. FIG. 14 is a diagram for explaining the ablation information generation process in step S24, and is a diagram for explaining the size calculation of the cauterable region from the difference region.

Hereinafter, the medical information processing apparatus, the medical image processing method, and the medical image processing program according to the embodiment will be described in detail with reference to the attached drawings.

FIG. 1 is a diagram showing a configuration of a treatment system S in which the medical information processing device 2 according to the embodiment is used. As shown in FIG. 1, the treatment system S is composed of a medical diagnostic imaging device 1, a medical information processing device 2, a clinical information database 3, and a treatment device 4. The medical diagnostic imaging apparatus 1, the medical information processing apparatus 2, and the clinical information database 3 can communicate with each other via a network. The treatment device 4 may not be able to communicate with the medical image diagnosis device 1, the medical information processing device 2, and the clinical information database 3. Further, the clinical information database 3 does not necessarily have to be installed in the hospital, and may be installed anywhere as long as it can communicate with the medical information processing device 2 via the network.

The medical image diagnosis device 1 is a medical image diagnosis device for acquiring in real time an image used for monitoring the position of the puncture needle used for the treatment in the subject and the treatment target area in the treatment using the treatment device 4. Is. The medical image diagnostic apparatus 1 is typically an X-ray diagnostic apparatus, an X-ray computer tomography apparatus (X-ray CT (Computed Tomography) apparatus), an angio-CT system, a magnetic resonance imaging apparatus, and an ultrasonic diagnostic apparatus. .. In the present embodiment, for the sake of specific explanation, the medical image diagnostic device 1 is assumed to be an X-ray diagnostic device (hereinafter, the medical image diagnostic device 1 is referred to as an "X-ray diagnostic device 1").

The medical information processing device 2 executes the pretreatment planning process in the treatment using the treatment device 4 by using the image data acquired from the clinical information database 3. In addition, the medical information processing device 2 uses the image data acquired from the X-ray diagnostic device 1 to execute a planning process during treatment in the treatment using the treatment device 4. The pre-treatment planning process and the intra-treatment planning process executed by the medical information processing apparatus 2 will be described in detail later.

The clinical information database 3 includes an electronic medical record database 3a and an image database 3b. Here, the clinical information means information described in the electronic medical record, information associated with the electronic medical record (for example, patient information, past treatment information, etc.), image data, etc., and is managed for each patient.

The electronic medical record database 3a is a database that stores and manages electronic medical records and information associated with electronic medical records for each patient. The electronic medical record database 3a according to the present embodiment includes a database as HIS.

The image database 3b is a database that stores and manages image data acquired by various modality and information associated with the image data for each patient. The image database 3b according to the present embodiment includes databases as PACS and RIS.

The treatment device 4 pierces a needle into the tissue of the subject, and from the needle, for example, ablation by radio wave, ablation by microwave, freezing treatment by CRYO (needle ice bowl treatment), photoimmunotherapy (near infrared ray). It is a treatment device that kills cancer cells by supplying heat, energy, vibration, etc., such as treatment).

In addition, in this embodiment, in order to make the description concrete, it is assumed that the treatment device 4 is an ablation device that performs ablation by radio waves (hereinafter, the treatment device 4 is also referred to as an "ablation device 4"). Further, in the present embodiment, the tumor region targeted for cauterization by the ablation device 4 and the region added as a margin around the tumor region and targeted for cauterization in the subject (hereinafter, referred to as "cauterization addition region"). The area including both of (.) Is referred to as a "cauterization target area", and an area (for example, a blood vessel or the like) located around the ablation target area and in which ablation must be avoided is referred to as a "cauterization avoidance area". A plurality of ablation target areas and ablation avoidance areas may be set. In addition, the area that the operator must observe before and during the ablation treatment, such as the ablation target area, the ablation avoidance area, and the route from the body surface to the ablation target area, is called an "observation area". Further, a region that can be cauterized by one ablation using one puncture needle is called a "cauterable region". In addition, there are areas where cauterization needles should not be inserted (passed) (bones, blood vessels, etc. in the subject) or areas where cauterization needles cannot be inserted (bed top plate, already inserted cautery needles). Areas, etc.) are called "insertion avoidance areas".

FIG. 2 is a diagram showing a configuration of a medical information processing device 2 according to an embodiment.

The medical information processing device 2 includes a storage circuit 20, a processing circuit 21, an input circuit 22, a communication I / F circuit 23, and a display circuit 24.

The storage circuit 20 is composed of semiconductor memory elements such as a RAM (Random Access Memory) and a flash memory, a hard disk, an optical disk, and the like. The storage circuit 10 may be composed of a USB (Universal Serial Bus) memory and a portable medium such as a DVD (Digital Video Disk).

The storage circuit 20 stores various processing programs (in addition to the application program, an OS (Operating System), etc.) used in the processing circuit 21, data necessary for executing the program, volume data, and medical images. , The OS may include a GUI (Graphical User Interface) that makes extensive use of graphics for displaying information on the display circuit 24 to the operator and allows basic operations to be performed by the input circuit 22.

Further, the storage circuit 20 stores the cauterization needle information and the ablation information. Here, "cauterization needle information" is related to the type (use of cauterization, freezing, etc., model number, etc.), length, price, inventory status at the hospital, availability status, etc. of each cauterization needle. It is information and is an example of the first information. Further, the "ablation information" is information including a cauterable region for each cauterizing needle, and is an example of the second information.

The processing circuit 21 is a processor that realizes a function corresponding to each program by reading a program from the storage circuit 20 and executing the program. The processing circuit 21 has, for example, a planning information generation function 210 and a display control function 211. The processing circuit 21 reads various control programs stored in the storage circuit 20 to realize the planning information generation function 210 and the display control function 211, and also realizes the storage circuit 20, the input circuit 22, the communication I / F circuit 23, and the display. The processing operation in the circuit 24 is comprehensively controlled. In other words, the processing circuit 11 in the state where each program is read has each function shown in the processing circuit 21 of FIG.

The planning information generation function 210 is a first one including a three-dimensional image acquired by imaging an area including a treatment target area of a subject and at least one type and length of a puncture needle used for treatment of the treatment target area. The information and a second piece of information indicating the treatable area of at least one puncture needle are used to generate planning information for treatment of the area to be treated. That is, the planning information generation function 210 executes the pretreatment planning process in the ablation process using the ablation device 4 by using the image data acquired from the clinical information database 3, the cauterization needle information, and the ablation information. Further, the planning information generation function 210 executes the in-treatment planning process in the ablation process using the ablation device 4 by using the image data acquired from the X-ray diagnostic device 1, the cauterization needle information, and the ablation information.

Here, the "pretreatment planning process" refers to three-dimensional image data (for example, CT image data or MR image data) obtained by imaging a range including the treatment target of the subject in the pretreatment stage by ablation. Using the ablation needle information and the ablation information, the type and number of ablation needles used for ablation, the insertion route of each ablation needle, in consideration of the tumor area, the ablation target area, the ablation avoidance area, and the ablation avoidance area. It is a process of planning (the position and angle of the body surface to be inserted) and the depth of insertion.

The pretreatment planning process is executed, for example, as follows. That is, the processing circuit 21 is based on the tumor region extracted from the volume data obtained by imaging the range including the treatment target of the subject by the planning information generation function 210, and various sites around the tumor region. , Set the cauterization target area, the cauterization avoidance area, and the insertion avoidance area. The processing circuit 21 generates planning information based on the cauterization needle information and ablation information such as the set cauterization target area by the planning information generation function 210.

More specifically, the processing circuit 21 assumes all combinations of cauterization needles that can be used (including single use) by the planning information generation function 210, and cauterizes each cauterization needle in the ablation target area for each combination. Execute the matching process to acquire multiple arrangement patterns of possible areas. In this matching process, it is considered that the cauterable regions do not overlap, the region sandwiched between the cauterable regions is indirectly cauterized (synergistic effect of cauterization), and the like. The processing circuit 21 executes a filtering process (condition filtering process) using a condition from a plurality of arrangement patterns for each combination of cauterization needles obtained by the matching process by the planning information generation function 210 to select the arrangement pattern. do. The conditions used for condition filtering are that each ablation needle can reach the ablation target area based on the length of each ablation needle, that there is no insertion avoidance area in the insertion path, and that the ablation avoidance area is also ablated. It is possible to set that there is no influence of the above, that the ablation area outside the ablation target area is as small as possible, and the like. The processing circuit 21 generates planning information in which a cauterization target area, a cauterable area, an insertion route, and the like are mapped on a three-dimensional image for each arrangement pattern selected by the conditional filtering process by the planning information generation function 210. ..

In addition, the "planning process during treatment" has already been stabbed using volume data obtained by imaging a range including the treatment target of the subject during treatment by ablation, cauterization needle information, and ablation information. Considering the ablationable area, tumor area, ablation target area, ablation avoidance area, and ablation avoidance area of at least one ablation needle inserted, the type and number of ablation needles to be inserted, and the ablation of each ablation needle. It is a process of replanning the entry route and the depth of penetration in real time.

The in-treatment planning process is executed, for example, as follows. That is, the processing circuit 21 is a region (residual region) excluding the cauterable region from the cauterable target region set in the volume data obtained by imaging the range including the treatment target of the subject by the planning information generation function 210. And, planning information is generated using the insertion route, the cauterization avoidance area, the information about the cautery needle, and the ablation information (cauterable area).

More specifically, the processing circuit 21 assumes all combinations of cauterization needles that can be used (including single use) by the planning information generation function 210, and can cauterize each cauterization needle in the residual area for each combination. Execute the matching process to acquire multiple arrangement patterns of the area. In the matching process of this arrangement pattern, as in the pretreatment planning process, the cauterable areas do not overlap, and the area sandwiched between the cauterable areas is indirectly cauterized (synergistic effect of cauterization). Will be considered. The processing circuit 21 executes a conditional filtering process to select an arrangement pattern from a plurality of arrangement patterns for each combination of cauterization needles obtained by the matching process by the planning information generation function 210. The processing circuit 21 generates planning information in which a cauterization target area, a cauterable area, an insertion route, and the like are mapped on a three-dimensional image for each arrangement pattern selected by the conditional filtering process by the planning information generation function 210. ..

In the pre-treatment and during-treatment planning processing, if necessary, the processing circuit 21 uses the planning information generation function 210 to use fewer cautery needles as a condition for condition filtering, and the treatment cost is as low as possible. It is also possible to further set the fact that (for example, the cost of the cautery needle to be used is the lowest).

The display control function 211 causes the display circuit 24 to display the planning information generated in the pre-treatment planning process and the in-treatment planning process.

In FIG. 2, it has been described that the processing circuit 21 which is a single processor realizes the processing function performed by the planning information generation function 210 and the display control function 211, but a plurality of independent processors are combined. The processing circuit may be configured and the function may be realized by each processor executing the program. Further, in FIG. 2, a single storage circuit 20 has been described as storing a program corresponding to each processing function, but a plurality of storage circuits 20 are distributed and arranged, and the processing circuits 11 are individual storage circuits. The configuration may be such that the corresponding program is read from 20.

The term "processor" used in the above description refers to, for example, a CPU (Central Processing Unit), a GPU (Graphical Processing unit), an integrated circuit for a specific application (Application Special Integrated Circuit: ASIC), a programmable logic device (for example, a simple programmable logic device, etc.). A circuit of a programmable logic device (Single Programmable Logical Device: SPLD), a composite programmable logic device (Complex Programmable Logic Device: CPLD), and a field programmable gate array (field programmable gate array (meaning FPGA)). The processor realizes the function by reading and executing the program stored in the storage circuit 10. Instead of storing the program in the storage circuit 10, the program may be directly incorporated in the circuit of the processor. In this case, the processor realizes the function by reading and executing the program embedded in the circuit.

The input circuit 22 is a circuit for inputting a signal from an input device such as a pointing device (mouse or the like) or a keyboard that can be operated by an operator, and here, the input device itself is also included in the input circuit 22. .. When the input device is operated by the operator, the input circuit 22 generates an input signal corresponding to the operation and outputs the input signal to the processing circuit 21. The medical information processing device 2 may include a touch panel in which the input device is integrally configured with the display circuit 24.

The input circuit 22 performs an input operation by touching a track ball for setting an area of interest (ROI), a switch button, a mouse, a keyboard, a touch pad for performing an input operation by touching an operation surface, and an operation surface. It is realized by a touch pad, a touch screen in which a display screen and a touch pad are integrated, a non-contact input circuit using an optical sensor, a voice input circuit, and a touch panel display in which a display screen and a touch pad are integrated. ..

The input circuit 22 is not limited to those provided with physical operating parts such as a mouse and a keyboard. For example, an example of the input circuit 22 includes an electric signal processing circuit that receives an electric signal corresponding to an input operation from an external input device provided separately from the device and outputs the electric signal to a control circuit.

The communication I / F (interface) circuit 23 performs a communication operation with an external device according to a predetermined communication standard. When the medical information processing device 2 is provided on the network, the communication I / F circuit 23 transmits / receives information to / from an external device on the network.

The display circuit 24 is a display for displaying an image, and is composed of an LCD (Liquid Crystal Display or the like. The display circuit 24 receives various operation screens, image data, and the like on the LCD in response to an instruction from the processing circuit 21. Display various display information such as planning information.

(Planning process)
Next, the pretreatment planning process executed by the medical information processing apparatus 2 according to the present embodiment will be described.

FIG. 3 is a flowchart showing the flow of processing in the pretreatment planning process. As shown in FIG. 3, first, the processing circuit 21 acquires pretreatment three-dimensional image data (for example, CT image data) regarding the treatment target site of the patient from the image database 3b by the planning information generation function 210. (Step S1).

Next, the processing circuit 21 acquires ablation information and cauterization needle information from the storage circuit 20 by the planning information generation function 210 (step S2).

Next, the processing circuit 21 sets the tumor region, the cauterization addition region, the cauterization target region, the cauterization avoidance region, and the puncture avoidance region by the planning information generation function 210 (step S3).

That is, the processing circuit 21 extracts and sets the tumor region from the acquired three-dimensional image data by the planning information generation function 210. For the extraction of this tumor region, for example, a segmentation treatment (region division treatment) or an existing region extraction treatment using anatomical information can be used. Further, the tumor region may be extracted manually or semi-manually according to the input from the input circuit 22 by the user.

Next, the processing circuit 21 sets the ablation addition region based on the extracted tumor region by the planning information generation function 210, and sets the region including the tumor region and the ablation addition region as the ablation target region. The ablation addition region may be automatically set along the contour of the extracted tumor region, or the tumor region is manually or semi-manually extracted according to the input from the input circuit 22 by the user. You may try to do it.

Further, the processing circuit 21 extracts and sets the cauterization avoidance area and the insertion avoidance area by the planning information generation function 210. For the extraction of the cauterization avoidance area and the insertion avoidance area, for example, a segmentation process (region division process) or an existing region extraction process using anatomical information can be used. Further, the cauterization avoidance area and the insertion avoidance area may be extracted manually or semi-manually according to the input from the input circuit 22 by the user.

FIG. 4A shows an MPR image (axial image) in which the ablation target region R1 is set. FIG. 4B shows a three-dimensional image (volume rendering image) in which the cauterization target region R1 is set. As shown in FIGS. 4 (a) and 4 (b), a cauterization target area R1, an insertion avoidance area such as a bone, and the like are set on the image data.

Next, the processing circuit 21 executes a matching process of arranging a cauterable region of each cauterizing needle in the cauterizing target region for each combination of cauterizing needles by the planning information generation function 210 (step S4).

FIG. 5A shows an example of an MPR image (axial image) in which a cauterable region R2, R3, R4 and an insertion path L2, L3, L4 are set for each cauterizing needle with respect to the cauterization target region R1. There is. FIG. 5B shows a three-dimensional image in which the cauterable regions R2, R3, R4 and the insertion paths L2, L3, L4 are set for each cautery needle with respect to the cauterization target region R1. As shown in FIGS. 5A and 5B, the matching process in step S4 sets a cauterable region for each cauterizing needle with respect to the cauterizing target region, so that each combination of cauterizing needles is set. The placement pattern is determined.

Next, the processing circuit 21 executes selection by conditional filtering for the plurality of arrangement patterns acquired by the matching process by the planning information generation function 210 (step S5).

That is, the processing circuit 21 determines the arrangement pattern using the cauterization needle whose type is not cauterization based on the cauterization needle information by the planning information generation function 210, and eliminates this.

Further, the processing circuit 21 determines the arrangement pattern using the ablation needles that are out of stock and the ablation needles that cannot be used based on the ablation needle information by the planning information generation function 210, and eliminates them.

Further, the processing circuit 21 uses the planning information generation function 210 to determine the arrangement pattern in which the bed top plate is on the extension line of the viewpoint of the cauterization needle based on the pre-input position of the subject during treatment. Eliminate this as it is difficult to insert.

Further, the processing circuit 21 excludes, for example, an arrangement pattern in which the length of the cauterization needle is insufficient due to the relationship between the length of the cauterization needle and the insertion path by the planning information generation function 210 because it is not feasible. ..

Further, the processing circuit 21 excludes the arrangement pattern in which the insertion avoidance region exists on the insertion path because it is not feasible by the planning information generation function 210.

Further, the processing circuit 21 excludes the arrangement pattern that may affect the cauterization avoidance region by the planning information generation function 210 because it affects the subject.

Further, the processing circuit 21 orders the arrangement patterns on the condition that the cauterization region outside the cauterization target region becomes as small as possible by the planning information generation function 210.

Further, the processing circuit 21 determines the recommended order of the selected arrangement patterns by the planning information generation function 210 under the conditions that the number of cauterized needles used is as small as possible and the treatment cost is as small as possible, if necessary. Is also possible.

Next, in the processing circuit 21, the planning information generation function 210 maps the cauterized area, the cauterable area, the insertion route, and the like on the three-dimensional image for each arrangement pattern selected by the conditional filtering process in step S5. Generate planning information (step S6).

Next, the processing circuit 21 displays the generated planning information on the display circuit 24 by the display control function 211 (step S7).

FIG. 6 is a diagram showing an example of planning information displayed on the display circuit 24, in which the cauterable regions R5 and R6 and the insertion paths L5 and L6 for each cauterization needle are arranged with respect to the ablation target region R1. An example of a three-dimensional image is shown. By observing the planning information shown in FIG. 6, the user can determine the area to be cauterized, the type of ablation needle to be used, the number of needles, each insertion route, the insertion depth, the surrounding organs, etc. before treatment. It is possible to visually confirm the positional relationship with and to objectively make a concrete plan for treatment.

Next, the in-treatment planning process executed by the medical information processing apparatus 2 according to the present embodiment will be described.

FIG. 7 is a flowchart showing the flow of processing in the planning process during treatment. When FIG. 7 is compared with FIG. 3, the processes of steps S11 and S13 are different. Further, in the following description, it is assumed that at least one cauterizing needle has already been inserted.
As shown in FIG. 7, first, the processing circuit 21 acquires, in real time, three-dimensional image data during treatment regarding the treatment target site of the patient from the X-ray diagnostic apparatus 1 by the planning information generation function 210 (step). S11).

Next, the processing circuit 21 acquires ablation information and cauterization needle information from the storage circuit 20 by the planning information generation function 210 (step S12).

Next, the processing circuit 21 uses the planning information generation function 210 to perform a tumor region, a cauterization addition region, a cauterization target region, a cauterization avoidance region, a penetration avoidance region, and a cauterable region of at least one already inserted cautery needle. Is set (step S12).

That is, the processing circuit 21 uses the planning information generation function 210 to set a cauterable region of at least one cauterized needle that has already been inserted, in addition to the setting of the tumor region and the like described in step S2 (step S13). .. The setting of the cauterable region is performed based on the actual position of the cauterizing needle and the ablation information in the three-dimensional image data.

Hereinafter, the processes of steps S14 to S17 are executed, but since they are the same as the processes of steps S4 to S7, the description thereof will be omitted.

By observing the planning information displayed on the display circuit 24, the user can determine the arrangement pattern of the cauterizing needles to be inserted from now on, assuming the cauterable area of at least one cauterized needle that has already been inserted. It can be visually confirmed including the positional relationship with organs and the like. In actual treatment, for example, due to the bending of the cautery needle and individual differences of the subject, it is often impossible to insert the cautery needle as planned before the treatment. Even in such a situation, by executing the planning process during the treatment, it is possible to flexibly and objectively make a concrete plan for the treatment.

As described above, the medical information processing apparatus 2 according to the present embodiment includes a planning information generation function 210 as a first generation unit and a display control function 211 as a display control unit. The processing circuit 21 uses the planning information generation function 210 to image the area including the ablation target area of the subject, and obtains the three-dimensional image data, the type of at least one ablation needle used for ablation of the ablation target area, and the puncture. The ablation target area using at least the ablation needle information as the first information including the entry route and the insertion depth and the ablation information as the second information indicating the viable range of at least one ablation needle. Generate planning information about cauterization. The processing circuit 21 causes the display circuit 24 to display the planning information by the display control function 211.

For example, in pretreatment planning, the tumor area, the ablation target area, the ablation avoidance area, and the ablation avoidance area are considered by using the three-dimensional image data obtained by imaging the area including the ablation target area in advance. , It is possible to generate and display planning information including the type and number of cauterization needles used for ablation, the insertion route and insertion depth of each cauterization needle, and the like. Therefore, the user can perform concrete and objective pretreatment planning by observing the displayed planning information.

Further, in the in-treatment planning process, it is possible to ablate at least one ablation needle that has already been inserted by using the three-dimensional image data obtained by imaging the area including the ablation target area during the treatment by ablation. Considering the area, tumor area, ablation target area, residual area, ablation avoidance area, and puncture avoidance area, the type and number of ablation needles to be inserted, the insertion route and insertion depth of each ablation needle, etc. Planning information including can be generated and displayed in real time. Therefore, the user can perform specific and objective in-treatment planning by observing the planning information displayed in real time.

As a result, in ablation treatment, it is possible to realize highly accurate and objective pre-treatment planning and re-planning during treatment without depending on the experience and intuition of the operator.

Further, when generating the planning information, for example, in consideration of the burden on the patient, it is possible to set the filtering conditions for planning such as the planning with the smallest number of cauterized needles and the planning with the lowest cost. Therefore, the user can select a plan according to a desired condition from a plurality of planning candidates.

(Modification example 1)
In the above embodiment, a case where a cauterization needle that can be used and a cauterization needle that is in stock is determined based on the cauterization needle information has been exemplified. On the other hand, the user is made to input the type of cauterization, freezing, etc. and the cauterization needle to be used, for example, by GUI, and the planning information is generated by using the cauterization needle information about the cauterization needle according to the input contents. It may be.

(Modification 2)
In the above embodiment, the case where the X-ray diagnostic apparatus 1 as the medical diagnostic imaging apparatus and the medical information processing apparatus 2 are separate bodies has been described as an example. On the other hand, the X-ray diagnostic apparatus 1 and the medical information processing apparatus 2 may be integrated.

(Second Embodiment)
Next, the medical information processing device 2 according to the second embodiment will be described. The medical information processing apparatus 2 according to the second embodiment uses image data and electronic medical record data acquired from the clinical information database 3 to generate ablation information based on an actual clinical case.

FIG. 8 is a block diagram for explaining the configuration of the medical information processing apparatus 2 according to the second embodiment. As shown in FIG. 8, the processing circuit 21 of the medical information processing apparatus 2 according to the second embodiment further includes an ablation information generation function 212. The processing circuit 21 reads out various control programs stored in the storage circuit 20 to realize the ablation information generation function 212.

The processing circuit 21 accesses the electronic medical record database 3a by the ablation information generation function 212, and acquires data (for example, patient information, ablation site, ablation needle information, etc.) related to the past ablation treatment. The processing circuit 21 accesses the image database 3b by the ablation information generation function 212, and acquires an image acquired before the past ablation treatment (pre-ablation treatment image) and an image acquired after the treatment (post-ablation treatment image). do. In the present embodiment, the post-ablation treatment image also includes an image acquired in a state where the ablation treatment is partially completed during the ablation treatment.

Further, the processing circuit 21 generates a difference image using the acquired pre-ablation treatment image and post-ablation treatment image by the ablation information generation function 212, and cauterizes the ablation needle used for the ablation process based on the difference image. Calculate the possible area. The processing circuit 21 generates ablation information including a combination of a cauterable region and a cauterized portion by the ablation information generation function 212, and registers the ablation information in the database in the storage circuit 20.

FIG. 9 is a flowchart showing the flow of the ablation information generation process executed by the medical information processing apparatus 2 according to the second embodiment. As shown in FIG. 9, the processing circuit 21 accesses the electronic chart database 3a and the image database 3b by the ablation information generation function 212, and provides information on past ablation treatments (for example, patient information, ablation site, ablation needle information, etc.). An image before ablation treatment, an image after ablation treatment, etc.) is acquired (step S21).

Next, the processing circuit 21 extracts the tumor region from the pre-ablation treatment image and the tumor region and the ablated region from the post-ablation treatment image by the ablation information generation function 212 (step S22). As a result, the tumor region R7 as shown in FIG. 10, for example, is extracted and set in each of the pre-ablation treatment image and the post-ablation treatment image.

Next, the processing circuit 21 acquires a difference region using the pre-ablation treatment image and the post-ablation treatment image by the ablation information generation function 212 (step S23).

11, FIG. 12, and FIG. 13 are diagrams for explaining the acquisition of the difference region in step S23. As shown in FIG. 11, the tumor region R7 is extracted in the pre-ablation treatment image. Further, as shown in FIG. 12, the tumor region R8 and the ablated region R9 are extracted in the image after the ablation treatment. The processing circuit 21 generates the difference image shown in FIG. 13 from the pre-ablation treatment image shown in FIG. 11 and the post-ablation treatment image shown in FIG. 12 by the ablation information generation function 212, and uses the difference image. Get the difference area.

Next, the processing circuit 21 generates ablation information from the acquired difference region by the ablation information generation function 212 (step S24). That is, the processing circuit 21 calculates the cauterable region of the ablation needle used for the ablation process based on the difference region by the ablation information generation function 212. The processing circuit 21 generates ablation information about the ablation needle by using the calculated ablationable region and the ablation information generation function 212. The ablation information can also include information on the ablated site (organ) as information on the temperature sensitivity of the tissue.

FIG. 14 is a diagram for explaining the ablation information generation process in step S24, and is a diagram for explaining the size calculation of the cauterable region from the difference region. As shown in FIG. 14, the combination (X, Y, Z) of the major axis diameter X, the minor axis diameter Y, and the height Z is calculated by using the ellipsoidal sphere having the smallest volume including the difference region as a cauterable region. Can be done.

The processing circuit 21 acquires the cauterization needle information from the information related to the past ablation treatment by the ablation information generation function 212 (step S25), associates the generated ablation information with the ablation needle information, and registers it in the database in the storage circuit 20. do.

As described above, the medical information processing apparatus 2 according to the present embodiment has ablation related to the acupuncture needle and the treatment site used for the treatment from the images acquired before the past ablation treatment and the images acquired after the treatment. Generate information and register it in the database in association with ablation needle information.

The ablation information generated in this way can be said to be highly accurate information based on actual measurement. The registered ablation information can be used in planning. Therefore, planning information can be generated using a more accurate cauterable region based on actual measurement. As a result, in treatment using a puncture needle such as ablation, it is possible to realize highly accurate and objective planning and replanning as compared with the conventional case.

According to at least one embodiment described above, in the treatment using a puncture needle such as ablation, it is possible to realize highly accurate and objective planning and replanning as compared with the conventional case.

In addition, although some embodiments of the present invention have been described, these embodiments are presented as examples and are not intended to limit the scope of the invention. These embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the gist of the invention. These embodiments and modifications thereof are included in the scope and gist of the invention, as well as in the scope of the invention described in the claims and the equivalent scope thereof.

1 Medical image diagnostic device (X-ray diagnostic device)
2 Medical information processing device 3 Clinical information database 3a Electronic medical record database 3b Image database 4 Treatment device 20 Storage circuit 21 Processing circuit 22 Input circuit 23 Communication I / F circuit 24 Display circuit 210 Planning information generation function 211 Display control function 212 Ablation information generation Function S treatment system

Claims (8)

A three-dimensional image acquired by imaging a region including a treatment target region of a subject, a first information including the type and length of at least one puncture needle used for treatment of the treatment target region, and at least one of the above. A first generator that uses at least a second piece of information indicating the treatable area of the puncture needle to generate planning information about the treatment of the area to be treated.
A display control unit that displays the planning information on the display unit,
Medical information processing device equipped with. The medical information processing apparatus according to claim 1, wherein the first generation unit generates the planning information by using the three-dimensional image captured before the treatment of the treatment target area. The first generation unit refers to the three-dimensional image captured during the treatment of the treatment target area and the at least one puncture needle already inserted into the treatment target area during the treatment of the treatment target area. The medical information processing apparatus according to claim 1, wherein the planning information is generated by further using the first information and the second information. The first generation unit is
A matching process for acquiring a plurality of arrangement patterns of the treatable region in the treatment target region is executed, and the matching process is executed.
Conditional filtering is executed on the acquired plurality of arrangement patterns to generate the planning information.
The medical information processing device according to any one of claims 1 to 3. The first generation unit determines the feasibility of inserting the at least one puncture needle into the treatment target area, the influence on the outside of the treatment target area, and the above-mentioned influence on the acquired plurality of arrangement patterns. The medical information processing apparatus according to claim 4, wherein the conditional filtering is performed subject to at least one of the number of puncture needles and at least one of the costs in the treatment. A medical information processing apparatus further comprising a second generator that generates the second information about at least one puncture needle used in the past treatment based on pretreatment and posttreatment images in the past treatment. .. A first three-dimensional image obtained by imaging an area including a treatment target area of a subject, and a first including at least one type of puncture needle used for treatment of the treatment target area, a puncture route, and a puncture depth. A first generator that generates planning information regarding the treatment of the treatment target area by using at least the information of the above and the second information indicating the treatable area of the at least one puncture needle.
A display control unit that displays the planning information on the display unit,
Medical diagnostic imaging equipment equipped with. The area including the treatment target area of the subject is imaged and the acquired three-dimensional image is acquired.
The three-dimensional image, the first information including the type of at least one puncture needle used for the treatment of the treatment target area, the puncture route, and the puncture depth, and the treatable area of the at least one puncture needle are shown. Using at least the second piece of information shown to generate planning information for treatment of the treatment area.
Medical information processing method equipped with.

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