JP2022134823A - transcranial magnetic stimulation system - Google Patents

Abstract

To provide a transcranial magnetic stimulation system capable of reducing a load on a doctor.SOLUTION: A transcranial magnetic stimulation system 10 comprises a transcranial magnetic stimulation device 8 including a coil unit 82 for generating a magnetic field for applying magnetic stimulation to a specific part in a patient's head 43. The transcranial magnetic stimulation device 8 includes: a camera unit 83 for imaging the coil unit 82 positioned by a practitioner 51 and the patient's head 43; and a device communication unit 81 capable of communicating with a doctor terminal 32 operated by a doctor 30. The doctor terminal 32 comprises: a doctor terminal display unit 34 capable of displaying video imaged by the camera unit 83; and an authentication device 33 for authenticating the doctor 30 who operates the doctor terminal 32. The transcranial magnetic stimulation system 10 is configured to be capable of energizing the coil unit 82 according to an instruction from the doctor terminal 32.SELECTED DRAWING: Figure 1

Description

The present invention relates to a transcranial magnetic stimulation system for applying magnetic stimulation to specific regions of a patient's head.

In recent years, interest in transcranial magnetic stimulation (TMS) has increased as a therapeutic method for patients with mental disorders such as depression and addiction. In this transcranial magnetic stimulation therapy, a transcranial magnetic stimulation device is used, a coil is placed on the patient's scalp surface, and eddy currents associated with magnetic field fluctuations formed by current flowing through the coil generate mainly nerve axons in the cerebral cortex. is minimally invasively stimulated to activate the brain (see Patent Document 1, for example).

Transcranial magnetic stimulation is roughly divided into single stimulation and repetitive stimulation, and repetitive transcranial magnetic stimulation therapy (repetitive TMS, rTMS) is often performed in the treatment of mental disorders such as depression. For example, in the treatment of depressed patients, the left dorsolateral prefrontal cortex is targeted and magnetic stimulation is applied transcranially by placing a coil close to the patient's head. The placement position of the coil on the patient's head and the intensity of the magnetic stimulation are different for each patient and are determined by searching for the motor area that induces thumb spasms.

Japanese Patent Application Laid-Open No. 2016-128001

In order to properly perform repetitive transcranial magnetic stimulation therapy using a transcranial magnetic stimulation device, it is required that a doctor who is proficient in knowledge and techniques regarding repetitive transcranial magnetic stimulation therapy perform the treatment. Then, the doctor in charge of treatment moves from the office or other waiting area to the treatment room where the transcranial magnetic stimulation device is installed before performing magnetic stimulation therapy on the patient. position), and energize the coil to start treatment.

However, there is a problem that the doctor has to move from the waiting place to the treatment room and set up the transcranial magnetic stimulation device and start the treatment by himself/herself every time the magnetic stimulation treatment is given to the patient. rice field.

SUMMARY OF THE INVENTION It is an object of the present invention to provide a transcranial magnetic stimulation system that can reduce the burden on doctors.

The present invention is a transcranial magnetic stimulation system comprising a transcranial magnetic stimulation device having a coil unit for generating a magnetic field for applying magnetic stimulation to a specific site in the patient's head, wherein the transcranial magnetic stimulation The device has a camera section for imaging the coil section and the patient's head positioned by a practitioner, and a device communication section capable of communicating with a doctor terminal operated by a doctor, and the doctor terminal is the camera section. A doctor terminal display unit capable of displaying captured images is provided, and an authentication device is provided to authenticate that a doctor who operates the doctor terminal is the person himself/herself, and the coil unit according to an instruction from the doctor terminal is configured to be energized.

According to the transcranial magnetic stimulation system of the present invention, even if the doctor is in a place away from the transcranial magnetic stimulation device (for example, in the office), the doctor can, via the camera image, be positioned by the practitioner. The position of the coil part with respect to the patient's head can be confirmed. On top of that, the doctor whose identity has been confirmed by the authentication device issues an instruction to energize the coil part of the transcranial magnetic stimulator via the doctor terminal, thereby preventing the doctor from impersonating the appropriate patient confirmed by the doctor. Since magnetic stimulation can be applied to the region of the head, the safety of magnetic stimulation treatment can be ensured.

Here, the authentication device may perform identity verification by inputting authentication information such as an ID and a password, or by reading authentication information stored in a magnetic card or IC card. In order to avoid this, it is preferable to perform personal identification by so-called biometric authentication, for example, biometric information (physical characteristics) such as fingerprint pattern, iris pattern, and vein pattern.

In the transcranial magnetic stimulation system of the present invention, it is preferable that the transcranial magnetic stimulation device and the doctor's terminal are configured to enable two-way voice communication.

According to this aspect, the doctor can easily and accurately instruct the practitioner to change the position of the coil unit through voice communication with the practitioner. In addition, the doctor can obtain information on the patient and the state of the device from the practitioner by voice. As a result, appropriate and highly safe magnetic stimulation therapy can be performed.

In the transcranial magnetic stimulation system of the present invention, a coil marker used for positioning the coil unit may be displayed on the doctor terminal display unit by superimposing it on the image captured by the camera unit. good.

According to this aspect, it is not necessary to directly display or draw the marker for coil alignment on the patient's head, so the burden on the patient can be reduced.

In the transcranial magnetic stimulation system of the present invention, a management server that can be connected to at least one of the doctor terminal and the device communication unit and stores patient ID information, doctor ID information, practitioner ID information, and device ID information In addition, the management server may store patient ID information in association with a history of magnetic stimulation treatment by the transcranial magnetic stimulation device.

According to this aspect, the doctor can easily check the magnetic stimulation treatment history for each patient, and can perform magnetic stimulation treatment without excess or deficiency for each patient, and determine the subsequent treatment strategy. can be used as a reference.

Furthermore, the management server may associate the patient ID information with other treatment histories such as electroencephalogram measurement history, mental state measurement history, mental disorder recovery program participation history, and antidepressant treatment history. I do not care.

According to this aspect, the doctor can determine an appropriate treatment policy for each patient by referring to each treatment history linked to the patient ID information, and comprehensive treatment for the patient becomes possible. .

ADVANTAGE OF THE INVENTION According to the transcranial magnetic stimulation system of this invention, even if a doctor does not go to a treatment room, since repetitive transcranial magnetic stimulation treatment can be performed appropriately, a doctor's burden can be reduced.

It is a schematic diagram which shows the facility of the same embodiment, a hospital, and a management server with a network. 1 is a flow chart showing a procedure for rTMS treatment; FIG. 10 is a timing chart showing an authentication operation for starting rTMS therapy; FIG. 4 is a timing chart showing the positioning operation of the coil initial position; It is a timing chart which shows magnetic irradiation operation|movement with respect to a patient's head. FIG. 10 is a diagram showing an example of an image displayed when positioning the coil initial position; FIG. 10 is a diagram showing an example of an image displayed when positioning a coil irradiation position; 4 is a timing chart showing another example of the positioning operation of the coil initial position with respect to the patient's head; 4 is a timing chart showing another example of magnetic irradiation operation on the patient's head. FIG. 2 is a schematic diagram of another embodiment of a transcranial magnetic stimulation system; It is a schematic diagram which shows the facility of the same embodiment, a hospital, and a management server with a network.

An embodiment embodying the present invention will be described below with reference to the drawings. First, the transcranial magnetic stimulation system of this embodiment will be described below with reference to FIG. In the following description, repetitive transcranial magnetic stimulation therapy may be referred to as rTMS therapy, and a transcranial magnetic stimulation device capable of performing rTMS therapy may be referred to as a TMS device. Although rTMS therapy is described in this embodiment, the transcranial magnetic stimulation system of the present invention is also applicable to single-stimulation TMS therapy.

The transcranial magnetic stimulation system 10 of the present embodiment allows a doctor (such as a specialist doctor) to check the magnetic irradiation position on the patient's head via camera images without going to the installation location of the TMS device. By remotely manipulating the start of magnetic stimulation, the rTMS treatment can be appropriately performed.

As shown in FIG. 1, in this embodiment, the transcranial magnetic stimulation system 10 includes a device terminal 81 provided in the treatment room 201 of the clinic 200, a doctor terminal 32 provided in the office 202 of the clinic 200, and a management server 60. The device terminal 81 and the doctor terminal 32 are configured to be able to transmit and receive data via the network, and are configured to be able to transmit and receive data via the communication network 20 .

A treatment room 201 of the clinic 200 is a place where rTMS therapy is performed on a patient 41, and a TMS device 8 including a device terminal 81 is installed. The clinic 200 may be a medical institution such as a hospital in which medical facilities are installed in addition to the TMS device 8 .

The office 202 is an office of a doctor 30 who is a doctor specializing in rTMS therapy, and is equipped with a doctor terminal 32 network-connected to the TMS device 8 so that data can be sent and received. Doctor 30, who is a specialist in rTMS therapy, is, for example, a psychiatrist who is familiar with the knowledge and techniques of rTMS therapy. The office 202 may be any place where the doctor 30 can operate the doctor terminal 32, and may be an office (or a waiting room) called a medical office, for example.

In the treatment room 201 , a practitioner 51 is staying who positions the coil section 82 of the TMS device 8 on the patient's head 43 according to instructions from the doctor 30 . Practitioner 51 is preferably a person who has received training on the operation method of TMS device 8 and rTMS therapy. medical staff. It should be noted that the practitioner 51 may be a person who is qualified as a medical doctor. Also, the practitioner 51 may be a person who works full-time at the clinic 200, or may be a person dispatched from the outside.

The terminals 32 and 81 and the management server 60 are composed of information terminal devices such as workstations, personal computers, smartphones, tablet terminals, etc., and include a central processing unit that executes various arithmetic processing and control, control programs and various data. It has a storage device for storing data, an input interface, a communication interface, and the like. The communication network 20 is, for example, the Internet, and may be wired or wireless. Moreover, the apparatus terminal 81 and the doctor terminal 32 may be connected via the communication network 20 so as to be capable of two-way communication.

As described above, the treatment room 201 is a place where the patient 41 receives rTMS therapy, and the TMS device 8 is installed in the treatment room 201 . The device terminal 81 is a terminal that constitutes a communication unit (device communication unit) of the TMS device 8, and is connected to the device main body 80 by wire or wirelessly. A plurality of TMS apparatuses 8 may be installed in one treatment room 201 , or a TMS apparatus 8 may be installed in each of the plurality of treatment rooms 201 in the clinic 200 . In this case, each TMS device 8 is preferably assigned a device ID.

The TMS device 8 includes a device main body 80, a coil section 82 that generates a magnetic field for applying magnetic stimulation to a specific site in the patient's head, and a coil section 82 that is operated and positioned by the practitioner 51 and the patient 41. and a camera unit 83 for imaging the patient's head 43 . In this embodiment, the camera unit 83 includes three cameras for imaging the front, plane, and left side of the patient's head. Note that the camera unit 83 is not particularly limited in terms of the number of cameras, arrangement, etc., as long as the doctor 30 can acquire imaging data that allows the doctor 30 to check the positional relationship between the patient's head 43 and the coil unit 82 via the doctor terminal 32. .

The TMS device 8 also includes a monitor section 84 , a microphone section 85 and a speaker section 86 . Although the microphone section 85 and the speaker section 86 are illustrated in a simplified manner in FIG. 1, they may be those that can be worn on the body of the practitioner 51, such as a head microphone, a pin microphone, headphones, or earphones. In the present embodiment, the image captured by the camera unit 83 and the sound captured by the microphone unit 85 can be transmitted to the doctor terminal 32 . The TMS device 8 is provided with input devices (not shown) such as a mouse and a keyboard connected to the device terminal 81 .

Also, the connection of the device main body 80, the device terminal 81, the camera section 83, the monitor section 84, the microphone section 85, the speaker section 86, and the input device (not shown) that constitute the TMS device 8 may be wired or wireless. . Also, the device terminal 81 may be incorporated in the device main body 80 .

The doctor's terminal 32 in the office 202 is a terminal operated by the doctor 30 and is configured to display image information from the TMS device 8 on the monitor section 34 . The monitor section 34 constitutes a doctor terminal display section. The doctor terminal 32 also has a microphone and a speaker, although not shown. As a result, the voice of the doctor 30 can be transmitted to the speaker section 86 of the TMS device 8, and the voice information from the microphone section 85 of the TMS device 8 can be reproduced. That is, two-way audio communication is possible between the TMS device 8 and the doctor terminal 32 . The doctor terminal 32 is provided with input devices such as a mouse and a keyboard.

A camera for imaging the doctor 30 may be provided in the office 202 , and an image (for example, face image) of the doctor 30 may be transmitted from the doctor terminal 32 to the TMS device 8 and displayed on the monitor section 84 . As a result, a so-called video call becomes possible, so that the operator 51 (and the patient 41) in the treatment room 201 and the doctor 30 in the office 202 away from the treatment room 201 can communicate more smoothly. become.

In the office 202, an authentication device 33 used for identity verification of a doctor 30 who is suitable for using the TMS device 8 is arranged. In this embodiment, the authentication device 33 is wire-connected to the doctor terminal 32 . The authentication device 33 preferably performs identity verification by so-called biometric authentication, for example, biometric information (physical characteristics) such as a fingerprint pattern, an iris pattern, and a vein pattern. This can prevent unauthorized authentication. Here, when the authentication method is biometric authentication, biometric information (referred to as a template) collected and registered in advance is stored (saved) in any of the doctor terminal 32, the device terminal 81, and the management server 60. I don't mind.

Note that the authentication device 33 may perform identity verification by inputting authentication information such as an ID, password, and personal identification number, or by reading authentication information stored in a magnetic card or IC-embedded card. In addition, biometric authentication may be combined with other authentication such as card, password, and personal identification number to perform identity verification. Also, the authentication device 33 may be incorporated in the doctor terminal 32 .

Further, the authentication device 33 may directly communicate with the device terminal 81 by wire or wirelessly, or may be connected to the doctor terminal 32 by wireless communication. However, it is preferable that the authentication device 33 is electrically connected to the doctor terminal 32 or incorporated in the doctor terminal 32 as in this embodiment. Thereby, the doctor 30 can be prevented from operating the authentication device 33 at a place away from the doctor terminal 32, and unauthorized authentication can be prevented. In this case, the authentication information (biometric information) acquired by the authentication device 33 is transmitted to the device terminal 81 or the management server 60 via the authentication program stored in the doctor terminal 32 or the doctor terminal 32, and the device terminal 81 Alternatively, verification work is performed by an authentication program stored in the management server 60 .

The management server 60 is a server that manages patient ID information, doctor ID information, practitioner ID information, device ID information, etc., and is configured to be communicable with the terminals 32 and 81 via the communication network 20. there is

In this embodiment, the management server 60 permits communication between the doctor terminal 32 and the device terminal 81 when the patient ID information, doctor ID information, practitioner ID information, and device ID information registered in advance are combined. is configured to As a result, it is possible to treat each patient 41 in consideration of the compatibility with the doctor 30, the practitioner 51, and the TMS device 8, thereby reducing the anxiety factor of the patient 41. FIG. In addition, such an authentication operation may be executed by software (program) stored in the device terminal 81 or the doctor terminal 32 .

Further, for example, the management server 60 may limit the number of registered doctors 30 who can use (remotely control) one TMS device 8 . For example, it may be up to three people. As a result, it is possible to permit the use of the TMS device 8 only by the doctor 30 who is familiar with the operation method and individual differences (device variations) of a certain TMS device 8, thereby improving the accuracy and safety of treatment. It should be noted that such restrictions on the license for the doctor 30 may be executed by software stored in the device terminal 81 or the doctor terminal 32 .

Also, the management server 60 may be installed within the clinic 200 . In this case, transmission and reception of data between the management server 60 and the device terminal 81 and doctor terminal 32 may be performed by wire or wirelessly, or may be performed via the communication network 20 . In addition, the transcranial magnetic stimulation system 10 includes a plurality of clinics 200, and the management server 60 can transmit and receive data between the device terminal 81 and the doctor terminal 32 of each clinic 200 via the communication network 20. It does not matter if it is configured to be possible.

Next, procedures for rTMS treatment will be described with reference to FIGS. 1 to 7. FIG. FIG. 2 is a flow chart showing the rTMS treatment procedure. FIG. 3 is a timing chart showing the authentication operation for starting rTMS therapy. FIG. 4 is a timing chart showing the positioning operation of the coil initial position with respect to the patient's head. FIG. 5 is a timing chart showing the magnetic irradiation operation on the patient's head. FIG. 6 is a diagram showing an example of an image displayed when positioning the coil initial position. FIG. 7 is a diagram showing an example of an image displayed when the coil irradiation position is positioned.

As shown in FIG. 1, when performing rTMS therapy on a patient 41 in a clinic 200, the patient 41 and the practitioner 51 stay in the same treatment room 201, while the doctor 30 is in an office separate from the treatment room 201. I am staying at 202. As shown in FIG. 2, before starting the rTMS treatment, the doctor 30, the patient 41, the practitioner 51, and the TMS device 8 are authenticated (STEP 1).

As shown in FIG. 3 , the power of the TMS device 8 including the device terminal 81 is turned on, and device ID information, patient ID information, and practitioner ID information are transmitted from the device terminal 81 to the management server 60 . On the other hand, the doctor terminal 32 is powered on, and the doctor ID information is transmitted from the doctor terminal 32 to the management server 60 .

The management server 60 performs an authentication operation on the received device ID information, patient ID information, practitioner ID information, and doctor ID information using software stored inside the management server 60 . The management server 60 collates these pieces of ID information, and requests the doctor terminal 32 to verify the identity of the doctor 30 when the pieces of ID information are a combination registered in advance. The doctor terminal 32 performs an authentication operation for prompting the doctor 30 to perform an authentication operation using the authentication device 33 . The doctor 30 performs authentication using the authentication device 33, for example, biometric authentication using a fingerprint or an iris. The doctor terminal 32 transmits the doctor authentication information obtained from the authentication device 33 to the management server 60 .

The management server 60 performs a doctor authentication operation of collating the received doctor authentication information with the doctor authentication information stored in association with the doctor ID information. If it matches, the device usage permission information and the connection permission information are transmitted to the TMS device 8 , and the connection permission information is transmitted to the doctor terminal 32 .

The doctor terminal 32 may transmit the doctor ID information to the management server 60 after confirming the identity of the doctor 30 by the authentication device 33 . In this case, the management server 60 transmits the device use permission information and the connection permission information to the TMS device 8 without requesting the identity verification of the doctor 30 after receiving each ID information, while transmitting the device use permission information and the connection permission information to the doctor terminal 32 to send connection authorization information.

Further, an authentication device for confirming the identity of the operator 51 may be arranged in the treatment room 201 to perform the identity confirmation operation for the operator 51 in the same manner as the identity confirmation operation for the doctor 30 . As a result, impersonation of the practitioner 51 can be prevented.

Also, the ID authentication operation of the device ID information, patient ID information, practitioner ID information, and doctor ID information may be performed by software stored inside the device terminal 81 or the doctor terminal 32 . Note that the ID authentication operation can be omitted. In this case, for example, when the TMS device 8 is powered on and the doctor terminal 32 is powered on, either automatically or upon request from the TMS device 8 or the doctor terminal 32 or both, the TMS device 8 and the doctor terminal 32 may be connected in a state in which two-way communication is possible.

In addition, the doctor authentication operation of collating the doctor authentication information (for example, biometric information) acquired by the authentication device 33 with the registered doctor authentication information (for example, biometric information) registered in advance is performed inside the device terminal 81 or the doctor terminal 32. It may be implemented by stored software. The registered doctor authentication information registered in advance may be stored in any of the doctor terminal 32 , the device terminal 81 and the management server 60 .

As shown in FIG. 3 , the TMS device 8 that has received the device use permission information transmits the video information acquired by the camera section 83 and the audio information acquired by the microphone section 85 to the doctor terminal 32 . The doctor terminal 32 that has received the video/audio information displays the video from the camera section 83 on the monitor section 34 and reproduces the audio from the microphone section 85 through a speaker (not shown). Note that the speaker may be a device that can be attached to the body of the doctor 30, such as headphones or earphones. Also, the TMS device 8 displays the video information acquired by the camera section 83 on the monitor section 84 .

On the other hand, the doctor terminal 32 permitted to connect transmits voice information of the doctor 30 acquired by a microphone (not shown) to the TMS device 8 . The TMS device 8 that has received the doctor's voice information reproduces the doctor's voice through the speaker unit 86 . The microphone of the doctor terminal 32 may be one that the doctor 30 can attach to the body, such as a head microphone or a pin microphone.

This enables voice communication between the doctor 30 and the practitioner 51 (and the patient 41) who are in separate locations. Further, the doctor 30 can recognize the position of the coil section 82 of the TMS device 8 with respect to the patient's head 43 of the patient 41 through the image information from the TMS device 8 displayed on the monitor section 34 . This allows smooth communication between the practitioner 51 (and the patient 41) in the treatment room 201 and the doctor 30 in the office 202. FIG. Then, the doctor 30 can give appropriate instructions to the operator 51 while checking the condition of the patient 41 while staying in the office 202 away from the treatment room 201 .

The video/audio information of the TMS device 8 and the voice information of the doctor 30 may be transmitted and received between the TMS device 8 and the doctor terminal 32 via the management server 60, or may be transmitted and received without the management server 60. good too. Also, the video/audio information of the TMS device 8 and the voice information of the doctor 30 are preferably stored in at least one of the management server 60 , the doctor terminal 32 and the device terminal 81 .

As shown in FIG. 2, when the TMS device 8, the doctor 30, the patient 41, and the operator 51 are authenticated, the operation of the TMS device 8 is started (STEP 2). As shown in FIG. 1, a patient 41 is seated in a chair. The chair on which the patient 41 sits may have a headrest (head support).

The camera unit 83 of the TMS device 8 is configured to be able to capture images of the patient's head 43 from the front, top, and left sides. A front camera image screen 91, a top camera image screen 92, and a side camera image screen 93 are displayed in real time.

The positioning work of the patient's head 43 is performed while referring to the camera image screens 91, 92, and 93 (STEP 3 in FIG. 3). On the camera image screens 91, 92, and 93, a head position auxiliary line 94, a longitudinal center auxiliary line 95, and a lateral center auxiliary line 96, which are used for alignment of the patient's head 43, are displayed. While looking at the monitor unit 84 , the practitioner 51 adjusts the position and orientation of the patient's head 43 and the orientation of each camera of the camera unit 83 so that the patient's head 43 is positioned within the head position auxiliary line 94 . Adjust position and orientation. Further, the doctor 30 may issue instructions to the practitioner 51 while viewing the camera image screens 91 , 92 , 93 displayed on the monitor section 34 of the doctor terminal 32 .

Although the practitioner 51 holds the coil portion 82 in FIG. 1 , the manner of holding the coil portion 82 is not limited to this. For example, the TMS device 8 is provided with a coil holding mechanism such as an arm device that holds the coil portion 82 so that the position and posture can be changed, and the practitioner 51 operates the coil holding mechanism to change the position and posture (angle) of the coil portion 82. ) can be changed. Further, an actuator capable of changing the position and posture of the coil portion 82 is provided in the coil holding mechanism, and the position and posture of the coil portion 82 are changed by operating the actuator by the operation of the doctor 30 or the practitioner 51 or by automatically operating the actuator. can be enabled.

Next, confirmation work of the initial position of the coil portion 82 with respect to the patient's head 43 is performed (STEP 4 in FIG. 2). As shown in FIG. 4, each camera of the monitor unit 34 of the office 202 and the monitor unit 84 of the TMS device 8 is in a state in which voice communication (two-way communication) is possible between the TMS device 8 and the doctor terminal 32. Coil markers 97 are displayed on video screens 91 , 92 , 93 . As shown in FIG. 6, the coil marker 97 is superimposed on the image of the patient's head 43 and displayed. The display of the coil marker 97 can be realized by software (program) stored in the device terminal 81, the doctor terminal 32, or the management server 60, for example.

Note that the patient 41 may wear a cap that tightly covers the patient's head 43 when performing the rTMS treatment. A front-rear direction center line and a left-right direction center line passing through the top of the patient's head 43 may be drawn on the surface of the cap. In this case, the positions and postures of the patient's head 43 and the camera unit 83 are adjusted so that these center lines on the cap and the auxiliary lines 95 and 96 match on the camera image screens 91, 92 and 93. , the alignment of the patient's head 43 can be performed simply and accurately. Further, when the patient 41 wears the cap, the display of the auxiliary lines 95 and 96 on the camera image screens 91, 92 and 93 may be omitted.

In this embodiment, the coil markers 97 include a scalp position marker 97a corresponding to the magnetic irradiation site on the patient's head 43, an outer shape marker 97b matching the outer shape (appearance) of the coil portion 82, the upper surface of the coil portion 82 and and a posture marker 97c corresponding to a posture confirmation marker (not shown) provided on the front side surface. For example, the coil portion 82 is provided with posture confirmation markers at two locations on the left and right of the upper surface and two locations on the left and right of the front side surface, respectively. Is displayed.

A scale bar image (for example, a 10 cm scale bar in units of 1 cm) may be displayed on the camera image screens 91 , 92 and 93 . In this case, the doctor 30 and the practitioner 51 can easily recognize the positions of the scalp position markers 97a with respect to the center auxiliary lines 95 and 96 on the camera image screens 91, 92 and 93, respectively.

For the initial position of the coil part 82 with respect to the patient's head 43, for example, the motor area of the right abductor maternal and fetal muscle in the brain of the patient 41 is the stimulation site. Since the position of the motor area of the right abductor brevis muscle varies greatly among individuals, magnetic stimulation is first performed while observing muscle contraction of the right brevis muscle in order to estimate the position of the motor area.

In this embodiment, the coil marker 97 is configured to be movable on the camera image screens 91 , 92 and 93 by the doctor 30 operating the doctor terminal 32 . The doctor 30 operates the doctor terminal 32 to determine the position of the coil marker 97 with respect to the image of the patient's head 43 on the monitor section 34 . The operator 51 operates the coil part 82 so as to overlap the coil marker 97 while confirming the coil marker 97 on the camera image screens 91, 92, 93 of the monitor part 84 of the TMS device 8 according to the instructions of the doctor 30. Align. At this time, the doctor 30 and the practitioner 51 can communicate with each other through voice communication.

The doctor 30 confirms that the coil unit 82 is placed at the target position through the monitor unit 34 of the doctor terminal 32, and then operates the doctor terminal 32 to set the magnetic stimulation intensity and perform the magnetic stimulation operation on the TMS device 8. send instructions. The TMS device 8 energizes the coil section 82 and starts magnetic stimulation in accordance with the operation instructed by the doctor 30 . The transcranial magnetic stimulation system 10 of this embodiment is configured so that the doctor 30 can observe muscle contraction of the patient's 41 right hand short mother and child through communication between the TMS device 8 and the doctor terminal 32 . The TMS device 8 is configured such that the operator 51 cannot perform an operation to start electrifying the coil section 82 (operation to start magnetic stimulation).

For example, an electromyogram obtained from an electrode (not shown) of a myoelectric potential measurement device worn around the base of the right thumb of the patient 41 is displayed on the monitor unit 34 of the doctor terminal 32, so that the doctor 30 can see the patient 41. Muscle contraction of the right abductor brevis muscle can be confirmed. In addition, by connecting a camera that captures an image around the right wrist of the patient 41 to the TMS device 8 and displaying an image acquired by the camera on the monitor unit 34 of the doctor terminal 32, the doctor 30 can perform the right-hand abductor maternal-femoral muscle of the patient 41. muscle contraction may be observed. In addition, the muscle contraction of the patient's 41 right hand abductor macinus brevis may be transmitted to the doctor 30 by voice of the practitioner 51 .

Positioning operation of the coil marker 97 and setting of the magnetic stimulation intensity by the doctor 30, alignment operation of the coil part 82 by the practitioner 51, and magnetic stimulation start by the doctor 30 until the contraction of the right maternal and child muscle of the patient 41 is observed. operation is repeated. When the desired contraction of the right maternal and fetus brevis muscle is observed in the patient 41, the position (initial position) of the coil marker 97 and the magnetic stimulation intensity are stored in association with the patient ID information of the patient 41, and the initial position of the coil is confirmed. is completed. In the next treatment for the same patient 41, by searching for the initial position of the coil part 82 (searching the motor area of the right abductor brevis muscle) with reference to the stored initial position of the coil marker 97 and the magnetic stimulation intensity, , the initial position searching time of the coil unit 82 can be shortened.

Next, the alignment work of the irradiation position of the coil part 82 with respect to the patient's head 43 is performed (STEP 5 in FIG. 2). Specifically, the coil unit 82 is moved to the coil irradiation position with the left dorsolateral prefrontal cortex of the brain of the patient 41 as the magnetic irradiation region.

As shown in FIG. 5, camera image screens 91 and 92 of the monitor section 34 of the office 202 and the monitor section 84 of the TMS device 8 are displayed in a state in which voice communication is possible between the TMS device 8 and the doctor terminal 32. , 93, a coil marker 97 corresponding to the magnetic irradiation position is displayed. The left dorsolateral prefrontal cortex is located approximately 5 cm anterior to the motor area of the right abductor brevis muscle. As shown in FIG. 7, on camera image screens 91, 92, and 93, the coil marker 97 is moved from the initial position of the coil section 82 and displayed at a position corresponding to the magnetic irradiation position.

The display of the coil marker 97 corresponding to the magnetic irradiation position may be performed by the doctor 30 operating the doctor terminal 32 to move the coil marker 97 on the camera image screens 91, 92, and 93. , the management server 60 or the doctor terminal 32 may automatically move the coil marker 97 forward from the initial position by, for example, 5 cm and display it.

The doctor 30 confirms the position of the coil marker 97 with respect to the image of the patient's head 43 on the monitor section 34 of the doctor terminal 32 . The operator 51 operates the coil part 82 so as to overlap the coil marker 97 while confirming the coil marker 97 on the camera image screens 91, 92, 93 of the monitor part 84 of the TMS device 8 according to the instructions of the doctor 30. Align. The doctor 30 confirms that the coil part 82 has been placed at the target position (magnetic irradiation position) by the monitor part 34 of the doctor terminal 32 . At this time, the doctor 30 and the practitioner 51 can communicate with each other through voice communication.

After that, treatment work (magnetic stimulation to the patient's head 43) is performed on the patient 41 (STEP 6 in FIG. 2). After confirming that the coil unit 82 is placed at the magnetic irradiation position, the doctor 30 operates the doctor terminal 32 to transmit the setting of the magnetic stimulation intensity and the instruction of the magnetic stimulation operation to the TMS device 8 . The TMS device 8 energizes the coil section 82 and starts magnetic stimulation in response to a magnetic stimulation start instruction from the doctor terminal 32 by the doctor 30 .

During the magnetic stimulation treatment, the practitioner 51 checks the condition of the patient 41, that the TMS device 8 is operating normally and magnetic stimulation is being performed, and that the coil section 82 is in the proper position (coil position overlapping the marker 97). The doctor 30 can monitor the condition of the patient 41 through the monitor section 34 of the doctor terminal 32 .

After the patient's head 43 is magnetically stimulated in a predetermined cycle, the energization of the coil section 82 is stopped, and the magnetic stimulation treatment is completed.

When an abnormality such as a convulsion is observed in the patient 41, the practitioner 51 reports the abnormality to the doctor 30 through voice communication, and the doctor 30 stops the magnetic stimulation operation of the TMS device 8 through the doctor terminal 32. . Moreover, the operator 51 may make the magnetic stimulation operation of the TMS device 8 stop urgently.

A treatment history performed on the patient 41 is transmitted from the TMS device 8 to the management server 60 . The management server 60 stores the rTMS treatment history information in association with the patient ID information. The patient ID information and the rTMS treatment history information may be stored in the device terminal 81 or the doctor terminal 32.

This completes the sequence of rTMS therapy actions. The rTMS treatment history information includes, for example, information on the clinic that received the treatment, information on the doctor in charge, information on the person in charge, treatment date/time information, treatment time information, treatment content information (magnetic irradiation position and magnetic stimulation intensity), and the like.

In addition to the rTMS treatment history information, the patient ID information is linked to the electroencephalogram measurement history and other treatment history (for example, the history of participation in the mental disorder recovery program, the history of antidepressant drug treatment, the history of mental state measurement, etc.). can be memorized. Accordingly, the doctor 30 can determine an appropriate treatment policy for each patient 41 by referring to each treatment history linked to the patient ID information, and comprehensive treatment for the patient 41 is possible.

Here, an example of the mental state measurement history is the measurement history using a device called a wave motion measurement device that measures the mental state from images of a patient captured by a camera. Such a wave measuring device obtains measurement results as mental state information. There is known a device (Mental-Checker, a product of ELESYS JAPAN Co., Ltd.) that visualizes the mental state by quantifying 10 emotions by analyzing physical movements and micro-vibrations.

Further, as shown in the timing charts of FIGS. 8 and 9, the authentication operation (for example, biometric authentication) of the doctor 30 using the authentication device 33 is performed immediately before the magnetic stimulation start information is transmitted from the doctor terminal 32 to the TMS device 8. I don't care if it happens. The authentication operation for the doctor 30 here may be performed by the doctor terminal 32, by the management server 60, or by the device terminal 81. FIG.

The doctor terminal 32 transmits the magnetic stimulation start information to the TMS device 8 after confirming the identity of the doctor 30 based on the determination result of the authentication device 33 . As a result, the magnetic stimulation start instruction by the doctor 30 himself is guaranteed, and the spoofing of the operator of the doctor terminal 32 after the communication between the TMS device 8 and the doctor terminal 32 is permitted can be prevented, and the safety can be improved.

Although the embodiments have been described above, the present invention is not limited to the above-described embodiments, and can be embodied in various aspects. The configuration of each part is not limited to the illustrated embodiment, and various modifications can be made without departing from the scope of the present invention.

For example, various methods can be used to display markers used for positioning the coil portion 82 of the TMS device 8 on the patient's head 43 . As an example, markers may be displayed on the patient's head 43 (or a cap that tightly covers the patient's head 43) by laser irradiation or direct drawing. In this case, the doctor 30 can refer to the patient's head 43 and markers displayed on the camera image screens 91 , 92 , 93 to instruct the practitioner 51 to position the coil section 82 .

It should be noted that, as in the above embodiment, the method of drawing alignment markers for the coil portion 82 such as the coil markers 97 on the camera image screens 91, 92, and 93 is a method of displaying the markers directly on the patient's head 43. Compared to , the burden on the patient 41 can be reduced, for example, laser light does not enter the eye.

Also, the coil marker 97 is not limited to the shapes shown in FIGS. The display form of the coil marker is not particularly limited as long as it is a display form that allows the operator 51 to accurately indicate.

Further, the transcranial magnetic stimulation system of the present invention may be configured without the management server 60 as long as the doctor terminal 32 and the TMS device 8 can communicate bidirectionally. In this case, authentication data such as biometric information (template) collected and registered in advance is stored in the doctor terminal 32 or the TMS device 8, and the doctor terminal 32 or the TMS device 8 stores the authentication data and the acquired data of the authentication device 33. It suffices to configure so as to perform collation with. Also, the patient ID information, the doctor ID information, the practitioner ID information, and the device ID information may be stored in the doctor terminal 32 or the TMS device 8 .

By the way, in order to properly implement repetitive transcranial magnetic stimulation therapy, as described above, it is necessary to have sufficient knowledge and experience regarding differential diagnosis and treatment procedures for depression, and knowledge of repetitive transcranial magnetic stimulation therapy. and preferably a doctor 30 who is skilled in the art.

On the other hand, the repetitive transcranial magnetic stimulation therapy for the patient 41 is preferably performed continuously, preferably every day, with short time intervals. Therefore, in order to allow continuous treatment without imposing a physical burden on the patient 41, it is ideal to allow treatment at home or at a nearby family doctor's office. is.

However, there is a problem that the doctor 30 has to go to the home of the patient 41 or a nearby doctor's office for each treatment, which increases the burden on the doctor 30 .

Therefore, the transcranial magnetic stimulation system of the present invention may be configured so that the doctor 30 can appropriately perform repetitive transcranial magnetic stimulation therapy without going to the patient 41 . For example, the facility where the TMS device 8 is installed and the patient 41 receives treatment may be located away from the facility where the doctor 30 operates the doctor terminal 32 .

Other embodiments of the transcranial magnetic stimulation system are described below with reference to FIGS. 10 and 11. FIG. In the description of this embodiment, the same reference numerals are given to the same constituent elements as those of the above-described embodiments.

In the transcranial magnetic stimulation system 100 of the present embodiment, even if the doctor 30 does not go to the installation place (facility 21) of the TMS device 8 from the hospital 31, which is the place of work and the doctor terminal 32 is installed, for example, The rTMS treatment can be properly performed by confirming the magnetic irradiation position on the patient's head 43 via the camera image and then operating the start of the magnetic stimulation by remote control.

As shown in FIGS. 10 and 11, in the present embodiment, the transcranial magnetic stimulation system 100 includes device terminals 81 of a plurality of facilities 21, doctor terminals 32 of a plurality of hospitals 31, and a management server 60. Data can be transmitted and received via the network 20 . In addition, patient terminals 42 of a plurality of patients 41 and practitioner terminals 52 of a plurality of practitioners 51 are connected to the communication network 20, and data can be transmitted and received to and from the management server 60. .

Note that the management server 60 may be installed in any one of the plurality of facilities 21 . In this case, in the facility 21 where the management server 60 is installed, data transmission and reception between the management server 60 and the device terminal 81 and the doctor terminal 32 may be performed by wire or wirelessly, and the communication network 20 It may be done through

Patient 41 is a recipient of rTMS therapy. The doctor 30 who operates the doctor terminal 32 is a doctor specializing in rTMS therapy, for example, a psychiatrist who is proficient in the knowledge and technique of rTMS therapy. In addition, the practitioner 51 is a person who operates the TMS device 8 at the facility 21, and is preferably a person who has received training on the operation method of the TMS device 8 and rTMS therapy. and medical staff such as clinical laboratory technologists. It should be noted that the practitioner 51 may be a person who is qualified as a medical doctor.

The terminals 32, 42, 52, and 81 are, for example, information terminal devices such as workstations, personal computers, smart phones, and tablet terminals. The communication network 20 is, for example, the Internet, and may be wired or wireless.

A facility 21 is a place where a patient 41 receives rTMS treatment, and a TMS device 8 is installed in each of the facilities 21 . The facility 21 is, for example, a medical institution such as a clinic, and preferably has a doctor other than the doctor 30 staying there. As a result, when an abnormality such as convulsion is found in the patient 41 during treatment, immediate treatment can be performed. The facility 21 where the TMS device 8 is installed may be a treatment facility where a doctor does not work full time, or the home of the patient 41 . In this case, it is preferable that a doctor other than the doctor 30 stays at the facility 21 to perform the treatment, and to prepare a system that can immediately treat the patient 41 when an abnormality is found during the treatment.

Also, the hospital 31 is an example of a place where the doctor 30 operates the doctor terminal 32 and the authentication device 33, and is not limited to the so-called hospital, and any place where the doctor 30 can operate the doctor terminal 32 and the authentication device 33 is acceptable. , for example, other medical institutions such as clinics.

2, the TMS device 8 installed in the facility 21 includes a device main body 80, a device terminal 81, a coil section 82, a camera section 83, a monitor section 84, a microphone section 85, and a speaker section. 86. On the other hand, a doctor's terminal 32 placed in a hospital 31 also includes an authentication device 33, a monitor section 34, a microphone and a speaker (not shown), as in the embodiment of FIG. The TMS device 8 and the doctor's terminal 32 are configured to be capable of two-way communication via the communication network 20 .

In this embodiment, the management server 60 is a server that manages patient ID information, doctor ID information, practitioner ID information, device ID information, and the like. are configured to allow communication between The patient 41 can reserve the date and time of treatment and the facility 21 (place of treatment) via the patient terminal 42 . In addition, the practitioner 51 can input the date and time when the worker can come to work and the place of work (facility 21) via the terminal 52 of the practitioner. Also, the doctor 30 can input the date and time when the patient can be treated via the doctor terminal 32 .

The management server 60 is configured to permit communication between the doctor terminal 32 and the device terminal 81 when the patient ID information, the doctor ID information, the practitioner ID information, and the device ID information registered in advance are combined. . As a result, treatment can be performed for each patient 41 in consideration of compatibility with the doctor 30, the practitioner 51, and the TMS device 8, so that the anxiety factor of the patient 41 can be reduced.

Also, for example, the management server 60 may limit the number of registered doctors 30 (for example, three) who can use (remotely control) one TMS device 8 . As a result, it is possible to permit the use of the TMS device 8 only by the doctor 30 who is familiar with the operation method and individual differences (device variations) of a certain TMS device 8, thereby improving the accuracy and safety of treatment.

The rTMS treatment procedure using the transcranial magnetic stimulation system 100 is similar to the treatment procedure of the above embodiment described with reference to FIGS. 1-9. However, in the transcranial magnetic stimulation system 100 , communication between the TMS device 8 (device terminal 81 ) and the doctor terminal 32 is performed via the communication network 20 .

According to the transcranial magnetic stimulation system 100 of the present embodiment, the doctor 30 does not need to go to the facility 21 where the treatment is performed for the patient 41, but through the camera image and voice communication with the practitioner 51, the TMS device rTMS treatment with 8 can be performed. In this embodiment as well, the TMS device 8 can be operated after the doctor 30 is authenticated using the authentication device 33, so that the safety of the rTMS treatment can be ensured.

8 TMS device (transcranial magnetic stimulator)
10 transcranial magnetic stimulation system 20 communication network 30 doctor 32 doctor terminal 33 authentication device 34 monitor unit (doctor terminal display unit)
41 patient 42 patient terminal 43 patient head 51 practitioner 52 practitioner terminal 60 management server 80 device body 81 device terminal (device communication unit)
82 Coil part 83 Camera part 84 Monitor part 85 Microphone part 86 Speaker part 91 Front camera image screen 92 Top camera image screen 93 Side camera image screen 94 Head position auxiliary line 95 Front-back center auxiliary line 96 Left-right center auxiliary line 97 Coil Marker 97a Scalp Position Marker 97b Outline Marker 97c Posture Marker 200 Clinic 201 Treatment Room 202 Office

Claims (5)

A transcranial magnetic stimulation system comprising a transcranial magnetic stimulation device having a coil unit that generates a magnetic field for applying magnetic stimulation to a specific site in the patient's head,
The transcranial magnetic stimulation device has a camera unit for imaging the coil unit positioned by a practitioner and the patient's head, and a device communication unit capable of communicating with a doctor terminal operated by a doctor,
The doctor terminal includes a doctor terminal display unit capable of displaying an image captured by the camera unit,
An authentication device for authenticating the identity of a doctor who operates the doctor terminal,
The coil unit is configured to be energized according to an instruction from the doctor terminal,
Transcranial magnetic stimulation system. The transcranial magnetic stimulation device and the doctor terminal are configured to enable two-way voice communication,
The transcranial magnetic stimulation system of claim 1. A coil marker used for alignment of the coil unit is displayed on the doctor terminal display unit, superimposed on the image captured by the camera unit.
The transcranial magnetic stimulation system according to claim 1 or 2. A management server that is connectable to at least one of the doctor terminal and the device communication unit and stores patient ID information, doctor ID information, practitioner ID information, and device ID information,
The management server stores the patient ID information in association with the magnetic stimulation treatment history by the transcranial magnetic stimulation device,
4. The transcranial magnetic stimulation system according to any one of claims 1-3. The management server associates the patient ID information with other treatment histories such as electroencephalogram measurement history, mental state measurement history, mental disorder recovery program attendance history, and antidepressant treatment history, and stores them.
The transcranial magnetic stimulation system according to claim 4.

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