JP3217593B2 - Surgical instrument position display device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention is called a surgical navigation apparatus, and is used when a surgical instrument such as a suction tube is inserted into a subject for a surgical operation or a biological sample collection.
A device for displaying the position of the surgical instrument in the subject, in particular, an X-ray CT image, an MRI image collected before the operation,
Alternatively, the present invention relates to a surgical instrument display device for displaying the position of a surgical instrument on an X-ray fluoroscopic image.

[0002]

2. Description of the Related Art MRI images and X-ray CT collected in advance
Examples of a surgical instrument position display device that superimposes and displays the position of a surgical instrument on an image or an X-ray fluoroscopic image include NEU
RO-NAVIGATOR (“Three Dimensional Digitizer (Neuro
navigator): New Equipment Computed Tomography-Guid
ed Stereotaxic Surgery '': E. Watanabe et al .: SurgN
eurol 1987: 27: p543-p547), "Medical three-dimensional stereotactic apparatus" (Japanese Patent Laid-Open No. 03-106359), Stereotactic brain surgery support apparatus using NEURO-SAT, "Localized brain surgery support apparatus" (Japanese Patent Laid-open No. 03-267)
054) and CANS-NAVIGATOR, “3D position display device in the body” (Japanese Patent Laid-Open No. 03-284253) and the like.

In these conventional surgical instrument position display devices, a means for accurately detecting the position of the surgical instrument and a means for displaying the detected position of the surgical instrument are devised so that the position of the surgical instrument can be accurately and accurately determined. Is simply displayed on the tomographic image.

Further, there has been proposed a position display device of a surgical instrument having a function of examining a surgical path or the like using a tomographic image of a subject before an operation.

[0005]

In surgery, particularly brain surgery, it is essential to remove only the affected part while minimizing the effect on normal brain functions and structures.

For this purpose, it is necessary to know the position of a cautionary structure such as a nerve or a blood vessel of a subject (surgical patient) from a tomographic image or the like collected in advance before the operation, and to determine a surgical procedure or the like based on the position. is there.

According to the conventional position display apparatus for surgical instruments, the position of the surgical instrument during the operation is displayed on the tomographic image, but the position of the cautionary structure or the grasp thereof is stored in the memory of the operator (surgeon). I have to rely on it.

Although a position display device of a surgical instrument having a function of examining an operation route and the like is useful for examining and determining an operation method and the like prior to an operation, this function is used to determine the result of the operation. It is not directly available inside, and the position of the attention structure and its grasp must rely on the operator's memory.

Since the positions of the cautionary structures are usually not one but many and different for each subject, memorizing those positions imposes a great mental burden on the operator. And disturb the operator's concentration.

SUMMARY OF THE INVENTION The present invention has been made in view of the above, and provides a surgical instrument position display device that can notify an operator that a surgical instrument has approached a cautionary structure during an operation. The purpose is to do.

[0011]

Means for Solving the Problems The present invention has the following configuration to achieve the above object.

In other words, the position display device of the surgical instrument according to the present invention superimposes the position of the surgical instrument inserted into the subject during the operation on the tomographic image of the region of interest of the subject which has been collected in advance. A position display device for a surgical instrument to be displayed together, wherein a cautionary structure position specifying means for specifying a position of a cautionary structure requiring attention on the collected tomographic image; Attention structure position storage means for storing the position of the attention structure, and the position of the surgical instrument detected by the surgical instrument position detection means coincides with the position information of the attention structure stored in the attention structure position storage means. A position monitoring unit that monitors whether the operation is to be performed and outputs a warning signal, and a warning unit that is activated by an output signal of the position monitoring unit.

[0013]

The operation of the present invention is as follows.

The attention structure position designation means designates the position (coordinates) of the attention structure on the tomographic image for each region of interest of the subject stored in the image storage means, and designates the position of the designated attention structure (Coordinates) are stored in the attention structure position storage means.

The position monitoring means monitors the positions of the surgical instruments sequentially detected by the position detecting means and the positions of the attention structures stored in the attention structure position storage means. When the position of the structure approaches a predetermined range, the warning means is activated.

The warning means appeals to the operator's hearing, such as a speaker, or a visual display of a warning message on a display means on which a pattern indicating the position of the surgical instrument is displayed together with the tomographic image. Thus, the surgeon can perceive that the surgical instrument approaches or is located at the attention structure.

[0017]

Embodiments of the present invention will be described below with reference to the drawings.

FIG. 1 is a diagram showing a schematic configuration of an embodiment of a position display device for a surgical instrument according to the present invention.

In FIG. 1, reference numeral 1 denotes an operating table on which a subject M is placed. Reference numeral 2 denotes a surgical instrument inserted into the subject M by the operator during the operation. On the operating table 1,
A magnetic source 3a that generates a magnetic field in each of three-dimensional directions
However, they are arranged so that the relative positional relationship with the subject M does not change. The magnetic source 3a may be attached and fixed to the subject M itself. A magnetic sensor 3b for detecting a three-dimensional magnetic field generated from a magnetic source 3a is attached to a rear end of the surgical instrument 2. As shown in FIG. 2, the magnetic source 3a includes three coils 3ax, 3ay, 3az that generate magnetic fields in three-dimensional directions X, Y, and Z, respectively. The magnetic source 3a is connected to the drive circuit 4 and generates a three-dimensional magnetic field H by receiving an alternating current from the drive circuit 4. Similarly, the magnetic sensor 3b also includes three coils 3bx, 3by, and 3bz orthogonal to each other. The magnetic sensor 3b is connected to the detection circuit 5. The detection circuit 5 includes three coils 3bx,
a, amplifies the detection signal from 3bz, and outputs position data converted into an appropriate digital signal. Magnetic source 3
a, the magnetic sensor 3b, the drive circuit 4, the detection circuit 5, and the position calculation unit 7, which will be described later, correspond to a position detection unit in the present invention.

The image processing computer 6 includes the surgical instrument 2
Position detection, position detection of the tip, selection of an image according to the detected position, synthesis of the pattern of the surgical instrument 2 on the selected image, attention structure designated by the attention structure position designation unit The position of the surgical instrument, and to monitor whether the surgical instrument position exists at the position of the cautionary structure,
The internal configuration is roughly classified into functions, and includes a position calculation unit 7, a position information conversion unit 8, a conversion value calculation unit 9, an image selection unit 10, an image synthesis unit 11, a cautionary structure position memory 12, and a position monitoring unit 13. .

The position calculator 7 calculates the three-dimensional position and direction of the magnetic sensor 3b based on the position data from the detection circuit 5. Furthermore, in consideration of the size of the surgical instrument 2 given in advance as data, the three-dimensional position and direction of the distal end of the surgical instrument 2 are finally obtained. A method for calculating the real space coordinates and the direction of the magnetic sensor 3b using the magnetic source 3a and the magnetic sensor 3b described above is known, for example, from Japanese Patent Application Laid-Open No. 3-267054, and therefore the description thereof is omitted here. I do.

The conversion value calculation unit 9 converts the position information consisting of the coordinates / direction of the magnetic sensor 3b calculated in the real space calculated by the position calculation unit 7 from the size and shape of the surgical instrument 2 to the conversion position information including the position of the tip. The conversion value for converting into is stored in advance. The position information conversion unit 8 uses the conversion value in the conversion value calculation unit 9 to convert the position information from the position calculation unit 7 into position information on an image.

The image selecting section 10 selects required tomographic image data from the image memory 14 based on the position information of the distal end of the surgical instrument 2 provided from the position information converting section 8. It corresponds to a selection means.
The image memory 14 stores image data of a tomographic image for each region of interest in the region of interest of the subject M, and corresponds to image storage means in the present invention.

The image synthesizing unit 11 superimposes a predetermined pattern indicating the position of the surgical instrument 2 on the position selected by the position information converting unit 8 on the image selected by the image selecting unit 10. Corresponds to the image synthesizing means in the present invention. The image synthesized by the image synthesizing unit 11 is provided to a monitor 15 corresponding to a display unit in the present invention.

The attention structure position memory 12 stores the position (coordinates) of the attention structure designated by the attention structure position designation unit 16 such as a mouse, and corresponds to the attention structure position storage means in the present invention. And cautionary structure position designation unit 1
Reference numeral 6 corresponds to a cautionary structure position specifying means in the present invention.

The position monitoring unit 13 compares the position of the distal end of the surgical instrument 2 provided from the position information conversion unit 8 with the position of the cautionary structure stored in the cautionary structure position memory 12 to compare the surgical instrument 2 with the cautionary structure. Is constantly monitored, and a warning signal is issued when the surgical instrument 2 approaches or locates the cautionary structure, and corresponds to the position monitoring means of the present invention.

In this embodiment, the audio unit 17 emits a sound or a sound by a warning signal of the position monitoring unit 13 by a speaker in this embodiment, and corresponds to a warning unit of the present invention.

In order to display the position of the surgical instrument 2 in the apparatus having the above configuration, before operating the apparatus, a tomographic image is collected and stored in the image memory 14 and the position of the attention structure is stored in the attention structure position memory 12. You need to remember it.

The acquisition of tomographic images stored in the image memory 14 will be described with reference to FIG. As shown in FIG. 3 (a), markers P ₁ are placed at four places on the body surface near the site of interest (in this example, the head) of the subject M placed on the operating table ₁ .
P _2, paste P _3, P _4, a plurality of slice planes S ₁ to S _n each marker a cross-sectional image of _{P 1, P 2, P 3} , P 4 with X-ray CT apparatus in the area including the area of interest , MRI
Photograph with a device. A schematic view of the thus tomogram I ₁ ~I _n obtained is shown in FIG. 3 (b). These tomographic images I ₁ ~I _n and markers _{P 1, P 2, P 3} , P
_4, the position is defined by a unique spatial coordinates of the X-ray CT apparatus used in photographing (CT coordinate system). The tomographic image I ₁ ~I _n and markers _{P 1, P 2, P 3} ,
CT coordinate system P ₄ is stored in the image memory 13.

The position of the cautionary structure is designated and the position memory 1
2 is stored in the cautionary structure position specifying unit 16. The image collected and stored in the image memory 14 by the attention structure position specifying unit 16 is read out and displayed on the monitor 15, and the position on the image of the attention structure such as a blood vessel or nerve that needs to be handled carefully during the operation is indicated by a mouse. The coordinates on the image are stored in the attention structure part position memory 12. At this time, the coordinates (CT coordinate system) of the marker appearing in any of the plurality of images are also stored. In addition,
A and B in FIG. 3 (b) show a cautionary structure.

The image data collected and stored in the image memory 14 is represented by the spatial coordinates (CT coordinate system) unique to an apparatus that has performed tomography such as an X-ray CT apparatus. It is necessary to perform correspondence between the space coordinates and the real space coordinates of the position display device of the surgical instrument (a coordinate system based on the position detecting means of the surgical instrument), that is, so-called calibration immediately before the operation.

The calibration is performed for each marker P ₁ ,
The position of P ₂ , P ₃ , and P _{4 in} the real space is measured by using the magnetic source 3a and the magnetic sensor 3b described with reference to FIG.

That is, the subject M is fixed to the operating table 1 together with the magnetic source 3a, and the tip of the calibration probe, to which the magnetic sensor 3b is attached and whose tip position can be detected, is attached to each marker P on the subject M. _1, P _2, P
_3, are sequentially contacted with P _4. Each marker position is calculated as a respective three-dimensional position coordinate in the real space from a relative position with respect to the magnetic source 3a through the detection circuit 5.

All the markers P ₁ , P
The coordinates in the real space of ₂ , P ₃ , and P ₄ are respectively associated with the coordinates of the same marker on the image obtained earlier, and are used for three-dimensional affine transformation from the position in the real space to the position on the image. The conversion value is calculated by the conversion value calculation unit 9, and the conversion value is stored in the position information conversion unit 8.

As described above, when the collection of the tomographic image, the designation of the position of the cautionary structure and its storage, and the correspondence (calibration) between the position on the image and the position in the real space are completed,
Move to surgery.

In the operation, a surgical instrument 2 such as a suction tube to which the magnetic sensor 3b is fixed and whose tip coordinates can be calculated is inserted into a site of interest (in the body) of the subject M. An alternating current is sent from a drive circuit to the magnetic source 3a whose position is fixed with respect to the subject M, and a magnetic field is generated in a three-dimensional direction by a coil inside the magnetic source 3a. The detection circuit 5 calculates the position of the magnetic sensor 3b from the alternating current, and the position calculation unit 7 sequentially obtains the coordinates of the tip of the surgical instrument 2 in the real space.

The coordinates of the tip of the surgical instrument 2 in the real space are converted into coordinates on a tomographic image by the position information converter 8.
The image selection unit 10 selects and extracts a tomographic image corresponding to the coordinates on the converted tomographic image from the image memory 14.
The selected image is sent to the image synthesizing unit 11.

The image synthesizing section 11 superimposes a predetermined pattern indicating the position of the surgical instrument 2 on the coordinate position converted by the position information converting section 8 on the selected tomographic image, and displays the synthesized image on the monitor 15. Output to By sequentially executing the above processing in real time, an image representing the current position of the surgical instrument 2 detected by the position calculator 7 on the selected image in a predetermined pattern is sequentially displayed on the monitor 15.
The surgeon can perform the operation while checking the position of the surgical instrument 2.

In parallel with this operation, the position monitor 13 monitors in real time whether the tip of the surgical instrument 2 approaches or is located at the position of the cautionary structure. FIG. 4 shows the position monitoring unit 1
6 is a flowchart showing the operation of No. 3;

The position calculator 7 calculates the coordinates of the distal end of the surgical instrument 2 in the real space every time (step S ₁ ), and the position information converter 8 converts the coordinates into coordinates on a tomographic image (step S ₂ ). The coordinates on the tomographic image of the distal end of the sent surgical instrument 2, which is the positional information of the sent surgical instrument 2, are immediately compared with the coordinates on the image of the attention structure stored in the attention structure position memory 12 (step). S _3, S _4).

This comparison is performed by the position monitoring unit 13. If the coordinates of the distal end of the surgical instrument in the real space do not exist within a sphere having a radius of 5 mm, which is the center of the coordinates of the cautionary structure, no instruction is given. returns to the step S ₁ without an, following the surgical instrument 2
And the same operation is repeated. If the coordinates of the distal end of the surgical instrument in the real space are within a sphere having a radius of 5 mm centering on the coordinates of the cautionary structure A (step S ₃ ), the sound unit 17 is operated, and no warning sound is given.
Warning Messeiji the monitor 15 together to generate a warning Messeiji Show (Step S _5). Thus, the surgeon can know that the tip of the surgical instrument is located within a sphere having a radius of 5 mm at the coordinates (position) of the cautionary structure A. When the procedure is performed on the cautionary structure A and the tip of the surgical instrument approaches the position of the next cautionary structure B and exists within a sphere having a radius of 5 mm centered on the coordinates thereof (step S ₄ ), the audio unit 16
It is operated to display a warning Messeiji the monitor 15 causes a warning sound is generated to alert Messeiji therefrom (Step S _6).

This operation is performed for all the attention structures stored in the attention structure position memory 12.

Therefore, the surgeon can know in real time during the operation that the tip of the surgical instrument has approached the cautionary structure designated by the cautionary structure position designation section 16 before the operation.

[0044]

[Modified embodiment]

1) In the embodiment, the image photographed by the X-ray CT apparatus is directly stored in the image memory. However, the film of the tomographic image photographed by the X-ray CT apparatus or the like is read by a film reader or the like and stored in the image memory. Alternatively, the information may be read from a recording medium such as a magneto-optical disk and stored in an image memory.

2) In the embodiment, a warning sound and a warning message are issued when the tip of the surgical instrument is located within a sphere having a radius of 5 mm centered on the attention structure coordinate. If included, it may be in any range of any shape.

The shape and range may be changed before or during the operation. Further, the type of the warning sound and the content of the warning message may be changed according to the range centered on the attention structure coordinate.

In this way, the surgeon can know how close the tip of the surgical instrument is to the cautionary structure.

It is also possible to emit a warning sound or a warning message while the tip of the surgical instrument is within a predetermined range centered on the attention structure coordinate.

3) When designating a cautionary structure, the site names of the cautionary structure such as "internal carotid artery" and "optic nerve" are also input and stored together with their coordinate values, and the site name is warned. Good.

In this way, the surgeon can know which cautionary structure the tip of the surgical instrument has approached.

4) In the embodiment, the position of the cautionary structure is stored in the cautionary structure position before the calibration, but this procedure may be reversed.

5) In the embodiment, the calibration probe is used at the time of calibration, but the surgical instrument 2 may be shared for calibration.

In this way, it is possible to save the trouble of replacing the magnetic sensor according to the instrument to be used, thereby reducing the burden on the operator.

6) In the embodiment, the positions of the surgical instrument 2 and the calibration probe are detected using the magnetic source 3a and the magnetic sensor 3b. However, the present invention is not limited to this. Or by attaching the calibration probe to the tip of the multi-joint arm and detecting the angle of the arm at each joint,
You may comprise so that the position of the surgical instrument 2 or a calibration probe may be detected. With such a configuration, it is possible to use an instrument composed of a magnetic substance or a conductor that disturbs the magnetic field formed by the magnetic source 3a.

[0055]

As is apparent from the above, according to the present invention, when the surgical instrument approaches a cautionary structure such as a nerve or a main blood vessel, the surgeon is notified by a warning sound or the like. Regardless of the difference in the attention structures due to the difference in the distance, the surgeon can know that the surgical instrument has approached the attention structure, so it is necessary to memorize all the positions of the attention structures for each subject. Disappears.

Therefore, the mental burden on the operator is remarkably reduced, and the operator can concentrate on the operation.

Further, since it is possible to easily know whether or not there is a structure to be noted behind a visually obstructive object such as a bone, there is no possibility of a serious medical error.

[Brief description of the drawings]

FIG. 1 is a diagram showing a schematic configuration of a position display device on a surgical instrument according to an embodiment.

FIG. 2 is an explanatory diagram of a magnetic source and a magnetic sensor.

FIG. 3 is a diagram provided to explain collection of a tomographic image.

FIG. 4 is a flowchart showing the operation of the position monitoring means of FIG.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Operating table 2 ... Surgical instrument 3a ... Magnetic source 3b ... Magnetic sensor 4 ... Drive circuit 5 ... Detection circuit 6 ... Image processing computer 7 ... Position calculation part 8 ... Position information conversion part 9 ... Conversion value calculation part 10 ... Image selection Unit 11 Image synthesis unit 12 Attention structure position memory 13 Position monitoring unit 14 Image memory 15 Monitor 16 Attention structure position designation unit 17 Voice unit

──────────────────────────────────────────────────続 き Continued on the front page (72) Inventor Tohru Hayakawa 1-2-2 Mikage Yamate, Higashinada-ku, Kobe City, Hyogo Prefecture (72) Inventor Toshiki Yoshimine 3-7 Takezonocho, Ashiya City, Hyogo Prefecture (72) Inventor Amami Kato 9-20 Uenocho, Ibaraki-shi, Osaka (72) Inventor Shoichi Okamura 1 Nishinokyo-kuwabaracho, Nakagyo-ku, Kyoto Shimazu Works Sanjo Plant (72) Inventor Takeshi Okumura 1 Nishinokyo-Kuwaharacho, Nakagyo-ku, Kyoto Shimazu Works In the Sanjo Plant (56) References JP-A-63-294835 (JP, A) JP-A-5-123327 (JP, A) JP-A-5-300910 (JP, A) Table 8-509393 (JP, A) A) Tokio Hei 2-500410 (JP, A) Tokio Hei 5-500911 (JP, A) Tokio Table 2-503519 (JP, A) (58) Fields surveyed (Int. Cl. ⁷ , DB name) ) A61B 17/00-18/28 A 61B 19/00

Claims (1)

(57) [Claims] An image storage means for storing image data for each region of interest of a subject, a position detection means for sequentially detecting the position of a surgical instrument, and the image storage means based on position information from the position detection means. An image selecting means for sequentially selecting image data from, and a position on the image selected by the image selecting means, detected by the position detecting means,
In a surgical instrument position display device comprising: an image synthesizing unit that superimposes a predetermined pattern indicating a position of a surgical instrument; and a display unit that displays an image synthesized by the image synthesizing unit, the position is stored in the image storage unit. Attention structure position designation means for designating a structure requiring attention on the selected image, attention structure position storage means for storing position information of the designated attention structure, and an operation detected by the position detection means Position monitoring means for monitoring whether the position of the appliance matches the position information of the cautionary structure stored in the cautionary structure position storage means and outputting a warning signal; and operating with a warning signal from the position monitoring means. And a warning means for performing the operation.