JP3857710B2 - Surgery support system - Google Patents

Description

  The present invention relates to a surgical operation support system for performing navigation of operations (biopsy, catheter insertion, etc.) using real-time reconstruction by an X-ray tomography apparatus.

  A subject is fixed, and an insert such as a catheter or a puncture needle (hereinafter simply referred to as “insert”) is inserted into the subject, and the insert reaches a foreign substance such as a tumor existing in the subject. There is a surgical support system that guides the inserts. As this surgery support system, for example, there is a coordinate calculation system for CT guided stereotaxy, and according to this coordinate calculation system for CT guided stereotaxy, the presence in the subject is obtained by taking a tomographic image of the subject. The position of the foreign object to be measured is measured, and the insert can be inserted toward the position of the foreign object.

  In the coordinate calculation system for CT guided stereotaxy described above, the subject can be scanned when the position of the measured foreign substance is reached, and it can be confirmed that the insert has been correctly inserted. Furthermore, the subject can be scanned before the insert reaches the foreign object, and the positional relationship between the insert and the foreign object can be confirmed.

  However, the conventional CT-guided stereotaxic coordinate calculation system has a problem of low time resolution. That is, the conventional system has a low time resolution, so it is not possible to observe in real time whether the insert is in the correct position during manipulation of the insert. Furthermore, since there is a time lag between the current insertion position of the insert and the image taken by the tomography apparatus, strictly speaking, the insert is not necessarily inserted at the correct position.

  In addition, in the conventional coordinate calculation system for CT-guided stereotaxy, a projector that displays the slice position and slice width from the outside when obtaining a tomographic image of the subject is fixed, so the slice position and slice width are determined by the projector. However, if the tomography device is seen through while inserting the insert, the position of the insert cannot be confirmed from the outside by the projector. Only can be confirmed.

  In addition, when the direction of travel of the insert is close to the slice plane of the tomography apparatus, the tomogram is displayed on the cross section where the size of the foreign object is the largest, so that the insert is inserted. The progress of the insert in the subject cannot be observed.

  Although the above describes the CT guided stereotaxic coordinate calculation system, there is a similar problem in a system that takes a tomographic image of a subject and advances an insert such as a catheter according to the tomographic image.

  As described above, the conventional surgery support system has problems such as low time resolution and inability to observe how the insert proceeds in the subject.

  An object of the present invention is to provide a surgical operation support system that has a high time resolution and can easily confirm the progress of an insert, that is, the insertion state.

The invention according to an aspect of the present invention provides an insertion to be inserted into the subject by acquiring a tomographic image of the subject mounted on a couch top and displaying the tomographic image on a display unit in substantially real time. An operation support system having an X-ray tomography apparatus for displaying the progress of an object and navigating the insert, wherein the X-ray is equipped with the X-ray tomography apparatus. A pair of collimators provided between the X-ray tube and the subject to set an X-ray irradiation field; input means for moving only the one pair of collimators; and input to the input means And a control means for moving only one of the pair of collimators .

The invention according to another aspect of the present invention obtains a tomographic image of the subject which is mounted on the top of the bed, by displaying on the display unit the tomographic image in a substantially real-time, it is inserted into the inside of the subject A surgical support system having an X-ray tomography apparatus for displaying the progress of an insert and navigating the insert, and exposing the X-rays installed in the X-ray tomography apparatus A pair of collimators that are provided between the X-ray tube and the subject and set the X-ray irradiation field, and the pair of collimators is moved while keeping the width of the pair of collimators constant. And a control means for moving the pair of collimators while keeping the width of the pair of collimators constant based on the input to the input means .

  Since the X-ray tomography apparatus scans the subject while changing the slice width and slice position, the position of the insert can be easily confirmed on the image.

  As described above, according to the present invention, it is possible to improve the accuracy of the position setting of an insert such as a puncture needle and the progress of the insertion is observed in real time, so that the insert can be easily and safely advanced to the target site. Can be made. Further, when the CT value of a target site such as a tumor part can be increased with a contrast agent, for example, a change in the volume of the tumor part due to puncture can be confirmed in real time.

  According to the present invention, the accuracy of position setting of an insert such as a puncture needle can be increased, so that the insert can be easily and safely advanced to a target site.

  Embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a block diagram showing a schematic configuration of a surgery support system according to an embodiment of the present invention. In the following embodiments, a stereotaxic surgery support system will be described.

  The surgical operation support system of the present invention includes a central processing unit 10 that controls the overall operation of each unit, an input unit 20 that inputs an instruction from a user, a display unit 30 that displays a tomographic image of a subject, and the like. It consists of a gantry 40 (to be described later) and a bed 50 for fixing the subject. The bed 50 is provided with a localization brain support device 60 for fixing the head of the subject. The top plate 51 of the bed 50 can be driven in the direction of arrow A in the figure, and is inserted into the opening of the gantry 40 so as to obtain a desired tomographic image of the subject. The central processing unit 10 includes an image reconstruction unit, an image memory, and a storage device such as a hard disk or an optical disk (not shown).

  FIG. 2 is a diagram showing details of the gantry 40. 2A is a front view, and FIG. 2B is a 2B-2B sectional view of FIG. In FIG. 2, a gantry 40 includes an X-ray tube 41 that irradiates a subject with X-rays, a detector 42 that detects X-rays transmitted through the subject, a collimator 43 that sets an X-ray irradiation field, A projector 44 for displaying the tip of the insert with the sample inserted from the outside is mounted. There is an opening 45 at the center of the gantry, and the X-ray tube 41 and the like mounted on the gantry 40 can rotate while maintaining a relative position around the center point a of the opening 45 into which the subject is inserted. In addition, the tomographic image of the subject can be obtained by rotating the X-ray tube 41 and the like. Further, by rotating the detector or the like while moving the top plate 51, the subject can be scanned helically (helical scan), and tomographic images of the subject can be obtained continuously.

  The operation of the surgery support system of the present invention configured as described above will be described. A subject (not shown) is mounted on the top 51 and the head of the subject is fixed to the stereotaxic brain support device 60. The top plate to which the subject is fixed is driven in the direction of arrow A in the drawing, inserted into the gantry 40, and the subject is irradiated with X-rays from the X-ray tube 41. The X-ray irradiated from the X-ray tube 41 sets an irradiation field with a collimator and is irradiated to the subject. The X-rays that have passed through the subject are collimated by a collimator to remove scattered radiation, and input to the detector 42. The slice width and slice position of the subject by the X-ray tomography apparatus at this time can be confirmed from the outside by a projector 44 that can be driven in the same direction as the driving direction of the top board 51. The tomographic image of the subject thus obtained is displayed by the display unit 30.

  FIG. 3 is a diagram for explaining the first embodiment of the surgery support system of the present invention. FIG. 3 shows a case where the top plate 51 is moved to track the position of the insert 70. 3A shows the time when the insert 70 is inserted into the subject 52, and FIG. 3B shows the time when the insert 70 reaches the foreign object 53. FIG.

  In FIG. 3, the portion sandwiched between broken lines is the scan width, and the arrow indicates the scan direction (or body axis direction). While tracing from (a) to (b) in FIG. 3, the device of the present invention performs the following operation.

  The current scan position and scan width of the subject by the X-ray tomography apparatus are displayed on the body surface of the subject by the projector 44. In this case, when the surface detector is used, the top plate 51 is moved to change the reconstruction position of the tomographic image, and the projector 44 is moved in the moving direction of the subject or the collimator as necessary. The slice position is displayed on the body surface.

  As in the conventional case, the current scan position and slice width are displayed on the display unit 30 on a scan image, a side image of MPR (Multiple-Planar Reconstruction), or a top image. Further, the scanned image is displayed on the display unit 30.

  In addition to the above, the present invention has a function of displaying the coordinates of the tip of the insert 70 on the display unit 30 and displaying the distance between the insert 70 and the foreign object 53 on the display unit 30 as will be described later.

  Furthermore, it has the following functions as an alarm function. If the insert 70 is not correctly directed toward the foreign object 53, a warning is displayed by displaying a voice, a flash on the screen, and the like to notify the user. Conversely, when the insert approaches the foreign object 53, the user is notified of the distance between the insert 70 and the foreign object 53 by voice or the like.

  FIG. 4 is a flowchart for notifying the user (alarm function). The subject is scanned in advance to obtain a CT image in a desired range (step A1). The user designates a target and an allowable error Dp on the CT image (step A2).

  The central processing unit stores the target coordinates and allowable error specified in step A2 (step A3). When CT fluoroscopy is started (step A4), scanning is started, and the three-dimensional coordinates of the tip are obtained from the bed position and the position of the puncture needle on the image and stored (step A5).

  The straight line of the locus of the past tip is obtained by the least square method or the like, and the distance between the target and the straight line and the distance D between the target and the tip are obtained (step A6). The distance D between the target and the tip is displayed and spoken (step A7).

  It is determined whether the distance D between the target and the trajectory is within the allowable error range Dp (that is, D = <Dp) (step A8). If it is determined in step A8 that the distance between the target and the tip is within the allowable error range, the process returns to step A5, and scanning is continued. Thereafter, the operation from step A5 is continued.

  A warning is issued as described above. FIG. 5 is a diagram showing a modification of FIG. 3, the same parts as those in FIG. 3 are denoted by the same reference numerals, and detailed description thereof is omitted. 5A shows the time when the insert 70 is inserted into the subject 52, and FIG. 5B shows the time when the insert 70 reaches the foreign object 53.

  FIG. 3 is performed by moving the top plate 51 to track the tip of the insert 70. In the case of FIG. 5, the collimator 43 is moved to track the tip of the insert 70. Is going. In this case, since the collimator 43 is moved according to the movement of the tip of the insert 70, the subject 52 does not move unlike the case of FIG. Therefore, according to this embodiment, since the subject 52 does not move, the influence on the subject 52 is reduced and the influence on the operation is reduced as compared with the case where the top 51 is moved.

  As described above, in the first embodiment, since the tomographic image of the subject is displayed in real time, when the slice position is changed with high time resolution, the slice position is displayed on the body surface by the projector. Since the width can be grasped by the projector, the slice position and the slice width can be easily confirmed from the outside. In addition, the coordinates of the tip of the insert and the distance between the tip of the insert and the foreign object are displayed, and in addition, a warning is issued whether the insert is correctly proceeding to the foreign object. The state and the position in the subject can be easily confirmed, and the insert can be correctly inserted.

FIG. 6 is a diagram for explaining a second embodiment of the surgery support system of the present invention. 6, the same reference numerals are given to the same parts as in FIG. 5, a detailed description thereof will be omitted. 6A is a diagram showing a case where the insert 70 is inserted into the subject 52, FIG. 6B is a diagram showing a case where the slice width is widened in the state of FIG. 6A, and FIG. The figure which shows a mode that the insert 70 arrived at the foreign material 53, (d) is a figure which shows the case where it is confirmed whether the insert 70 has penetrated from the foreign material 53. FIG.

  FIG. 6A is the same as FIG. 5A, and here, the tip of the insert 70 is captured by the movement of the collimator 43 or the movement of the top plate 51. The distance and direction from the pre-marked foreign object 53 are measured, and it is checked whether or not the correct position is reached when the insert 70 advances as it is. If the result of the check is dangerous, a warning is given. If so, the insert 70 is advanced as it is.

  Next, as shown in FIG. 6B, the slice width is appropriately increased to know that the insert 70 has approached the target. Then, while the slice width is changed as shown in FIGS. 6A and 6B, when the insert 70 reaches the foreign object 53 as shown in FIG. 6C, the slice width is narrowed. Then, it is confirmed that the tip of the insert 70 is in the correct position in the foreign object 53.

  Furthermore, as shown in FIG. 6D, it is confirmed that the insert 70 does not penetrate the foreign object 53 by moving the scan position or widening the slice width as necessary. In this case, it is desirable to move the slice position in the vicinity of the foreign object 53 only by moving the collimator 43 as much as possible so as not to move the bed.

  During the tracking as described above, the following operation is performed in the same manner as in the first embodiment. The current scan position and scan width of the subject by the X-ray tomography apparatus are displayed on the body surface of the subject by the projector 44. That is, according to the scan position and the scan width, for example, in the case of FIG. 6B, the scan position and the scan width are displayed by the projector 44 so that the display width by the projector 44 is widened. In this case, when the surface detector is used, the top plate 51 is moved to change the reconstruction position of the tomographic image, and the projector 44 is moved in the moving direction of the subject or the collimator as necessary. The slice position is displayed on the body surface.

  As in the conventional case, the current scan position and slice width are displayed on the display unit 30 on a scan image, a side image of MPR (Multiple-Planar Reconstruction), or a top image. Further, the scanned image is displayed on the display unit 30.

  In addition to the above, the present invention has a function of displaying the coordinates of the tip of the insert 70 on the display unit 30 and displaying the distance between the insert 70 and the foreign object 53 on the display unit 30. Furthermore, it has the following functions as an alarm function.

  If the insert 70 is not correctly directed toward the foreign object 53, a warning is displayed by displaying a voice, a flash on the screen, and the like to notify the user. Conversely, when the insert approaches the foreign object 53, the user is notified of the distance between the insert 70 and the foreign object 53 by voice or the like.

  As described above, according to the second embodiment of the present invention, the same effect as in the first embodiment can be obtained. In addition, since the slice width is variable in the second embodiment, the positional relationship between the tip of the insert 70 and the foreign object 53 can be grasped more clearly by setting an arbitrary slice width. In addition, since the change in slice width can be displayed outside the subject by displaying the projector, the slice width can be easily confirmed in addition to the current slice position.

  FIG. 7 is a diagram illustrating an example of a control panel that controls movement of the collimator in the second embodiment. In FIG. 7, the control panel 22 is provided with four types of switches, (a) and (b) are switches for moving the left and right collimators 43 independently, and (a) is the left collimator. 43 is a switch for moving the collimator 43 on the right side. (C) is a switch for changing the slice position without changing the width of the collimator 43 (that is, making the slice width constant). (D) is a switch for changing the slice width without changing the slice position.

  In the above configuration, the procedure for tracking the insert will be described with reference to FIGS. FIG. 8 is a flowchart showing the procedure for tracking an insert. FIG. 9 is a diagram showing how the actual insert is tracked.

  As shown in FIG. 9A, the position of the foreign matter and the initial movement direction of the insert are designated (step B1). In this case, when the position of the foreign object and the insert are marked on the reconstructed image, the CPU stores the position of the foreign object, the current position of the insert, and the CT value. The initial movement direction of the insert may be a direction in which the insert advances toward the inside of the subject.

  The slice position is moved in the moving direction of the insert designated in step B1 (step B2, FIG. 9B). In this case, the movement in the slice direction is performed by moving either the bed or the collimator.

  If there is an insert in the reconstructed image (step B3), as shown in FIG. 9C, the slice position is further moved in the same direction (step B2). In step B3, when there is no insert in the reconstructed image, as shown in FIG. 9D, it is determined that the slice position has moved too much, and moves in the reverse direction until the insert is found (step B4).

  Thereafter, if the insert proceeds in the traveling direction, the slice position is moved in the initial movement direction. If the insert proceeds in the direction opposite to the traveling direction, the slice position is moved in the direction opposite to the initial movement direction.

  FIG. 10 shows an example of an image displayed on the display unit 30 when the insert 70 is actually tracked according to the present invention. In FIG. 10, (a) is an operation plan screen, and (b) to (c) are screens during operation.

  First, for example, a tomographic image of a subject is obtained by a helical scan, a foreign object 53 is specified from the tomographic image, and the position of the specified foreign object 53 is shown as a tomographic image of the object 52 as shown in FIG. Display (mark) inside. Simultaneously with the display, the coordinates of the center position of the foreign object 53 are also displayed. In addition, the stereotaxic brain support device 60 is displayed on both sides of the subject in FIG.

  In FIG. 10B, the slice width and the slice position by the X-ray tomography apparatus in operation are displayed as appropriate. When the insert 70 is inserted, as shown in FIG. 10C, the distance between the foreign object 53 and the tip of the insert 70 and the coordinates of the tip of the insert 70 are displayed, as shown in FIG. In addition, the position of the tip of the insert 70 is displayed in the sectional view. In this case, the display of the insert 70 in FIG. 10C is made from a scanned image, or by calculating from the coordinates of the tip of the insert 70 and combining and displaying the line segment.

  In the above display, when the needle moves to a dangerous direction or position, the operator is notified by voice, a warning message, a screen flash or the like as in the previous embodiment. When normal, the back of the screen can be blue, when abnormal, red (more effective when flashing), etc. In that case, it is not necessary for the operator to look at the screen, the screen is the visual field of the operator If it is in, you can inform the status of the screen.

  FIG. 11 is a diagram illustrating a method for obtaining the coordinates of the tip of the insert 70. 11A is a schematic diagram when the insert 70 is advanced with respect to the foreign object 53 in the subject 52, and FIG. 11B is a diagram illustrating an example of a trace screen of the insert 70. c) is a diagram schematically showing the movement of the insert 70 from the mark position of the insert 70 to the foreign object 53. FIG.

  First, as shown in FIG. 11A, an insert 70 whose direction is specified in advance with respect to a foreign substance 53 such as a tumor is inserted into a subject. The predetermined position of the insert 70 is set to 0, and the position of the foreign object 53 is set to 40.

  Then, as shown in FIGS. 11 (b-1) and 11 (c-1), the insert 70 at a predetermined position is marked. When the scan is started, as shown in FIG. 11C-2, the marked object (in this case, the insert 70) is searched for the designated direction. If the insert 70 is not found, the part to be scanned is moved in the direction opposite to the designated direction. When the insert 70 is found, tracing of the insert 70 is started.

  As shown in FIG. 11 (b-2), tracing is performed in real time, and finally, the insert 70 reaches the foreign object 53 as shown in FIGS. 11 (b-3) and 11 (c-3). At that point, the trace ends.

  As described above, according to the present embodiment, since the coordinates of the tip of the insert can be obtained accurately, the progress of the insert can be easily monitored. FIG. 12 is a diagram illustrating another method for acquiring the coordinates of the tip of the insert 70.

  According to FIG. 12, a position detecting device (not shown) is attached to the stereotaxic brain support device 60, and a part of the insert 70 is fixed by the fixing tool 62 so as to be movable in the traveling direction of the insert. The coordinates of the tip of the insert 70 are obtained using the insert 70. Also according to this embodiment, an accurate position coordinate of the tip of the insert 70 can be obtained as in the previous embodiment.

  In the above embodiment, since the tomographic image of the subject is displayed in a cross section, the insert inserted into the subject can be confirmed only with a point. FIG. 13 is a diagram illustrating an example in which the state of movement of the insert is displayed by the MPR image.

  As shown in FIG. 13, in the present embodiment, the movement history of the insert inserted across the subject can be visually confirmed by displaying it as an MPR image. In this case, the MPR image is replaced with the image of that portion based on the data obtained by the latest scan. As a result, the latest image information is always displayed.

  The MPR image may be a three-dimensional image. Furthermore, as shown in FIG. 14, a desired tomographic image may be displayed as a main image, and an MPR image or a three-dimensional image may be displayed, for example, at the lower right to display the state of insertion.

  The present invention is not limited to the above embodiment. For example, the scan of the subject by the X-ray tomographic imaging apparatus may be made to obtain many tomographic images at once (volume scan) using a surface detector.

  In FIGS. 13 and 14, the display examples are MPR images, but three-dimensional stereoscopic image display may be used. In the above embodiment, the insert to be inserted into the subject has been described as a puncture needle or a catheter. However, the present invention monitors the progress of the contrast agent when the contrast agent is injected into the subject, for example. It is also applicable to.

  In the above embodiment, the tomographic imaging apparatus has been described as an X-ray tomographic imaging apparatus. However, the present invention is not limited to this, and any configuration that can obtain a tomographic image may be used. Furthermore, in the above-described embodiment, for example, when a foreign substance can be displayed with a high contrast value using a contrast medium or the like, for example, a change in the volume of the tumor site due to puncture can be confirmed in real time, and the operability is further increased. Of course, various modifications can be made without departing from the scope of the present invention.

  The present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the invention at the stage of implementation. Further, the above embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements.

  In addition, for example, even if some structural requirements are deleted from all the structural requirements shown in each embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the effect of the invention Can be obtained as an invention.

The block diagram which shows schematic structure of the surgery assistance system which concerns on one Embodiment of this invention. The figure which shows the detail of a mount frame. The figure for demonstrating 1st Embodiment of the surgery assistance system of this invention. The flowchart which performs alerting | reporting to a user. The figure which shows the modification of FIG. The figure for demonstrating 2nd Embodiment of the surgery assistance system of this invention. The figure which shows an example of the control panel which controls movement of a collimator in 2nd Embodiment. The flowchart which shows the procedure in the case of tracking an insert. The figure which shows a mode that the actual insert is tracked. The example of an image displayed on the display part in the case of actually tracking an insert by this invention. The figure explaining the method of acquiring the coordinate of the front-end | tip of an insert. The figure which shows the other method of acquiring the coordinate of the front-end | tip of an insert. The figure which shows the example which displays a mode that an insertion object moves with a MPR image. The figure which shows the example which displayed the MPR image on a part of display of a tomogram.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 10 ... Central processing unit, 20 ... Input part, 22 ... Control panel, 30 ... Display part, 40 ... Mount, 41 ... X-ray tube, 42 ... Detector, 43 ... Collimator, 44 ... Floodlight, 45 ... Opening part, 50 ... Bed, 51 ... Top plate, 52 ... Subject, 53 ... Foreign object, 60 ... Localization brain support apparatus, 62 ... Fixing tool, 70 ... Insert.

Claims (2)

Get the object tomogram mounted on top of the bed, by displaying on the display unit the tomographic image in a substantially real time, wherein the displaying the progress of the insert to be inserted into a subject In a surgery support system having an X-ray tomography apparatus for navigation of an insert,
A pair of collimators provided between the X-ray tube for irradiating X-rays equipped in the X-ray tomography apparatus and the subject, and for setting an X-ray irradiation field;
Input means for moving only one pair of collimators ;
And a control means for moving only one of the pair of collimators based on an input to the input means . By acquiring a tomographic image of the subject mounted on the couch top and displaying the tomographic image on the display unit in substantially real time, the progress of the insert inserted into the subject can be determined. In a surgical support system having an X-ray tomography apparatus for displaying the situation and navigating the insert,
A pair of collimators provided between the X-ray tube for irradiating X-rays equipped in the X-ray tomography apparatus and the subject, and for setting an X-ray irradiation field;
Input means for moving the pair of collimators while keeping the width of the pair of collimators constant ;
And a control means for moving the pair of collimators based on an input to the input means while keeping a width of the pair of collimators constant .

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