JP3914199B2 - Ultrasonic therapy device - Google Patents

Description

  The present invention relates to an ultrasonic therapy apparatus for performing treatment by intensively irradiating intense ultrasonic waves from outside or inside a body cavity under the guidance of an MRI apparatus (magnetic resonance imaging apparatus).

  In recent years, a stone crushing apparatus that irradiates powerful ultrasound from outside the body and crushes stones non-invasively for the treatment of calculus has been put into practical use and has attracted attention. Further, hyperthermia that heats the affected area to 42.5 ° C. or higher, and heat treatment that causes heat denaturation by raising the affected area to 42.5 ° C. or higher have attracted attention as methods for treating tumors. As described in Japanese Patent Application No. 3-306106 and Japanese Patent Application No. 3-306106, intense ultrasonic waves generated outside the body are focused on the treatment site in the body, and the cancer is heated by heat generated by absorption of the ultrasonic energy of the tissue.・ Devices for heat treatment have been developed. In addition, treatments that irradiate cancer with a powerful pulse-like shock wave that crushes stones, instead of fever caused by ultrasonic waves, and necrotize cells with that mechanical force are also being studied (Hoshi, S. et al. al .: J. Urology, Vol.146: 439, 1991.). In “Japanese Patent Application No. 3-306106”, attention is paid to the fact that the calculus breaking device and the heating / heating device are substantially the same, and an integrated device has been proposed.

  By the way, in the cancer treatment apparatus, an ultrasonic tomographic image is used when positioning the focal point. However, a tumor to be treated often has a three-dimensionally complicated shape, and the two-dimensional image completely covers the entire tumor. It is very difficult to treat evenly. Therefore, a combination with a three-dimensional image using ultrasonic waves has been proposed as disclosed in Japanese Patent Application Laid-Open No. 61-209634. However, with ultrasound, the back of a recorded organ such as a bone or lung cannot be seen, and an accurate three-dimensional image cannot be obtained based on ultrasound information. Further, in the conventional example, the relative position between the focal point and the treatment site is merely confirmed, and there is no means for judging the effect of treatment, and it is not possible to decide whether to continue or end the treatment until several weeks to several months later. In order to solve this problem, an apparatus combined with MRI or X-ray CT has been proposed as in “Japanese Patent Application No. 4-43603”.

  It has been reported that when a T2-weighted image is taken by MRI, the state of tissue degeneration due to heat can be confirmed (Jolesz, FA. Et al,: Diagnostic Imaging, Sept., 1990.). Therefore, by observing the difference between the T2-weighted images before and after treatment, it is possible to determine the biological action / treatment effect by this treatment, and treatment can be performed while checking the untreated part. Can be secured. It is also possible to make a treatment plan such as the shock wave focus scanning method / scanning range, irradiation intensity / time / interval, etc. along the MRI freeze image.

  However, even if a treatment plan is made, accurate treatment cannot be performed unless accurate alignment is achieved.

  In the above proposal, due to the method of moving the ultrasonic applicator, the treatment table, the structure of the apparatus such as the MRI gantry, the ultrasonic applicator must be removed from the patient when the patient is moved in and out of the MRI gantry. For example, after taking a MRI image before the start of treatment and making a treatment plan, pulling out the patient from the gantry and attaching an ultrasonic applicator, and then positioning a strong ultrasonic focus on the affected area with the MRI image and the ultrasonic image Start treatment. When proceeding with the treatment while judging the treatment effect or confirming the untreated part with the MRI image, remove the ultrasonic applicator from the patient and send the patient into the gantry to take the MRI image and take the treatment effect. After the determination is made, the patient is again pulled out of the gantry, the ultrasonic applicator is attached, the focus position is confirmed again, and the treatment is restarted. Here, even if the initial focal position is accurately stored in the computer or the like by the relative position of the ultrasonic transducer and the affected area, the focal position is deviated if the patient moves even a little. In particular, when the applicator is attached and removed many times, the probability that the focal point shifts from the target position increases. Further, if the ultrasonic applicator is simply pressed against the body surface, there is a risk that the body surface moves from the ultrasonic applicator due to respiratory movement.

  Also, in recent years, an ultrasonic transducer is attached to a catheter, inserted into the patient's body, the affected area is positioned under an MRI guide, and the affected area is treated by irradiating a powerful ultrasonic wave from the ultrasonic transducer. Is considered (Japanese Patent Application No. 2-161434).

  In such a case, if the reception system of the magnetic resonance signal is for the whole body, the S / N ratio becomes insufficient particularly for performing high-definition confirmation of treatment plans and treatment effects or performing treatment monitoring in real time. . Further, when the surface coil is used, the surface coil has a large sensitivity unevenness, so that it is difficult to perform alignment for imaging a desired treatment target with high S / N.

  On the other hand, the conventional piezo-type ultrasonic therapy apparatus has a very small focal point, so that the cells are mechanically destroyed by a treatment method or a shock wave in which the tissue is thermally denatured by heating to a high temperature of 80 ° C. or more particularly in a limited range. In the treatment method, unlike normal hyperthermia, which uses a difference in tissue heat sensitivity, the normal tissue is destroyed if the focal position is shifted. For this reason, high-accuracy positioning was necessary, but with conventional devices there is a risk that the affected area of the patient will move due to breathing or body movement relative to the applicator, or the focal position may change due to refraction on the body surface. was there.

  Further, when the focus is defocused due to refraction, the temperature at the focus may not rise to an expected temperature, or the intensity of the shock wave may be insufficient and the treatment may be insufficient. This causes cancer to recur or require retreatment, increasing the burden on both the patient and the physician. Furthermore, the focus size may increase due to defocusing, and there is a fear that treatment in the correct range cannot be performed.

  Further, in the treatment of the ultrasonic transducer, it is necessary to obtain electrical matching between the drive circuit and the ultrasonic transducer. However, since the Q at the mechanical resonance point of a piezo element used as an ultrasonic transducer is high, the impedance matching between the amplifier and the element shifts as the treatment progresses if the characteristics change due to heat generation of the element. As a result, the planned sound output may not be obtained.

  In addition, there is a possibility that reflection is increased due to the mismatch of the matching and the electro-acoustic conversion efficiency is deteriorated.

  Furthermore, because the focus injection power is large in a treatment method that burns off malignant tumor tissue that matches the focus, the negative pressure at the focus also increases, so stable cavitation occurs and grows when a strong ultrasonic wave is applied continuously. However, there is a possibility that sufficient power does not reach the planned focus by scattering ultrasonic waves. Furthermore, there is a possibility that heat is generated by the scattered ultrasonic waves and a hot spot is formed at an unexpected position.

  As described above, in conventional ultrasonic treatment apparatuses, for example, tumor treatment may require accuracy on the order of several millimeters, but an ultrasonic applicator is attached or detached when repeating treatment and MRI imaging. If it is, there are many mechanical adjustment points, and the affected part may move by pressing the applicator, so that the positioning accuracy is unavoidable. The movement of the affected part due to breathing in the body is inevitable, but in order to solve the problem that the ultrasonic applicator is displaced from the body surface, the ultrasonic applicator is fixed to the affected part and cannot be removed even when taking a three-dimensional image. It is necessary to do so.

  In addition, when performing ultrasound treatment under an MRI guide, if a high-definition image of a specific affected area is to be obtained, a reception or transmission / reception coil called a surface coil is placed on the body surface, and nearby signals Are collected high in S / N. However, in such a case, since an ultrasonic applicator must be attached to the part of interest, it was impossible to treat the body coil while placing the surface coil directly on the body surface.

  Furthermore, in order to take a magnetic resonance image necessary for determining a treatment site with a high S / N ratio, it is necessary to dispose a surface coil in the vicinity of the treatment site. However, in the case where an ultrasonic transducer is attached to the catheter and treatment is performed by irradiating ultrasonic waves from inside the body cavity, the surface coil cannot be disposed in the vicinity of the treatment site, so that a good magnetic resonance image can be obtained. could not.

  Further, the conventional ultrasonic therapy cancer apparatus has a drawback that the affected part of the patient moves with respect to the applicator by breathing or body movement, or the focal position changes due to refraction on the body surface.

Furthermore, if impedance matching is shifted between the amplifier for driving the ultrasonic transducer and the transducer, the reflected power from the transducer is increased, thereby deteriorating the electro-acoustic conversion efficiency. was there.
JP-A 61-13955 Japanese Patent Application No. 3-306106 Japanese Patent Application No. 3-306106 JP-A 61-209634 Japanese Patent Application No. 4-43603 Japanese Patent Application No. 2-161434 Hoshi, S. et al .: J. Urology, Vol.146: 439, 1991. Jolesz, FA. Et al,: Diagnostic Imaging, Sept., 1990.

  An object of the present invention is to provide an ultrasonic treatment apparatus that can obtain a good magnetic resonance image even when an ultrasonic transducer is mounted on a catheter and treatment is performed from inside a body cavity.

The present invention relates to an ultrasonic treatment in which a probe with an ultrasonic transducer attached is inserted into a body cavity of a patient, and a powerful ultrasonic wave is irradiated from the ultrasonic transducer toward an affected area under an MRI guide to perform treatment. In the apparatus, the probe includes a balloon that is disposed so as to cover the ultrasonic transducer and can be inflated, and a coil that is disposed on a surface of the balloon and receives or transmits / receives electromagnetic waves to obtain an image , and the balloon The coil is fixed together with the balloon in the body cavity by rotating the ultrasonic transducer, and the ultrasonic transducer is rotated and translated to focus the ultrasonic wave on the affected part. An ultrasonic therapy apparatus is provided.

  According to the present invention, an excellent magnetic resonance image can be obtained even when an ultrasonic transducer is mounted on a catheter and treatment is performed from inside a body cavity.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a block diagram showing the configuration of the first embodiment of the present invention. First, the ultrasonic treatment unit will be described. The ultrasonic applicator 1 attached under the treatment table 22 includes an ultrasonic vibrator 2 that irradiates high-power ultrasonic waves for treatment, a coupling liquid 4 that guides high-power ultrasonic waves to the patient 3, and the coupling liquid 4 It consists of a water bag 5 that stores water. The applicator 1 is fixedly attached to a treatment table 22 and has a shape obtained by dividing a circular flat plate ultrasonic transducer 2 in a radial direction and a circumferential direction as shown in FIG. An ultrasonic probe 6 for imaging a diagnostic image is attached. The ultrasonic probe 6 is configured to be capable of sliding and rotating in the front-rear direction, and is connected to the ultrasonic diagnostic imaging apparatus 10. When treating, the affected part is inserted into the treatment hole 24, the focal point 7 is made to coincide with the tumor 8, and then the ultrasonic vibrator 2 is driven by the drive circuit group 12 to irradiate the powerful ultrasonic wave. Treat the site at a high temperature.

  In this embodiment, a phased array is used as a powerful ultrasonic wave generation source. Therefore, by controlling the drive timing of the drive circuit group 12 by the phase control circuit group 11, the focal position, the sound field, and the heating / heating region can be operated without moving the applicator 1. The drive circuit group 12 is divided into channels corresponding to the number of divided ultrasonic transducers, and is driven by an independent timing signal delayed by the phase control circuit group 11 by a signal from the control circuit 9. As a result, the focal points 7 and 7 'of the ultrasonic waves can be set at arbitrary locations in three dimensions. The operation of moving the focal position by this delay time control is described in detail in “USP-4526168”.

  Next, positioning and a three-dimensional image capturing unit will be described. The patient 3 is set face down on the treatment table 22 so that the affected area matches the location of the treatment hole 24. The size of the treatment hole 24 can be changed by changing the type of table depending on the size and shape of the treatment site.

  Next, the tumor 8 is confirmed by the ultrasonic diagnostic image drawn by the ultrasonic probe 6 attached to the ultrasonic applicator 1, and the ultrasonic diagnostic apparatus 10 controls the relative position data of the tumor 8 and the probe 6 at this time. Send to circuit 9. Further, the relative position between the ultrasonic probe 6 and the vibrator 2 at this time is obtained by the probe position detection device 26 and sent to the control circuit 9. The applicator position detection device 15 also sends data on the entire position of the applicator 1 and the position of the ultrasonic transducer 2 to the control circuit 9. The control circuit 9 calculates the relative position between the tumor 8 and the ultrasonic transducer 2 from the data of these positions, determines the set focal position 7 in the phased array, and stores this.

  Further, information on the set focal position 7 by the phased array is sent from the control circuit 9 to the ultrasonic imaging apparatus 10, and the situation of the tumor 8 that is the treatment site and the position of the focal spot 7 are real-time during the treatment. Can be displayed.

  Next, the patient 3 is fed into the imaging gantry 25 in which the static magnetic field coil 18 and the gradient magnetic field coil 19 are incorporated, by the treatment table 22 controlled by the control circuit 9. At this time, since the ultrasonic applicator 1 moves while being attached to the treatment table 22 without being removed from the patient, it is not necessary to perform alignment every time the ultrasonic applicator 1 is taken in and out of the gantry 25. In addition, the transmission / reception RF coil 20 necessary for imaging is attached around the treatment hole 24 from the beginning.

  By the way, when imaging an MRI image, in order to prevent the magnetic field from being disturbed by the influence of the ultrasonic applicator 1 and the treatment table 22, it is necessary to configure the ultrasonic applicator 1 and the treatment table 22 with a non-magnetic material as much as possible. There is. For example, the treatment table is made of wood or reinforced plastic. Applicators and mechanical arms are usually made of reinforced plastic or non-magnetic mechanical properties, except for parts that must be made of an electrical and magnetic material such as wiring connecting the ultrasonic transducer 2 and the drive circuit group 12. It is conceivable to use austenitic cast iron which is almost equal to cast iron. It is also conceivable to reduce the use of a magnetic material by using a mechanical arm power unit instead of an electric motor and a hydraulic type.

  Next, the control circuit 9 activates the gradient magnetic field power supply 13 and the transmission / reception circuit 14 by a predetermined sequence (for example, T2-weighted imaging method) instructed from the console 16, and stores the three-dimensional image information in the patient 3 in a memory (not shown). Remember.

  Here, it is possible to make a treatment plan in advance based on the MRI image in the patient's body. A method for displaying the MRI image on the CRT 23, a method for using it in combination with an ultrasonic tomographic image, and a method for treatment planning are described in Japanese Patent Application No. 4-43603.

  When the MRI image is obtained, the matching state between the position of the focus 7 and the position of the tumor 8 stored in the control circuit 9 is checked while the patient is in the gantry 25, and the control circuit 9 starts the ultrasonic irradiation. Is instructed to the drive circuit 12 to start treatment.

  If it is not necessary to put the patient 3 in and out of the gantry 25, the time difference between treatment and observation and the risk of movement of the patient 3 between them can be reduced.

  Ultrasound irradiation is stopped at the time when it seems to be in the middle or the end of the initial treatment plan, and the progress of treatment is observed. This is performed in the same manner as the above operation, and an MRI image around the tumor 8 is imaged to check a change in the living body. During this time, the ultrasonic applicator 1 remains attached to the patient 3. Here, if the T2-weighted image data stored in the memory before the treatment and the current data are subtracted, the heat-denatured region can be clearly confirmed, and whether the treatment has been performed sufficiently or is insufficient. Can determine if necessary. It is also possible to incorporate this into the treatment plan from the beginning and automatically capture images every predetermined treatment time.

  When it becomes possible to determine that the treatment has been sufficiently completed by the treatment effect determination by MRI, the operator ends the treatment. At this time, the control circuit 9 can call the history of treatment conditions from the memory and output the treatment record from the CRT 23. Here, a coil in the body cavity may be used as the RF coil for transmission and reception.

  Further, although the phased array is used for the ultrasonic transducer, this may be an annular array, or the focal point may be moved by mechanically moving the applicator. Further, X-ray CT may be used instead of the MRI apparatus.

  In the present embodiment, the treatment of breast cancer has been described, but other tumors such as skin and prostate can be described in the same manner. Further, the ultrasonic applicator can be used not only in the downward approach as in the present embodiment but also in the upward approach by being moved by the mechanical arm 17.

  FIG. 3 is a block diagram showing a second embodiment of the present invention. As shown in the figure, an ultrasonic transducer 32 that emits powerful therapeutic ultrasonic waves is installed in the applicator 31. Since the ultrasonic transducer 32 has a concave shape, the powerful ultrasonic wave is focused toward the center of curvature, and a focal point 33 in which high energy is concentrated is formed. The ultrasonic transducer 32 is fixed to a resin housing 34, and a coupling liquid 35 for transmitting therapeutic ultrasonic waves to the patient's body is enclosed by a water bag 36 in the front. The coupling liquid 35 is injected / extracted from an injection / outlet 37 provided in the housing 34.

  In this embodiment, a surface coil 38 for MRI imaging is fixed to the water bag 36 at a position where it does not enter the therapeutic ultrasound passage path 39 indicated by a dotted line in the figure. For this reason, when the applicator 31 is attached to the patient via an ultrasonic jelly or the like, the applicator 31 is held in close contact with the patient's body surface corresponding to the deformation of the water bag 36.

  Incidentally, the ultrasonic vibrator 32 is usually made of piezoelectric ceramics. This is a non-magnetic material / non-conductive material, and electrodes for applying a driving voltage are formed on the front and back surfaces thereof. Therefore, when a high-frequency magnetic field is applied in the MRI, an eddy current is generated in the electrode, disturbing the magnetic field, and thus deteriorating the image. In order to prevent this, the electrode of the present invention has a plurality of slits 51 as shown in FIG. 4 to reduce the conductivity against eddy currents on the electrode surface.

  Furthermore, the applicator 31 of the present invention is configured with a structure that indicates the focal position of the therapeutic ultrasound. Specifically, a needle or rod-shaped protrusion 41 is attached on a central axis 40 connecting the center of the ultrasonic transducer 32 and the focal point 33. In addition, a structure 42 that is part of a cone and coincides with the path 39 for passing ultrasonic waves for treatment is attached to the edge of the ultrasonic transducer 32. The protrusions 41 and the structure 42 are made of a flexible material, such as rubber, which is depicted by MRI and does not cause any damage even if it comes into contact with the patient. The housing 34 is also provided with a projection 43 at the position of the central axis 40. A tomographic image taken by MRI with the applicator 31 attached to a patient is schematically shown in FIG. At the time of this MRI imaging, since the image of the whole body of the patient 61 and the high-resolution image around the affected area are taken together, the imaging is performed using the entire coil (not shown) at the same time as the surface coil 38 in the applicator 31. At this time, the tumor 62 to be treated in the body is depicted in the high resolution region 63 by the surface coil 38. In addition, a tomographic image of the applicator 31 is also captured in the image simultaneously with the patient's body cross section 61. At this time, if the projections 41 and 43 in the applicator 31 are depicted, it can be seen that the tomographic plane coincides with the central axis of the therapeutic ultrasonic wave, so that the operator can see both sides of the ultrasonic transducer 32. It can be recognized that the portion where the two extension lines of the structure 42 are intersected is the focal point. If the projections 41 and 43 are not depicted even though the tumor 62 is clearly depicted, “the central axis of the therapeutic ultrasound coincides with the tumor but the angle with the tomographic plane is different”, “treatment There are two cases where the central axis of the ultrasound does not match the tumor. Therefore, the operator first aligns the tomographic plane of the MRI with the central axis of the therapeutic ultrasonic wave, then detects a vertical deviation from the tumor, and adjusts the position of the applicator 31. By this work, the operator can visually align the position of the applicator 31 in the MRI spatial coordinates without mechanically measuring the absolute position.

  In the above embodiment, two types of structures are used for the guide indicating the focal position, but the focal position can be specified by either one. In addition to the main shape, the same effect can be obtained with a shape as shown in FIG.

  In the above-described embodiment, the ultrasonic transducer has a single-plate concave shape, but a phased array type applicator in which a plurality of transducers are assembled can be similarly implemented. For example, with respect to the electrode shape, in the case of the vibrator group shown in FIG. 7A, a slit may be formed in each vibrator electrode as shown in FIG. 7B. In the phased array type applicator, the focal position changes electronically, but the actual focal position can be grasped by indicating the reference point of the focal position by the structure and recognizing the amount of movement from there.

  Although the applicator to be mounted from outside the patient's body is shown in the above embodiment, the same applies to the intracavity applicator that is inserted into the patient's oral cavity, large intestine, vagina and the like for treatment. This embodiment can be applied to all ultrasonic therapy apparatuses as well as hyperthermia and stone crushing.

  FIG. 8 is a block diagram showing the configuration of the third embodiment of the present invention. In the figure, a static magnetic field magnet 71 is excited by an excitation power source 72 and applies a uniform static magnetic field in the z direction to a subject 79. The gradient magnetic field coil 73 is disposed in the static magnetic field magnet, and is driven by a drive circuit 74 controlled by the sequence controller 82. The gradient magnetic field coil 73 is in three directions x, y, and z orthogonal to the subject 79 on the bed 80, respectively. Gradient magnetic fields Gx, Gy, and Gz in which the magnetic field clamping changes linearly are applied. The uniform coil 77 is a transmission / reception coil and is disposed in the gradient magnetic field coil. Under the control of the sequence controller 92, a high-frequency signal from the transmission unit 75 is applied to the uniform coil 77 via the duplexer 76, and a high-frequency magnetic field generated thereby is applied to the subject 79 in the transmission coil on the bed 80. Is done. The uniform coil is capable of generating a uniform high-frequency magnetic field in the region to be imaged of the subject 79. For example, a saddle type coil, a distributed constant type coil, or a quadrature transmission coil configured using them is used. .

  A body cavity probe 81 having a magnetic resonance signal receiving surface coil is inserted into the body cavity of the subject 79, receives a magnetic resonance signal from the subject 79, and the received signal is sent to the receiving unit 78. The uniform coil 77 may receive a signal. In this case, the received signal is sent to the receiving unit 78 via the duplexer 76. The duplexer 76 is used to switch the uniform coil 77 between transmission and reception, transmits a multi-high wave signal from the transmission unit 75 to the uniform coil 79 at the time of transmission, and receives from the uniform coil at the time of reception. It works to guide the signal to the receiver. The received signal is subjected to detection and band limitation by a low-pass filter, and then sent to the data collection unit 83 under the control of the sequence controller 82. The data receiver unit 83 collects received signals and performs A / D conversion, and sends them to the computer 84 as image reconstruction data.

  The electronic computer 84 is controlled by the console 85, and performs image reconstruction processing including two-dimensional Fourier transform on the image reconstruction data input from the receiving unit 78. The sequence controller 82 is also controlled. The image data obtained by the electronic computer 84 is supplied to the image display 96 and an image is displayed.

  The body cavity probe 81 is provided with an ultrasonic transducer composed of a piezo element group capable of generating focused ultrasonic waves, and an independent driving pulser group 88 and a delay circuit 89 are coupled to each element. Yes. The strength of the driving pulser 88 is determined by the potential of the power supply 87, and a voltage pulse is applied to each piezoelectric element in response to a trigger from the delay circuit 89. The computer 87 controls the power supply 87 and the delay circuit 89.

  Under the control of the electronic computer 84, the water circuit 90 inflates the balloon in the body cavity probe 81 and adheres the balloon surface to the body cavity.

  FIG. 9 shows the internal structure of the body cavity probe 81. The balloon 91 is inflated with water supplied from an external water circuit 90. A magnetic resonance signal receiving surface coil is arranged on the surface of the balloon 91, and the balloon surface can be imaged at a high S / N. A vibrator 93 is disposed below the balloon 91. It is well known that the position of the focal point can be electronically moved three-dimensionally by controlling the transfer of each element when transmitting ultrasonic waves using an ultrasonic transducer. (US Pat. No. 4,526,168). With the arrangement as shown in FIG. 9, the range that can be imaged at a high S / N with the surface coil and the focal movable range of the focused ultrasonic wave can always be overlapped.

  Next, a treatment procedure will be described. First, an MR image is obtained by transmission and reception of a uniform coil without inserting a body cavity probe, and a position of a treatment target is obtained. The body cavity probe is inserted in a direction and depth so that the position can be treated. After insertion, water is injected into the balloon and inflated to fix the probe. And it excites by the high frequency magnetic field signal transmitted from the uniform coil, the generated magnetic resonance signal is received by the surface coil, and the treatment site is imaged. Treatment is performed by irradiating the affected area with ultrasound according to the image. After the treatment, MRI imaging is performed once again in the same manner as the imaging before the treatment in order to confirm the effect of the treatment.

  In order to obtain the position of the treatment target, the position of the probe may be aligned while monitoring the rough position in real time using an ultrasonic diagnostic apparatus or the like without using MRI. You may align with an affected part, monitoring the inside of a body cavity endoscopically. In addition, the treatment may be performed up to the treatment positioning.

  Moreover, high frequency may be transmitted from the arranged coil, induction heating may be caused in the affected area, and heat treatment may be performed. Further, an ultrasonic transducer may be used for the treatment monitor, and the treatment site may be monitored like a normal ultrasonic diagnostic apparatus.

  Here, since the balloon, the MR surface coil, and the ultrasonic transducer are all integrated, when the balloon is inflated after insertion, all are completely fixed, and the position and orientation of the probe cannot be easily changed. However, by doubling the balloons as shown in FIG. 10 and inflating each, the ultrasonic transducer and the coil balloon 95 with the surface coil fixed are integrated, and only the shaded portion in the figure is rotated. Then, it becomes possible to move in the direction by rotation of the inner probe after the probe is inserted and fixed. The probe itself is fixed by the outer balloon 94. Furthermore, by extending the outer balloon 94 in the axial direction and allowing the vibrator and the surface coil part to move in the axial direction, it is possible to image the uniform coil in advance and determine the treatment position. Alternatively, the probe can be inserted and fixed by the outer balloon and then aligned with the treatment site. Even if the ultrasonic transducer cannot electronically move the three-dimensional focal point, if the electronic control only in the depth direction is possible, the transducer and the surface coil portion are mechanically rotated and translated to provide a three-dimensional movement. It is possible to move the focal point.

  In addition, as shown in FIG. 11, a coil 101 that generates a uniform magnetic field in the circumferential direction is arranged on the surface of the balloon 102, so that a constant image can be obtained in the circumferential direction. Then, treatment positioning may be performed by rotating / translating only the vibrator 103. In particular, here, oppositely wound solenoid coils are arranged on the left and right sides so that the circumferential direction between them can be imaged with high S / N.

  Here, water is injected into the balloon, but it is appropriate to use ion-exchanged water, pure water or the like instead of tap water. Other materials that can acoustically match impedance may be used. If water is injected into the balloon, a portion where water exists is brightly captured in the MRI image, and there is a possibility that the sensitivity of other portions to be observed is relatively deteriorated. In order to suppress this, the position where the balloon is present is recognized in advance, the signal inside it is suppressed, or fat is injected instead of water, thereby using fat suppression, which is one of the MRI techniques. It seems possible to suppress the signal. A signal other than fat can be suppressed by injecting a liquid whose magnetic resonance frequency is different due to chemical shift and whose acoustic impedance is not significantly different from that of a living body.

  Further, as shown in FIG. 13, a fixing balloon 102 is attached to the rear part of the vibrator 103, normal air 104 is injected into the balloon 102, and the vibrator 103 is brought into close contact with the body cavity in such a manner that it is pushed from the opposite side. You may let them. In this case, any substance may be injected into the balloon 102.

  The above are mainly probes inserted into body cavities such as rectum and urethra, but this can also be applied to catheters for the treatment of thrombolysis in blood vessels. As shown in “Japanese Patent Application No. 3-209446”, an intravascular thrombolysis probe is a device that increases the therapeutic effect by administering a thrombolytic agent near the affected area and irradiating it with ultrasonic waves. is there. It can be treated without thrombolytic agents or with ultrasonic irradiation alone.

  As shown in FIG. 12 as an embodiment, an ultrasonic transducer 103 is externally provided at the distal end of an intravascular catheter, and the vicinity of the external ultrasonic transducer 103 is uniformly high in the circumferential direction inside the catheter. By placing a solenoid type coil 105 capable of imaging N, a catheter is inserted at a position where a thrombus is present in the blood vessel, and a thrombus in the vicinity of the transducer is monitored by MRI. Thrombolytic treatment such as administration or irradiation with ultrasound can be performed.

  In addition, the therapeutic means is ultrasonic waves so far, but any therapeutic means may be used. For example, as shown in FIG. 14, a laser irradiation unit 106 is provided in place of the ultrasonic transducer 103 of FIG. 11, and this is rotated to irradiate the treatment site around the body cavity with heat or photochemically. Give treatment. However, in this method, in the case of thermal treatment, there is a possibility that the normal tissue in the shallow part of the body cavity may be affected. Therefore, the water injected into the balloon 102 needs to be convected in the water circuit and cooled. Photochemical treatment is a treatment that administers a drug that has tumor selectivity and exhibits an anti-tumor effect by irradiating a laser, and irradiates the laser to treat the drug. By performing according to the monitor, the tumor selectivity of the drug can be increased.

  In addition, it seems that MRI imaging parameters change due to the influence of treatment such as temperature change. The timing of treatment and imaging should be sufficient to allow imaging when the treatment effects are sufficiently removed. These timings (sequences) are synchronized with the MRI pulse sequence under the control of the computer 84.

  Since real-time performance is important as a therapeutic monitor, S / N deteriorates for imaging, but it is necessary to use a high-speed or ultrasonic pulse sequence.

  However, high-definition imaging is also required to accurately determine the treatment position and determine the treatment effect. For that purpose, especially when there is a treatment target around the body cavity such as the prostate, the treatment area and the imaging area are shifted in a range where there is no influence of the treatment in order to improve the efficiency of treatment and imaging. Imaging can be performed simultaneously to improve real-time performance. In this case, since the imaging time can be shortened by limiting the imaging region, high-definition imaging can be performed with a pulse sequence such as a normal spin echo. For example, as shown in FIG. 15, when there is a treatment planned site 115, the treatment site 111 is irradiated with ultrasonic waves, and at the same time, the region 115 not affected by the ultrasonic irradiation is imaged, and the treatment effect of the previously treated site 113 is obtained. By confirming or determining the next treatment site 114 from the captured image, treatment and imaging can be performed in parallel. In this case, the MR surface coil can capture images uniformly in the circumferential direction. In the case of a normal surface coil that images only in one direction, treatment and imaging can be performed simultaneously by taking a sufficiently large imaging area as compared with a region affected by treatment. It was assumed that only a specific area can be imaged with high resolution by a selective excitation method or the like.

  FIG. 16A is a block diagram showing the configuration of the fourth embodiment of the present invention. In the figure, one or a plurality of piezo elements 125 for irradiating therapeutic ultrasonic waves are coupled to a patient 121 via a water bag 124. The piezo element 125 is driven by a drive circuit 127, and forms a focus 123 of intense ultrasonic waves in the affected part 122 in the patient body via the coupling liquid in the water bag.

  In the treatment state, the reflected wave signal from the ultrasonic probe 126 fixed to the applicator is displayed on the CRT 129 by the ultrasonic diagnostic device 128 so that a tomographic image of the plane passing through the geometrical focus of the piezo element can be obtained. To monitor. Moreover, there is a possibility that the patient 121 body surface and the piezo element 125 may generate heat due to the irradiation of intense ultrasonic waves, and particularly the heat generation on the body surface may cause side effects such as burns. Cool and perfuse the coupling fluid. Control such as ultrasonic irradiation, change of ultrasonic intensity, and setting of cooling temperature is performed by the control circuit 132. Further, the applicator fixing belt 133 is used to fix the affected part 122 to the affected part 122 so that the focal point 123 aligned with the affected part 122 does not shift due to the patient's body movement / breathing.

  In the above embodiment, a belt is used as a means for fixing the applicator to the affected part of the patient. However, as shown in FIG. The applicator can also be adsorbed and fixed to the patient by sucking air between the body surface and the coupling membrane.

  Further, in the above embodiment, when the applicator is heavy and places a burden on the patient, the applicator is held by the pulling arm 136 as shown in FIG. 17 so that the weight of the applicator is not applied to the patient. It can also be controlled by the arm moving mechanism 137. Furthermore, by monitoring the patient's respiration with the respiration monitor device 138, the control circuit 132 sends a control signal to the arm moving mechanism 137 to control the movement of the arm so that the applicator follows the affected part according to the respiration. Is also possible.

  FIG. 18 is a block diagram showing a modification of the third embodiment. In superficial tumors such as breast cancer and skin cancer, in order to suppress side effects due to fever on the surface of the body and the ribs behind the focal point, the ultrasonic focusing angle is widened to increase the energy density in the ultrasonic passage area other than the focal point. Need to lower. Furthermore, it is thought that the water temperature in the water bag needs to be lowered in order to cool the body surface, and a difference in sound speed occurs between the biological tissue and water that is usually used as an ultrasonic transmission medium, There is a possibility that the focal point is not accurately generated at the target position on the ultrasonic image due to refraction at the boundary surface.

  In the present embodiment, in order to solve such a problem, the mixing ratio of the sound speed adjusting agent such as propanol and water is made variable by the sound speed adjusting agent mixing device 139 according to the temperature of the acoustic coupling liquid in the water bag 124. By controlling in such a manner, it becomes possible to eliminate the difference in sound velocity between the coupling liquid and the living tissue and suppress the refraction of the ultrasonic waves.

  At this time, the change in the sound speed due to the mixing ratio of propanol and water and the change in the sound speed of water due to temperature are described in the Ultrasonic Technical Handbook (published by Nikkan Kogyo Shimbun), and data is stored as a table in a memory (not shown). , And the control circuit 132 sends the mixing ratio data to the sonic speed adjusting agent mixing circuit 139 to determine the acoustic coupling liquid in the water bag 124. The speed of sound is matched with the speed of sound of a living body. Here, the sound velocity of the living tissue is calculated in advance as 1570 m / s.

In the above embodiment, the sound speeds of the living tissue and the coupling liquid are fixed. However, in the case of breast cancer, the transmitting transducer 141 and the receiving transducer 143 facing the end of the applicator as shown in FIG. In addition, those values may be obtained. The detailed operation will be described with reference to the drawings. First, the transmission transducer 141 is driven by the transmission drive amplifier 142 in accordance with a signal from the control circuit 132. The transmitted ultrasonic wave propagates through the coupling liquid in the water bag 124 and is received by the receiving transducer 143. The received ultrasonic wave is converted into an electrical signal, and the signal is sent to the control circuit 132 via the receiving circuit 144. Then, the control circuit calculates a propagation time t ₁ from transmission to reception. Next, the propagation time when the applicator is brought into contact with the patient is measured in the same manner, and at the same time, the length d of the living tissue in the ultrasonic propagation path obtained from the ultrasonic image is measured. to calculate the t _2. From these values, the propagation velocity C _{1 of the} coupling liquid and the propagation velocity C ₂ of the living tissue are obtained.

Alternatively, it is also possible to measure the coupling liquid and the sound velocity in the living body as shown in FIG. First, the ultrasonic probe 126 fixed to the applicator so as to be movable by a pulse motor or the like is held so that the body surface itself is vertical. Then, for example, an ultrasonic marker 145 having a large reflection echo such as a rib is used as an ultrasonic marker 145 in the body, and an applicator or an ultrasonic probe is placed so that the marker 145 is on the central axis as shown in (1). Move. Thereby obtaining the propagation time t ₂ until the propagation times t ₁ and the marker up body. Next, tilt the ultrasonic probe or the entire applicator at an angle θ with respect to the body surface and move it parallel to the body surface so that the marker 145 is on the central axis as shown in (3) on the ultrasound image. Then, a value of 1 is obtained from the moving distance of the probe, and the value is sent to the control circuit 132 to calculate C ₁ and C ₂ . Then, according to the value, the sound velocity adjusting agent mixing device 139 is controlled to align the sound velocity of the coupling liquid with that of the living body.

  In the above, refraction and defocusing of the ultrasonic wave on the body surface was suppressed by mixing the sound velocity adjusting agent, but by mixing glycerol etc., the acoustic impedance of the coupling fluid was made to match the living tissue and the body surface. It is also possible to control so as to suppress the reflection of ultrasonic waves. In this case, refraction may occur on the surface of the body because the sound speed is different. In such a case, the drive timing of the piezo element 125 is changed by changing the drive phase of the drive circuit 127 by the delay circuit 140. The phase timing at the focal point 3 is controlled to correct the defocus due to refraction.

  FIG. 21 is a block diagram showing the configuration of the fifth embodiment of the present invention. One or more piezo elements 155 for generating therapeutic ultrasound and irradiating the affected area are coupled to the patient 151 via a water bag 154. The piezo element 155 amplifies an AC signal from the signal generator 159 by an amplifier 158 and is driven through a wattmeter 156 and an impedance matching circuit 157, and powerful ultrasonic waves enter the affected area 152 in the patient body through the coupling liquid in the water bag. The focal point 153 is formed.

  In the treatment state, the reflected wave signal from the ultrasonic probe 160 fixed to the applicator is displayed on the CRT 162 by the ultrasonic diagnostic apparatus 161 so that a tomographic image of the plane passing through the geometrical focus of the piezo element 155 can be obtained. To monitor. Further, irradiation of intense ultrasonic waves may cause the patient 151 body surface and the piezo element 155 to generate heat. In particular, since heat generation on the body surface may cause side effects such as burns, the cooling device 164 causes the water bag 154 to be heated. Cool and perfuse the coupling fluid. The control circuit 163 controls the irradiation of ultrasonic waves, the change of ultrasonic intensity, the setting of the cooling temperature, the driving frequency, and the like.

  Next, the operation of the entire system of this embodiment will be described. In general, the frequency of mechanical resonance determined by the thickness of the piezo element 155 is determined, and the frequency matches the frequency of the antiresonance point in the electrical impedance characteristics of the element. In actual use, the most efficient use is to tune the impedance matching circuit 157 to match the output impedance of the amplifier 158 at this frequency. However, when high power is applied, each matching element (L or C) generates heat, or the piezoelectric element itself generates heat, and the electrical and mechanical resonance characteristics change. Occur. In order to suppress this phenomenon, the passing power in the forward and reverse directions is monitored by a passing watt meter 156, and the frequency of the signal generator 159 is adjusted by the control circuit 163 so that the reflected power from the vibrator is minimized. Control. Here, if the drive frequency deviates greatly from the mechanical resonance frequency of the vibrator, no sound output is generated, so the drive frequency is variable within a range of ± 15% of the mechanical resonance frequency.

  In the driving frequency detection method, the amount of change ΔW in reflected power when the frequency is changed by Δf from the current frequency is obtained, and the frequency is controlled in a direction in which ΔW / Δf is minimized. At this time, since the impedance itself viewed from the output terminal of the amplifier 158 also changes with the change in frequency, the electric power supplied to the piezo element 155 also changes, so that the signal generator 159 has a constant focus injection energy per unit time. The drive voltage is controlled by the control circuit 163 (FIG. 22).

  In the above embodiment, the driving voltage of the signal generator is controlled so that the focus input energy per unit time is constant. However, it is also possible to control the peak intensity at the focus to be constant. Furthermore, heat generation at the focal point is known to be proportional to the cube of the frequency because of the focusing effect of the ultrasonic wave and the frequency dependence of the attenuation rate. -It is also possible to calculate the theoretical value of heat generation at the focal point from the mechanical conversion efficiency and control the value to be constant.

In the above embodiment, impedance matching is corrected by changing the frequency on the driving side. However, L and C in the matching circuit 7 are made variable and ω ² LC = 1 (where ω = 2πf).
It is also possible to control the impedance by the control circuit 13 so that the reflected power is minimized while maintaining the relationship of L: inductor C: capacitor f: frequency (FIG. 23).

  As a modification of the present embodiment, the frequency of the signal generator 159 is changed stepwise or continuously by the control circuit 163 in order to suppress cavitation occurring at the focus when high power is turned on. As a result, even if cavitation of the size depending on the frequency is made in the focal region, when the frequency changes, the cavitation of the size depending on the original frequency disappears, and a new size of cavitation is generated. Since it takes time to grow, cavitation becomes difficult to drive compared to driving at a single frequency. As a result, ultrasonic treatment does not reach the target treatment site and sufficient treatment cannot be performed, or ultrasonic waves are scattered by cavitation that occurs before the focal point, and a maximum fever point is created on the front side of the target site. The situation can be avoided, and treatment can be performed more accurately and with fewer side effects.

  Note that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the components without departing from the scope of the invention in the implementation stage. In addition, various inventions can be formed by appropriately combining a plurality of components disclosed in the embodiment. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, constituent elements over different embodiments may be appropriately combined.

It is a block diagram which shows the structure of 1st Embodiment of this invention. It is a schematic diagram which shows the structure of an ultrasonic applicator. It is a block diagram which shows the ultrasonic applicator which concerns on 2nd Embodiment of this invention. It is a figure which shows the electrode shape of an ultrasonic transducer | vibrator. It is a MRI image which imaged the patient with which the ultrasonic applicator was equipped. It is a figure showing the shape of the structure which shows a focus position. It is a figure which shows the electrode shape of another ultrasonic transducer | vibrator. It is a block diagram which shows the structure of the magnetic resonance imaging device which concerns on 3rd Embodiment of this invention. It is a perspective view of the body cavity ultrasonic probe in FIG. It is the cross-sectional schematic of the intrabody cavity ultrasonic therapy probe which doubled the balloon. It is a perspective view of the body cavity ultrasonic therapy probe provided with the surface coil which has a uniform sensitivity area | region in the circumferential direction. FIG. 2 is a perspective view and a sectional view of an ultrasonic thrombolysis probe having an MRI surface coil. It is sectional drawing of the body cavity probe which has a surface coil and an ultrasonic transducer | vibrator on the opposite side of a balloon, and the figure seen from upper direction. It is a perspective view of the probe for body cavity laser treatment provided with the surface coil which has a uniform sensitivity area | region in the circumferential direction. It is explanatory drawing of the method of performing imaging and treatment simultaneously by shifting a place. It is a block diagram which shows the structure of the ultrasonic therapy apparatus which concerns on 4th Embodiment of this invention. It is a figure which shows the holding mechanism of an applicator. It is a block diagram which shows the modification of 4th Embodiment. It is a figure which shows the method of measuring the acoustic characteristic of each ultrasonic transmission medium. It is a figure which shows the 2nd method of measuring the acoustic characteristic of each ultrasonic transmission medium from an ultrasonic image. It is a block diagram which shows the structure of the ultrasonic therapy apparatus which concerns on 5th Embodiment of this invention. It is a schematic diagram regarding the detection method of the optimal drive frequency. It is a block diagram of an impedance matching circuit.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 Ultrasonic applicator, 2 Ultrasonic transducer, 6 Ultrasonic probe, 7 Focus, 8 Tumor, 11 Phase control circuit, 12 Drive circuit, 14 Transmission / reception circuit, 15 Applicator position detection apparatus, 17 Mechanical arm, 18 Static magnetic field Coil, 20 RF coil, 21 Table moving device, 22 Treatment table, 24 Treatment hole, 26 Ultrasonic probe position detection device, 31 Applicator, 32 Ultrasonic transducer, 33 Focus, 34 Housing, 36 Water bag, 38 Surface coil 41, 43 Projection, 42 Structure, 51 Slit, 79 Subject, 80 Bed, 81 Intracavity probe, 83 Pulser, 89 Delay circuit, 90 Water circuit, 91 Balun, 92 Surface coil, 93 Vibrator, 106 Laser Irradiation unit, 122 affected area, 127 drive circuit, 128 ultrasonic diagnostic apparatus, 129 CTR, 130 temperature sensor 131, cooling device, 132 control circuit, 133 applicator fixing belt, 134 breathing rubber ring, 134 suction rubber ring, 135 suction pump, 136 traction arm, 137 arm moving mechanism, 138 patient respiratory monitoring device, over 139 Sonic adjustment device mixing device, 140 delay circuit, 141 transmission transducer, 142 transmission drive amplifier, 143 reception transducer, 144 reception circuit, 145 marker, 151 patient, 152 affected area, 157 impedance matching circuit, 158 amplifier, 159 signal generator , 160 ultrasonic probe, 161 ultrasonic diagnostic apparatus, 162 CRT, 163 control circuit, 164 cooling device, 165 input device, 166 arm control mechanism

Claims (2)

In an ultrasonic treatment apparatus that inserts a probe with an ultrasonic transducer into a body cavity of a patient, irradiates a strong ultrasonic wave from the ultrasonic transducer toward an affected area under an MRI guide, and performs treatment.
The probe has a balloon that is disposed so as to cover the ultrasonic transducer and can be inflated, and a coil that is disposed on the surface of the balloon and receives or transmits / receives electromagnetic waves to obtain an image ,
Under the MRI guide, the coil is fixed in the body cavity together with the balloon by inflating the balloon, and the ultrasonic transducer is rotated and translated to focus the ultrasonic wave on the affected area. Ultrasonic therapy device used in   The ultrasonic therapy apparatus used under an MRI guide according to claim 1, wherein the coil is an RF coil.

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