JP4471651B2 - 血管内撮像方法および装置 - Google Patents
血管内撮像方法および装置 Download PDFInfo
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Description
本発明は、不透明な液状媒体を介する可視化のための方法および装置を含む、身体の小さい内腔の内視鏡画像の取得を可能にする血管内撮像方法および装置に関する。
が主に、不安定斑、別名脆弱斑によって引き起こされることを示した。この型の斑は通常小さく、したがってあまり目立たず、現在使用されている後述の血管造影法では検出することが難しい。
本発明の第一態様では、したがって、
a.近端および遠端を備えた可撓性カテーテルであって、前記遠端がガイドワイヤに沿って血管内に挿入するように形作られ、それによって脈管構造または他の器官の遠隔場所に到達するように構成された可撓性カテーテルと、
b.前記カテーテルの長手軸に対し非直角に配置された画像センサを備え、前記カテーテルの遠端に配置された光学アセンブリと、
c.前記カテーテルの遠端の向こう側の直近領域を照明するための少なくとも一つの照明源と、
d.前記カテーテルの近端から遠端まで走る少なくとも一つのワーキングチャンネルと、
を備えた侵襲性撮像装置を提供する。
a.近端および遠端を備えた可撓性カテーテルであって、前記遠端がガイドワイヤに沿って血管内に挿入するように形作られ、それによって脈管構造または他の器官の遠隔場所に到達するように構成された可撓性カテーテルと、
b.前記カテーテルの遠端に配置された光学アセンブリと、
c.前記カテーテルの近端から遠端まで走る少なくとも一つのワーキングチャンネルと、d.前記カテーテルの前記遠端の周囲の前記血管内の血液の不透明度を調整するための制御装置であって、前記光学アセンブリの近傍の前記血管内へ多量の流体を制御可能に注入し、それによって視認性を向上する制御装置と、
を備えた侵襲性撮像制御装置を提供する。
a.近端および遠端を備えた可撓性カテーテルであって、前記遠端がガイドワイヤに沿って血管内に挿入するように形作られ、それによって脈管構造または他の器官の遠隔場所に到達するように構成された可撓性カテーテルと、
b.前記カテーテルの遠端に配置された光学アセンブリと、
c.前記カテーテルの近端から遠端まで走る少なくとも一つのワーキングチャンネルと、d.前記カテーテルの前記遠端に配置され、前記光学アセンブリの周囲から血液を押しのけて明瞭な視認性を可能にするために延長可能な前記光学アセンブリを包囲する半透膜と、
を備えた侵襲性撮像制御装置を提供する。
a.オフライン画像訓練初期化と、
b.実時間画像データ補間と、
を含む方法を提供する。
a.画像構成を訓練することと、
b.前記訓練画像から低解像度の新しい画像を再構成することと、
c.前記低解像度の画像のエッジ方向を見出すことと、
d.ニューラルネットワークを訓練して一組のフィルタを得ることと、
を含むことが好ましい。
a.前記実時間画像の平均強度を算出して、強度画像を生成し、
b.前記強度画像の強度を補正することによって第一画像を生成し、
c.局所的コントラスト画像を算出し、
d.前記局所的コントラスト画像を強調することによって第二画像を生成し、
e.前記第一画像および前記局所的コントラスト画像を加算して出力画像を生成する
ことを含むことが好ましい。
a.各画素のエッジ方向を見つけ出し、
b.一組の方向フィルタから適切な方向フィルタを使用してデータを補間する
ことを含むことが好ましい。
本発明をよりよく理解し、それをいかに実行に移すことができるかを示すために、今から、純粋に例として、添付の図面を参照する。
図1は患者システム全体の簡易図である。
図2Aは光学ヘッドの簡易側面図である。
図2Bは光学ヘッドの簡易平面図である。
図3はシステムブロック図である。
図4Aは光学配列アセンブリの簡易図である。
図4Bは光学設計Aの例示的構成の模式図である。
図4Cは光学設計Bの例示的構成の模式図である。
図5Aは光学ヘッドがPTCA/ステントバルーンより遠位の透明なバルーンの内側にある構成の簡易図である。
図5Bは光学ヘッドがPTCA/ステントバルーンに隣接している構成の簡易図である。
図6は画像センサの略図である。
図7は後処理アルゴリズムのブロック図である。
図8は外部IR源の使用の簡易図である。
図9は生体試料収集器の簡易図である。
本発明の少なくとも一つの実施形態を詳細に説明する前に、本発明はその適用を、以下の説明に記載しあるいは図面に図示する構成要素の構成および配列の詳細に限定されないことを理解されたい。本発明は他の実施形態に適用可能であり、あるいは様々な方法で実施または実行することができる。また、ここで使用する表現および専門用語は、記述を目的とするものであり、限定とみなすべきではないことを理解されたい。
1.ガイドワイヤに沿って血管または他の内腔内に挿入し、脈管構造または他の器官内の遠隔場所に到達することのできる遠端を備えた小径の可撓性カテーテル。
2.カテーテルの遠端に配置され、特別に設計された画像センサと、歪曲光学アセンブリと、照明源から成る観察装置。
(a)画像センサは、カテーテルの制限された寸法内に嵌ることが好ましい。画像センサは、カテーテルの長手軸に対して非直角に、好適な実施形態ではカテーテルの長手軸に平行に配置する。撮像領域の小さい幅は、カテーテルの直径を低減することを可能にする。センサの設計は、カテーテルの直径をひどく増大することなく、カテーテルが増加観察装置およびワーキングチャンネルの両方を収容することを可能にする。
(b)光学アセンブリ。一つの好適な実施形態は、二つの光学面を持つレンズと、シャッタと、反射面を持つプリズムまたはミラーから成る。光学アセンブリは、観察対象から受け取った光をセンサに適合するように歪曲して偏向させるように設計される。
(c)単数または複数の光源は一実施形態では、実施形態の用途によって可視光源、IR源、または光源の何らかの組合せとすることができる。照明は、光学センサヘッドの方向から撮像対象に直接照準するか、または一般的にシーンに、すなわち光源を対象物のまっすぐ前方に向けることなく、向けることができる。
3.前記カテーテルに沿って近端から遠端まで走り、それに沿って治療器具をそれらの操作の部位まで挿入することができる一つまたはそれ以上のワーキングチャンネル。ワーキングチャンネルはまた、一部の実施形態で記載するように、液体または気体の注入にも使用される。ガイドワイヤ用のチャンネルが必要であり、ガイドワイヤのみのための専用チャンネルとして提供するか、または注入チャンネルと組み合わせることができる。
4.光学画像センサヘッドに出入りするデータの流れを調整し、かつ身体外部の中央処理および制御装置から来る、例えばシャッタ速度および光源の強度の変化に関するコマンドを実行するために、カテーテルの遠端ヘッドに配置された局所制御装置。局所制御装置と中央装置との間の通信は、ワイヤ接続またはワイヤレス接続を介して行なわれる。局所制御装置は、上述の通りカテーテルの遠端ヘッドに配置された完全に別個の要素であるが、それは画像センサの一部とすることもできる。別の選択肢では、局所制御装置の機能の一部または全部を、本書で後述する中央制御および表示装置によって実行する。
5.中央制御および表示装置は一般的に、手術/カテーテル術室のラック上に配置される。この装置は、多数のタスクの中でも特に、色の再構成を含む画像の基本的再構成、ユーザへのインタフェース、映像および追加データの表示、画像取得パラメータに対する手動/自動制御、およびセンサの特定の設計に基づき解像度および局所コントラストを改善するための特定画像再構成アルゴリズムを実行する。
1.特に画像の解像度を改善するように意図された、システムに常駐する冗長情報に基づく画像解像度の改善。
2.特定の医療用途向けの画像品質および画像調整、例えば病変における色、局所的コントラスト、および強調の改善。
3.炎症が疑われる病変領域を目立たせるための、映像情報に基づく相対温度の評価。
4.血液のぼけモデルに基づく画像および取得画像のぼけパラメータの評価。
5.ぼけモデルおよび評価パラメータによる原画像の再構成。
以下は、不透明な液体の媒体中、好ましい血液中で視認性を達成するように設計された様々な方法および適用例の様々な好適な実施形態である。後述する様々な実施形態を独立システムとして別個に、または相互に組み合わせて使用できることを強調することが重要である。
媒体中を通過する特定波長による光の視認性に影響を及ぼす光の三つの特性、すなわち散乱、吸収、および減衰がある。散乱は、血液に通したときに近IRおよび可視光の両方で著しい。他方、吸収および減衰は近IR放射では最小限である。したがって、近IRは可視光と比較すると、血液のような媒体を通しての効果的な照明にとって有利であるかもしれない。以下のテキストでは、IRについて言及する場合、特に異なる記載が無い限り、近IR(1μmより短い波長の放射)を使用することが好ましいことに注意されたい。
別の方法および実施形態は、可視光またはIR放射を利用する光源を使用する。血液は浮遊細胞を含むので、血液は可視光照明では不透明である。この現象は、霧中の水蒸気滴により遭遇する現象によく似ている。たとえ赤血球の内容物が透明であっても、赤血球の内容物が膜によって取り囲まれた「液滴」状に構成される場合、溶液の反射率から不透明な状況が生じる。したがって、明瞭に見通せる視界を得るために、撮像対象の部位の血液を一時的に薄めることができる。
本実施形態もまた、可視光またはIR波長の光源を利用する。視界を明瞭にするために血液を押しのける必要がある。この実施形態は、剛性または可撓性いずれかの透明なドームまたはバルーンを使用する。この構造は、カテーテルの遠端の観察装置の先に配置される。前述し、図5Aおよび5Bを参照した一形態の実施形態では、遠端の構造は、透明な流体または気体をその中に注入することによって膨張する可撓性バルーンである。それは、その収縮モードでカテーテルの遠端に配置される。注入は中央制御することが好ましく、観察装置が作動しているときにいつでも流体または気体を注入してバルーンを膨張させることができる。膨張しているとき、上記のドームのように、バルーンは視界から血液を押しのける。別の形態の実施形態では、構造は、遠端付近およびその縁に配置され、その遠位に延長する剛性ドームである。剛性構造はそれが観察装置の周囲から血液を除去するように配置され、こうして動脈の血流を閉塞することなくドームと装置の間の視界が明瞭になる。剛性の構造は中空(真空、気体)であるか、または透明流体を充填することができる。
表面に衝突する光は、偏向して跳ね返る成分を有する。入射角が垂直に近い場合、反射光はより大きく偏向する。血管内環境では、壁および/またはそれに接続しているいずれかの構造にぶつかる光は大部分が偏向して跳ね返る一方、血管に充満している流体中に浮遊する細胞にぶつかる光は偏向して跳ね返らない。撮像対象は通常、血管の壁に接続している表面である。その結果、光学アセンブリの前に偏光フィルタを配置することによって、センサに到達する光は偏光、すなわち撮像対象構造から反射した光だけにすることができる。偏光を使用するこの方法により画像/雑音比が増加し、受け取る画像の品質が改善される。
前述した実施形態に加えて、以下は、前述した実施形態に関連する他の四つの実施形態を表わす。
1.立体画像を得るために二つのセンサを備えた光学センサヘッド。
2.赤血球の通過を阻止するが流体の通過は可能な透明な膜から作られた遠位バルーン。本実施形態では、注入される流体を使用して、遠位バルーン膜を膨張させることができる。
3.サービスチャンネルおよび局所撮像装置を使用するレーザ手術機構。この実施形態は、手術領域の連続撮像により正確な手術手順が可能になる。
4.生検および他の診断または治療処置を実行するために、観察装置を針の正面端の近くに配置する。
5.別の実施形態は生検および試料検索のそれである。図9を参照する。ワーキングチャンネルB9は、吸込みおよびナノグリッパ98ならびにレーザ装置98のいずれかまたは両方を光学ヘッド90の前に遠位に通すために使用される。吸込み/ナノグリッパ99機構および光学ヘッド90を使用する生体試料の収集により、所望の場所の視覚検査が可能になる。試料は分析のために、ワーキングチャンネルB9を通して患者の体外に移送することができる。吸込み/ナノグリッパ99は、試料を所定の位置に保持するために使用され、レーザ装置は試料を周囲の組織から切断するために使用される。光学ヘッド90は、前述した光学ヘッド構成と同様である。吸込み/ナノグリッパ99およびレーザ装置98は、視覚的フィードバックを提供するために、交互に、または一緒に光学ヘッド90の前に配置することができる。このプロセスにより、ワーキングチャンネルB9を通して患者の体内から取り出すことができる試料の生検が可能になる。
Claims (37)
- a.近端および遠端を備えた可撓性カテーテルであって、前記遠端がガイドワイヤに沿って血管内に挿入するように形作られ、それによって脈管構造または他の器官の遠隔場所に到達するように構成された可撓性カテーテルと、
b.前記カテーテルの遠端の向こう側の直近領域を照明するための少なくとも一つの照明源と、
c.画像を取得するための画像センサであって、前記カテーテルの長手軸に対し非直角に配置された画像センサと、照明源からの照明の反射の振幅を測定するための光センサであって、画像センサとは別個のものである光センサとを備え、前記カテーテルの遠端に配置された光学アセンブリと、
d.前記カテーテルの近端から遠端まで走る少なくとも一つのワーキングチャンネルと、
を備えた侵襲性撮像装置。 - 前記照明源は、可視光、近赤外、および赤外光を含む範囲内から選択された少なくとも一つの波長を利用する請求項1に記載の装置。
- 複数の照明源を備え、前記照明源は一緒に制御される請求項2に記載の装置。
- 複数の照明源を備え、前記照明源は別個に制御される請求項2に記載の装置。
- 前記照明源は、血液を通しての視認性を改善するために予め選択された少なくとも一つの波長を使用する請求項1に記載の装置。
- 前記照明源は、前記患者の身体の外部に配置可能な赤外照明源から構成される請求項1に記載の装置。
- 前記照明源は、前記撮像アセンブリの方向から撮像対象に直接照準するように制御可能である請求項4に記載の装置。
- 前記照明源は、全ての視認方向に向けるように制御可能である請求項1に記載の装置。
- 前記光学アセンブリは光学部品および撮像アセンブリを備える請求項1に記載の装置。
- 前記光学部品は二つの光学面を持つレンズ、シャッタ、および光偏向器を含む請求項9に記載の装置。
- 前記光偏向器は、反射面を備えたプリズムおよびミラーの一つである請求項10に記載の装置。
- 患者の身体の外部から前記カテーテルの近端に接続可能な中央制御および表示装置を備える請求項1に記載の装置。
- 前記ワーキングチャンネルはガイドワイヤを備える請求項1に記載の装置。
- 前記ワーキングチャンネルは、カテーテルの前記遠端へ流体を制御可能に通すために使用可能である請求項1に記載の装置。
- 前記画像センサは、前記カテーテルの長手軸に実質的に平行に配置する請求項1に記載の装置。
- 前記画像センサは、前記カテーテルの制限された寸法内に嵌るように形作られる請求項1に記載の装置。
- 前記画像センサは、CMOSまたはCCDに基づく画素センサである請求項1に記載の装置。
- 前記画像センサは、矩形の画素配列状に形作られた撮像領域を備える請求項1に記載の装置。
- 前記矩形の画素配列は128×256画素のサイズである請求項18に記載の装置。
- 前記センサは、前記撮像領域の短辺の下に配置されたセンサ制御電子回路機構を備え、前記撮像領域が矩形の画素配列として構成される請求項1に記載の装置。
- 前記電子回路機構のI/Oおよび電源パッドは、前記画像センサの短辺の少なくとも一つに沿って配置される請求項20に記載の装置。
- 前記光学アセンブリと、並びに前記中央制御および表示装置と連通して前記カテーテルの遠端に配置された局所制御装置をさらに備える請求項12に記載の装置。
- 前記表示および制御装置は、前記流体の注入のタイミングおよび量を制御するように動作可能である請求項14に記載の装置。
- 透明なバルーン状構造を前記カテーテルの遠端に配置して、光学センサヘッドの周囲から血液を押しのけ、明瞭な視認性を可能にする請求項1に記載の装置。
- 前記バルーン状構造は剛性である請求項24に記載の装置。
- 前記バルーン状構造は可撓性である請求項24に記載の装置。
- 前記バルーン状構造は、前記ワーキングチャンネルに通した液体または気体を使用することによって膨張および収縮する請求項26に記載の装置。
- 前記光学アセンブリは、立体画像を得るための二つの画像センサを含む請求項1に記載の装置。
- 前記流体の注入は前記光学アセンブリの動作と同期し、前記動作および前記注入が患者の生理的条件のサイクルと同期する請求項27に記載の装置。
- 前記生理的条件の一つが、患者の身体に前記患者の身体の外部から接続可能な、または前記カテーテルを通して前記血管内に挿入可能な心拍センサを使用して感知可能な拍動である請求項29に記載の装置。
- 前記心拍センサがプレチスモグラフを含む請求項30に記載の装置。
- 前記心拍センサからの情報は前記中央制御装置に転送され、前記生理的条件との同期を可能にする請求項30に記載の装置。
- 前記バルーン状構造は圧力感知され、前記バルーン状構造が血管壁などの障害物に衝突したときに実時間フィードバックを提供する請求項27に記載の装置。
- 前記ワーキングチャンネルは、治療器具を手術の部位に通すために使用可能である請求項1に記載の装置。
- 前記光学アセンブリは、レーザ外科手術を可能にするためにレーザ切断装置と共に使用する請求項1に記載の装置。
- 前記レーザ切断装置を使用して、切断および前記ワーキングチャンネルを通した前記カテーテルの近端への移送によって、生検用生体試料を得る請求項35に記載の装置。
- 前記光学アセンブリおよび前記レーザ切断装置は、生体試料の検索に望ましい位置の視診を可能にするために、吸込みおよびナノグリッパ機構の一つと共に使用する請求項36に記載の装置。
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2001
- 2001-10-10 US US09/973,181 patent/US6692430B2/en not_active Expired - Lifetime
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2002
- 2002-08-11 AU AU2002324316A patent/AU2002324316A1/en not_active Abandoned
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US20040147806A1 (en) | 2004-07-29 |
IL159829A0 (en) | 2004-06-20 |
EP1465684A2 (en) | 2004-10-13 |
US7758499B2 (en) | 2010-07-20 |
US20020068853A1 (en) | 2002-06-06 |
WO2003013624A2 (en) | 2003-02-20 |
EP1465684B1 (en) | 2012-09-19 |
AU2002324316A1 (en) | 2003-02-24 |
US20070100241A1 (en) | 2007-05-03 |
WO2003013624A3 (en) | 2004-08-05 |
US6692430B2 (en) | 2004-02-17 |
JP2005503203A (ja) | 2005-02-03 |
EP1465684A4 (en) | 2009-01-07 |
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