JP4717683B2 - Medical image display device - Google Patents

Description

  The present invention relates to a medical image display apparatus that displays a volume image captured before surgery and assists in surgery or the like.

  A magnetic resonance imaging apparatus (MRI apparatus), which is an example of a medical image display apparatus, continuously measures a nuclear magnetic resonance signal (MR signal) from hydrogen, phosphorus, etc. in a subject, and the density distribution and relaxation time of the nucleus. The distribution is visualized. At present, the imaging target of the MRI apparatus that is widely used clinically is the main constituent substance of the subject, proton. The MRI apparatus images the form or function of the human head, abdomen, limbs, etc. in a two-dimensional or three-dimensional manner by imaging the spatial distribution of proton density and the spatial distribution of the relaxation phenomenon in the excited state.

  There is known an I-MRI apparatus (abbreviation for Interventional-MRI apparatus or Intraoperative-MRI apparatus) used for cardiac imaging using such an MRI apparatus, puncture monitoring during surgery, percutaneous treatment, and the like. In this I-MRI apparatus, there is a demand for arbitrarily setting a tomographic plane to be imaged in real time.

  As a method of arbitrarily selecting a tomographic plane to be imaged, a method of displaying an MRI image on a graphical user interface, clicking a button on the screen, and determining a tomographic plane to be imaged next (Non-Patent Document 1), 3 A method using a three-dimensional mouse or the like (Patent Document 1) has been proposed. In these methods, the position and orientation of the tomographic plane to be imaged must be adjusted and set with an input means such as a mouse, which is cumbersome. As an MRI apparatus, the position and orientation of the tomographic plane to be imaged can be adjusted more easily. It is desirable that it can be set.

  As such a technique, Patent Document 2 and Patent Document 3 propose an MRI apparatus that determines a tomographic plane to be imaged using a tomographic plane indicating device (pointer or the like). In the technique described in Patent Document 2, a light emitting diode is provided in a pointer which is a tomographic plane indicating device, and the position pointed by the operator by the pointer is detected by an infrared camera, or the tip of an arm provided with a sensor at a joint is detected. A pointer is provided, the position of the pointer is detected based on the angle of the joint of the arm, and the tomographic plane is automatically adjusted based on the detected position. Moreover, the technique described in Patent Document 3 automatically determines and images a tomographic plane instructed using two infrared cameras and a pointer provided with three reflecting spheres.

  On the other hand, a surgical navigation system using a position detection device and volume data captured in the past is known. This surgical navigation system is a system for navigating a surgical operation by displaying a position designated by a pointer or the like with respect to a patient at the time of surgery on a tomographic image having cross sections of three orthogonal planes including the position. It is applied to high-precision surgery such as neurosurgery.

  Here, a tomographic image of a patient in the surgical navigation system is generated in advance by volume data that is three-dimensional data captured by an MRI apparatus. On the other hand, methods for detecting the position of the pointer required for determining the designated position by the pointer include methods such as a mechanical method, an optical method, a magnetic method, and an ultrasonic method.

  Then, the correspondence (registration) between the detected pointer position and the position in the volume data is obtained by, for example, imprinting the patient marker in the volume by performing imaging while fixing a plurality of patient markers to the patient. This is performed by associating the detected position of the pointer at the time when the patient marker is designated with the pointer with the position of the patient marker in the three-dimensional data.

  The technique of surgical navigation is described in Patent Literature 4 and Patent Literature 5. A technique combining the I-MRI and the surgical navigation system is described in Patent Document 6.

  Since the patient who is taking an image by the MRI apparatus is confined in a closed space, the patient may feel pain due to a feeling of occlusion or a feeling of pressure. Therefore, an open-type MRI apparatus has been proposed that does not give pain to the patient who is imaging. Since this open-type MRI apparatus can access a patient from an open part, a tomographic plane can be easily indicated using a pointer or the like, and the indicated tomographic plane can be imaged in real time. -Development as an MRI system is in progress.

  Here, as a part of the surgical simulation function for the purpose of improving surgical treatment accuracy, a method related to the remote surgery support device (Patent Document 7), a method of drawing and segmenting a specific area (Patent Document 8), and an access route of the surgery A method (Patent Document 9) for calculating / extracting a signal has also been proposed.

  As an RF coil for an I-MRI apparatus, a surgical coil having a structure capable of approaching an imaged tissue without any obstacle has been proposed (Patent Document 10).

US Pat. No. 5,512,827 US Pat. No. 5,365,927 US Pat. No. 6,063,315 JP 2002-35007 A Japanese Patent Laid-Open No. 2003-79637 JP 2003-190117 A Japanese Patent Laid-Open No. 8-215111 Japanese Patent Laid-Open No. 2002-248083 JP 2002-186588 A JP 2000-157514 A Magnetic Resonance in Medicine: Real-time interactive MRI on a conventional scanner; AB. Kerr et al., 38, pp. 355-367 (1997)

  The pre-operative simulation described above can be said to be an effective means for planning an operation because it draws (segments) a specific region of the subject and calculates / draws the access route of the operation.

  However, even if the surgical access path in a specific area of the subject is displayed, the displayed surgical access path depends on the position, body position, bed position, coil type, and coil installation position of the subject at that time. Is not always appropriate.

  For this reason, it may be necessary to change to a path different from the displayed access path from the relationship such as the coil position and the body position of the subject. In this case, not only the preoperative simulation is wasted, but also the start of the operation may be delayed, which places an unnecessary burden on the operator and the subject.

  An object of the present invention is to realize a medical image display device capable of optimal assist such as surgery by performing and displaying a preoperative simulation in consideration of the position of a subject.

  A medical image display device according to the present invention is a device that acquires and displays three-dimensional image data of a subject, and a three-dimensional position detection means detects the position of the subject, the surgical instrument, and the bed on which the subject is placed. The arithmetic control unit simulates the surgical route from the surgical instrument insertion position to the target position using the captured three-dimensional image data of the subject, and the subject position is determined according to the simulated surgical route. The body position of the subject and the bed position where the subject is placed are calculated. Then, the position of the subject, the posture of the subject, and the position of the bed on which the subject is placed calculated by the computation control means are displayed on the display means.

  This makes it possible for an operator or the like to easily grasp the relationship between the surgical access path, the position of the subject, the body position of the subject, and the position of the bed on which the subject is placed.

  A magnetic resonance imaging apparatus according to the present invention is an apparatus that acquires and displays three-dimensional image data of a subject. A three-dimensional position detection unit includes a subject, a surgical instrument, a bed on which the subject is arranged, a nucleus The position of the receiving coil of the magnetic resonance signal is detected, and the operation control means simulates the surgical route from the surgical instrument insertion position to the target position using the captured three-dimensional image data of the subject, and this simulation. The position of the subject, the body position of the subject, the position of the bed where the subject is placed, the type of the receiving coil for the nuclear magnetic resonance signal, and the installation position of the receiving coil are calculated according to the operated surgical route. Then, the display means displays the position of the subject, the body position of the subject, the position of the bed where the subject is placed, the type of the receiving coil of the nuclear magnetic resonance signal, and the installation position of the coil.

  By performing and displaying a preoperative simulation in consideration of the position of the subject and the like, it is possible to realize a medical image display apparatus capable of optimal assist such as surgery.

  Embodiments of the present invention will be described below with reference to the accompanying drawings. The embodiments described below are examples when the present invention is applied to an MRI apparatus.

  FIG. 1 is an operation flowchart of operation simulation and operation support display in an MRI apparatus according to an embodiment of the present invention. FIG. 2 is a schematic external configuration diagram of an MRI apparatus to which the present invention is applied.

First, the MRI apparatus will be described with reference to FIG.
In FIG. 2, an MRI apparatus 1 is a vertical magnetic field type 0.3T permanent magnet MRI apparatus, which connects an upper magnet 3 that generates a vertical static magnetic field, a lower magnet 5, and these magnets 3 and 5 to each other. And a support column 7 that supports the upper magnet 3, and has a structure in which the subject 24 can be easily approached from the opening 32.

  The MRI apparatus 1 includes a position detection device 9, an arm 11 that supports the position detection device 9, a monitor 13, a monitor support unit 15, a reference tool 17, a personal computer (calculation control means) 19, A bed 21, a control unit 23, and a video recording device 34 are provided.

  A gradient magnetic field generation unit (not shown) of the MRI apparatus 1 generates a gradient magnetic field in a pulse manner, has a maximum gradient magnetic field strength of 15 mT / m, and a slew rate of 20 mT / m / ms. Furthermore, the MRI apparatus 1 includes an RF transmitter (not shown) for generating nuclear magnetic resonance in the subject 24 in a static magnetic field, and an RF receiver (not shown) that receives a nuclear magnetic resonance signal from the subject 24. These are 12.8 MHz resonant coils.

  The position detection device 9 includes two infrared cameras 25 and a light emitting diode (not shown) that emits infrared rays, and detects a pointer 27 that is a tomographic plane indicating device, a position, and a posture. The position detection device 9 detects the position and posture of the surgical coil 37 by detecting a reflective sphere (reflective marker) 38 attached to the surgical coil 37. Further, the position detection device 9 is connected to the upper magnet 3 so as to be movable by the arm 11, and the arrangement position with respect to the MRI apparatus 1 can be appropriately changed.

  As shown in FIG. 3, the monitor 13 displays an image of the tomographic plane of the subject 24 indicated by the pointer 27 (reflection marker) held by the operator (operator) 29. As with the infrared camera 25, the upper magnet 3 is connected. The reference tool 17 links the coordinate system of the infrared camera 25 and the coordinate system of the MRI apparatus 1, includes three reflection spheres (reflection markers) 35, and is provided on the side surface of the upper magnet 3. Then, the position of the pointer 27 detected and calculated by the infrared camera 25 is transmitted to the personal computer 19 via the RS232C cable 33 as position data, for example.

  The control unit 23 includes a workstation and controls an RF transmitter, an RF receiver, and the like (not shown). The control unit 23 is connected to the personal computer 19. In the personal computer 19, the infrared camera 25 detects, and the calculated position of the pointer 27 is converted into position data that can be used by the MRI apparatus 1 and transmitted to the control unit 23.

  The position data of the pointer 27 is reflected on the imaging section to be displayed in the imaging sequence, and the image acquired in the new imaging section is displayed on the liquid crystal monitor 13. For example, when the pointer 27, which is a tomographic plane indicating device, is attached to a puncture needle or the like and configured so that the position where the puncture needle is located is always an imaging cross section, the monitor 13 displays a cross section that always includes the needle. .

Next, operations of surgery simulation and surgery support display using the MRI apparatus will be described. In FIG. 1, after 3D imaging by the MRI apparatus (step 101), a 3D volume image is displayed in a three-axis two-dimensional display (MPR (Mu1ti Planar Reconstruction)) and a 3D volume image (step 102).
If necessary, registration of accessible areas such as normal tissues and tumors in the data storage device based on the three-dimensional data of the subject stored in the data storage device (not shown) and the dimensional data of the MRI apparatus 1 ( In step 103), inaccessible areas such as blood vessels and organs are registered (step 104), surgical instruments used for surgery are registered (step 105), and a virtual display is displayed. When displaying on the display, the registered parts are color-coded and displayed in an easy-to-understand manner.

  Next, the operation plan (safety route) from the surgical instrument access start unit to the target region is automatically calculated and displayed using the registered site and virtual surgical instrument (step 106).

  Here, an operator or an operator selects an operation route that seems to be optimal from the displayed operation plan simulation (step 107). According to the selected surgical route, the bed position, patient's body position, coil type, and coil placement position suitable for the surgical route are automatically calculated and displayed (step 108). The patient's body position and the like are stored in advance in the data storage means, and the personal computer 19 selects an appropriate one from them and displays it on the monitor 13.

  Next, in step 109, the operator or the like again selects whether or not simulation is necessary. If simulation is necessary again, the process returns to step 103. In step 109, if there is no problem in the simulation result, the preoperative planning is ended.

  The result of the simulation executed in steps 101 to 109 described above is displayed immediately before the operation, and the patient's body position and the like are adjusted according to this display. That is, the operator or operator guides the subject so that the patient is in the displayed position (step 110), and then installs the dedicated coil so as to be at the displayed coil position (step 111). . And it moves so that the position of a bed may become the displayed bed position (step 112).

Next, the actual position, posture, and coil position of the patient at that time are photographed using the position detection device 9 and displayed on the monitor 13. The displayed information is used to determine the position, posture, and coil position of the patient. Fine adjustment is performed (step 113).
Then, the actual operation is started according to the operation route selected by the preoperative planning (step 114).

  Here, for comparison with the present invention, a patient position / coil installation positioning method in the prior art will be described with reference to FIG. This prior art does not simulate the position of the patient, the coil position, etc. before the operation, and the assist display of the patient position etc. is not performed.

  In step 201 of FIG. 3, the patient is placed on the bed immediately before the operation (step 201), and a dedicated coil having an arbitrary size is attached to an arbitrary position (step 202). Next, using a laser beam, the bed is moved into the MRI apparatus by an operator or the like (step 203), and an image obtained by MRI imaging is acquired (step 204).

  After acquiring the MRI image in step 204, it is determined whether or not the operator needs to reset the patient position and the like (step 205). The operator usually reexamines the patient position and coil position, and when re-installation is necessary, the bed is taken out of the MRI apparatus (step 206), and the process returns to step 201 to repeat re-installation. Then, after re-installation, after executing steps 202 to 204 including MRI imaging, if it is determined that re-installation is not necessary, surgery is started (step 207).

  As described above, steps 201 to 206 are repeatedly performed. In each case, MRI imaging must be performed with the patient and the like actually set to a patient position and posture suitable for the operation, as shown in FIG. Compared to one embodiment of the present invention, it can be understood that it takes a long time to prepare for the operation and the burden on the operator and the patient is large.

  FIG. 4 is a diagram showing an example of a display screen of various surgical support software GUIs using the three-dimensional position detection device in one embodiment of the present invention. In FIG. 4, the left screen of the full screen 401 shows information related to the navigation software 402, and the right screen 403 displays preoperative planning results 417 such as patient positions and information about the actual patient positions 423. Yes.

  First, in order to perform preoperative planning, a 3D scan button 404 is pressed to execute a 3D scan, and Axial 405, Sagittal 406, Coronal 407, and Volume rendering 408 are displayed. Here, by pressing the preoperative planning function button 409 and using it together with preoperative planning, the surgical routes 410, 411, 412, and 413 can be depicted and displayed. As a result, the coil type, installation position 414, and bed movement amount 415 are displayed as the planning result.

  By pressing the preoperative planning application button 416 during actual surgery, coil information 418, a surgical route 419 and a patient position 420 are displayed in the preoperative planning result portion 417. Further, when the position detection button 421 by the infrared camera 25 is pressed, a position 423 in the real space is displayed, and the bed 21 is automatically moved by pressing the bed movement guidance button 422. This bed movement can be instructed by voice from an operator or the like. The infrared camera 25 captures the posture of the patient who is the subject when the bed 21 is outside the imaging space region of the subject, and after the bed 21 is moved to the imaging space region, It is also possible to display the posture on the monitor 13.

FIG. 5 is an external view of the entire coil 501 for intra-MRI surgery, and FIG. 6 is a diagram showing a display example of the movable range of the coil 37 with respect to the patient.
The coil 37 has a plurality of sizes of S, M, and L, and can be easily replaced as necessary. Further, as shown in FIG. 6A, the coil 37 has a rotation function with respect to the bed 21, and the movable range is displayed on the GUI (display example 502). Further, as shown in FIG. 6B, the vertical movable range of the coil 37 with respect to the bed 21 is also displayed at the same time, and the surgical staff can freely position (display example 503).

  FIG. 7 is a diagram showing a GUI display example of the bed operable range in the MRI apparatus of the present invention. 7A shows a display example 601 of the bed left and right movable range, and FIG. 7B shows a display example 602 of the bed vertical movable range. FIG. 8 is a diagram showing a GUI display example of the patient position in the present invention. 8A shows the right-side prone position 701, FIG. 8B shows the left-side prone position 702, FIG. 8C shows the supine position 703, and FIG. 8D shows the prone position 704. . The example shown in FIG. 8 is four, but other examples can be added and user customization such as deletion can be made according to the operator's request.

  FIGS. 9-12 is explanatory drawing of the calculation protocol of a patient position, a patient body position, the type of coil, and the installation position of a coil in one Embodiment of this invention. FIG. 9 is an explanatory diagram of a protocol for displaying a screen used when selecting a surgical route in Step 107 of FIG. In FIG. 9, first, after 3D imaging, preoperative planning by GUI is performed, and puncture start position, target rendering, surgical route calculation, and patient posture calculation are performed.

  Next, FIG. 10 corresponds to the screen displayed in step 108 of FIG. 1, and shows a screen display 811 for matching the simulation result with the state in the real space (MRI space). In the example shown in FIG. 10, in the preoperative planning path 812, when the patient is in the prone position, the surgical instrument 813 touches the upper magnet, and thus it is determined that access is impossible.

  FIG. 11 is a diagram showing that the access path 812 is possible by changing the patient's body position to the left-side prone position 821 without changing the access path 812 shown in FIG. FIG. 12 is a diagram for simulating the selection and placement position 831 of the optimal surgical coil 37 from the patient position obtained from the image.

  At the time of actual surgery, using information according to the simulation performed as described above, navigating patient position, patient position, coil type, coil installation position, and performing incorrect operation and arrangement, There is a warning and a function to guide the user to reinstall.

  As described above, the present invention is always optimal by performing surgery assist by displaying the patient position, patient body position, bed position, coil type, and coil installation position from the simulation calculated before the operation, and the coil installation position immediately before the operation. It is possible to provide a simple surgical environment.

  As a result, it is possible to shorten the time required for preparation for surgery, and to reduce the burden on the operator / patient.

  The above-described example is an example when the present invention is applied to an MRI apparatus, but the present invention can be applied not only to an MRI apparatus but also to other medical image display apparatuses such as a CT apparatus. .

It is an operation | movement flowchart of the surgery simulation and surgery assistance display in the MRI apparatus which is one Embodiment of this invention. 1 is a schematic external configuration diagram of an MRI apparatus to which the present invention is applied. It is an operation | movement flowchart of the kind of coil different from this invention, and a coil installation position determination method, and is a figure which shows the comparative example with this invention. It is a figure which shows the example of a display screen of various surgery assistance software GUI using the three-dimensional position detection apparatus in one Embodiment of this invention. It is a whole external view of the coil for operation in MRI. It is a figure which shows the example of a display which shows the movable range with respect to the patient of the coil in this invention. It is a figure which shows the example of GUI display of the bed operable range in the MRI apparatus of this invention. It is a figure which shows the example of a GUI display of the patient position in this invention. It is calculation protocol explanatory drawing of the preoperative planning in one Embodiment of this invention. It is a figure which shows the example of a GUI display for adapting the simulation result in one Embodiment of this invention to the conditions on real space. It is a figure which shows that access is possible by changing a patient position, without changing an access path | route. It is a figure which simulates selection and arrangement position of the optimal surgical coil from patient posture obtained from an image.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 MRI apparatus 3 Upper magnet 5 Lower magnet 7 Column 9 Position detection device 11 Arm 13 Monitor 15 Monitor support part 17 Reference tool 19 Personal computer 21 Bed 23 Control part 24 Subject 25 Infrared camera 27 Pointer 29 Operator 32 Opening 34 Video Recording device 35, 38 Reflecting sphere 37 MRI surgical coil

Claims (10)

In a medical image display device that acquires and displays 3D image data of a subject,
Three-dimensional position detecting means for detecting the position of the bed on which the subject, the surgical instrument, and the subject are disposed;
Using the 3D image data of the imaged subject, a surgical path from the surgical instrument insertion position to the target position is simulated to the subject, and according to the simulated surgical path, the position of the subject, the posture of the subject, Calculation control means for calculating the position of the bed where the subject is placed;
Means for displaying the position of the subject, the body position of the subject, and the position of the bed where the subject is placed, calculated by the arithmetic control means;
A medical image display device comprising: In a magnetic resonance imaging apparatus that acquires and displays three-dimensional image data of a subject,
A subject, a surgical instrument, a bed on which the subject is placed, a three-dimensional position detecting means for detecting the position of a receiving coil of a nuclear magnetic resonance signal;
Using the 3D image data of the imaged subject, a surgical path from the surgical instrument insertion position to the target position is simulated to the subject, and according to the simulated surgical path, the position of the subject, the posture of the subject, Calculation control means for calculating the position of the bed where the subject is arranged, the type of the reception coil of the nuclear magnetic resonance signal, and the installation position of the reception coil;
Means for displaying the position of the subject, the posture of the subject, the position of the bed where the subject is placed, the type of the receiving coil of the nuclear magnetic resonance signal, and the installation position of this coil, calculated by the arithmetic control means;
A magnetic resonance imaging apparatus comprising:   3. The magnetic resonance imaging apparatus according to claim 2, wherein the calculation control means displays the actual current position of the subject detected by the three-dimensional position detection means on the display means. apparatus.   3. The magnetic resonance imaging apparatus according to claim 2, further comprising storage means for storing the three-dimensional image data of the subject, wherein the calculation control means is configured to perform measurement according to the dimension data of the magnetic resonance imaging apparatus and the three-dimensional image data of the subject. A magnetic resonance imaging apparatus characterized in that among regions of a specimen, a region that can be accessed by surgery and a region that cannot be accessed are determined and registered in the data storage unit.   3. The magnetic resonance imaging apparatus according to claim 2, further comprising data storage means, wherein the posture of the subject displayed on the display means is registered in advance in the data storage means, and the arithmetic control means selects the registered posture. Then, the magnetic resonance imaging apparatus is characterized in that it is displayed on the display means.     3. The magnetic resonance imaging apparatus according to claim 2, wherein the calculated bed position is obtained from the calculated body position of the subject.   3. The magnetic resonance imaging apparatus according to claim 2, wherein the type of the reception coil to be calculated is obtained using the three-dimensional image data of the imaged subject.   3. The magnetic resonance imaging apparatus according to claim 2, wherein the calculated installation position of the receiving coil is obtained from the simulated surgical path and the calculated body position of the subject.   The magnetic resonance imaging apparatus according to any one of claims 2 to 8, wherein a reflective marker indicating a reference position is arranged, and the three-dimensional position detecting means detects the position of the reflective marker, and A magnetic resonance imaging apparatus that detects the position of a subject, a surgical instrument, a bed on which the subject is placed, and a receiving coil of a nuclear magnetic resonance signal based on the position.   10. The magnetic resonance imaging apparatus according to claim 2, wherein the bed is moved between an imaging space area of a subject and the outside of the imaging space, and the three-dimensional position detection unit includes the bed. Detecting the posture of the subject when the object is outside the imaging space, and the calculation control means displays the detected posture of the subject after the bed is moved to the imaging space area. A magnetic resonance imaging apparatus.

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