JP4744284B2 - Treatment child - Google Patents

Description

  The present invention relates to a treatment device (treatment device) of a treatment device used for cryotherapy.

Among medical devices, there are devices that allow an intruder to enter (including puncture) into the body of a subject. For example, there are a gastric camera, a monitoring optical fiber, a collection tool for cutting and collecting tissue, an injection tool for injecting a drug into a specific site, and a treatment tool for treating a lesion site by irradiating energy such as heat or electromagnetic field.
For intrusion monitoring of such an intruder, a fluoroscopic monitoring method in which a fluoroscopic image is obtained and displayed in real time to monitor the intrusion, and CT monitoring in which an X-ray CT tomographic image is obtained in real time and displayed in two or three dimensions to monitor the invasion. There is a law.
Such fluoroscopy monitoring method and CT monitoring method are a method in which an operator performs monitoring while looking at a screen, and an operator performs medical treatment while determining and confirming the position and route from the monitoring image.
The CT monitoring method is a treatment in which a CT image and / or a three-dimensional image thereof are displayed in real time while performing CT imaging of an intrusion route and an affected part, and an operator advances and treats the intruder while monitoring the display screen. Refers to the law. The CT monitoring method is suitable for monitoring a complex part or a deepened part of the body (lung, heart, prostate, pancreas, etc.). The latest example using this CT monitoring method is a cryotherapy method for necrosis of lung cancer tissue. This cryotherapy is based on the principle that the lung cancer site cells are frozen and then thawed, and the inside of the cells is destroyed by the generation of a difference in salt concentration in the process of thawing, leading to cell death. Two high-pressure gases are used for freezing and thawing. When the volume of high-pressure gas expands suddenly, there are ones that rapidly increase the temperature depending on the type of molecule and ones that rapidly decrease the temperature. This is called the Joule-Thompson effect, which is one of the physical phenomena. . Therefore, high-pressure argon gas is used to raise the temperature, and helium gas is used to lower the temperature. For treatment, a hollow metallic treatment child (synonymous with a treatment tool, also called a guide needle) is used. Under CT monitoring, this therapeutic child is guided to the affected part, and the two gases are alternately discharged from the inside of the hollow or the tip of the hollow part to the outside, and cryotherapy is performed on the affected part using the heat exchange action.

There is Non-Patent Document 1 as a document of such general cryotherapy. Furthermore, there is Non-Patent Document 2 as a document that describes a mechanical system including a therapeutic element used for cryotherapy, and a method and an actual case of the treatment.
The magazine “Ayumi of Medicine” (Vol. 206 No. 3, 2003. 7.19). Kawamura et al., “Freeze-thaw necrosis therapy for lung cancer” (P229-P231). Magazine "Cryogenic Medicine" (30, 2004). Nakatsuka, Kawamura et al., “Percutaneous cryotherapy for lung malignant tumor using CT fluoroscopy” (P9-P15).

  Document 2 is a technique in which the puncture state of the treatment child is photographed with an X-ray CT apparatus in real time, reconstructed and displayed as a tomographic image in real time, and a procedure is performed. The X-ray CT apparatus is multi-slice imaging, and obtains and displays a large number of tomographic images at one time. The progress of the treatment child can be monitored, and it can be viewed as an image in almost real time along the tracking and procedure to the affected area.

  On the other hand, the treatment element uses a stainless steel double tube (coaxial needle) whose tip protrudes like a blade. In the treatment, with the double tube placed on the body surface, a long and thin guide needle is inserted along the central axis of the double tube, and the guide needle is punctured to the affected area. Next, the double tube is advanced to the affected area along the guide needle, and the double tube is further advanced to penetrate the tumor.

  Thereafter, the guide needle is removed, and a freezing terminal is inserted and loaded along the hollow shaft in the double tube instead. At this time, the terminal tip which becomes the freezing / thawing portion of the freezing terminal is set to a position in contact with or close to the rounded inner surface of the tip of the double tube. The freezing terminal is connected to a high-pressure argon gas inlet and a high-pressure helium gas inlet via a switching valve. After the filling is confirmed, the switching valve is switched to inject high-pressure helium gas, then high-pressure argon gas is injected, and freezing and thawing are performed in a short time. This cycle may be repeated multiple times. A series of these operations are performed while observing and confirming under CT monitoring with displaying a real-time CT image.

The above-mentioned double tube has a rounded shape at the front end, in the forward direction. Therefore, when the freezing terminal is attached to the inside and the freezing / thawing is performed, the directivity characteristic of the heat follows the rounded shape in the forward direction (that is, the depth direction) from the tip. However, the directivity is uniform in the peripheral direction of the tip (that is, in the lateral direction perpendicular to the depth).
Since the treatment site and the affected area have various depths and lateral spreads, the role of the leading edge shape of the double tube is important.
An object of the present invention is to provide a therapeutic element that enables various effective directional characteristics in depth and lateral direction.

The present invention relates to a hollow metal tube that can be punctured inside a subject, a freezing terminal that can be inserted / attached along the central axis of the tube, and a freezing terminal that is connected to the freezing terminal and alternately switches between freezing and thawing gases. There is disclosed a therapeutic device comprising a gas supply unit to be supplied and having at least one protrusion shape in the outer circumferential direction or the inner inner direction near the tip of the metal tube.
Further, the present invention performs subject variation correction such as the posture of the subject at the time of medical treatment on the three-dimensional formula data, and the corrected three-dimensional formula data and formula data representing the shape of the subject intruder. To determine and determine at least one of the entry start position to the subject, the arrival point on the contour of the entry tool, the entry direction, the angle and rotation angle of the entry tool, and the travel route from the start position to the arrival point. A medical device intended is disclosed.
Furthermore, the present invention discloses a treatment element in which the metal tube is a cylinder.
Furthermore, the present invention provides a hollow metal tube that can be punctured inside a subject, a freezing terminal that can be inserted / attached along the central axis of the tube, and a gas that connects to the freezing terminal and alternately switches between freezing and thawing gases. And a gas supply section for supplying the therapeutic tube, and a treatment element comprising a protrusion-shaped body movable to the distal end on the outer periphery or inner periphery on the tube side of the distal end of the metal tube.
Furthermore, the present invention discloses a treatment element in which an operation part is provided on a freezing terminal located outside the tube after insertion and attachment.
Furthermore, the present invention discloses a treatment element in which a plastic tube is used instead of the metal tube.

  According to the present invention, it is possible to realize a therapeutic element having a heat directing characteristic effective for treatment.

[Summary of the Invention]
The present invention relates to a treatment element having a freezing terminal, and at least one protrusion-shaped portion having a heat directing characteristic in an outward direction is provided around a distal end portion of a tube such as a double tube. Thereby, the heat directing characteristic toward the outward direction of the protrusion is increased, and the concentrated heat energy can be supplied to the treatment lesion in that direction.

  Further, according to the present invention, the protrusion can be moved in conjunction with the progress of the freezing terminal, so that the protrusion can be moved to the tip in conjunction with the progress of the freezing terminal at the time of puncturing or completion thereof.

  Furthermore, according to the present invention, the operation portion is provided at a portion of the freezing terminal located outside the tube such as a double tube, so that the rotation angle and the intrusion angle of the freezing terminal can be freely made.

Furthermore, the present invention is suitable for a treatment apparatus using a treatment child having a freezing terminal. Therefore, the basic concept of a new treatment device that has never existed before will be described.
The internal structure of the human body can be seen using reflected and transmitted waves. For example, there are ultrasonic waves in the former and X-rays in the latter. In particular, the latter CT and various X-ray devices using electromagnetic waves (X-rays, etc.) having a short wavelength and high transparency have been developed to be very useful in practice because of the advantages of transparency and theoretical resolution. In the CT apparatus, an image (hereinafter simply referred to as an image) obtained by the difference in the amount of transmission of electromagnetic waves due to the human body structure is obtained as XY two-dimensional plane data with the density obtained as a constant fracture surface as a plane. . This plane can be handled mathematically as an array in the depth (Z) direction of a parallel plane with the coordinate center defined and the axis as the axis. That is, it can be handled as three-dimensional array data.

  Therefore, in the treatment apparatus, since the image on the Zn plane at the depth position Zn has the structure information of the human body obtained from the reflected transmission characteristics of the transmitted wave, this image is contoured using a spatial filter such as mathematical convolution processing. Perform feature extraction. Since the extracted contour feature is discrete, it does not necessarily represent the structural contour correctly. These contour data are used as statistically acquired data as a mathematical formula using a mathematical method such as a least square method. Further, the three-dimensional function is unified in the Z-axis direction by a mathematical method not described in detail by the close function of Zn-1 and Zn + 1. Since Zn-1, Zn, and Zn + 1 are finely obtained to about 1/100 mm, the three-dimensional function obtained by these can fairly represent the actual human body faithfully. In obtaining the Zn image, it does not matter whether there is a projection substance injected into the human body in order to further enhance the transmitted X-rays. It is considered that these auxiliary operations can easily contrast structures with little difference in permeability with surrounding substances such as blood vessels and cancer tissues.

The above is the principle of the treatment apparatus, but another treatment apparatus that has been further developed will be described.
The above-mentioned three-dimensional human body data is the past measured before treatment, and there is a so-called body motion change (deviation) due to changes in posture, movement of organs, etc. during treatment. That is, the three-dimensional human body model is different depending on the individual in advance and also depending on the posture. Of course, the target cancer tissue is individual. These are observed and measured in advance by a CT apparatus or the like, and the target human body is converted into sufficient data. Dissociation in the surgical operation scene such as posture must be eliminated. For this purpose, a plurality of light reflecting stickers are set in specific parts of the human body set by a doctor, and in a further developed invention, specific points inside the human body, which are recognized and determined by the computer, such as skeletal feature points, are detailed. A method of automatically detecting by a method not described, performing a three-dimensional contour function and coordinate axis conversion already possessed using a mathematical method, and eliminating errors such as physical dimensions in principle in the insertion of a therapeutic element.

  In another treatment apparatus, since the shape of a therapeutic element to be inserted into the human body is determined (including the structure), this is mathematically defined and expressed as a three-dimensional mathematical expression as data. Then, from the above three-dimensional function and the mathematical expression indicating this shape, a rational percutaneous insertion point useful for treatment, a treatment site (position), an approach direction matching the shape, and a rotation angle of the treatment element at the time of entry (for example, Each treatment parameter such as a treatment having a directional shape) and an approach route is uniquely calculated by mathematical data processing. In addition, since the percutaneous insertion point is an important parameter, some parameters, for example, the percutaneous insertion point, are determined by the operator's advanced judgment and other parameters are calculated.

Furthermore, this unique method and another treatment apparatus for treating a child using the method will be described.
A preferred example of a therapeutic child is a lung cancer therapeutic child, which is related to those described in the prior art. Therefore, the first therapeutic element is the double tube for lung cancer treatment described in the conventional example. Therefore, this therapeutic element has a tip shape having no direction in the peripheral direction, and when viewed in the longitudinal direction, the freezing terminal is inserted from the outside in the central axis direction with respect to the double tube, so that the traveling direction or insertion When viewed in the direction, both can be defined as a linear shape body. That is, the therapeutic element having a linear shape is composed of a part (double tube and its tip) A entering the body and an extension part (a part of the freezing terminal exposed to the outside) B. The B portion has the reflectivity of a light source regardless of the control visible laser defined separately, and can be mathematically handled with respect to the X, Y, and Z axes.
The second therapeutic element is an example in which a touch part C for operation is fixed in the middle of a part located outside the freezing terminal so as to be orthogonal to the terminal. By operating the touch part C, the freezing terminal is advanced and rotated. Since the position and shape of the touch part C can be mathematically regulated, the operation content can also be converted into data.
The third therapeutic element is an example in which the tip of the freezing terminal is shaped so as to have a specific heat directivity characteristic. For example, there is a heat directivity characteristic that is beamed in a specific direction. Used to accurately deliver heat energy to the treatment site. Such a therapeutic child can also formulate the shape and formulate the directivity characteristic of the thermal energy. Furthermore, by providing the touch part C described in the second therapeutic element, a therapeutic element that directs the heat directivity characteristic in a specific direction (angle) is provided.

Another treatment apparatus related to the operation of the treatment child will be described.
The first is a fully automated example. An actuator is attached to each of the double tube and the freezing terminal (or the touch part of the freezing terminal) of the treatment child in common or individually. These actuators are controlled by XYZ control means (for example, a computer) according to the data determined mathematically in advance to puncture the double tube and advance the freezing terminal.
The second is a semi-automated example. There are various ways to automate and to what extent.
The third is a manual example.
Thus, if the percutaneous position and path determined by an advanced doctor are uniquely determined, the insertion position and the simulation operation (virtual operation) can be performed automatically, regardless of the manual operation of the doctor. As soon as it reaches, there is a feature that can be confirmed and tried in advance.

A further alternative treatment device will be described.
A therapeutic child using a freezing terminal alternately performs freezing and thawing. However, in still another invention, thermal energy is applied based on thermal physical property information of the treatment site. Thermal physical property information includes temperature, specific heat, thermal conductivity, and tissue state. The parameters of thermal energy are time zone, number of times, freezing temperature, thawing temperature, and the like. In a broad sense, the invasion angle and rotation angle of the therapeutic element are also related. Such parameters may be determined empirically or mathematically.
Furthermore, a parameter determination method is proposed as another treatment apparatus. The parameters include a first parameter such as an intrusion angle, a rotation angle, and a treatment position of the therapeutic element, and the second parameter related to thermal energy. These parameters are determined empirically or through repeated trial runs.

[Description of treatment device]
FIG. 2 is a model diagram for obtaining a three-dimensional image by superimposing CT tomographic images, and also shows an example of setting the coordinate system XYZ. For example, the point A of the first tomogram can be defined as (X1, Y1, Z1), and the point B of the kth tomogram can be defined as (Xk, Yk, Zk). A plurality of tomographic images 10 of a patient are acquired in advance by a CT apparatus.
In FIG. 2, it appears that adjacent tomographic images have gaps, but the gap spacing is actually about 1/100 mm, which is an image very close to the actual human body of the patient. An example is also included in which the interval is further reduced by interpolation.

  On the other hand, if the coordinate system of the tomographic image is XY and the coordinate system in the overlapping direction is Z, an arbitrary position of the tomographic image can be defined by (X, Y, Z).

FIG. 1 shows the overall processing flow of the novel treatment device.
First, CT image data is acquired (step S1). This is shown in FIG. The acquisition timing does not matter immediately before treatment or the day before. Obtain prior to treatment.
Next, contour extraction is performed (step S2). This contour extraction is performed by a convolution operation between the contour extraction spatial filter and the CT image data. There are various contours such as the body surface, skin, bones, organs, cancer lesions, etc., and these contours are extracted. The contour extraction is useful for calculating the intersection with the therapeutic element and grasping the relative positional relationship with other contours. The contour for each CT tomographic image data is discrete because it is extracted in pixel units, and when viewed in the Z direction, each tomographic position has a discrete positional relationship. Therefore, for each tomographic image data, a two-dimensional function is formed by using the least self-discard method or the like, and further, a three-dimensional function of each two-dimensional function in the Z direction is performed by the least square method or the like (step S3). As a result, a three-dimensional function of the contour is obtained.
In step S4, a parameter for entering the treatment child is calculated. This calculation uses a three-dimensional function expressing the shape of the treatment element and the calculated three-dimensional function of the contour, and the treatment element necessary for the treatment element to safely, surely, and quickly arrive at the treatment site on the contour line. Is the calculation of the parameters.
The parameters of the treatment element include the position of the body surface that serves as the entry point of the treatment element, the position of the treatment site that the treatment element reaches, the direction (angle) of entry of the treatment element into the body surface position, and the treatment element at the entrance to the body surface. There is its own rotation angle and the route of entry (system path).
Among these parameters, the intrusion position is often specified by the operator. The rotation angle of the treatment element itself is a parameter for designating what angle the treatment element itself should have when the shape of the tip of the treatment element itself is directional.

A method of calculating parameters will be described.
FIG. 3 shows an example of the relationship between the extracted contour model, the treatment model, and the treatment site model. In FIG. 3, E1, E2, E3, and E4 are different extracted contour models, M is a therapeutic model, and the contour model E3 is a cancer lesion model. Each of these models E1, E2, E3, and M has a three-dimensional shape, but in the figure, it is assumed to be two-dimensional for convenience because of drawing.
Assume that the entrance is P1, which is set by the surgeon. Therefore, if a lesion model E3 is found on the contour model, the intrusion angle θ1 of the treatment model M from the point P1 to the lesion model and the rotation angle φ1 of the treatment model itself are uniquely known. If the point P0 is a point on the y-axis line, if it enters from here, it will hit the contour model E4. Therefore, the surgeon has selected the entrance P1 as a result of this determination.

The therapeutic element model M is a therapeutic element 100 as shown in FIG. The therapeutic element 100 includes a freezing terminal 2 (which may not have 21A) having a double tube 1 and an operation unit 21A such as a rotation, and a pipe 6 connected thereto, a switching valve 5, a high pressure helium gas supply source 3, a high pressure An argon gas supply source 4; Assuming that the length L1 of the tube 1 and the length L2 of the externally exposed portion of the freezing terminal 2, the therapeutic element 100 may be considered as a linear component having a length of approximately (L1 + L2). Assuming that the distal end 20B penetrates from P1 to the lesion site E3, θ1, φ1, P2, P1 → P2 (route) at that time can be calculated.
In step S5, the calculated intrusion parameter is determined as operation data, and in step S6, the therapeutic element intrusion operation is performed automatically, semi-automatically, or manually based on the operation data. In step S7, it is confirmed that the point P2 has been reached, and treatment by freezing / thawing is performed.

  In addition, as a guiding means to the lesion, there is a guiding needle, which is inserted at the time of guiding. When the induction is completed, a freezing terminal is inserted in place of this induction needle. The concept of the induction needle is the same as that in Document 2.

  A more advanced embodiment will be described. The superimposed three-dimensional image in FIG. 2 is based solely on past tomographic images taken before treatment. At the time of treatment, the posture may be different from that at the time of the past photographing. As a result, parameters such as a start position, a target position, and a route set on the three-dimensional image may not coincide with the body at the time of actual treatment.

Therefore, the operator attaches small marker seals to multiple locations on the patient's body, and automatically identifies specific points inside the human body (for example, part of the stomach, shoulder bone projections, etc.) that the computer recognizes and determines. The detected three-dimensional contour function and coordinate axis conversion are performed using a mathematical method to eliminate errors (distortions) such as physical dimensions in principle in the invasion operation of the therapeutic element (so-called body motion correction). As a result, appropriate parameters such as the insertion start position, the arrival point, and the route are calculated.
Furthermore, based on the data subjected to the above-mentioned subject variation correction, a test is performed by determining the intrusion position, the arrival point of the intruder, the intrusion direction, the angle and rotation angle of the intruder, and the travel route from the start position to the arrival point. Repeat the operation, and based on the results, at least one of the entry start position to the subject, the arrival point on the contour of the entry tool, the entry direction, the angle and rotation angle of the entry tool, and the travel route from the start position to the arrival point If one is determined to be changed, the accuracy can be improved.

[Explanation of treatment child]
Next, an embodiment relating to the therapeutic element of the present invention having directionality in shape, particularly a tube structure will be described. The tip of the tube is two operating parts, freezing and thawing, and performs a so-called heat exchange function. The lesion site, which is a cancer lesion, also has various shapes, and it is an important consideration to determine from what direction puncture is an efficient freezing method. Furthermore, it is necessary to protect normal tissues in the vicinity of the lesion from freezing and thawing (especially freezing). Therefore, the direction of heat directivity with directionality is made large and small, and heat distribution characteristics for giving thermal energy in a concentrated manner according to the lesion site are given. This is an embodiment of the tube shown in FIG.

FIG. 5A is an example in which a protruding portion 20 is provided by protruding a part of the periphery of the distal end portion 20A immediately before the leading edge 20B of the double metal tube 1. The cross section of the arrow has a shape that is rounded outward as shown in FIG. 5 (b), and its heat directivity characteristic is as shown in FIG. 5 (c). The tip 20B of the tip 20A has a blade shape at the tip of puncture, and there is an example in which puncture is easy and heat directivity characteristics are given in the deep direction.
FIG. 6A shows an example in which the tip portion 20A is provided with two protrusions 21 and 22 so that the heat directing characteristics are elongated. As a result, as shown in FIG. 6B, a sharp heat directing characteristic was given in the (+) direction of the y direction.
The tip portions 20A and 20B are sites involved in freezing / thawing.
FIG. 7 shows an example of use of a therapeutic element characterized by this tip shape. FIG. 7A shows an example in which the therapeutic element 100 is punctured on the side surface of the spherical cancer lesion 23 and the cancer lesion 23 is necrotized by applying thermal energy based on its directivity. This cancer lesion 23 is a structurally solid example, and is more suitable for necrosis from the surrounding rather than puncturing the lesion 23 directly.
FIG. 7B is an example in which the left side inside the cancer lesion 24 is punctured and treated with the therapeutic element 100 having rightward directionality. This also helps necrosis of the entire lesion.

FIG. 7C shows a case where the blood vessel 24 is nearby and the lesion 23 is treated away from the blood vessel 24. The treatment child 100 was punctured on the opposite side (right side) of the blood vessel 24. This has the purpose of not only damaging blood vessels but also reducing the effect of blood vessel temperature on treatment. FIG. 7D shows an example in which two or more treatment elements 100A and 100B are used to puncture both sides of the lesion 23 and perform simultaneous treatment. FIG. 7D is effective for cases where the lesion size is large.
In each of the embodiments described above, the type and form of the protrusion shape are determined by what directivity characteristics are given. There is also a method of providing a recess in the inner direction instead of the protrusion shape. The projection shape (including the concave portion) that realizes the directivity can be obtained by a computer. There is a way to prepare tubes with various protrusions and use them properly according to the focus and purpose of treatment.

FIG. 8A is a diagram showing another embodiment of the double pipe. In FIG. 5, the fixed protrusion shape is formed. However, in FIG. 8, the movable wing 30 is provided along the outer side surface of the double pipe 1, and the movable wing 30 is extended to the tip of the pipe as shown in FIG. It is made to move and is formed into a protruding shape as shown in FIG. The movable blade 30 is moved by, for example, a spring. For example, the spring is interlocked with the freezing terminal in accordance with the progress of the freezing terminal. In this case, a roundness is made around the movable wing 30 so as not to damage the human body.
When the human body is inserted, it is used as shown in FIG. 8A, and when it reaches the affected part, it is moved as shown in FIG. 8B.

FIG. 9 shows an embodiment in which an operation touch part 21 </ b> A is provided in the middle of the freezing terminal 2 for convenience of operation. The touch part 21 </ b> A only needs to be large enough to be grasped by a hand, and is, for example, a bar-shaped body slightly extending in the direction orthogonal to the terminals 2. The touch part 21A has an advantage that the freezing terminal 2 can be reliably advanced and the terminal itself can be rotated (Φ). By attaching an actuator to this touch part, automation and semi-automation can be performed.
Further embodiments will be described.
(1) About temperature characteristics (temperature change).
A specific example is shown in FIG. FIG. 12A shows an example of one cycle in which the freezing peak temperature and the thawing peak temperature are set to the same absolute value T1 (actually -T1 during freezing and + T1 during thawing). Since it is preferable that the thermal energy be offset by both, the area determined by (temperature) × (time) during freezing and thawing is the same area (S1). FIG. 12B shows an example in which the absolute values of the freezing peak temperature and the thawing peak temperature are T1 and T2 (T1> T2). Since T1> T2, in order to achieve the same area S1, the thawing period is set longer than the freezing period. In addition, as a modified example of 12 (a) and (b), there can be an example of one cycle of one freezing and two thawings.
FIG. 12 (c) shows a two-cycle donation example of freezing and thawing. There are also examples of more than 3 cycles.
Although the area is the same for freezing and thawing, strict identity is not required if the goal of necrosis of the lesion can be achieved. Since a human treatment site has a body temperature of 38 ° C., an actual temperature characteristic is often determined in consideration of such body temperature.
In order to realize such various temperature characteristics (temperature changes), the gas supply of both helium and argon to the treatment element 100 may be controlled using the amount and time as parameters.
(2) Realization of temperature characteristics (temperature change) and determination of gas supply control method.
i. For the above three-dimensional mathematical data, taking into account the thermal constants such as the specific heat and conductivity of the objects that make up each, and the physical constants such as the object shape incorporating the volume weight, the temperature of the object Determine the time change.
ii. Calculate the temperature change with respect to the time around the intruder arrival point considering the thermal and physical constants of the subject represented by the above three-dimensional mathematical data, and calculate the dynamic change with respect to the set temperature or the set time to the dynamic change. It is determined so that it can be determined.
iii. The rotation angle of the intruder is determined so that the thermal change in the vicinity of the determined arrival point becomes the set temperature change.
iv. A plurality of intruders are inserted into the reaching point object, and the temporal change of the thermal temperature of the reaching point object and the objects in the vicinity thereof is determined.
v. The intruder having the plurality of thermal directions is subjected to the test operation by repeating the temporal change of the thermal temperature at the arrival point and the vicinity thereof under the determined geometrical constant as a result. Determining and determining at least one of the entry start position from the object to the subject, the arrival point on the contour of the entry tool, the entry direction, the angle and rotation angle of the entry tool, and the travel route from the start position to the arrival point; Determine the temperature distribution and temporal changes of surrounding objects.
vi. A gas changeover switch in the gas inflow passage that switches between heat generation and heat absorption of the heat exchanger installed at the tip of the intruder is a gas with a gas amount and a supply sequence (timing) such that the temperature changes in the vicinity of the arrival point. Find the supply control method. At the time of treatment, puncture is performed according to the intrusion parameters, and gas supply is performed by the gas supply control method after reaching the treatment site.

  FIG. 13 shows a processing flow in consideration of temperature characteristics. Compared to FIG. 1, new steps S8, S9, and S10 are added between steps S4 and S6. In step S8, the above-described temperature characteristics are determined and the gas supply control method is calculated based thereon. In step S9, treatment simulation based on the parameters calculated in steps S4 and S8, temperature characteristics, and the gas supply control method is performed. If it is determined that there is no therapeutic effect as a result of the simulation, the process returns to step S4. If it is determined that there is a therapeutic effect, the process proceeds to step S10 and a final decision is made.

  FIG. 10 is a specific example of a freezing terminal. Reference numeral 40 denotes a freezing terminal main body, which is made of a material having low thermal conductivity, for example, metal, and has a heat exchange mechanism 41 therein. A high-pressure gas flows in through the switching valve 5 and is discharged from the tip opening portion 42 to the inside of the main body 40 and exhausted to the outside. In addition, 31 and 32 are cocks for each gas.

[Specific examples of treatment devices]
FIG. 11 is an overall configuration example diagram of the treatment apparatus 50. The treatment device 50 includes a CT scanner 51, an image processing device 52, a display unit 53, an operation unit 54, a drive control unit 55, a planning unit 56, a therapeutic element 57, a gas supply unit 58, and a monitoring unit 59.

  The CT scanner 51, the image processing device, the display unit 53, and the operation unit 54 are original CT devices. Using this CT apparatus, a plurality of tomographic images are acquired in advance to form a three-dimensional image. There is also an example in which an interpolation image for filling a gap is used as a three-dimensional image from a plurality of tomographic images.

The CT apparatus 51 is also used to obtain a real-time CT image during a puncturing operation. This real-time image is also obtained by superimposing the puncture operation of the therapeutic element 57 in the monitoring unit 59, and is used for puncture monitoring and treatment monitoring.
The planning unit 56 determines the puncture start position, the treatment site, and the progression route of the treatment element based on the three-dimensional image data obtained in advance or based on the shape (and / or structure) data of the treatment element 57. To create plan data.

The drive control unit 55 performs drive control such as movement of the therapeutic element 57 and supply control of the gas supply unit 58 based on the plan data of the plan unit 56, and performs alternating operations of freezing and thawing.
The monitoring unit 59 monitors drive control. There are two types of monitoring: CT image monitoring and control mechanism monitoring. The monitoring unit 59 may be combined with the display unit 53.

The above is an example of a therapeutic element, but the basic idea of the present invention can be applied to the other intruders described above.
Although the metal tube is a double tube, there is an example of a single tube. In addition to metal pipes, there can be examples of rigid plastic pipes and other examples of materials.

It is a processing flow of a treatment apparatus. It is an example figure of a three-dimensional image. It is an explanatory model figure of the contour model, the treatment example of the treatment child, and treatment parameters. It is explanatory drawing of the treatment child of this invention. It is a figure which shows the other shape of the metal tube of this invention, and a thermal characteristic figure. It is a figure which shows the other shape of the metal tube of this invention, and a thermal characteristic figure. It is treatment explanatory drawing by the treatment child with a directional shape. It is a figure which shows the other structure of the metal tube of this invention. It is a figure which shows the treatment child example of this invention. It is a figure which shows the specific example of the freezing terminal of this invention. It is a figure which shows the example of a treatment apparatus of this invention. The temperature change figure of this invention is shown. The processing flow example figure based on the temperature characteristic of this invention is shown.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Single or double metal tube 2 Freezing terminal 100 Treatment element 20, 21, 22 Protrusion-shaped part 30 Moving piece

Claims (3)

A hollow metal tube that can be punctured inside the subject, a freezing terminal that can be inserted and mounted along the central axis of this tube, and a gas supply that connects to this freezing terminal and alternately switches between freezing and thawing gases And providing a partial heat directivity characteristic in addition to the heat directivity characteristic to the periphery of the metal tube determined by the outer shape of the metal tube in the outer periphery direction or the inner inner direction near the tip of the metal tube. A treatment element in which a protrusion-shaped part can be arranged, and the protrusion-shaped part can be moved by an operation unit . The therapeutic element according to claim 1, wherein an arrangement position of the protrusion-shaped portion is a position determined according to a treatment target site of the subject. The therapeutic element according to claim 1 or 2, wherein the hollow metal tube has a cylindrical shape.

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