JP4970201B2 - Medical diagnostic imaging equipment - Google Patents

Description

  The present invention relates to a medical image diagnostic apparatus that displays a medical image, and more particularly to a medical image diagnostic apparatus that displays a medical image for surgery support.

  The medical image diagnostic apparatus includes an imaging unit that captures a medical image, a medical image processing unit that processes the medical image, and the like. Examples of the medical image diagnostic apparatus include an X-ray tomographic apparatus (CT), an X-ray fluoroscopic apparatus, a magnetic resonance imaging apparatus (MRI), and an ultrasonic diagnostic apparatus. Along with the development of such a medical image diagnostic apparatus, an opportunity for a doctor to perform a diagnosis, an operation, or the like using a medical image indicating a patient's part is increasing. For example, when performing a resection operation to remove a tumor, an operator refers to a medical image before the operation, and implants a plurality of markers for indicating the position of the tumor in the patient's body, and then, during the operation, The resection operation is performed while visually confirming the marker and confirming the resection range. In addition, the technique which embeds the marker in a patient's body is proposed (for example, refer patent document 1).

On the other hand, in recent years, there has been a movement to reduce the resection range of organs as much as possible in order to improve QOL (Quality Of Life) of patients. Therefore, there are cases where treatment with chemotherapy or radiation therapy is performed for the purpose of weakening tumor cells or reducing the size of the tumor before excision of the malignant tumor. As a result, for example, it is possible to remove only a tumor of 3 cm or less, instead of excising all one area of the liver, and there is an advantage that the recovery of the patient after the operation is accelerated.
JP 2000-33089 A

  However, even if the tumor appears to have disappeared on the medical image due to treatment, if it is determined by biopsy or the like that minute tumor cells that are not visible remain, the part where the tumor was (disappeared) All previous tumor areas) must be excised. At this time, since the tumor is not visible, it is difficult for the operator to determine the resection range (surgical range) for the site (eg, liver). That is, it is very difficult to determine the operation range for a tumor that is not visible.

  On the other hand, if a CT image before treatment is used, it is possible to embed a marker in the vicinity of the tumor region before disappearance or reduction. The surgeon can visually identify the marker during the operation, or search for the marker using an intraoperative ultrasound image or X-ray image to identify the excision range. In addition, examples of the intraoperative image photographing apparatus include an ultrasonic diagnostic apparatus and an X-ray photographing apparatus. However, since the profit and loss differ depending on the target organ, one of them is used. For example, in the case of a lung tumor, since an ultrasonic image becomes very unclear, an X-ray fluoroscopic image is used. When the ablation line is determined by visually confirming the embedded marker with a medical image during or after surgery, if about 20 markers are embedded so as to surround the tumor before treatment, reliable ablation is performed. You should be able to determine the line.

  However, in order to embed a large number of markers so as to completely surround the tumor before treatment, a large number of insertion paths are required, and whether this is possible depends on the target tissue and the position of the tumor. It is a very rare case that this is possible, and there is a current situation in which the ablation range must be determined with a small number of markers of about 3 to 4 at most. Although it is possible to assume the tumor area before treatment to some extent with only a few markers of about 3 to 4, it is possible to completely remove the tumor before treatment within the actually assumed resection range (surgical range). I haven't come to the confidence that I can do it. That is, it is difficult for an operator to determine the resection range that covers the entire area of the tumor region before treatment with confidence only by embedding a small number of markers.

  The present invention has been made in view of the above, and an object of the present invention is to provide a medical image diagnostic apparatus capable of supporting determination of a surgical range for a tumor that cannot be visually recognized.

  A feature according to an embodiment of the present invention is that, in the medical image diagnostic apparatus, a display unit that displays a medical image indicating a part of a subject, a storage unit that stores information, and a tumor range that surrounds the tumor of the part from the medical image Means for generating first position information indicating the position of the tumor range, means for storing the generated first position information in the storage unit, and the stored first position information Based on the above, the tumor range is reproduced, the reproduced tumor range is displayed on the display unit together with the medical image for operation, the means for detecting the marker embedded in the site, the position and storage of the marker detected before the incision Means for generating second position information indicating the positional relationship between the marker position and the tumor range based on the first position information, means for storing the generated second position information in the storage unit, and incision Marker position detected later And saved on the basis of the second position information to reproduce the tumor range, further comprising a means for displaying on the display unit together with the medical image surgical reproducibility tumor range.

  ADVANTAGE OF THE INVENTION According to this invention, the medical image diagnostic apparatus which can assist the determination of the operation range with respect to the tumor which cannot be visually recognized can be provided.

  An embodiment of the present invention will be described with reference to the drawings.

  As shown in FIG. 1, a medical image diagnostic apparatus 1 according to an embodiment of the present invention includes a control unit 2 such as a CPU (Central Processing Unit) that centrally controls each unit, a ROM (Read Only Memory), and a RAM. (Random Access Memory) or the like, an imaging unit 4 that captures a medical image showing a part of a subject such as a patient, a display unit 5 that displays an image such as a medical image, and operations of an operator or an assistant An operation unit 6 that receives an input operation from a person, a storage unit 7 that stores various programs and various data, a communication unit 8 that communicates with an external device, and an image processing unit 9 that processes an image such as a medical image. And. These parts are electrically connected by a bus 10.

  The control unit 2 controls each unit based on various programs and various data stored in the storage unit 7. In particular, the control unit 2 executes a series of data processing for calculating or processing data, image display processing for displaying an image, and the like based on various programs and data.

  The memory 3 is a memory that stores a startup program executed by the control unit 2 and also functions as a work area of the control unit 2. The activation program is read and executed by the control unit 2 when the medical image diagnostic apparatus 1 is activated.

  The imaging unit 4 performs an imaging operation for imaging a medical image on a subject such as a patient. As this imaging unit 4, for example, an imaging unit using X-rays, an imaging unit using ultrasonic waves, or the like is used. When X-rays are used, the imaging unit 4 detects an X-ray irradiation unit that irradiates the subject on the top of the bed with X-rays and the X-rays irradiated by the X-ray irradiation unit. And an X-ray detection unit. The imaging unit 4 is provided so as to be movable around the couch top, and images medical images (CT images) of each part of the subject on the couch from the imaging position.

  The display unit 5 is a display device that can display an image such as a medical image in color, and in particular, a display device that displays a medical image for surgery on a region of the subject (for example, the liver). For example, a liquid crystal display or a CRT (Cathode Ray Tube) display is used as the display unit 5.

  The operation unit 6 is an input unit that is input by an operator, and is an input unit that accepts various input operations such as start of image display and image switching. For example, an input device such as a mouse or a keyboard is used as the operation unit 6.

  The storage unit 7 is a storage device that stores various programs, data, and the like. In particular, image data (image information) D1 relating to a medical image, and first position data (position information) indicating a tumor range for a tumor in a site It is a storage device that stores D2 and second position data (position information) D3 indicating the position of the marker. For example, a magnetic disk device or a semiconductor disk device (flash memory) is used as the storage unit 7. The image data D1 is obtained by the photographing unit 4 and stored in the storage unit 7 via the bus 10. Here, examples of the site of the subject include the liver, breast, lung, and various digestive organs.

  The communication unit 8 is a device that communicates with an external device via a network such as a LAN (Local Area Network) or the Internet. As the communication unit 8, a LAN card, a modem, or the like is used. Examples of the external device include a database server and other medical image diagnostic devices.

  The image processing unit 9 performs various image processing (for example, image processing including image reconstruction) on an image such as a taken medical image or a stored medical image. Here, the image processing unit 9 generates a two-dimensional or three-dimensional medical image from the image data. Specifically, the image processing unit 9 performs image processing such as volume rendering processing, MPR (Multi Planer Reconstruction) processing, and MIP (Maximum Intensity Projection) processing on image data (for example, volume data) to display an image for display. Generate data. The image processing unit 9 is configured by one or both of software and hardware.

  Next, ablation range determination support processing (tumor range storage processing and surgical image display processing) performed by such a medical image diagnostic apparatus 1 will be described. The control unit 2 of the medical image diagnostic apparatus 1 performs a tumor range storage process for storing the position of the tumor range before treatment, and displays a surgical medical image during surgery for embedding and excising a marker. Execute display processing.

  Usually, when a doctor finds a tumor in the liver, for example, by a medical checkup, the size and number of tumors using a medical image (clinical image) by the medical image diagnostic apparatus 1 (CT, MRI, ultrasonic diagnostic apparatus, etc.) Diagnose whether type, primary or metastatic, resection surgery, etc. As a result, if the tumor is a single primary liver cancer of about 4 cm, the doctor reduces the tumor by, for example, treatment with chemotherapy or radiation therapy (preoperative treatment), and then surgically removes it. Make a treatment plan. At this time, the doctor considers that the tumor may not be visible due to treatment, and before the tumor disappears or shrinks, that is, before the treatment, the medical image diagnosis apparatus 1 determines the position of the tumor, that is, the position of the tumor range. save. Thereafter, the doctor embeds one or a plurality of markers (for example, four) in the patient's body while visually confirming the medical image (intraoperative image) for surgery by the medical image diagnostic apparatus 1 at the time of surgery, and confirms these markers. Excise the resected area of the site.

  First, a tumor range storage process in the case where an operator such as a doctor stores the position of a tumor range using the medical image diagnostic apparatus 1 before treatment will be described with reference to FIGS.

  As shown in FIG. 2, the control unit 2 first captures a medical image G1 (step S1). That is, the control unit 2 causes the photographing unit 4 to perform a photographing operation. Thereby, for example, as shown in FIG. 3, a medical image (three-dimensional image) G1 showing the liver T as a part is obtained. The medical image G1 is stored in the storage unit 7 as image data D1.

  Next, the control unit 2 sets a tumor range (trace line) R for the captured medical image G1 (step S2). Thereby, as shown in FIG. 3, the tumor range R is set around the tumor Ta on the medical image G1. Here, when the tumor range R is automatically set, for example, the image processing unit 9 recognizes the tumor Ta by a technique such as CAD, and the tumor is based on distance information from the tumor Ta to the resection margin. An optimal tumor range R is set around Ta. The distance information at this time is stored in the storage unit 7. On the other hand, when the tumor range R is manually set, the captured medical image G1 is displayed on the display unit 5, and an operator such as a doctor or an assistant inputs to the operation unit 6 while referring to the medical image G1. The operation is performed, and a tumor range R surrounding the tumor Ta is set around the tumor Ta. When the medical image G1 is a three-dimensional image, the tumor range R is also set in three dimensions, and when the medical image G1 is a two-dimensional image, the tumor range R is also set in two dimensions.

  Thereafter, the control unit 2 divides the tumor range R into a plurality of regions Ra (step S3), and associates these regions Ra with structures around the tumor Ta (for example, the surface of the liver T and the surface of the rib J). First position data D2 is generated (step S4), and the generated first position data D2 is stored (step S5). That is, the control unit 2 controls the image processing unit 9 to divide the tumor range R into each region Ra, and divide the region Ra into each surface of each structure, for example, the surface of the liver T and the surface of the rib J ( For example, the first position data D2 is generated in association with the outer surface, and the first position data D2 is stored in the storage unit 7. As a result, as shown in FIG. 3, the tumor range R is divided into regions Ra, and the regions Ra are associated with the surface of the liver T and the surface of the ribs J (each feature region), respectively. First position data D2 that is an aggregate is generated. Thereafter, the first position data D2 is stored in the storage unit 7. Each feature region on the surface of the structure is, for example, a feature amount such as a shape of a blood vessel on the surface of the liver T that is invariable for a long time, a shape of the rib J that is invariable for a long time, a degree of curvature, or the like. Specified by the feature amount.

  Here, as shown in FIG. 3, when specifying the position of a certain region Ra, the recording surface K1 characterized by the shape of the blood vessel on the surface of the liver T, the shape and curvature of the rib J Are extracted, and the position of one region Ra is specified by these recording surfaces K1 and K2. These recording surfaces K1 and K2 each function as a characteristic area. For example, the position of a quadrangular (for example, square) region Ra is the distance from each corner to each corner of the quadrangular recording surface K1, and from each corner of the recording surface K1 to each corner of the quadrangular recording surface K2. It is specified by the distance. Therefore, the recording surface K1 (feature amount information), the recording surface K2 (feature amount information), and the distance information are acquired as one set of related information for one region Ra. Note that the region Ra, the recording surface K1, and the recording surface K2 have a similar relationship, for example. This process is performed on all the regions Ra or a certain number of regions Ra in the tumor range R, and the first position data D2 that is an aggregate of the related information is generated.

  In the course of treatment with chemotherapy or radiotherapy, if the tumor Ta is clearly reduced or if the liver T is deformed due to treatment, the above-described tumor range preservation process is performed again. The first position data D2 may be rewritten. When treatment by chemotherapy or radiation therapy is completed and the tumor Ta cannot be visually recognized on the medical image G1, the presence or absence of tumor cells is confirmed by an examination such as biopsy. If the result is negative, the treatment ends here and the patient is followed up. On the other hand, if the result is positive, or if the treatment is intended to weaken the tumor cells and it was planned to remove the original tumor part from the beginning, perform a surgical plan for resection, Surgery markers are embedded (indwelled).

  Next, a surgical image display process when an operator such as a doctor embeds a surgical marker using the medical image diagnostic apparatus 1 will be described with reference to FIGS.

  As shown in FIG. 4, the control unit 2 first captures a medical image G2 for surgery (step S11). That is, the control unit 2 causes the photographing unit 4 to perform a photographing operation. At this time, imaging is performed with the same posture as possible as the medical image G1 before treatment (see FIG. 3). Thereby, for example, as shown in FIG. 5, a medical image (three-dimensional image) G2 showing the liver T as a part is obtained. The medical image G2 is stored in the storage unit 7 as image data D1.

  Next, the control unit 2 reproduces the tumor range R composed of each region Ra based on the first position data D2 (step S12), and displays the reproduced tumor range R together with the medical image G2 for operation (step S13). ). That is, the control unit 2 reads the first position data D2 from the storage unit 7, controls the image processing unit 9, and sets each region Ra on the medical image G2 for surgery based on the first position data D2. The tumor range R is reproduced and displayed on the medical image G2 for operation. Thereby, for example, as shown in FIG. 5, the tumor range R is displayed superimposed on the medical image G2.

  Here, the image processing unit 9 reproduces each region Ra based on the recording surface K1, the recording surface K2, and the distance information corresponding to each region Ra in the first position data D2. At this time, the positions of the recording surface K1 and the recording surface K2 are specified based on the feature amount information of the recording surface K1 and the recording surface K2, and the area is determined based on the distance information about the recording surface K1 and the recording surface K2. Ra is reproduced. This is executed for all regions Ra. Thereafter, the control unit 2 superimposes the reproduced image showing the tumor range R on the medical image G2 for operation and causes the display unit 5 to display it together with the medical image G2 for operation as a medical image for operation support. In addition, it becomes possible to display the tumor range R on the medical image G2 for a real-time operation by setting it as the apparatus which can perform an image process at high speed.

  Thereafter, as shown in FIG. 5, the surgeon uses the insertion member H such as a needle to refer to the displayed medical image G2 for surgery and the tumor range R, and uses a plurality of markers M1 to M4 such as resin beads. Is inserted into the body of the patient, ie, at the periphery of the tumor area R. The number of insertion of the markers M1 to M4 is determined by the size of the tumor range R, the possibility of approach with a needle from the body surface, etc., and may be singular or plural.

  Next, the control part 2 detects the position of each marker M1-M4 before incision (step S14). The position detection of these markers M1 to M4 is performed under the guide of a CT image as a medical image G2, for example. For example, an operator such as an operator or an assistant manually positions the image of the markers M1 to M4 displayed on the CT image by using the operation unit 6 such as a touch pen that touches the display screen of the display unit 5 ( Mark). Alternatively, the image processing unit 9 automatically detects and positions (marks) each marker M1 to M4 from the shape of resin beads or the like constituting each marker M1 to M4, or from the feature value such as CT value or luminance. May be performed. Further, the image processing unit 9 may automatically detect the positions of the markers M1 to M4 from the difference between the CT images before and after the marker insertion. When there are a plurality of markers M1 to M4, different numbers, characters, symbols, etc. may be assigned to the markers M1 to M4 so that each of the markers can be distinguished. Markers M1 to M4 may be shown. Further, each of the markers M1 to M4 to be inserted may have different characteristics (for example, differences in substance, shape, density, CT value, etc.), and may be discriminated on the CT image.

  Next, the control unit 2 generates second position data D3 indicating the positional relationship between the positions of the markers M1 to M4 detected before the incision and the reproduced tumor range R (step S15), and the generated second The position data D3 is stored (step S16). That is, the control unit 2 controls the image processing unit 9 to obtain a positional relationship between the detected positions of the markers M1 to M4 and the reproduced tumor range R, and generates second position data D3 indicating the positional relationship. Then, the second position data D3 is stored in the storage unit 7.

Here, as shown in FIG. 6, the second position data D3 is, for example, an arbitrary surface on the surface of the tumor range R by three-dimensional spatial coordinates with the center of the ellipsoid as (x ₀ , y ₀ , z ₀ ). This is data in which the positions of points and markers M1 to M4 are set. That is, the center of the tumor range R is (x ₀ , y ₀ , z ₀ ), and four points (x ₁ , y ₁ , z ₁ ), (x ₂ , y) of the center points of the markers M1 to M4. ₂ , z ₂ ), (x ₃ , y ₃ , z ₃ ) and (x ₄ , y ₄ , z ₄ ), an ellipsoid having a major axis of acm and a minor axis of bcm is assumed. This makes it possible to specify the tumor range R later based on the four points of the markers M1 to M4. This is a case where all the markers M1 to M4 are embedded in the boundary of the tumor range R. When embedding in the vicinity outside the tumor range R, in order to determine the positional relationship between each marker M1 to M4 and the tumor range R, the distance from each marker M1 to M4 for each reproduced region Ra Is calculated in advance. As another example, a method of obtaining the distance between each of the surface element groups constituting the boundary of the tumor range R and the positions of the markers M1 to M4 can be used.

  As described above, the position of the tumor Ta is associated with the structure around the tumor Ta, for example, the surface of the liver T and the surface of the rib J, and the first position data D2 indicating the position of the tumor Ta is generated from the medical image G1. The first position data D2 is stored in the storage unit 7. Thereafter, the tumor range R with respect to the liver T is reproduced based on the first position data D2, as necessary, before surgery for embedding each of the markers M1 to M4, and the tumor range R is a medical image for surgery. It is displayed together with G2 (see FIG. 5). Thereby, since the tumor range R for the invisible tumor Ta is displayed, the surgeon can visually recognize the tumor range R. As a result, the operator can embed the markers M1 to M4 around the tumor range R of the liver T with confidence without hesitation, and can easily determine the resection range for the liver T.

  Next, an operation image display process when an operator such as a doctor performs a resection operation using the medical image diagnostic apparatus 1 will be described with reference to FIGS. When the operator starts excision and incises (opens) the patient to expose the surface of the liver T, the imaging unit 4 such as a three-dimensional ultrasonic probe is applied to the surface of the liver T, and the inside of the liver T Search for the markers M1 to M4 embedded in.

  As shown in FIG. 7, first, the control unit 2 captures a surgical medical image (intraoperative image) G3 after the incision (step S11). That is, the control unit 2 causes the photographing unit 4 to perform a photographing operation. As a result, for example, as shown in FIG. 8, a medical image (three-dimensional image) G3 showing the liver T as a part is obtained. The medical image G3 is stored in the storage unit 7 as image data D1 as necessary. Here, the alternate long and short dash line in FIG. 8 indicates the position of the liver T before incision.

  Next, the control unit 2 detects the positions of the markers M1 to M4 after the incision (Step S22). That is, the control unit 2 recognizes the positions of the markers M1 to M4 on the medical image G3 automatically or manually. In the case of automatic, the feature amounts of the markers M1 to M4 on the three-dimensional ultrasonic image are registered in the storage unit 7 in advance, and the respective markers M1 to M4 are recognized based on the feature amounts, and their positions are determined. To detect. On the other hand, in the case of manual operation, an operator such as an operator or an assistant marks the markers M1 to M4 with the operation unit 6 such as a touch pen. The control unit 2 recognizes the markers M1 to M4 according to the marking and recognizes their positions.

  Thereafter, the control unit 2 reproduces the tumor range R based on the positions of the markers M1 to M4 detected after the incision and the stored second position data D3 (step S23), and the reproduced tumor range R is used for surgery. It is displayed together with the medical image G3 (step S24). That is, the control unit 2 reads the second position data D3 from the storage unit 7 and controls the image processing unit 9 to control the tumor range R based on the second position data D3 and the detected positions of the markers M1 to M4. And the reproduced tumor range R is displayed on the medical image G3 for surgery. Thereby, for example, as shown in FIG. 8, the tumor range R is displayed superimposed on the medical image G3.

  Here, for example, as shown in FIG. 9, the marker position (second position data D3) on the CT image (medical image G2) before the incision and the marker position on the ultrasonic image (medical image G3) after the incision. The distance to (the detected positions of the markers M1 to M4) is obtained. If the distance is equal to or greater than a predetermined amount (for example, 2 mm), it is determined that the positional relationship between the markers M1 to M4 has changed before and after the incision. In this case, as shown in FIG. 9, the image processing unit 9 obtains a square formed by each of the markers M1 to M4 from the position (ellipse) of each of the markers M1 to M4 before the incision, and each of the markers M1 to M1 after the incision. Obtain the angle θ at which the Y axis of the quadrangle made by M4 is tilted, and reset the tumor range R by tilting the Y axis of the tumor range R indicated by the ellipse surrounding each marker M1 to M4 by the angle θ from the original position. To do. At this time, the quadrangle formed by each of the markers M1 to M4 is deformed and used as a square, and the deformation amount is also stored and used when the tumor range R is reset.

  In addition, the image processing unit 9 determines from the center of the tumor range R obtained from the positions of the markers M1 to M4 on the CT image before the incision and the positions of the markers M1 to M4 on the ultrasonic image after the incision. The movement amount of the tumor range R is obtained from the center of the obtained tumor range R, and the tumor range R is reset based on the movement amount. Actually, the deformation of the liver T before and after the incision is not simple as shown in FIG. 9, and therefore, using a technique such as a finite element method, the change of the marker position and the associated tumor range R The change will be calculated. Moreover, since the shape of the liver T changes not only immediately after the incision but also during the excision operation, the above processing is repeated, and the excision operation can be performed while confirming the tumor range R with a real-time image. desirable.

  In addition, when the distance between each marker M1 to M4 and each region Ra is recorded as the second position data D3, the distance between each marker M1 to M4 and each region Ra and the intraoperative ultrasound image are displayed. The position of each region Ra is determined so that the square error of the distance between each region Ra to be reproduced and each marker M1 to M4 determined by the intraoperative ultrasound image is determined (determined by the least square method). Can do). The same applies when using the face element group. The obtained tumor range R composed of each region Ra is superimposed and displayed on the intraoperative ultrasound image (medical image G3).

  As described above, the tumor range R is reproduced based on the positions of the markers M1 to M4 detected after the incision and the stored second position data D3, and the tumor range R is displayed together with the surgical medical image G3. . Thereby, even when the liver T is deformed after incision or the like, the tumor range R is adjusted and displayed based on the markers M1 to M4, so that the operator can be sure only by embedding a small number of markers M1 to M4. The excision range covering the entire area of the tumor Ta before disappearance can be determined. In particular, the operator can easily determine the position and direction of inserting the scalpel by the position and angle of the ultrasonic probe applied to the liver T and the ellipsoidal tumor range R shown on the three-dimensional image. Become. Compared to the case where a large number of markers need to be placed in the patient's body before the operation as usual, a small number of markers M1 to M4, for example, about four may be placed, and the tumor range R before the reduction can be determined during the operation. Since the medical image G3 can be displayed, it is possible for the surgeon to determine the resection range that covers the entire area of the tumor Ta before disappearance with certainty. As a result, the operator can excise the portion within the excision range and accurately excise all the tumor Ta before treatment.

  In this way, the tumor range R is set by the medical image G1 taken before the treatment by the chemotherapy or the radiotherapy, and the medical image G2 before the resection operation is taken and displayed after the tumor Ta disappears by the treatment. . In this medical image G2, the tumor Ta is not displayed, but the tumor range R is reproduced using information on each feature region (for example, each recording surface K1, K2) of the structure to be a landmark. Can embed the markers M1 to M4 using the tumor range R as a guide. In the medical image G2, the relationship between the reproduced tumor range R and the embedded markers M1 to M4 is obtained. During the operation, the tumor range R is reproduced again based on the markers M1 to M4 shown in the medical image G3 during the operation. As described above, the tumor range R in the medical image G1 before treatment is reproduced in the preoperative medical image G2 using the characteristic region of the structure as a base point, and the reproduced tumor range R is intraoperatively based on the markers M1 to M4. Two-stage alignment is performed in which the medical image G3 is reproduced again. As a result, the tumor range R with respect to the tumor Ta before disappearance is accurately reproduced and displayed on the medical image G2 when the markers M1 to M4 are embedded, and even when excision surgery is performed, Since it is reproduced and displayed on the medical image G2, the operator can easily determine the resection range that covers the entire area of the tumor Ta before disappearance with certainty. As a result, the surgeon can accurately embed each of the markers M1 to M4 using the reproduced tumor range R as a guide, and further, the part within the determined excision range is excised to ensure all the tumor Ta before disappearance. Can be extracted.

  As described above, according to the embodiment of the present invention, the position of the tumor range R with respect to the tumor Ta of the liver T from the medical image G1 is changed to the structure around the tumor Ta (for example, the surface of the liver T and the rib J The first position data D2 indicating the position of the tumor range R is generated, the first position data D2 is stored, and then stored in the stored first position data D2 as necessary. The tumor range R is reproduced based on this, and the reproduced tumor range R is displayed together with the medical image G2 for operation, whereby the tumor range R for the invisible tumor Ta is displayed, and the operator visually recognizes the tumor range R. It becomes possible to do. Thereby, determination of the resection range with respect to the tumor Ta which cannot be visually recognized can be supported. That is, the operator can embed the markers M1 to M4 around the tumor range R of the liver T with confidence without hesitation, and can easily determine the resection range for the liver T. In particular, since it is possible to embed the markers M1 to M4 in the patient's body without depending on the experience and skill level of the operator, an accurate operation can be performed.

  Furthermore, based on the position of each marker M1 to M4 detected before the incision and the stored first position data D2, the second position indicating the positional relationship between the detected position of each marker M1 to M4 and the tumor range R Data D3 is generated, the second position data D3 is stored, and then the tumor range R is reproduced based on the positions of the markers M1 to M4 detected after the incision and the stored second position data D3. By displaying the performed tumor range R together with the medical image G3 for surgery, the operator determines the resection range that covers the entire area of the tumor Ta before disappearance with confidence only by embedding a small number of markers M1 to M4. be able to. As a result, the surgeon can excise the portion within the excision range and reliably extract all the tumor Ta before disappearance. In particular, even when the liver T is deformed after an incision or the like, the tumor range R is reproduced based on the markers M1 to M4, so that the operator can perform an accurate resection operation.

  In addition, the tumor range R is divided into a plurality of regions Ra, and the divided regions Ra are associated with the surface of the liver T and the surface of the rib J located around the liver T, respectively, to generate the first position data D2. Therefore, the position of the tumor Ta, that is, the tumor range R can be accurately reproduced, so that the tumor range R can be accurately indicated.

  Here, in the above-described embodiment, the case where an ultrasonic image is used as an intraoperative image is described. However, the present invention is not limited to this, and an X-ray fluoroscopic image (two-dimensional image) is used as an intraoperative image. Is also possible. An X-ray fluoroscopic image is a projected two-dimensional image, and the pre-operative marker position is three-dimensional information. Therefore, the following alignment technique is required for the alignment.

  FIG. 7 is a diagram showing a means for reproducing the tumor range R on the intraoperative X-ray image based on the position on the CT image of each of the markers M1 to M4 (marker group) embedded in the patient's body and the position on the intraoperative X-ray image. 10 will be used for explanation.

  First, the surgeon performs an imaging operation on the patient by the imaging unit 4 as an X-ray apparatus, and images an X-ray image G4 including the markers M1 to M4 in the patient's body. Thereby, an X-ray image G4 as shown in FIG. 10 is obtained. Here, an arrow A2 in FIG. 10 is a shooting direction. The four markers M1 to M4 constituting the marker group can be distinguished by the image processing unit 9, respectively. On the other hand, as in the above-described embodiment, as shown in FIG. 10, four markers M1 to M4 (marker group) and a tumor range R are registered in the CT image G2, which is a three-dimensional medical image. ing.

  The image processing unit 9 projects the markers M1 to M4 displayed on the X-ray image G4 on the simulation plane image G5. Next, the image processing unit 9 projects four markers M1 to M4 (marker group) on the three-dimensional CT image G2 from the simulation X-ray source A1 onto the simulation plane image G5. Next, the image processing unit 9 moves the arrow in FIG. 10 so that the image of the three-dimensional CT image G2 projected onto the simulation plane image G5 matches the image of the X-ray image G4 projected onto the simulation plane image G5. The three-dimensional CT image G2 is moved in the direction of A3 and adjusted. Here, the distance from the simulation X-ray source A1 to the simulation plane image G5 coincides with the distance from the X-ray source to the detector in the actual intraoperative X-ray apparatus.

  Thereafter, when the positions of the markers M1 to M4 in the three-dimensional CT image G2 and the X-ray image G4 coincide with each other on the simulation plane image G5, the image processing unit 9 displays four markers M1 to M4 on the three-dimensional CT image G2. The tumor range R based on the positional relationship with M4 is called and reproduced, and the tumor range R on the three-dimensional CT image G2 is projected onto the simulation plane image G5 and registered. At this time, the reproduced tumor range R is a region having a three-dimensional volume, but the projected resection region R is a region having a two-dimensional area. When the two-dimensional ablation region R is displayed so as to overlap the X-ray image G4, the X-ray image (grayscale image) G4 is displayed as it is except for the ablation region R, and the grayscale intermediate color of the X-ray image is displayed in the ablation region R. (For example, yellow) is displayed. Further, the boundary of the excision region R is extracted, and the boundary line is superimposed on the X-ray image G4. By displaying the simulation plane image G5 superimposed on the actual X-ray image G4, the two-dimensional tumor range R projected on the simulation plane image G5 is displayed on the X-ray image G4. Thereby, the operator can determine the operation range that covers the entire region of the tumor Ta before disappearance with certainty. As a result, the surgeon can excise the portion within the excision range and reliably extract all the tumor Ta before disappearance. In particular, the surgeon can proceed with resection surgery while confirming the two-dimensional tumor range R on the real-time X-ray image G4.

(Other embodiments)
The present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the scope of the invention.

  For example, in the present embodiment, the surface of the liver T and the surface of the rib J are used as the structure around the tumor Ta, but the present invention is not limited to this. For example, another structure is used. May be. Further, although both the surface of the liver T and the surface of the rib J are used as the structure around the tumor Ta, the present invention is not limited to this. For example, only one of them may be used. . However, when both the surface of the liver T and the surface of the rib J are used, the positional accuracy of the tumor range R can be improved as compared with the case where only one of them is used.

  In the above-described embodiment, the range larger than the region of the tumor Ta of the liver T is set as the tumor range R. However, the present invention is not limited to this. For example, the same as the region of the tumor Ta of the liver T A range may be set. In this case, the tumor range R is a region of the tumor Ta before the preoperative treatment.

  Furthermore, in the above-described embodiment, the setting and reproduction of the tumor range R by three-dimensional CT has been described. However, the present invention is not limited to this. For example, other medical image diagnosis such as MRI or ultrasonic diagnostic apparatus. It may be a device or a combination thereof. Furthermore, although a three-dimensional image is used, the present invention is not limited to this, and a two-dimensional image may be used.

  In addition, in the above-described embodiment, various types of processing are executed by the control unit 2 based on a program that is software. However, the present invention is not limited to this. For example, either one of software and hardware or Various processes may be executed by both.

1 is a block diagram showing a schematic configuration of a medical image diagnostic apparatus according to an embodiment of the present invention. It is a flowchart which shows the flow of the tumor range preservation | save process which the medical image diagnostic apparatus shown in FIG. 1 performs. It is explanatory drawing for demonstrating preservation | save of the tumor range by the tumor range preservation | save process shown in FIG. It is a flowchart which shows a part of operation | movement image display process which the medical image diagnostic apparatus shown in FIG. 1 performs. It is explanatory drawing for demonstrating the display of the image by the surgery image display process shown in FIG. It is explanatory drawing for demonstrating 2nd position data. It is a flowchart which shows a part of operation | movement image display process which the medical image diagnostic apparatus shown in FIG. 1 performs. It is explanatory drawing for demonstrating the display of the image by the surgery image display process shown in FIG. It is explanatory drawing for demonstrating reproduction of the image by the surgery image display process shown in FIG. It is explanatory drawing for demonstrating reproduction of the image in the case of using a X-ray fluoroscopic image (two-dimensional image) as an intraoperative image.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Medical image diagnostic apparatus 4 Imaging | photography part 5 Display part 7 Memory | storage part D2 1st positional information (1st positional data)
D3 Second position information (second position data)
G1 Medical image G2 Medical image for surgery R Tumor range T Region (liver)
Ta tumor

Claims (3)

A display unit for displaying a medical image showing a part of the subject;
A storage unit for storing information;
Means for associating a tumor area surrounding the tumor of the site from the medical image with a structure around the tumor, and generating first position information indicating a position of the tumor area;
Means for storing the generated first position information in the storage unit;
Means for reproducing the tumor range based on the stored first position information, and displaying the reproduced tumor range together with the medical image for surgery on the display unit;
Means for detecting a marker embedded in the site;
Means for generating second position information indicating a positional relationship between the position of the marker and the tumor range based on the position of the marker detected before the incision and the stored first position information;
Means for storing the generated second position information in the storage unit;
Means for reproducing the tumor range based on the position of the marker detected after the incision and the stored second position information, and displaying the reproduced tumor range on the display unit together with the medical image for surgery;
A medical image diagnostic apparatus comprising:   The generating means divides the tumor range into a plurality of regions, and associates the divided regions with one or both of the surface of the site and the surface of the rib located around the site, The medical image diagnosis apparatus according to claim 1, wherein the first position information is generated.   The medical image diagnostic apparatus according to claim 1, further comprising an imaging unit that captures the medical image.

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