JP5111901B2 - x-ray equipment - Google Patents

x-ray equipment Download PDF

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Publication number
JP5111901B2
JP5111901B2 JP2007063358A JP2007063358A JP5111901B2 JP 5111901 B2 JP5111901 B2 JP 5111901B2 JP 2007063358 A JP2007063358 A JP 2007063358A JP 2007063358 A JP2007063358 A JP 2007063358A JP 5111901 B2 JP5111901 B2 JP 5111901B2
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catheter
timing
setting
site
part
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JP2008220641A (en
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健輔 篠田
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株式会社東芝
東芝メディカルシステムズ株式会社
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/50Clinical applications
    • A61B6/507Clinical applications involving determination of haemodynamic parameters, e.g. perfusion CT

Description

  The present invention relates to a technique for guiding catheter insertion in an X-ray imaging apparatus such as an X-ray diagnostic apparatus.

  When treating a vascular stenosis part etc. with a catheter, an operator operates a catheter, seeing the image image | photographed using the X-ray diagnostic apparatus. The operation of the catheter is composed of actions such as turning, pushing, and pulling out. In order to perform the operation of inserting the catheter into the affected area in a short time, the operator is required to be skilled.

  Therefore, a three-dimensional road map technique has been developed as a technique for supporting insertion of a catheter. The three-dimensional roadmap technique is a technique for guiding catheter insertion in an X-ray imaging apparatus by displaying a three-dimensional image such as a three-dimensional volume rendering image of a blood vessel as a mask image on an X-ray fluoroscopic image. (For example, refer to Patent Document 1).

JP 2000-116789 A

  However, it is difficult to perform a catheter insertion operation from only images such as a fluoroscopic image and a three-dimensional road map image, particularly in locations where blood flow is strong and the catheter position varies greatly due to heartbeat. There's a problem.

  For example, in the coronary artery opening, the shape of the tissue is greatly changed and the strength of the blood flow is periodically greatly changed, so that the position of the distal end of the catheter is not stable. Therefore, it is very difficult for the operator to insert the catheter into the coronary artery opening. For this reason, the contrast medium may be administered so that the surgeon can easily grasp the shape and blood flow of the blood vessel, but the contrast medium is a heavy burden on the patient.

The present invention has been made to solve the above-mentioned problems caused by the prior art, and is capable of supporting the insertion of a catheter at a site where insertion of the catheter is difficult, such as a coronary artery opening. an object of the present invention is to provide an imaging equipment.

In order to solve the above-described problems and achieve the object, the present invention sets the position for notifying the operator of catheter insertion guidance when the tip of the catheter arrives, and setting the timing for inserting the catheter first from the position. A site setting receiving unit that receives the site, a site arrival determining unit that determines whether or not the tip of the catheter has reached the site received by the site setting receiving unit, and the site reaching determination unit that includes the tip of the catheter at the site. When it is determined that the timing has been reached, timing determination means for determining whether or not it is the timing received by the region setting reception means; and when the timing determination means determines that the timing has been reached, catheter insertion Guidance notifying means for notifying the surgeon of guidance is provided.

Further, the present invention provides a coronary artery opening arrival determining means for determining whether or not the tip of the catheter has reached the coronary artery opening, and the coronary artery opening arrival determining means determines that the tip of the catheter is at the coronary artery opening. A coronary flow determining means for determining whether or not the coronary artery flow is at a timing when it is determined to have reached, and a timing at which the coronary artery flow is minimized by the coronary artery flow determining means. It is characterized by comprising a guide notification means for notifying the operator of catheter insertion guidance from the coronary artery opening when judged.

According to the present invention, insertion of a catheter by an operator can be facilitated.

With reference to the accompanying drawings, illustrating a preferred embodiment of an X-ray imaging equipment according to the present invention in detail.

  First, the catheter insertion guide method of the X-ray diagnostic apparatus according to the present embodiment will be described. FIG. 1 is an explanatory diagram for explaining a catheter insertion guide method of the X-ray diagnostic apparatus according to the present embodiment. Note that the X-ray diagnostic apparatus according to the present embodiment acquires a time-series three-dimensional image of a patient imaged in advance by an X-ray CT apparatus and an electrocardiogram of the patient recorded by an electrocardiograph before the catheter insertion operation, and during the operation. In addition, catheter tip position information and electrocardiogram information are acquired in real time.

  As shown in FIG. 1 (a), the X-ray diagnostic apparatus according to the present embodiment displays a time-series three-dimensional image of a patient at a pre-operative stage and requires a timing of catheter operation from the operator. For example, a site setting such as the coronary artery opening 41 is accepted. In FIG. 1A, regions (1) and (2) surrounded by a square are sites set by the operator, and a coronary artery opening 41 is set in (1).

  In addition, when the site set by the operator is a site in the heart, the X-ray diagnostic apparatus according to the present embodiment displays an electrocardiogram as shown in FIG. The timing setting at is accepted. Here, the timing setting is to set at which position of the waveform of the electrocardiogram the catheter insertion operation is performed.

  At a site in the heart such as the coronary artery opening 41, the strength of the blood flow periodically changes corresponding to the opening and closing of the aortic valve 42, and therefore the movement of the tip of the catheter is intense, making it difficult to insert the catheter. Therefore, when the operator sets a site in the heart such as the coronary artery opening 41, the operator further sets a timing at which the blood flow is minimized using an electrocardiogram or the like. At the timing when the blood flow is minimized, the movement of the distal end of the catheter is minimized, and the catheter can be easily inserted into the coronary artery opening 41 or the like. In FIG. 1 (b), timings are set on the electrocardiogram for the parts (1) and (2) shown in FIG. 1 (a).

  Then, the X-ray diagnostic apparatus according to the present embodiment acquires information on the catheter tip position and electrocardiogram information in real time during the operation, and determines whether the tip position of the catheter has reached any of the set sites. To do. Then, when the tip position of the catheter reaches any of the set sites, it is determined whether or not it is the timing set on the electrocardiogram for the reached site. As a result, when the set timing is reached, the catheter insertion timing is displayed in the fluoroscopic image and notified by voice. FIG. 1C shows a display example of catheter insertion timing. In this example, by displaying “GO!”, The operator is notified of the timing of insertion of the catheter into the coronary artery opening 41.

  As described above, the X-ray diagnostic apparatus according to the present embodiment inserts the catheter when the distal end of the catheter reaches the site set by the operator and the timing set on the electrocardiogram with respect to the reached site. It is notified that it is the timing. Therefore, the operator can perform an operation of inserting the catheter at an appropriate timing such as when the blood flow is weak, and can easily insert the catheter.

  It should be noted that the coronary artery opening may be preset with the timing of guidance as a site requiring guidance for timing of catheter operation so that the operator can omit the setting. It is also possible to set timing information for an operating part other than the heart. The notification of the catheter insertion timing can also be displayed in a time-series 3D image or a 3D roadmap image.

  Next, the configuration of the X-ray diagnostic apparatus according to the present embodiment will be described. FIG. 2 is a functional block diagram illustrating the configuration of the X-ray diagnostic apparatus according to the present embodiment. As shown in the figure, the X-ray diagnostic apparatus 100 detects image data by detecting an X-ray generator 1 that generates X-rays to be irradiated to a patient P on a bed 11 and X-rays transmitted through the patient P. The X-ray detection unit 2 to be generated, the arm 5 that holds the X-ray generation unit 1 and the flat detector 21, the mechanism unit 3 that moves the bed 11, and the height required for the X-ray generation unit 1 to generate X-rays An image for generating an image using image data generated based on X-rays detected by the X-ray detected by the high voltage generator 4 for supplying voltage, the mechanism controller 6 for controlling the mechanism 3, and the X-ray detector 2 A processing unit 7, a display unit 8 for displaying an image, an operation unit 9 for receiving an operation by an operator (user), a system control unit 10 for controlling the entire X-ray diagnostic apparatus 100, and a bed 11 on which a patient P lies. And catheter tip position to detect the tip position of the catheter A detecting section 12, and a timing information acquisition unit 13 for acquiring timing information to know when blood flow is minimized.

  The X-ray generator 1 irradiates the X-ray tube 18 that generates X-rays using the high voltage supplied from the high-voltage generator 4, and shields a part of the X-rays generated by the X-ray tube 18. And an X-ray restrictor 19 for controlling the field.

  The X-ray detector 2 converts the X-rays transmitted through the patient P into charges and detects them, a gate driver 22 that extracts charges from the plane detectors 21, and charges detected by the plane detector 21. And an image data generation unit 20 for generating image data from the image data. The image data generation unit 20 includes a charge / voltage converter 23 that converts the charge detected by the flat detector 21 into a voltage, and an A / D converter that converts the voltage converted by the charge / voltage converter 23 into a digital value. 24 and a parallel / serial converter 25 for converting the parallel output of the A / D converter 24 into a serial output.

  The mechanism unit 3 includes an arm moving mechanism 31 that moves the arm 5 based on an instruction from the mechanism control unit 6, and a bed moving mechanism 32 that moves the bed 11 based on an instruction from the mechanism control unit 6.

  The image processing unit 7 includes an image generation unit 71, a 3D image storage unit 72, an ECG storage unit 73, a display control unit 74, and a catheter guide unit 75.

  The image generation unit 71 is a processing unit that generates an X-ray fluoroscopic image by performing a reconstruction calculation or the like on the image data generated by the image data generation unit 20. The 3D image storage unit 72 is a storage unit that stores a time-series three-dimensional image of the patient P imaged by the X-ray CT apparatus. The ECG storage unit 73 is a storage unit that stores the electrocardiogram of the patient P recorded by the electrocardiograph simultaneously with the photographing of the time-series three-dimensional image.

  The display control unit 74 is a control unit that controls display on the display unit 8 such as an X-ray fluoroscopic image, a time-series three-dimensional image, a three-dimensional road map image, and an electrocardiogram of the patient P. When the X-ray fluoroscopic image is displayed, the display control unit 74 acquires display conditions such as the position and orientation of the image from the system control unit 10, and a time-series three-dimensional image having the same display conditions as the acquired display conditions. Is read from the 3D image storage unit 72 and displayed.

  The catheter guide section 75 is a processing section that performs processing related to catheter operation guidance. The details of the catheter guide 75 will be described later.

  The display unit 8 includes a display image memory 81 that holds display image data, a D / A converter 82 that converts image data in the display image memory 81 into an analog signal, and an output of the D / A converter 82. A display circuit 83 that performs a corresponding display on the monitor 84 and a monitor 84 are provided.

  FIG. 3 is a diagram illustrating a configuration example of the display unit 8. As shown in the figure, in this configuration example, the monitor 84 is a system that displays a fluoroscopic monitor 84a that displays a fluoroscopic image, a reference monitor 84b that displays a time-series three-dimensional image, a message output by the X-ray diagnostic apparatus 100, and the like. It is composed of a monitor 84c.

  The catheter tip position detector 12 detects the tip position of the catheter by, for example, measuring and aligning positions with respect to certain reference coordinates from a sensor attached to the catheter tip and a sensor attached to the patient P. In addition, by measuring the spatial position of the catheter having the same reference coordinates as the patient P with a sensor, it is possible to detect at which position in the patient the tip of the catheter is located.

  The timing information acquisition unit 13 acquires information on the electrocardiogram of the patient P as timing information from, for example, an electrocardiograph. The timing information may be information associated with a periodic motion, and may be information on a valve motion trajectory. Alternatively, the timing information can also be obtained by measuring the blood flow flowing out of the aortic valve using TEE (TransEsophageal Echocardiography) with Doppler.

  Next, details of the catheter guide 75 will be described. FIG. 4 is a functional block diagram showing the configuration of the catheter guide portion 75. As shown in the figure, the catheter guide unit 75 includes a setting UI unit 751, a setting site arrival determination unit 752, a timing determination unit 753, and a timing notification unit 754.

  The setting UI unit 751 is a processing unit that receives a setting of a part and timing required for catheter operation timing instruction from a surgeon and stores it as a setting part and setting timing before catheter insertion surgery.

  Specifically, the setting UI unit 751 instructs the display control unit 74 to display a time-series three-dimensional image stored in the 3D image storage unit 72, receives the setting of the part from the operator, and sets the setting part. Remember as. The part is set by marking a region including the target part using an animation of a time-series three-dimensional image, as shown in FIG. The setting UI unit 751 displays an image in the same direction as the X-ray fluoroscopic image captured during the operation, so that the operator can confirm the operation procedure while viewing the image imitated before the operation. be able to.

  In addition, the setting UI unit 751 stores a setting site using a coordinate system similar to the basic coordinates used by the catheter tip position detection unit 12. The setting UI unit 751 stores the set site using the same coordinate system as the basic coordinates used by the catheter tip position detecting unit 12, and the tip position of the catheter detected by the catheter tip position detecting unit 12 is set as the set site. It is possible to determine whether or not the stored part has been reached.

  In addition, when the set site is a site in the heart, the setting UI unit 751 instructs the display control unit 74 to display the electrocardiogram stored in the ECG storage unit 73, and the catheter from the operator. The operation timing setting is received and stored as the setting timing. The timing is set by marking the waveform of the electrocardiogram as shown in FIG.

  FIG. 5 is a diagram showing an example of an electrocardiogram waveform. As shown in the figure, the electrocardiogram is composed of waveforms such as P wave, Q wave, R wave, S wave and T wave. The setting UI unit 751 stores the guidance timing set by the operator as the setting timing, for example, 0.35 seconds after the peak of the R wave.

  In the case of the coronary artery opening, the catheter insertion timing is the time when the aortic valve is closed and the blood flow is settled and flows into the coronary artery. This point corresponds to the timing at which the left ventricle transitions to the diastole, and corresponds to the T-wave terminal portion 14 on the electrocardiogram shown in FIG.

  The setting part arrival determination unit 752 acquires information related to the catheter tip position from the catheter tip position detection unit 12, and determines whether the setting UI part 751 has reached any of the parts stored as the setting part. It is. When the distal end of the catheter reaches any of the sites set by the operator, the set site arrival determination unit 752 notifies the timing determination unit 753 to that effect.

  When the timing determination unit 753 receives a notification from the setting site arrival determination unit 752 that the tip of the catheter has reached any of the sites set by the operator, the timing determination unit 753 displays information regarding the setting timing stored in the setting UI unit 751. The processing unit instructs the display control unit 74 to do this. In addition, the timing determination unit 753 acquires timing information from the timing information acquisition unit 13 and determines whether or not it is a setting timing that the setting UI unit 751 stores in association with the arrival part. As a result, when it is the setting timing that the setting UI unit 751 stores in correspondence with the reaching part, the timing determination unit 753 notifies the timing notification unit 754 that it is the catheter operation timing.

  When the timing notification unit 754 receives a notification from the timing determination unit 753 that it is the catheter operation timing, the timing notification unit 754 instructs the display control unit 74 to display the catheter operation timing, and the operation unit 9 via the system control unit 10. The operator is notified of the catheter operation timing by voice from the speaker.

  Next, a procedure for catheter insertion guidance processing by the X-ray diagnostic apparatus 100 according to the present embodiment will be described. FIG. 6 is a flowchart illustrating a processing procedure of catheter insertion guidance processing by the X-ray diagnostic apparatus 100 according to the present embodiment.

  As shown in the figure, in this catheter insertion guidance process, the setting UI unit 751 receives a setting of a site and timing that require catheter insertion guidance from an operator before surgery (step S1). The surgeon sets a site requiring catheter insertion guidance on the time-series three-dimensional image, and sets an insertion timing corresponding to each set site on the electrocardiogram.

  When the operation is started, the display control unit 74 displays the X-ray fluoroscopic image generated by the image processing unit 7 on the fluoroscopic monitor 84a (step S2), and the operator visually recognizes the body tissue and the catheter position. Can do. Further, as shown in FIG. 7, the display control unit 74 displays the time-series three-dimensional image corresponding to the fluoroscopic image and the catheter tip position detected by the catheter tip position detection unit 12 on the reference monitor 84b (step S3). ).

  Then, the set site arrival determination unit 752 determines whether the tip position of the catheter has reached any of the set sites (step S4), and if it has not reached any of the set sites, the catheter tip Continue position detection and display.

  On the other hand, if any of the set parts has been reached, the timing determination unit 753 acquires timing information (step S5), and determines whether it is the set timing corresponding to the reached part (step S6). As a result, if it is not the set timing, acquisition of timing information is continued.

  On the other hand, when it is the set timing, the timing determining unit 753 notifies the timing notifying unit 754 that the set timing is reached, and the timing notifying unit 754 is the catheter insertion operation timing using the display and sound on the screen. Is notified (step S7).

  Then, the set part arrival determination unit 752 determines whether or not all the set parts have been reached (step S8). If there is a set part that has not reached, the process returns to step S3 to detect the catheter tip position. Display is continued and the catheter insertion guidance process is terminated when all the set sites have been reached.

  As described above, the setting site arrival determination unit 752 determines the position of the distal end of the catheter, and the timing determination unit 753 determines the timing, thereby guiding the insertion of the catheter.

  Here, display and sound are used as the catheter insertion guidance notification method, but only one of display and sound can be set before surgery. In addition, the site and timing that need guidance for catheter insertion and the notification method for catheter insertion guidance were set before surgery, but the site and timing that require guidance and the notification method for catheter insertion guidance can be set during surgery. It can also be.

  As described above, in this embodiment, the setting UI unit 751 of the catheter guide unit 75 receives the setting of the part and timing that require catheter insertion guidance from the operator. Then, the set site arrival determination unit 752 determines whether or not the distal end of the catheter has reached the set site. When the set site arrival determination unit 752 has reached the set site, the timing determination unit 753 determines whether it is the set timing. As a result, when it is the set timing, the timing notifying unit 754 notifies the operator of catheter insertion guidance using display and sound on the screen, thereby facilitating the catheter insertion operation by the operator. Can do.

  In particular, for the coronary artery opening where blood flow is strong and catheter position fluctuation due to heartbeat is large, if the catheter insertion guidance is notified at the terminal part of the electrocardiogram T wave, the operator will have the timing when blood flow is minimized. The catheter insertion operation can be performed.

  In the present embodiment, a case has been described in which a time-series three-dimensional image captured by an X-ray CT apparatus is displayed and a setting of a site requiring catheter insertion guidance is received, but the present invention is limited to this. Instead, the present invention can be similarly applied to a case where the setting of a site requiring catheter insertion guidance is directly received on an X-ray fluoroscopic image taken by the X-ray diagnostic apparatus before or during an operation.

  In the present embodiment, the case where the time-series three-dimensional image captured by the X-ray CT apparatus is displayed and the setting of the site requiring catheter insertion guidance is received has been described. However, the present invention is not limited to this. For example, the present invention can be similarly applied to a case where a setting of a part requiring catheter insertion guidance is received on a three-dimensional image captured by the X-ray diagnostic apparatus.

  As described above, the present invention is useful for treatment using a catheter, and is particularly suitable for inserting a catheter into a site where blood flow is strong, such as a coronary artery opening.

It is explanatory drawing for demonstrating the catheter insertion guide method of the X-ray diagnostic apparatus which concerns on a present Example. It is a functional block diagram which shows the structure of the X-ray diagnostic apparatus which concerns on a present Example. It is a figure which shows the structural example of a display part. It is a functional block diagram which shows the structure of a catheter guide part. It is a figure which shows an example of an electrocardiogram waveform. It is a flowchart which shows the process sequence of the catheter insertion guidance process by the X-ray diagnostic apparatus which concerns on a present Example. It is a figure which shows the example of a catheter tip position display.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 X-ray generation part 2 X-ray detection part 3 Mechanism part 4 High voltage generation part 5 Arm 6 Mechanism control part 7 Image processing part 8 Display part 9 Operation part 10 System control part 11 Bed 12 Catheter tip position detection part 13 Timing information acquisition Unit 14 T-wave termination unit 18 X-ray tube 19 X-ray diaphragm 20 Image data generation unit 21 Planar detector 22 Gate driver 23 Charge / voltage converter 24 A / D converter 25 Parallel / serial converter 31 Arm moving mechanism 32 Sleeper moving mechanism 41 Coronary artery opening 42 Aortic valve 43 Catheter 71 Image generation unit 72 3D image storage unit 73 ECG storage unit 74 Display control unit 75 Catheter guide unit 81 Display image memory 82 D / A converter 83 Display circuit 84 Monitor 84a fluoroscopic monitor 84b reference monitor 84c system monitor 100 X-ray diagnostic apparatus 51 setting UI unit 752 sets site arrival determination unit 753 a timing determination unit 754 timing notification unit

Claims (6)

  1. A site setting receiving means for receiving the setting of the site for notifying the operator of catheter insertion guidance when the tip of the catheter has reached, together with the setting of the timing for inserting the catheter first from the site;
    Site arrival determination means for determining whether or not the tip of the catheter has reached the site received by the site setting reception means;
    A timing determination unit that determines whether or not it is a timing received by the site setting reception unit when it is determined by the site arrival determination unit that the distal end of the catheter has reached the site;
    An X-ray imaging apparatus comprising: guide notification means for notifying an operator of catheter insertion guidance when the timing determination means determines that the timing is reached.
  2. The part setting accepting unit displays a time-series three-dimensional image and accepts the setting of the part on the time-series three-dimensional image from an operator,
    The part arrival determining means detects the tip position of the catheter, and determines whether or not the detected tip position has reached the part received on the time-series three-dimensional image by the part setting receiving means. The X-ray imaging apparatus according to claim 1.
  3. The part setting accepting unit accepts setting of the part on an X-ray fluoroscopic image from an operator,
    The part arrival determination means detects the tip position of the catheter, and determines whether or not the detected tip position has reached the part received on the X-ray fluoroscopic image by the part setting reception means. The X-ray imaging apparatus according to claim 1.
  4. The part setting accepting unit accepts setting of a part in the heart, displays an electrocardiogram, accepts the timing on the electrocardiogram from an operator,
    The timing determination means acquires electrocardiogram information from an electrocardiograph and determines whether or not it is the timing received on the electrocardiogram by the region setting reception means. The X-ray imaging apparatus described.
  5.   The X-ray imaging apparatus according to claim 1, wherein the guidance notification unit notifies the operator of catheter insertion guidance by screen display and voice.
  6. Coronary artery opening arrival determining means for determining whether or not the tip of the catheter has reached the coronary artery opening; and
    When it is determined by the coronary artery opening arrival determining means that the tip of the catheter has reached the coronary artery opening, the coronary artery flow determining means for determining whether or not the coronary artery flow is at a minimum timing;
    A guide notification means for notifying the surgeon of catheter insertion guidance from the coronary artery opening when the coronary artery flow determination means determines that the coronary artery flow is at the minimum timing. X-ray imaging device.
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