JP5140309B2 - X-ray fluoroscopic equipment - Google Patents

Description

  The present invention relates to an X-ray fluoroscopic apparatus, and more particularly to an X-ray fluoroscopic apparatus that observes the flow of a contrast medium in an angiographic examination.

  In recent years, vascular embolization has been performed in which an angiographic examination apparatus such as that disclosed in Patent Document 1 is used to stop and treat blood flow to a tumor with an embolus.

  This is performed by injecting a contrast medium containing a component that does not transmit X-rays from a catheter inserted into a blood vessel, and observing the embolization state while confirming the flow of the contrast medium by X-ray fluoroscopy of the angiography inspection apparatus. It is.

In order to observe the embolization state, it is necessary to continuously capture the blood flow, visualize the amount and flow velocity of the contrast agent, and grasp the movement state of the contrast agent.

JP 2004-81569 A

  The angiography inspection apparatus disclosed in Patent Document 1 or the like displays information on only X-ray permeability on a black and white gradation image display apparatus and confirms the flow of contrast medium by X-ray fluoroscopy.

  However, since blood always flows through the blood vessel for injecting the contrast medium, the contrast medium also flows. In the black and white gradation display, in order to confirm the flow of the contrast medium by one injection of the contrast medium Insufficient. Therefore, it was necessary to inject contrast medium several times while irradiating fluoroscopic X-rays.

  Therefore, the present invention is to visualize the amount of contrast agent movement in a certain time by colorizing or patterning and increasing the information obtained from the X-ray image such as the amount of contrast agent movement and the flow rate of the contrast agent. An object of the present invention is to provide an X-ray fluoroscopic apparatus capable of efficiently observing the flow state of a contrast agent.

  The X-ray fluoroscopic apparatus having an angiographic examination function of the present invention visualizes the flow state of a contrast medium injected into a blood vessel of a subject, and is specifically achieved by the following means.

  That is, a contrast medium injection means for injecting a contrast medium into a subject, an X-ray generation means for generating X-rays to be irradiated on the subject, an X-ray control means for controlling the X-ray dose, and the X A two-dimensional X-ray detection means for detecting transmitted X-rays of the subject, which is arranged opposite to the line generation means, and detecting it as digital image data, and an image for the image data detected by the two-dimensional X-ray detection means An X-ray fluoroscopic apparatus comprising image processing means for performing processing and image display means for displaying an X-ray image processed by the image processing means, wherein the image processing means is at least the contrast medium injection means A frame memory for storing an image taken by injecting a contrast medium into the blood vessel of the subject and a contrast medium visualization image generation for generating an image for visualizing the movement state of the contrast medium from the image stored in the frame memory Means and The contrast agent visualized image generated by this means and the current image are synthesized by the first image synthesis means, and the synthesized image is displayed on the image display means.

  The image stored in the frame memory is an image taken in a state where an embolic substance is placed in advance in the blood vessel of the subject and an image taken by injecting a contrast agent into the blood vessel by the contrast agent injecting means. The contrast agent visualized image generation means includes a calculation means for calculating between images stored in the frame memory, a contrast agent tip position detection means for detecting a tip position of the injected contrast agent from the calculation result, Contrast agent movement distance calculating means for calculating the movement distance of the contrast agent from the detected contrast agent tip position information, and contrast agent movement distance visualization means for converting the movement distance into visualization information. Visualize the state.

  The contrast medium tip position detecting means is a contrast medium passage area calculating means for calculating an area through which the contrast medium has passed by subtracting an image where the contrast medium has not been injected from the image into which the contrast medium has been injected by the calculating means, Contrast agent tip calculating means for calculating the tip of the contrast agent from the calculated contrast agent passage region is provided to detect the tip position of the contrast agent.

  The contrast agent moving distance visualizing means visualizes the moving distance of the contrast agent by a first hue converting means for converting to a hue corresponding to the moving amount of the contrast agent or a patterning converting means for converting to a pattern by a line interval. .

Further, a non-contrast agent injection means for injecting a non-contrast agent that transmits X-rays, a contrast agent injected from the contrast agent injection means, and a non-contrast agent injected from the non-contrast agent injection means are exclusively selected. The image stored in the frame memory includes a contrast medium injected from the contrast medium injection means and a non-contrast medium injected from the non-contrast medium injection means at regular intervals. An image selected by the injection selection means and intermittently injected with the contrast medium and the non-contrast medium, and an image obtained by injecting the contrast medium stored in the frame memory and the non-contrast medium An image connecting means for connecting a plurality of paired images with the injected image as a pair; and a second image combining means for combining the connected image connected by the image connecting means with the current image. Image synthesized by image synthesis means An image is displayed on the image display means.

  A front end shadow width calculating unit that calculates a shadow width of a front end of the connected image; a counter image shadow width calculating unit that calculates a shadow width of the plurality of pair images excluding the front end of the connected image; and the front end A contrast medium flow velocity calculating means for calculating a contrast medium flow velocity by calculating a ratio between the shadow width of the contrast image and the shadow width of the pair of images, and a tip of the contrast agent of the pair images from the initial position where the contrast agent is injected A graph showing the relationship between the contrast medium tip distance calculating means for calculating the distance to the head and the distance calculated by the contrast medium tip distance calculating means and the contrast medium flow speed calculated by the contrast medium flow speed calculating means Means for grasping the presence or absence of a stenosis in the blood vessel from the graph.

  Further, a logical sum calculation means for calculating a logical sum of the plurality of paired images is provided to image the trajectory of the contrast agent flow.

Further, the contrast medium injection by the contrast medium injector and the non-contrast medium injection by the non-contrast medium injector are performed only once, and then continuously captured images are stored in the frame memory, and a single shot is performed between the stored images. A contrast medium progress image calculating means for calculating an image showing the progress of the contrast medium, and by using this means, the relationship between the position from the catheter tip for flowing the contrast medium and the contrast medium flow velocity can be obtained. As a result, the presence or absence of a stenosis can be grasped, and in the procedure of placing an embolus, the flow rate is attenuated as it is embolized, so that the progress of the embolism can be known.

  The contrast medium progress image calculation means includes a difference calculation means for calculating a difference between images stored in the frame memory, and a movement of the contrast medium from the previous frame based on the difference calculated by the difference calculation means. Movement distance increase / decrease determination means for determining whether the increase / decrease in distance is positive or negative, and second hue conversion means for performing a hue conversion process on the contrast agent portion of the photographed image according to the result determined by the movement distance increase / decrease determination means , The moving direction of the contrast agent and the presence or absence of the backflow of the contrast agent can be known.

  The current image synthesized by the image synthesizing unit is a fluoroscopic image, and an image obtained by superimposing the visualized image on the fluoroscopic image is displayed on the image display unit.

As described above, according to the present invention, it is possible to visualize the moving amount of the contrast agent, and the amount of information obtained from the X-ray image increases, so that the state of the embolus and the state of the contrast agent in the blood vessel can be easily known. This can improve the efficiency of the angiographic examination.

Hereinafter, preferred embodiments of an X-ray fluoroscopic apparatus having an angiographic examination function according to the present invention will be described in detail with reference to the accompanying drawings.
First embodiment
FIG. 1 is a diagram showing the overall configuration of the first embodiment of the X-ray fluoroscopic apparatus of the present invention.

  The X-ray fluoroscopic apparatus shown in FIG. 1 limits an X-ray tube 1 (X-ray generating means) that generates X-rays to be irradiated on the subject M and an irradiation range of the X-rays to be irradiated on the subject M. X-ray movable diaphragm device 2, X-ray control device 3 for generating a signal for controlling the X-rays radiated from the X-ray tube 1 based on the X-ray conditions set by an operation console (not shown), and this X-ray control A DC high voltage (tube voltage) applied between the anode and cathode of the X-ray tube 1 corresponding to the X-ray control signal from the device 3 is generated, and a current for fluoroscopy between the anode and cathode of the X-ray tube 1 (X-ray control means is composed of the X-ray control device 3 and the X-ray high voltage device 4). ), An X-ray plane detector which is a semiconductor two-dimensional X-ray detector which is disposed opposite to the X-ray tube 1 and the X-ray movable diaphragm device 2 and detects the transmitted X-rays of the subject M and detects them as digital image data. An output unit 5 (two-dimensional X-ray detection means), an X-ray plane detector control device 6 for controlling the readout of image data detected by the X-ray plane detector 5, and an X-ray plane detector control device 6 An image processing device 7 (image processing means) that performs various image processing on the read image data, an image display device 8 (image display means) that displays an image processed by the image processing device 7, A table 9 provided with a top plate on which the subject M is placed; a contrast medium injector 10 (contrast medium injection means) for injecting a contrast medium into the subject M placed on the table 9; The system controller 11 is configured to control and manage the entire system based on an operation signal input from an operation console (not shown).

  As shown in FIG. 2, the image processing device 7 includes a frame memory 12 that stores captured images, a calculator 13 (calculation means) that performs a calculation between the captured images stored in the frame memory 12, and the calculation Contrast agent tip position detection unit 14 (contrast agent tip position detection means) for detecting the contrast agent tip position from the calculation result of the contrast device 13, and movement of the contrast agent from the contrast agent tip position detected by the contrast agent tip position detection unit 14 A moving distance visualization unit 15 (contrast medium moving distance visualization unit) that performs color classification by obtaining an amount, and an image synthesis unit 16 (first image synthesis unit) that synthesizes the image generated by the movement distance visualization unit 15 and the current image , Second image synthesis means) and display control means (not shown) (contrast medium visualization image generation means) for controlling display of the image synthesized by the image synthesis unit 16 on the image display device 8. .

  The current image is preferably a fluoroscopic image.

Visualizing the flow of the contrast agent, which is a feature of the present invention, using the X-ray fluoroscopic imaging apparatus configured as described above is executed by software based on the flowchart shown in FIG. Hereinafter, visualization of the flow of the contrast agent will be described with reference to the flowchart of FIG.
(1) Imaging without contrast medium (S100)

First, an image is taken in a state where the embolus 18 is filled in the blood vessel portion to be embolized and a contrast agent is not injected into the blood vessel 17, and this captured image is stored in the frame memory 12. This image is shown in FIG.
(2) Imaging while injecting contrast medium (S101)

Taking three images while injecting contrast medium into the blood vessel 17 with the embolus 18 packed, the images shown in FIGS. 4B, 4C, and 4D are stored in the frame memory 12. To do.
(3) Calculation of contrast agent passage area (S102)

4 (b), (c) and (d), which are images in which the contrast medium has been injected, are subtracted by the calculator 13 from the image 13 (a) in which no contrast medium has been injected, and the contrast medium has passed. An area is calculated (contrast medium passage area calculating means).
(4) Calculation of contrast medium tip (S103), calculation of contrast medium tip movement (S104)

  The contrast agent tip position y is detected by the contrast agent tip position detector 14 (contrast agent tip position detector) (contrast agent tip part calculator) (S103).

  Using the detected contrast agent tip position y, as shown in FIG. 5, the contrast agent movement amounts d1, d2, and d3 for each frame are obtained from the position of the contrast agent tip in each image (contrast agent movement distance). (Calculation means) (S104). Here, y1 in FIG. 5 is the tip position of the contrast agent in FIG. 4 (b), y2 in FIG. 5 is the tip position of the contrast agent in FIG. 4 (c), and y3 in FIG. 5 is the contrast agent in FIG. 4 (d). Corresponds to the tip position of.

Since the frame memory 12 stores pixel values for one coordinate per address, the address and the coordinate are associated with each other. Therefore, the movement amounts d1, d2, and d3 are stored in the X-ray flat panel detector 5. It is obtained from the x coordinate (number of pixels in the x direction) and the y coordinate (number of pixels in the y direction).
(5) Color coding according to the amount of movement (S105)

Next, color classification is performed in accordance with the amount of movement (for example, red when the pixel advances by 10 pixels, yellow when the pixel advances by 5 pixels, and gray if the pixel advances by 1 pixel).
The color classification according to the movement amount includes the hue conversion unit including the hue conversion table 20 and the palette table 21 shown in FIG. 6 in the movement distance visualization unit 15 (contrast agent movement distance visualization unit). The color value is output from the hue conversion table 20, and the color value is output as an RGB value from the palette table 21 to be subjected to hue conversion (first hue conversion means).

As shown in FIG. 7, the hue conversion table 20 and the palette table 21 are associated with a movement amount, a color, a color palette, and an RGB value.
(6) Combined with the fluoroscopic image and displayed on the image display device (S106)

The image shown in FIG. 8 is displayed on the image display device 8 by combining the color-coded image and the current fluoroscopic image by the image combining unit 16 (first image combining means).
In this way, by visualizing the flow of the contrast medium in color, the contrast medium can be injected once, so that the efficiency of the angiographic examination is improved.
Further, since the flow rate of the contrast medium is slow at the portion where the blood vessel is raised, it is also possible to know whether or not the blood vessel is raised.

In addition, although the example which performed the coloring as visualization of a contrast agent was demonstrated, this invention is not limited to this, For example, as shown in FIG. 9, the image patterned by the space | interval of a line is displayed on a monochrome monitor Even with this method, the same effect as described above can be obtained. FIG. 10 is a diagram showing the relationship between the movement amount and the pattern, and patterning can be performed by changing the interval of drawing a horizontal line having a certain width according to the movement amount (patterning conversion means).
<< Second Embodiment >>

  FIG. 11 is a diagram showing an overall configuration of the second embodiment in the X-ray fluoroscopic apparatus of the present invention. In addition to the contrast medium injector 10 in the first embodiment, the X-ray fluoroscopic apparatus shown in FIG. 11 further injects a non-contrast medium such as physiological saline having no contrast effect that transmits X-rays. A contrast medium injector 22 (non-contrast medium injection means) and a selector 23 (injection selection means) for exclusively selecting the contrast medium injector 10 and the contrast medium and non-contrast medium from the non-contrast medium injector 22 It is an additional configuration.

  In the thus configured X-ray fluoroscopic apparatus, when contrast medium is injected, normal contrast medium is injected from the contrast medium injector 10 and non-contrast medium is injected from the non-contrast medium injector 22 by the selector 23 at regular intervals. The type of the contrast agent to be changed is changed, and an image obtained by intermittently injecting the contrast agent and the non-contrast agent is stored in the frame memory 12.

  Then, a plurality of paired images paired with the image injected with the contrast agent and the image injected with the non-contrast agent stored in the frame memory 12 are connected (image connecting means), and the connected image and the current image 12 (second image composition means), as shown in FIG. 12, images with different contrast intervals of the contrast agent are obtained, and the flow rate of the contrast agent can be known from the interval between the paired images. it can. The current image is preferably a fluoroscopic image.

  In the present embodiment, only by intermittently injecting a contrast agent having a contrast effect and a non-contrast agent such as physiological saline having no contrast effect, without performing calculations as in the first embodiment, It is possible to visualize the flow velocity of the contrast agent.

  Further, at the catheter tip for injecting the contrast agent, since the injection speed by the contrast agent injector is directly the contrast agent flow velocity, as shown in FIG. 13, the shadow width d01 of the catheter tip and the respective shadow widths d11 , D21, d31..., Dn can be calculated to graph the contrast agent flow velocity according to the distance from the catheter tip as shown in FIG.

  That is, calculating the shadow width of the tip portion of the connected image and the shadow width of the plurality of image pairs excluding the tip portion of the connected image (tip portion shadow width calculating means, image shadow width calculating means), and the tip portion The contrast medium flow velocity is calculated from the ratio of the shadow width of the image to the shadow width of the image (contrast medium flow velocity calculation means).

  Then, the distance from the initial position where the contrast agent is injected to the tip of the contrast agent in the paired image is calculated (contrast agent tip distance calculating means) to obtain the relationship between the distance and the contrast agent flow velocity. And graphing the contrast medium flow velocity according to the distance from the catheter tip.

  In this case, in a normal blood vessel, the contrast medium flow velocity decreases according to the distance from the catheter tip as shown in FIG. 14, but when there is a stenosis in the middle of the blood vessel, the amount of contrast medium movement in the stenosis is small. Thus, the relationship between the distance from the catheter tip and the contrast medium flow velocity is as shown in FIG. From this result, it is possible to know the presence or absence of stenosis.

  Note that only two-dimensional image data can be obtained by X-ray imaging, and if there is a stenosis in the depth direction, it may not be recognized from the image, but the possibility of the presence of the stenosis is known from the relationship shown in FIG. Therefore, it is possible to grasp the stenosis by changing the imaging direction and performing additional imaging.

  In the present embodiment, the image shown in FIG. 16 can be obtained by performing imaging several times after intermittently injecting the contrast medium. By taking a logical sum of these images (logical sum operation means), the trajectory of the flow of the contrast agent can be imaged as shown in FIG. 16, and a blood vessel can be drawn.

  Further, after intermittently injecting the contrast agent, imaging was performed several times, and as shown in FIG. 17, the tip position of each contrast unit was detected, and the distance moved was calculated, whereby the catheter tip shown in FIG. The relationship between the position of the contrast medium and the flow rate of the contrast medium can be obtained, and the flow speed of the contrast medium in each part of the blood vessel can be known as in the first embodiment.

Thus, by knowing the flow velocity of the contrast agent, for example, it becomes possible to have a suspicion of stenosis in an unnatural attenuation part from the relationship between the distance from the catheter tip shown in FIG. 12 and the contrast agent flow velocity, In the procedure for providing an embolus, the flow rate decreases as the embolus is inserted, so that the progress of the embolism can be known.
<< Third embodiment >>

Next, a third embodiment of the present invention will be described. The overall configuration diagram is the same as in the second embodiment.
In the third embodiment of the present invention, the contrast medium injector 10 and the non-contrast medium injector 22 are injected only once using the X-ray fluoroscopic apparatus of FIG. 19 is stored in the frame memory 12, and an image showing the progress of the single contrast agent is calculated between the stored images (contrast agent progress image calculating means) and shown in FIG. An image showing the progress of a single contrast agent is acquired.

  The difference for each frame of the image is calculated (difference calculating means), and when the moving distance from the previous frame is positive, it is red, and the moving in the negative direction is blue (moving distance increase / decrease determining means, Second hue conversion means), the image shown in FIG. 20 can be obtained, and the movement of the contrast medium can be known.

  In this way, it is possible to know the presence or absence of the backflow of the contrast agent by knowing the moving direction of the contrast agent from the movement situation of the contrast agent.

  In other words, if the back flow of the contrast agent occurs, the increase or decrease in the travel distance of the contrast agent becomes negative. Therefore, after injecting a single contrast agent, continuous imaging was performed, and the travel distance from the previous frame was in the negative direction. In this case, a backflow has occurred, and the presence or absence of the backflow of the contrast agent can be known.

  As described above, in the first to third embodiments, the example of performing imaging after contrast medium injection has been described. However, the present invention is not limited to this, and the captured image after contrast medium injection can identify the contrast medium. If so, a fluoroscopic image may be used.

  Although an example in which an X-ray flat panel detector, which is a semiconductor two-dimensional X-ray detector, is used as a detector that detects transmitted X-rays of a subject and detects them as digital image data, it is converted into digital image data. Any two-dimensional X-ray detector may be used if possible.

1 is an overall configuration diagram of a first embodiment in an X-ray fluoroscopic apparatus of the present invention. 1 is a configuration diagram of an image processing apparatus of an X-ray fluoroscopic apparatus according to the present invention. The flowchart explaining visualization of the flow of a contrast agent by the present invention. The figure which shows the image which superimposed the picked-up image when not inject | pouring a contrast agent into the blood vessel in the state which packed the embolus in the blood vessel part, and when inject | pouring a fluoroscopic image. The figure which shows the moving amount | distance of the contrast agent for every frame from the position of the contrast agent front-end | tip part in each image. The block diagram of a hue conversion table. The figure which shows the correspondence of the movement amount of a contrast agent in a hue conversion table, and a color, a color palette, and an RGB value. The figure which shows the image which synthesize | combined the image which carried out hue conversion, and the present fluoroscopic image. The figure which shows the image which synthesize | combined the image patterned by the space | interval of a line, and the present fluoroscopic image. The figure which shows the correspondence of the contrast agent movement amount and the pattern by the interval of the line The whole block diagram of 2nd embodiment in the X-ray fluoroscopic imaging apparatus of this invention. The figure which shows the image which synthesize | combined the image image | photographed by inject | pouring a contrast agent and a non-contrast agent intermittently, and the present fluoroscopic image. The figure which shows the width | variety of each contrast agent shadow part in the image which synthesize | combined the image image | photographed by intermittently inject | pouring a contrast agent and a non-contrast agent, and the present fluoroscopic image. The figure which shows the relationship between the distance from a catheter front-end | tip, and a contrast agent flow velocity. The figure which shows the relationship between the distance from the catheter tip in case there exists a stenosis part, and contrast agent flow velocity. The figure which shows the locus | trajectory of the flow of a contrast agent. The figure which shows the front-end | tip position of each contrast agent shadow part. The figure which shows the relationship between the distance from a catheter front-end | tip, and a contrast agent flow velocity. The figure which shows progress of the flow of the contrast agent in 3rd embodiment. The figure which shows the movement condition of the contrast agent by the difference for every flame | frame of each image.

Explanation of symbols

1 X-ray tube, 3 X-ray control device, 4 X-ray high voltage device, 5 X-ray flat panel detector, 6 X
Line plane detector control device, 7 image processing device, 8 image display device, 10 contrast medium injector, 11 system control device, 12 frame memory, 13 computing unit, 14 contrast medium tip position detection unit, 15 travel distance visualization unit, 16 Image composition unit, 17 Blood vessels, 18 Embols, 19 Contrast shadow, 20 Hue conversion table, 21 Pallet table, 22 Non-contrast injector, 23 Selector, d1, d2, d3 Contrast travel, d01, d11 , D21,
d31, d41, dn, d11´, d21´, d31´ Shadow width of contrast agent, y1, y2, y3 Tip position of contrast agent

Claims (2)

Contrast medium injection means for injecting a contrast medium into the subject, X-ray generation means for generating X-rays for irradiating the subject, X-ray control means for controlling the X-ray dose, and X-ray generation A two- dimensional X-ray detection means that detects the transmitted X-rays of the subject that are arranged opposite to the means and detects them as digital image data, and performs image processing on the image data detected by the two-dimensional X-ray detection means An X-ray fluoroscopic apparatus comprising: an image processing unit to be applied; and an image display unit that displays a first X-ray image processed by the image processing unit,
The image processing means includes at least a frame memory for storing an image taken by injecting a contrast medium into the blood vessel of the subject by the contrast medium injecting means, and a moving state of the contrast medium from the image stored in the frame memory. the a contrast medium visible image generating means for generating a second image visualizing,
Further, a non-contrast agent injection unit that injects a non-contrast agent that transmits X-rays, a contrast agent injected from the contrast agent injection unit, and a non-contrast agent injected from the non-contrast agent injection unit are exclusively selected. The image stored in the frame memory has a constant interval between the contrast medium injected from the contrast medium injection means and the non-contrast medium injected from the non-contrast medium injection means. In this case, the contrast medium injection image in which the contrast medium stored in the frame memory is injected and the non-contrast medium in which the non-contrast medium is injected. An image connecting unit that connects a plurality of paired images with the injected image to obtain the second image, and an image that combines the second image obtained by the image connecting unit and the first image Specially equipped with synthesis means X-ray fluoroscopic imaging apparatus to. The image stored in the frame memory is an image taken in a state where an embolic substance is placed in advance in the blood vessel of the subject and an image taken by injecting a contrast agent into the blood vessel by the contrast agent injecting means. The contrast agent visualized image generation means includes a calculation means for calculating between images stored in the frame memory, and a contrast agent tip position detection means for detecting the tip position of the injected contrast agent from the calculation result. A contrast agent moving distance calculating means for calculating the moving distance of the contrast agent from the detected contrast agent tip position information; and a contrast agent moving distance visualizing means for converting the moving distance into visualization information. X-ray fluoroscopic apparatus according to claim 1.

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