JP5252994B2 - Ablation region confirmation device using excision marker and control program therefor - Google Patents

Description

  The present invention relates to an excision marker, an excision region confirmation apparatus using an excision marker, and a control program therefor, and in particular, excision capable of confirming that there is no tissue such as a blood vessel that should not be damaged on a line for excising an affected area. The present invention relates to a marker, an ablation region confirmation apparatus using an ablation marker, and a control program thereof.

  Recently, minimally invasiveness has been emphasized for the treatment of various diseases. In the field of surgical treatment, an operation for making a wound as small as possible by using an endoscope has been spreading from an operation for making a large incision on a body surface.

  For example, in conventional lung cancer surgery, surgery (standard thoracotomy) has been performed in which a large incision is made in the chest to remove the cancer. However, at present, relatively small and non-metastatic cancers that have been discovered at an early stage are undergoing a less invasive surgery with a small wound using a thoracoscope called a thoracoscope. It is coming.

  In addition, improvement in the quality of life after surgery is also regarded as important, and the extraction range tends to be kept as small as possible in consideration of the risk of recurrence due to residual cancer cells.

  In conventional lung cancer surgery, surgery to remove all lungs with cancer was also performed, but nowadays, surgery to remove a smaller area such as “leaf” or “zone” or “zone” In addition, "partial resection" that removes a smaller area is also performed, and surgery that can preserve the respiratory function as much as possible is spreading.

  Here, the tissue structure of the lung will be described. FIG. 27A shows the tissue structure of the lung H viewed from the front, and FIG. 27B shows the tissue structure of the lung H viewed from the back.

  The right lung H is composed of three lobes HR-1 to HR-3, and the left lung H is composed of two lobes HL-1 and HL-2. The leaves HR-1 to HR-3 and the leaves HL-1 and HL-2 are each composed of several areas.

  FIG. 28 shows a schematic diagram of lung tissue units and blood vessel and trachea travel.

  As shown in the figure, the lung tissue unit has a structure in which the trachea and the pulmonary artery pass through the center and the pulmonary vein passes through the center. The blood vessels and trachea branch off from the hilar region, and lung tissue can be divided into finer tissue units than “leaves” and “zones”. In surgery, in principle, excision and removal are performed in such a tissue unit.

  Surgery using an endoscope is less invasive, but is difficult to perform because it must be performed indirectly from outside the body using an instrument called forceps.

  Therefore, at present, an instrument called an automatic suturing device is widely used. The automatic suturing device is shaped like scissors, and it is a device that can be excised by pinching the part to be excised, and at the same time, the stump can be sewn with a fine needle like a stapler needle. . A procedure using such an automatic suturing device takes a very short time compared to a procedure in which excision proceeds while the tissue is peeled off little by little with a scalpel. However, there is also a risk of damaging healthy tissue, for example, by pinching a blood vessel to be left behind and performing an ablation.

  In the case of lung cancer thoracoscopic surgery, pulmonary veins that should be left with an automatic suture device may be removed by mistake. Originally, pulmonary vein travel is said to be more anatomically different than pulmonary arteries and trachea, and it is not easy for veteran respiratory surgeons to grasp. In addition, it is more difficult to determine the traveling as the extraction range is made smaller together with the less invasiveness. If the pulmonary vein is removed by mistake, blood flow is not supplied to healthy tissue, necrosis occurs, and the patient is seriously damaged, such as requiring reoperation.

  In addition, there are individual differences in the branching of blood vessels and trachea, and how to divide the tissue units differs from person to person if you look closely. However, there are several typical patterns of bifurcation patterns of trachea and pulmonary arteries that run through the center of each unit.

  Therefore, the respiratory surgeon presumes the travel of blood vessels and pulmonary arteries to some extent from the CT images taken before surgery and the position of the mesenchyme present between the leaves visible during the operation. Can be determined.

  On the other hand, the pulmonary veins that run around the area of the tissue unit are different for each individual and there is no typical pattern, so it is difficult to know where to run. Therefore, a situation occurs in which the pulmonary veins accidentally run on the line excised with the automatic suturing device and are excised.

  When the excised pulmonary veins dominate only the area to be excised and removed, no problem occurs, but if the pulmonary vein also dominates the adjacent, that is, healthy tissue that is not excised, it causes congestion, In the worst case, the tissue becomes necrotic. In this case, re-operation is forced, and a heavy burden is placed on the patient.

  Based on the pulmonary vein tissue structure as described above, on the CT (Computed Tomography) image taken before the operation, the region and the pulmonary vein where the lung is imaged and excised with air in the lung There is a method of confirming the positional relationship of. Then, it is assumed that a resection line that does not remove the pulmonary veins is assumed in advance, and the operation is expected to be performed.

For example, Patent Document 1 proposes a technique for providing a virtual image of a subject on which a cut surface marking image is superimposed and displayed during the procedure.
JP 2005-278888 A

  By the way, since air is extracted from the lung in which the scalpel is inserted during the operation, the image is greatly deformed from the photographed image of the lung in the state before the operation. For this reason, it is difficult for doctors to determine where the resection line assumed before the operation corresponds to the deflated lung during the operation, and there is a problem that erroneous resection of the pulmonary veins occasionally occurs.

  Moreover, in the technique of patent document 1, there existed a subject which cannot confirm whether the structure | tissue which should not be damaged on the resection line exists.

  The present invention has been made in view of such a situation, and its purpose is to confirm whether or not there is a tissue that should not be damaged on the line where the affected area is excised, and to correctly recognize the area to be excised. An ablation marker, an ablation region confirmation apparatus using the ablation marker, and a control program therefor.

The feature according to the embodiment of the present invention as set forth in claim 1 is that an excision marker is attached in an excision region confirmation device for confirming an excision region using an excision marker attached on a line for excising an affected part of a subject. X-ray tomographic imaging means for reconstructing an X-ray stereoscopic tomographic image of the subject, and marker image extracting means for extracting a marker image of the excision marker from the X-ray stereoscopic tomographic image reconstructed by the X-ray tomographic imaging means A region-of-interest extraction unit that extracts an image of a region of interest to be excised from the affected area from a marker image extracted by the marker image extraction unit, and a display unit that displays the image of the region of interest extracted by the region-of-interest extraction unit With.

According to a fourth aspect of the present invention, there is provided a computer equipped with an ablation area confirmation device for confirming an ablation area using an ablation marker mounted on a line for excising an affected part of a subject. An X-ray tomographic imaging step for reconstructing an X-ray stereoscopic tomographic image of a mounted subject, and a marker for extracting a marker image of an excision marker from the X-ray stereoscopic tomographic image reconstructed by the X-ray tomographic imaging step An image extraction step, a region of interest extraction step for extracting an image of a region of interest to be excised from the affected area from the marker image extracted by the marker image extraction step, and an image of the region of interest extracted by the region of interest extraction step are displayed. And a display program for executing the display step.

  According to the present invention, an excision marker capable of confirming whether or not there is a tissue that should not be damaged on a line for excising the affected area and correctly recognizing the excision region, and confirming the excision region using the excision marker A device and its control program can be provided.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  FIG. 1 is a diagram showing a configuration example of a resection line confirmation support system according to the present invention. In this system, an X-ray excision marker 1 mounted in the vicinity of a line for excising the affected part of the subject P, an automatic suturing device 2 for excising the immediate vicinity of the excision line indicated by the X-ray excision marker 1, and the subject P X-ray three-dimensional tomographic image X-ray digital three-dimensional tomography apparatus (Digital Volume Tomography) 10 is comprised.

  The X-ray ablation marker 1 is attached in the vicinity of the ablation line assumed by the doctor in the affected area of the subject P. Thereby, when an X-ray stereoscopic tomographic image is reconstructed by the X-ray digital stereoscopic tomography apparatus 10, the marker image of the X-ray ablation marker 1 is reflected in the X-ray stereoscopic tomographic image. Details of the X-ray ablation marker 1 will be described later.

  The automatic suturing device 2 is an instrument that performs suturing and excision at the same time, and performs suturing simultaneously with excision of the immediate vicinity of the excision line indicated by the X-ray excision marker 1. Details of the automatic suturing device 2 will be described later.

  The X-ray digital stereoscopic tomography apparatus 10 includes an X-ray generator 11, an X-ray detector 12, and a controller 13.

  The X-ray generator 11 includes an X-ray tube 11A, a high voltage generator and a moving mechanism (not shown), and the like. The X-ray tube 11 </ b> A is rotatably supported by the moving mechanism unit in the housing of the X-ray generator 11. A high voltage is applied to the X-ray tube 11A from a high voltage generator. Thus, the X-ray tube 11A exposes the X-ray to the subject P while rotating around the subject P.

  The X-ray detection device 12 includes an X-ray detector 12A, a moving mechanism unit (not shown), and the like. The X-ray detector 12 </ b> A is disposed so as to face the X-ray generation device 11 with the subject P interposed therebetween, and is rotatably supported by the moving mechanism unit in the housing of the X-ray detection device 12. The X-ray detector 12A has a plurality of X-ray detection elements arranged in a two-dimensional manner, and detects X-rays that have passed through the subject P. The detected signal is output to the control device 13.

  The control device 13 controls the X-ray generation device 11 and the X-ray detection device 12, and repeatedly images a certain region of the subject P while changing the X-ray imaging direction. The control device 13 reconstructs an X-ray three-dimensional tomographic image of a plane in a direction substantially perpendicular to the imaging direction, using a plurality of image data having different imaging directions. The control device 13 functions as an X-ray tomographic imaging unit that reconstructs an X-ray stereoscopic tomographic image of the subject P to which the X-ray ablation marker 1 is attached.

  The control device 13 extracts a region to be cut by the automatic suturing device 2 from the marker image of the X-ray excision marker 1 reflected in the X-ray stereoscopic tomographic image, and displays the extracted region. Thus, the operator can confirm whether or not there is a tissue such as a blood vessel that should not be excised in the extracted region.

  FIG. 2 is a diagram illustrating a configuration example of the X-ray ablation marker 1.

  The X-ray ablation marker 1 is provided at the insertion portion 1a for insertion into the chest cavity of the subject P and the distal end portion of the insertion portion 1a, and the scissors 1b-1, 1b-2 and scissors sandwiching the affected portion of the subject P Markers 1c-1, 1c-2 provided at the distal ends of the parts 1b-1, 1b-2, and protrusions 1d-1, 1d-2 provided at predetermined positions of the scissors 1b-1, 1b-2, It is comprised from the holding part 1e provided in the base end part of the insertion part 1a, and the opening / closing switch 1f provided in the holding part 1e.

  The scissors 1b-1 and 1b-2 hold the affected part while the open / close switch 1f provided on the gripping part 1e is pressed, and release the open / close switch 1f to release the held affected part. It has been made so that it can.

  The markers 1c-1 and 1c-2 have special shapes such as a spherical shape. This requires a delicate position adjustment until the operator determines the optimum position (optimum ablation line) to which the X-ray ablation marker 1 is to be attached. This is because the shape and material need not be damaged. Therefore, as long as it is such a shape, the shape of the tip portion may be any shape. In the embodiment of the present invention, the markers 1c-1 and 1c-2 are formed in a spherical shape, so that the marker image of the X-ray ablation marker 1 reflected in the X-ray stereoscopic tomogram is extracted. Can do.

  Protrusions 1d-1 and 1d-2 are provided to prevent mistaken sites to be excised. For example, when the X-ray excision marker 1 is attached to a site to be excised from the subject P, the projections 1d-1 and 1d-2 are attached so as to be on the non-excision side. Thereby, the excision side and the non-excision side can be distinguished from the protruding portion of the marker image reflected in the X-ray stereoscopic tomographic image.

  The open / close switch 1f closes the scissors 1b-1 and 1b-2 while being pressed by the operator, and opens the scissors 1b-1 and 1b-2 when the press is released by the operator.

  As the shape of the X-ray ablation marker 1, a shape that can be mounted on or near the ablation line assumed by the doctor in the affected part of the subject P is appropriate. That is, the tip side of the X-ray ablation marker 1 in the example of FIG. 2 is divided into two forks so that the part to be excised from the subject P can be sandwiched.

  The shape of the X-ray ablation marker 1 may be long or short depending on the application. For example, about 4 to 5 cm may be sufficient for partial resection of lung cancer. On the other hand, when a leaf is excised, a long one of about 10 cm may be required. That is, by selecting the X-ray ablation marker 1 having an appropriate size according to the length of the ablation line, an operation for wearing can be performed smoothly.

  As a material of the X-ray ablation marker 1, a material that can be photographed with X-rays and can be sterilized without being toxic because it touches a living body is suitable. In addition, it is better to have a certain degree of strength in order to perform imaging while maintaining the state of being attached to the affected part of the subject P. Examples of materials that satisfy these conditions include stainless steel that has already been adopted for surgical forceps, titanium, silicon, or ceramics that are used as implant materials.

  As a structure of the X-ray excision marker 1, it is necessary to insert it from outside the body of the subject P, insert it while sandwiching the affected part, and hold the attached state for a certain period of time. An example of a structure that satisfies this condition is surgical forceps used in endoscopic surgery.

  Further, until the excision is actually started by the automatic suturing device 2, the position of the X-ray excision marker 1 attached to the affected part must be held so as not to shift. One of the holding methods is a method of fixing with an arm attached to a surgical bed. Although it can be held by a medical worker, fixing with an arm or the like is desirable in order to suppress the exposure dose.

  FIG. 3 is a diagram illustrating a configuration example of the automatic suturing device 2.

  The automatic suturing device 2 is inserted into the thoracic cavity of the subject P to perform the suturing and excision, the tissue clamping force lever 2b provided at the proximal end of the cartridge 2a, and the operator operating the suturing and excision. And the safety lock 2d for preventing the suturing / cutting handle 2c from being inadvertently gripped.

  As shown in FIG. 4A, the cartridge 2a is divided into two forks, a cartridge 2a-1 and a cartridge 2a-2. A cam 2a-3 and a cutting knife 2a-4 are attached to the cartridge 2a-1. The cam 2a-3 is attached to be movable in the direction indicated by the black arrow, and the cutting knife 2a-4 is attached to be movable in the direction indicated by the white arrow.

  FIG. 4B is a cross-sectional view taken along line AA in FIG. As shown in FIG. 4B, staples 2a-5 (stapling needles) made of titanium or an alloy thereof with little tissue reaction are alternately arranged in the cartridge 2a-1. A groove 2a-6 parallel to the longitudinal direction of the cartridge 2a-1 is provided between the two central rows of 5.

  With such a configuration, when the operator grasps the suture excision handle 2c, the cam 2a-3 moves while being guided by the groove 2a-6, and the staple 2a-5 is driven into the affected part of the subject P. At the same time, the excision knife 2a-4 moves and the affected part is excised.

  Each staple 2a-5 is in the open state when it is in the cartridge 2a-1, but when it is driven, it closes with the tissue in between to close the tissue end.

  FIG. 5 is a block diagram illustrating a configuration example of the control device 13.

  As shown in the figure, the control device 13 includes a control unit 13a including a CPU (Central Processing Unit) that centrally controls each unit, and a memory 13b including a ROM (Read Only Memory) and a RAM (Random Access Memory). An image processing unit 13c that processes the projection image supplied from the X-ray detector 12A, and a marker extraction processing unit 13d that extracts a marker image of the X-ray ablation marker 1 from the X-ray stereoscopic tomogram supplied from the image processing unit 13c. The region-of-interest extraction processing unit 13e that extracts the region of interest of the affected part to be excised from the marker image supplied from the marker extraction processing unit 13d, the display unit 13f that displays the X-ray stereoscopic tomogram, and the input operation from the operator An input unit 13g that receives data and a data storage unit 13h that stores various programs and various data are provided. These units are electrically connected via a bus 13i.

  The control unit 13a executes a series of data processing, display processing for displaying images, and the like based on various programs and various data stored in the data storage unit 13h. The control unit 13a controls the X-ray generator 11 and the X-ray detector 12 to perform X-ray stereoscopic tomography of the subject P. The control unit 13a controls the image processing unit 13c, the marker extraction processing unit 13d, and the region-of-interest extraction processing unit 13e, and performs a process of extracting the marker image of the X-ray ablation marker 1 reflected in the X-ray stereoscopic tomogram. Make it. Details of the process of extracting the marker image will be described later.

  The memory 13b stores a startup program executed by the control unit 13a.

  The image processing unit 13c reconstructs X-ray stereoscopic tomographic image data of a plane substantially perpendicular to the imaging direction by using a plurality of projection image data having different imaging directions stored in the data storage unit 13h. The X-ray stereoscopic tomographic image data is supplied to the marker extraction processing unit 13d via the bus 13i.

  The marker extraction processing unit 13d reflects an X-ray stereoscopic tomographic image from the X-ray stereoscopic tomographic image data supplied from the image processing unit 13c based on the marker feature amount stored in the marker feature amount storage unit 13h-1. Marker image data of the recessed X-ray ablation marker 1 is extracted. The extracted marker image data is supplied to the region of interest extraction processing unit 13e via the bus 13i.

  The region-of-interest extraction processing unit 13e extracts the region of interest of the affected part to be excised from the marker image data supplied from the marker extraction processing unit 13d based on the processing parameters stored in the processing parameter storage unit 13h-2. To do.

  The display unit 13f is composed of, for example, a liquid crystal display, and is an X-ray stereoscopic tomographic image processed by the image processing unit 13c, a marker image extracted by the marker extraction processing unit 13d, and an image extracted by the region of interest extraction processing unit 13e. Is displayed.

  The input unit 13g includes, for example, a mouse and a keyboard, receives various input operations by an operator, and supplies signals corresponding to the input operations to the control unit 13a via the bus 13i.

  The data storage unit 13h is configured by a semiconductor memory, a magnetic disk, or the like, and stores programs and data executed by the control unit 13a and the image processing unit 13c. The data storage unit 13h stores the projection image data supplied from the X-ray detector 12A.

  Further, the data storage unit 13h is provided with a marker feature amount storage unit 13h-1 and a processing parameter storage unit 13h-2. The marker feature amount storage unit 13h-1 stores marker feature amounts including the lengths of the scissors 1b-1 and 1b-2 of the X-ray ablation marker 1 and the diameters of the spheres of the markers 1c-1 and 1c-2. The processing parameter storage unit 13h-2 stores parameters such as the number of pixels that are referred to when an equation of a plane passing through the marker image of the X-ray ablation marker 1 is obtained.

  Next, a process for confirming whether or not there is a blood vessel or the like that should not be damaged at the site to be excised will be described with reference to the flowchart of FIG.

  In this process, it is assumed that a part of the lung including the tumor is excised by the doctor, and it is confirmed whether or not there is a tissue such as a blood vessel that should not be damaged at the site to be excised.

  In starting this process, the subject P is inserted with two to three forceps in addition to the thoracoscope, and a port for taking out a part of the excised lung out of the body is also incised. As shown in FIG. 7, the doctor confirms the lung H and obtains a line L for excising a tissue unit (such as a leaf or a section) including the tumor S. In addition, since the doctor confirms the lung H through the thoracoscope, the entire image as shown in FIG. 7 cannot actually be seen, but the approximate position of the tumor S and the region to be excised on the CT image before the operation, etc. Can be confirmed.

  Next, as shown in FIG. 8, the doctor attaches the X-ray ablation marker 1 in the immediate vicinity of the registered ablation line L. The X-ray excision marker 1 can be inserted from a port provided for taking out a part of the excised lung H out of the body. The operator wears the projections 1d-1 and 1d-2 provided on the scissors 1b-1 and 1b-2 of the X-ray ablation marker 1 on the non-ablation side, respectively. Thereby, when a doctor excises the affected part used as the excision object using the automatic suturing device 2, it can prevent mistaken in the side to excise.

  In step S <b> 1, the X-ray digital stereoscopic tomography apparatus 10 performs X-ray stereoscopic tomography of the subject P with the X-ray ablation marker 1 attached to the lung H.

  More specifically, the X-ray detector 12A repeats taking an X-ray stereoscopic tomogram while rotating in synchronization with the X-ray tube 11A under the control of the control unit 13a of the control device 13. The captured projection image data is stored in the data storage unit 13h of the control device 13. Under the control of the control unit 13a, the image processing unit 13c reconstructs an X-ray stereoscopic tomogram using a plurality of projection image data stored in the data storage unit 13h and having different imaging directions.

  The display unit 13f displays the X-ray stereoscopic tomographic image reconstructed by the image processing unit 13c under the control of the control unit 13a. For example, as shown in FIG. 9, when X-ray stereoscopic tomography of the lung H to which the X-ray excision marker 1 is attached is performed, an X-ray stereoscopic as shown in FIGS. 10 (A) to 10 (E). A tomographic image is displayed on the display unit 13f.

  In the case of the example of FIGS. 10A to 10E, a 5-slice X-ray three-dimensional tomographic image G is shown from the dorsal side to the ventral side. In the X-ray stereoscopic tomogram G shown in FIGS. 10A and 10E, the marker image M of the X-ray ablation marker 1 is reflected, and the X-ray ablation marker 1 actually exists, or It turns out that it is the slice image of the vicinity.

  Usually, the marker image M is reflected only in the slice image in which the X-ray ablation marker 1 exists or in the vicinity of the X-ray ablation marker 1, but the two-dimensional obstacle shadow, the movement of the subject, or the failure of the apparatus Due to the occurrence of artifacts (so-called noise) due to the above, the marker image M may be reflected even in a slice image slightly away from the cut surface.

  When the X-ray stereoscopic tomographic image is obtained as described above, in step S2, the marker extraction processing unit 13d performs a process of extracting the marker image of the X-ray ablation marker 1 from the X-ray stereoscopic tomographic image.

  Here, the details of the marker extraction process of the X-ray ablation marker 1 from the X-ray stereoscopic tomogram will be described with reference to the flowchart of FIG.

  This marker extraction process is a process for recognizing the markers 1c-1 and 1c-2 of the X-ray ablation marker 1. In the present embodiment, a case will be described in which the markers 1c-1 and 1c-2 of the X-ray ablation marker 1 are spherical.

  In step S21, the marker extraction processing unit 13d performs threshold processing based on pixel values using the fact that the pixel value of the marker image M of the X-ray ablation marker 1 reflected in the X-ray stereoscopic tomographic image G is different from that of the living body. A marker image M is extracted from the line solid tomographic image G. The threshold value is determined by the operator operating the input unit 13g while viewing the image, or automatically determined from the image histogram.

  Depending on the imaging conditions, as shown in FIG. 12, a part of the bone and trachea other than the marker may be displayed on the X-ray stereoscopic tomographic image G. In such a case, the operator designates one point in the marker image M on the screen using the input unit 13g. Upon receiving this operation input, the marker extraction processing unit 13d extracts only the marker image M by leaving only the connected region including the designated point and removing the rest.

  In step S22, the marker extraction processing unit 13d receives from the marker feature amount storage unit 13h-1 the diameters of the spheres of the markers 1c-1 and 1c-2 of the X-ray ablation marker 1 and the scissors 1b-1 divided into two branches. , 1b-2 and other feature data are read out.

  The marker feature amount storage unit 13h-1 stores feature amount data for each size of the X-ray ablation marker 1 to be used, and the operator uses the input unit 13g to select a desired value on the display screen. The feature amount data may be selected.

  In step S23, the marker extraction processing unit 13d determines the markers 1c-1 and 1c-2 of the X-ray ablation marker 1 from the coordinate values of the extracted marker image M in the direction of the X-ray tube 11A and the X-ray detector 12A. Calculate how big the sphere is projected.

  Strictly speaking, it is necessary to calculate how much each of the two spheres of the marker 1c-1 and the marker 1c-2 is projected. However, since the distance between the two spheres of the marker 1c-1 and the marker 1c-2 is about several centimeters, an average value is obtained from the coordinate values in the directions of the X-ray tube 11A and the X-ray detector 12A for the entire marker image. You may make it calculate how big a sphere is projected using the average value.

  Thus, by calculating how large the sphere at the tip of the X-ray ablation marker 1 is projected, the sphere reflected in the X-ray stereoscopic tomogram from the actual sphere diameter and projection ratio. Can be obtained.

  In step S24, the marker extraction processing unit 13d obtains the distances to the extraction boundaries in the ± x direction, the ± y direction, and the ± z direction for each point of the marker image M.

For example, as shown in FIG. 13A, at a point n ₀ near the center of the sphere, the value in any direction is the half value (that is, the radius) of the diameter of the sphere reflected in the previously obtained X-ray stereoscopic tomogram. The value is close to the value of. On the other hand, as shown in FIG. 13B, at the point n ₁ away from the center of the sphere, the value is far from the half value of the diameter of the sphere shown in the previously obtained X-ray stereoscopic tomographic image.

FIG. 14 shows the distances to the extraction boundaries in the ± x direction, ± y direction, and ± z direction at the points n ₀ shown in FIG. 13A and the point n ₁ shown in FIG. An example of the calculation result is shown.

In the example of FIG. 14, the distance from the point n ₀ to the extraction boundary in the + x direction is 7.10 mm, and the absolute value of the difference between the value and the positive value of the radius of the sphere of the markers 1c-1 and 1c-2 ( Hereinafter, “abbreviated as“ difference from positive value ”) is 0.05 mm. The distance from the point n ₀ to the extraction boundary in the −x direction is 7.08 mm, and the difference between the value and the positive value is 0.03 mm. The distance from the point n ₀ to the extraction boundary in the + y direction is 9.11 mm, and the difference between the value and the positive value is 2.06 mm. The distance from the point n ₀ to the extraction boundary in the −y direction is 7.10 mm, and the difference between the value and the positive value is 0.05 mm. Distance from the point n ₀ to + z direction detection boundary is 7.08 mM, the difference between the value and the positive value is 0.03 mm. The distance from the point n ₀ to the extraction boundary in the −z direction is 7.01 mm, and the difference between the value and the positive value is 0.04 mm.

The distance from the point n ₁ to the + x direction of the detection boundary is 1.1 mm, the difference between the value and the positive value is 5.95 mm. The distance from the point n ₁ to the extraction boundary in the −x direction is 1.1 mm, and the difference between the value and the positive value is 5.95 mm. Distance from the point n ₁ to the + y direction of the extracted boundary is 1.05 mm, the difference between the value and the positive is 6 mm. The distance from the point n ₁ to the extraction boundary in the −y direction is 1.03 mm, and the difference between the value and the positive value is 6.02 mm. Distance from the point n ₁ to the + z-direction of the detection boundary is 7.20Mm, the difference between the value and the positive is 0.15 mm. The distance from the point n ₁ to the extraction boundary in the −z direction is 19.2 mm, and the difference between the value and the positive value is 12.15 mm.

  In this manner, after obtaining the distance to the extraction boundary for each point of the marker image M, the marker extraction processing unit 13d evaluates the maximum value of the obtained distances in step S25.

In the case of the example in FIG. 14, the distance from the point n ₀ to the extraction boundary is a maximum value (2.06), and the distance from the point n ₁ to the extraction boundary is the maximum value − Discard the value of the distance to the extraction boundary in the z direction (12.15) and evaluate.

As an evaluation method, a value obtained by summing up the differences from the positive value is a comprehensive evaluation. That is, the overall evaluation of the point n ₀ is 0.05 + 0.03 + 0.05 + 0.03 + 0.04 = 0.2, and the overall evaluation of the point n ₁ is 5.95 + 5.95 + 6 + 6.02 + 0.15 = 24.07. As described above, the comprehensive evaluation has a small value at points near the center of the sphere, but has a large value at other points.

  In step S26, the marker extraction processing unit 13d extracts a set of points located near the center of the sphere by setting a threshold value for comprehensive evaluation. That is, the points whose comprehensive evaluation exceeds the threshold are excluded from the extraction targets.

  In step S27, the marker extraction processing unit 13d divides the set of points located near the center of the sphere into a group belonging to the sphere of the marker 1c-1 and a group belonging to the sphere of the marker 1c-2.

  For example, one arbitrary point is selected from the set of points located near the center of the sphere, and the distance from other points is obtained. Since the distance between an arbitrarily selected point and a point belonging to the same sphere is small, and the distance between a point belonging to a different sphere is large, the group belonging to the sphere of marker 1c-1 and the sphere of marker 1c-2 Can be easily divided into groups belonging to.

  In step S28, the marker extraction processing unit 13d calculates barycentric coordinates for each point belonging to each divided group, and obtains the center point of each sphere of the markers 1c-1 and 1c-2.

  As described above, the center points of the spheres of the markers 1c-1 and 1c-2 of the X-ray ablation marker 1 are obtained, and the marker image M is extracted.

  Returning to the description of FIG. In step S <b> 3, the region-of-interest extraction processing unit 13 e performs processing for extracting the region of interest of the affected part to be excised from the marker image M.

  Here, with reference to the flowchart of FIG. 15, the details of the region-of-interest extraction process for the affected area to be excised from the marker image M will be described.

  In step S31, the region-of-interest extraction processing unit 13e searches for the shortest route from one to the other of the sphere center points of the markers 1c-1 and 1c-2 extracted by the marker extraction processing in step S2. Ask for.

  In step S32, the region-of-interest extraction processing unit 13e determines a plane that passes through a set of points located on the path from one of the center points of the sphere to the other. As the simplest method for obtaining a plane, there is a method for obtaining by a least square method.

  Another method for obtaining a plane will be described with reference to FIG. As shown in the figure, a cylinder V having a central axis O as a straight line connecting the center points of two spheres of markers 1c-1 and 1c-2 is defined.

  The region-of-interest extraction processing unit 13e obtains a plane (a set of pixels) where the cylinder V and the marker image M intersect when the radius of the cylinder V is changed to r1, r2,.

  The number of intersections to be obtained is stored in advance in the processing parameter storage unit 13h-2. That is, the region-of-interest extraction processing unit 13e can obtain 2n intersections by changing the radius r of the cylinder V from 1 to n, and can determine a plane equation using these points. .

  Depending on the value of the radius r of the cylinder V, it may overlap with the spheres of the markers 1c-1 and 1c-2 and the protrusions 1d-1 and 1d-2, but the marker feature amount storage unit 13h-1 Feature amount data of the markers 1c-1, 1c-2 such as the radius (diameter) of the spheres 1c-1, 1c-2 and the distance from the center point of the sphere to the protrusions 1d-1, 1d-2 are stored. By placing, it is possible to avoid the radius of the cylinder V that intersects the sphere and the protrusions 1d-1 and 1d-2.

  Further, the markers 1c-1, 1c-2 and the diameters of the markers 1c-1, 1c-2 at locations other than the protrusions 1d-1, 1d-2 are stored in the marker feature amount storage unit 13h-1. If the areas of the intersecting surfaces are inappropriate, the radius of the cylinder V overlapping the spheres of the markers 1c-1, 1c-2 and the protrusions 1d-1, 1d-2 can be avoided.

  In the method of defining the cylinder V having the straight line connecting the center points of the two spheres of the markers 1c-1 and 1c-2 as the central axis O, the result is more accurate than the shortest path search method using the least square method. There is an advantage that can be obtained.

  As described above, a cross section obtained by cutting an X-ray stereoscopic tomographic image (Volume data) with a plane equation is extracted as a region of interest of an affected area to be excised.

  Returning to the description of FIG. In step S4, the display unit 13f displays, as a result, an image of the region of interest of the affected part to be excised extracted in the process of step S3 under the control of the control unit 13a. That is, the display unit 13f displays a cross section obtained by cutting the X-ray stereoscopic tomogram with a plane equation.

  In practice, the line that the doctor cuts using the automatic suturing device 2 is not a plane that passes through the X-ray excision marker 1 but the vicinity thereof. Further, since the automatic suturing device 2 excises an “area” having a finite width, it is necessary to confirm the excision side up to a certain distance from the plane of the X-ray stereoscopic tomogram as shown in FIG.

  Therefore, in order to confirm the side to be cut up to a certain distance, it is necessary to recognize which side is to be cut across the plane. As described above, the X-ray ablation marker 1 is mounted so that the projections 1d-1 and 1d-2 do not come on the side to be excised, and the projection of the marker image M of the X-ray ablation marker 1 is used. Can recognize the side to be excised.

  Since the coordinate and plane equations of all the pixels included in the marker image M are obtained by the process of step S3, the control unit 13a determines which side each pixel is on the plane equation. Can do.

For example, the equation of the plane is assumed to be ax + by + cz = d, the pixels included in the marker image M, the coordinates _{(x n, y n, z} n) _is, as satisfying _{ax n + by n + cz n} ≧ d, Those satisfying ax _n + by _n + cz _n ≦ d can be divided into two groups.

  When the control unit 13a counts the number of pixels of the points included in each group, the number of pixels increases by that amount on the side where the protrusion is present. It is possible to recognize which side is the side to be excised with respect to the plane.

  However, since the scissors 1b-1 and 1b-2 have a constant intensity, they are thicker than the markers 1c-1 and 1c-2, and the ratio of the number of pixels in the marker image M tends to be large. For this reason, the number of pixel counts varies greatly depending on the slight inclination of the plane equation, and it may not be possible to correctly recognize which side has the protrusion.

  Therefore, the marker feature amount storage unit 13h-1 stores the lengths of the scissors 1b-1 and 1b-2, and the marker 1c that does not include the scissors 1b-1 and 1b-2 in the marker image M is stored. It is necessary to count the number of pixels described above only in the portions −1 and 1c−2.

  When the recognition on the side to be excised is completed as described above, the display unit 13f performs display processing. For example, a cut surface based on the plane equation obtained in the process of step S3 and an X-ray stereoscopic tomographic image parallel to the cut surface are created so that the operator can check while turning the image using the input unit 13g. At that time, the distance from the cut surface (the positions of the markers 1c-1 and 1c-2) is displayed for each X-ray stereoscopic tomographic image. This is because the automatic suturing device 2 has various sizes, and the range to be confirmed differs depending on the automatic suturing device 2 to be used.

  18 to 20 are diagrams showing examples of X-ray stereoscopic tomograms displayed by the display unit 13f.

  FIG. 18 shows an example of an X-ray three-dimensional tomographic image when the distance from the excision surface on which the X-ray excision marker 1 is mounted is 0 mm (that is, the excision surface). As shown in the figure, an X-ray three-dimensional tomographic image G is displayed on the display screen, and the marker image M is clearly displayed because it is a cut surface on the cut line. Further, on the display screen, the button B1 selected when displaying the previous image, the button B2 selected when displaying the next image, and the length of the marker (30 mm in the example of FIG. 18). Is displayed. In the X-ray stereoscopic tomographic image G displayed on the display screen, the distance from the cut surface (0 mm in the example of FIG. 18) is also superimposed and displayed.

  When the button B2 is selected by the operator while the X-ray stereoscopic tomogram G shown in FIG. 18 is displayed, the display is switched as shown in FIG. In the example of FIG. 19, the X-ray stereoscopic tomographic image G at a distance of 2 mm from the excision surface is displayed, and since it is 2 mm away from the excision surface, the marker image M is difficult to see. In addition, in the X-ray stereoscopic tomographic image G, in addition to the distance from the excision plane (2 mm in the case of FIG. 19), the letters “ablation side” indicating that the currently displayed cross section is the side to be excised It is superimposed.

  When the operator selects the button B2 while the X-ray stereoscopic tomogram G shown in FIG. 19 is displayed, the display is switched as shown in FIG. In the example of FIG. 20, the X-ray stereoscopic tomographic image G at a distance of 4 mm from the excision surface is displayed, and the marker image M is not visible because it is 4 mm away from the excision surface. In addition to the distance from the excision plane (4 mm in the example of FIG. 20), the X-ray stereoscopic tomogram G is also superposed with the characters “ablation side” indicating that the currently displayed cross section is the excision side. It is displayed.

  As described above, the operator can check whether there is a tissue that should not be excised in the affected area to be excised while turning the X-ray stereoscopic tomographic image.

  Further, when it is confirmed whether or not there is a tissue that should not be excised at a site opposite to the side to be excised, for example, as shown in FIG. 21, an X-ray stereoscopic tomogram on the side opposite to the side to be excised G can be displayed. In the example of FIG. 21, the X-ray stereoscopic tomographic image G at a distance of 2 mm from the excision surface is displayed, and since it is 2 mm away from the excision surface, the marker image M is difficult to see. In addition, in the X-ray stereoscopic tomogram G, in addition to the distance from the cut surface (2 mm in the case of FIG. 20), the characters “non-cut side” indicating that the currently displayed cross section is the non-cut side. Is also superimposed.

  Next, referring to the schematic diagrams of the X-ray stereoscopic tomogram G in FIGS. 22 (A) and 22 (B), whether or not a problem occurs when the affected part to be excised is actually excised. A method of confirming will be described.

  For example, in the X-ray stereoscopic tomogram G shown in FIG. 22A, the operator includes the blood vessel K in the region of the affected part to be excised. Need to do.

  That is, the operator confirms while turning the X-ray stereoscopic tomogram G as described above with reference to FIGS. 18 to 20, and is a blood vessel that controls the healthy tissue other than the region where the blood vessel K travels. Confirm whether or not. As a result of confirmation, when the blood vessel K is a blood vessel that controls a healthy tissue, the operator can determine that there is a high possibility of causing some kind of damage after the operation by excising the blood vessel K. The ablation at the position is stopped and another ablation line is set.

  On the other hand, in the X-ray stereoscopic tomogram G shown in FIG. 22 (B), there is no vascular system tissue such as a blood vessel or trachea in the region of the affected part to be excised. It can be judged that there is not. In this case, the operator can remove the immediate vicinity of the X-ray excision marker 1 by grasping the suture excision handle 2c of the automatic suturing device 2 without moving the X-ray excision marker 1 attached at the time of imaging.

  Further, referring to FIGS. 23 to 25, a confirmation method when a vascular tissue such as a blood vessel or trachea is present in the region of the affected part to be excised will be described. For example, the operator moves the display slice from the X-ray excision marker 1 in the direction of excision to the tumor S for the affected part to be excised, and confirms the travel of the blood vessel K.

  In the example of FIG. 23, the blood vessel K is taken into the tumor S. Therefore, the operator can determine that the blood vessel K is a nutrient blood vessel to the tumor S and can be removed (a blood vessel that must be removed).

  In the example of FIG. 24, the blood vessel K is not taken up by the tumor S. Therefore, when the operator assumes that the blood vessel K is a pulmonary vein that dominates the region to be excised, the operator moves the display slice to the non-excision side. When the operator confirms that another pulmonary vein is dominant on the non-resected side, the blood vessel K is a pulmonary vein that dominates the excision region. It can be determined that it will not affect.

  In the case of the example of FIG. 25, the blood vessel K is not taken into the tumor S. Therefore, the operator moves the display slice to the non-excised side as in the example of FIG. When the operator confirms that the blood vessel K is a pulmonary vein that also controls the non-resected region, the operator determines that the blood vessel K should not be excised, and stops the excision at this position. Try to set another ablation line.

  As described above, the operator images the affected part of the subject P with the X-ray ablation marker 1 attached, so that there is a tissue such as a blood vessel that should not be damaged on the ablation line that is registered. Can be confirmed with certainty.

  When it can be confirmed that there is no tissue that should not be damaged, the operator holds the X-ray excision marker 1 while holding the X-ray excision marker 1 to hold the suture excision handle 2c. The immediate vicinity of 1 can be excised. As a result, the risk of accidental excision can be greatly reduced.

  The X-ray ablation marker 1 is provided with projections 1d-1, 1d-2. By attaching the projections 1d-1, 1d-2 so as to be on the non-ablation side of the affected part, It is possible to prevent mistaken parts to be excised.

  In the above description, the X-ray digital stereoscopic tomography apparatus 10 is used as an apparatus capable of stereoscopic imaging. However, the present invention is not limited to this, and a CT apparatus, an angiography apparatus, or the like may be used.

  In the above description, the X-ray excision marker 1 and the automatic suturing device 2 are configured as separate mechanisms. However, the present invention is not limited thereto, and may be configured as a single unit.

  For example, as shown in FIG. 26A, the protrusion 2a-7 and the marker 2a-9 are integrally formed on the cartridge 2a-1 of the automatic suturing device 2, and the protrusion 2a-8 and the marker 2a are formed on the cartridge 2a-2. -9 is formed integrally. In addition, although it can attach to the existing automatic suturing device 2 and forceps by making a projection part and a marker into an attachment type, since there exists a concern about detachment | desorption in a body, the type formed integrally is preferable.

  Further, the positions of the markers 2a-9 and 2a-10 are made to coincide with the tip position of the stapler portion in which the staples 2a-5 (not shown in FIG. 26A) are arranged.

  FIG. 26B is a view of FIG. As shown in FIG. 26 (B), the protrusion 2a-7 has rounded corners so as not to damage the tissue.

  As described above, even if the X-ray excision marker 1 and the automatic suturing device 2 are configured integrally, it is possible to reliably confirm whether or not there is a tissue such as a blood vessel that should not be damaged on the excision line. When it is confirmed that there is no tissue that should not be damaged, the operator can remove the tissue by grasping the suture excision handle 2c of the automatic suturing device 2 as it is.

  Note that the present invention is not limited to the above-described embodiment as it is, and in the implementation stage, the constituent elements may be modified and embodied without departing from the scope of the invention, or a plurality of configurations disclosed in the above-described embodiment may be used. Various inventions can be formed by appropriately combining elements. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, you may combine the component covering different embodiment suitably.

It is a figure which shows the structural example of the ablation line confirmation assistance system which concerns on this invention. It is a figure which shows the structural example of the X-ray ablation marker of FIG. It is a figure which shows the structural example of the automatic suturing device of FIG. It is a figure which shows the detailed structural example of the cartridge of the automatic suturing device of FIG. It is a block diagram which shows the structural example of the control apparatus of FIG. It is a flowchart explaining the process which confirms whether there exists the blood vessel etc. which should not be damaged in the affected part to be excised. It is a figure which shows a mode that the excision line was registered by the doctor. It is a figure which shows a mode that the X-ray excision marker was mounted | worn. It is a figure of the other example which shows a mode that the X-ray excision marker was mounted | worn. It is a figure which shows the example of a X-ray solid tomogram. It is a flowchart explaining the detail of the marker extraction process in step S2 of FIG. It is a figure for demonstrating a removal process. It is a figure for demonstrating the process which calculates | requires the distance from each point of a marker image to an extraction boundary. It is a figure which shows the example of a calculation result of the distance from each point of a marker image to an extraction boundary. It is a flowchart explaining the detail of the region of interest extraction process in step S3 of FIG. It is a figure for demonstrating the process which calculates | requires the plane of a X-ray three-dimensional tomogram. It is a figure which shows confirming the side to cut out from the plane of a X-ray three-dimensional tomogram to a fixed distance. It is a figure which shows the example of a X-ray solid tomogram. It is a figure which shows the other example of a X-ray solid tomogram. It is a figure which shows the other example of a X-ray solid tomogram. It is a figure which shows the other example of a X-ray solid tomogram. It is a schematic diagram of a X-ray three-dimensional tomographic image. It is a figure for demonstrating the confirmation method of the affected part planned to be excised. It is a figure of the other example for demonstrating the confirmation method of the affected part planned to be excised. It is a figure of the other example for demonstrating the confirmation method of the affected part planned to be excised. It is a figure at the time of comprising X-ray resection marker and an automatic suturing device integrally. It is a figure which shows the tissue structure of a lung. It is a schematic diagram of the tissue unit of the lungs and the running of blood vessels and trachea.

Explanation of symbols

1 X-ray ablation marker 1c-1, 1c-2 Marker 1d-1, 1d-2 Protrusion part 2 Automatic suture device 13a Control part 13c Image processing part 13d Marker extraction processing part 13e Region of interest extraction process 13f Display part

Claims (4)

In the excision region confirmation device for confirming the excision region using the excision marker attached on the line for excising the affected part of the subject,
X-ray tomography means for reconstructing an X-ray stereoscopic tomogram of the subject to which the excision marker is attached;
Marker image extraction means for extracting a marker image of the ablation marker from the X-ray stereoscopic tomogram reconstructed by the X-ray tomography means;
A region-of-interest extracting unit that extracts an image of a region of interest to be excised from the affected area from the marker image extracted by the marker image extracting unit;
An ablation area confirmation apparatus using an ablation marker, comprising: display means for displaying an image of the area of interest extracted by the area of interest extraction means. The excision marker according to claim 1 , wherein the display means further displays information indicating that the affected part is to be excised, or information indicating that the affected part is not to be excised. Used excision region confirmation device. The said display means further displays the distance information from the position of the said excision marker. The excision area | region confirmation apparatus using the excision marker of Claim 1 characterized by the above-mentioned. In the computer provided with the excision region confirmation device for confirming the excision region using the excision marker attached on the line for excising the affected part of the subject,
An X-ray tomographic imaging step for reconstructing an X-ray stereoscopic tomographic image of the subject to which the excision marker is attached;
A marker image extraction step for extracting a marker image of the ablation marker from the X-ray stereoscopic tomogram reconstructed by the X-ray tomography step;
A region-of-interest extraction step of extracting an image of a region of interest to be excised from the affected area from the marker image extracted by the marker image extraction step;
And a display step of displaying an image of the region of interest extracted by the region of interest extraction step.

Images