JP5410021B2 - Medical diagnostic imaging equipment - Google Patents

Description

  The present invention relates to a medical image diagnostic apparatus such as a magnetic resonance imaging apparatus and a CT apparatus.

  With the spread of medical institution selection and treatment options by patients, minimally invasive treatments are becoming widespread, and surgical procedures are accelerating the transition from large incision surgery to endoscopic surgery. On the other hand, in endoscopic surgery, the limited visual field and surgical space have caused problems such as limitations in procedures / adaptations and increased operator stress.

  As a solution to this problem, Patent Document 1 proposes a function for displaying a segmentation specific area on an endoscopic image, but information necessary for surgery is insufficient. In general endoscopic surgery for the abdomen, the abdominal organs are deformed and moved during the operation, so it is difficult to always grasp the position of the tumor at a site where direct viewing is impossible, and the surgical tool is guided to the tumor position. It could take a lot of time.

  In recent years, an I-MRI (Interventional MRI) system that allows a surgical tool such as a puncture needle to reach a target site using an intraoperative magnetic resonance imaging image (MRI image) has appeared, and several reports have been made. Specifically, a method of displaying an MRI image on a graphical user interface and clicking a button on the screen to determine a tomographic plane to be imaged next (Non-Patent Document 1) or a method using a three-dimensional mouse or the like (Patent Document 2) has been proposed.

  In these methods, since the position and orientation of the tomographic plane to be imaged must be adjusted and set by an input means such as a mouse, the MRI apparatus can adjust the position and orientation of the tomographic plane to be imaged more easily. It is desirable that it can be set. As such a technique, an MRI apparatus that determines a tomographic plane to be imaged using a tomographic plane indicating device (such as a pointer) disclosed in Patent Literature 3 and Patent Literature 4 has been proposed (ISC).

  In the technique described in Patent Document 3, a light emitting diode is provided in a pointer which is a tomographic plane indicating device, and the position pointed by the operator with the pointer is detected by an infrared camera, or the tip of an arm provided with a sensor at a joint. The position of the pointer is detected by the angle of the joint of the arm, and the tomographic plane is automatically adjusted based on this. The technique described in Patent Document 4 is to automatically determine and image a tomographic plane instructed using two infrared cameras and a pointer provided with three reflecting spheres.

  A surgical navigation system using a position detection device and volume data captured in the past is also known. This system is a system for navigating a surgical operation by displaying a position designated by a pointer or the like for a patient at the time of surgery on a tomographic image having a cross section of each of three orthogonal planes including the position. It is applied to high-precision surgery such as neurosurgery.

  Here, a tomographic image of a patient in such a surgical navigation system is generated in advance by volume data that is three-dimensional data captured by an MRI apparatus.

  On the other hand, methods for detecting the position of the pointer required for determining the designated position by the pointer include methods such as a mechanical method, an optical method, a magnetic method, and an ultrasonic method. The position of the surgical tool detected by the pointer has device coordinates for each detection device, and a coordinate conversion / integration function is required for incorporation into the MRI apparatus. Patent Document 5 describes registration for unifying the position coordinates of an MRI apparatus and other surgical tools in I-MRI.

JP 2007-7041 A US Pat. No. 5,512,827 US Pat. No. 5,365,927 US Pat. No. 6,063,315 JP 2005-31698 A Magnetic Resonance in Medicine: Real-time interactive MRI on a conventional scanner; AB, Kerr et al., 38, pp. 355-367 (1997)

  The method using the endoscopic image superposition and various navigations in the I-MRI is an effective means and can provide information according to the operator's request.

  However, a plurality of displays are arranged, and different information is displayed on each display. For example, an untreated region for a target site is displayed on one display, the position of a needle or a surgical tool with respect to the target site is displayed on another display, and other information is displayed on another display.

  For this reason, for the surgeon, complicated information is displayed, and necessary information cannot be obtained instantaneously.

  In addition, there is a point to be improved as an operation support means because it is necessary to identify a display that performs display according to the work situation.

  An object of the present invention is to realize a medical image diagnostic apparatus that can display various navigation information and surgical information in a single screen and can provide improved surgical support.

  In order to achieve the above object, the present invention is configured as follows.

The medical image diagnostic apparatus of the present invention has an imaging means for imaging the inside of a subject, a surgical instrument position detection means for detecting the position of the surgical instrument, and a display means for displaying an image acquired by the imaging means. The specific region in the subject extracted using the image is identified as an untreated region and a treated region, and the subject corresponding to the position of the surgical tool detected by the surgical tool position detecting means A predicted therapeutic region that is expected as a region within the region, and a predicted untreated region that is predicted to be untreated at the position of the surgical tool detected by the surgical tool position detection means based on the untreated region and the predicted therapeutic region Calculating a predicted route to the surgical tool corresponding to the untreated region, and displaying the untreated region, the treated region, the predicted treated region, the predicted untreated region, and the predicted route on one screen of the display means. indicate.

  It is possible to realize a medical image diagnostic apparatus that can display various navigation information and surgical information in a single screen and can provide improved surgical support.

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

  The following embodiment is an example when the medical image diagnostic apparatus according to the present invention is applied to a magnetic resonance imaging apparatus (MRI apparatus).

  First, an overall schematic configuration of an MRI apparatus to which the present invention is applied will be described with reference to FIG. In FIG. 8, the MRI apparatus 1 is, for example, a vertical magnetic field type 0.3T permanent magnet type. The MRI apparatus 1 includes an upper magnet 3 that generates a vertical static magnetic field, a lower magnet 5, a support 7 that connects the magnets 3 and 5 to each other and supports the upper magnet 3, a position detection device 9, and an arm 11. And monitors 13 and 14, a monitor support unit 15, a reference tool 17, a personal computer 19 having an operation means such as a keyboard and a mouse, a display, a bed 21, and a control unit 23.

  A gradient magnetic field generation unit (not shown) of the MRI apparatus 1 generates a gradient magnetic field in a pulse manner, has a maximum gradient magnetic field strength of 15 mT / m, and a slew rate of 20 mT / m / ms. The MRI apparatus 1 further includes an RF transmitter (not shown) for generating nuclear magnetic resonance in the subject 24 in a static magnetic field, and an RF receiver (not shown) for receiving a nuclear magnetic resonance signal from the subject 24. Is a 12.8 MHz resonant coil.

  The position detection device 9 includes two infrared cameras 25 and a light emitting diode (not shown) that emits infrared rays, and detects the position and posture of a pointer 27 that is a tomographic plane indicating device. Further, the position detection device 9 is connected to the upper magnet 3 so as to be movable by the arm 11, and the arrangement with respect to the MRI apparatus 1 can be appropriately changed as shown in FIG. 8.

  Further, as shown in FIG. 8, the monitors 13 and 14 display an image of the tomographic plane of the subject 24 indicated by the pointer 27 held by the operator 29, an image of the endoscope 36, and the like. Similarly to the infrared camera 25, the support unit 15 is connected to the upper magnet 3. The reference tool 17 links the coordinate system of the infrared camera 25 and the coordinate system of the MRI apparatus 1, includes three reflecting spheres 35, and is provided on the side surface of the upper magnet 3.

  The position of the pointer 27 detected and calculated by the infrared camera 25 is transmitted to the personal computer 19 via the RS232C cable 33 as position data, for example. The control unit 23 includes a workstation and controls an RF transmitter, an RF receiver, and the like (not shown).

  The control unit 23 is connected to the personal computer 19. In the personal computer 19, the position of the pointer 27 detected and calculated by the infrared camera 25 is converted into position data that can be used by the MRI apparatus 1, transmitted to the control unit 23, and recorded by the video recording apparatus 34.

  The position data is reflected on the imaging section of the imaging sequence. The image acquired by the new imaging section is displayed on the liquid crystal monitors 13 and 14. For example, when the pointer 27 which is a tomographic plane indicating device is attached to a puncture needle or the like and configured so that the position where the puncture needle is located is always taken as an imaging cross section, the cross section always including the needle is displayed on the monitors 13 and 14. become.

  Next, an overall flow of the operation support operation in the MRI apparatus having the above configuration will be described. This operation support operation is executed by the personal computer 19 via the control unit 23 in accordance with a program stored in the memory in advance.

  FIG. 1 is an overall operation flowchart of the operation support operation. FIG. 2 is an operation flowchart of treatment area simulation.

  In FIG. 1, after the patient is carried into the MRI apparatus, 3D volume imaging is performed (step 101), and specific area extraction (segmentation) is performed on the target (treatment area) using the obtained volume image (step 102). Furthermore, after performing registration by the method of the existing technique (step 103), the operation is started (step 104). Here, since it is assumed that the intraoperative guide function is used together, tracking of the surgical tool is started.

Various settings are changed according to the state of the operation (step 105). Here, a threshold value for generating an alarm is set in advance. By actually following the surgical instrument, it is possible to grasp the endoscope, each segmentation region, and the position of each surgical instrument, so that the respective distances become clear and a warning can be issued according to the threshold value. The distances A _{1 to} A _i between the endoscope and each segmentation area are calculated (step 106). When the distance between the endoscope and each segmentation area is less than a predetermined distance, an alarm and warning display is displayed. Perform (step 107).

The distances B _{1 to} B _i between each surgical instrument and each segmentation area are calculated (step 108). When the distance between the surgical instrument and each segmentation area is less than a predetermined distance, an alarm and a color-coded warning display are displayed. Perform (step 109).

The distances C _{1 to} C _i between the endoscope and each surgical instrument are calculated (step 110). If the distance between the endoscope and the surgical instrument falls below a predetermined distance, an alarm and a color-coded warning display are displayed. Perform (step 111). Thus, various alarms can be obtained visually or audibly.

  Next, the function of the treatment region simulation (step 112) will be described with reference to FIG. In FIG. 2, since the treatment region simulation can be estimated from the surgical instrument position, the treatment region simulation at the current surgical instrument position is performed (step 113), and the segmentation region (surgical target region) is subtracted from the simulation result. The treatment area and the untreated area (residual treatment area) are predicted (step 114).

  The treatment area (prediction) is displayed by color (step 115), and the untreated area (prediction) is displayed by color (step 116). This color-coded display can visually convey the situation to the surgeon. As a further function, it has a function of calculating a route from the current needle position / direction to the untreated region (step 117), and the obtained route (numerical coordinates, route) is displayed on the GUI (step 118). .

  Here, there are two routes to be displayed. There are a route (route) for correcting the needle position so that the entire target can be treated, and a route for accessing only the untreated region from another route as a new target. The surgeon selects a route as necessary and corrects the needle position (step 119).

  Here, the simulation is performed again at the corrected position (step 120), and it is determined whether or not the simulation region has covered the target position (step 121). If so, actual treatment is started at that position. (Step 121) The process ends. If it is determined in step 121 that the simulation area does not cover the target position, the surgical instrument redrawing is continuously performed during the operation. That is, the process returns to step 105 shown in FIG.

  Next, the superposition function specification of the segmentation image will be described with reference to FIG. 3 showing the comparison between the real space and the endoscope video. In FIG. 3, an operator 301 performs an operation using an endoscopic image 302. That is, since the endoscope image 302 is the center, the surrounding surgical tools (the surgical tool 1 (305) and the surgical tool 2 (306)) are displayed on the image. Similarly, the segmentation images 303 and 304 are also superimposed on the relative position of the endoscopic video. The transparency inside the segmentation can be set to an appropriate value by the user.

  FIG. 4 is an explanatory diagram of the relative relationship between the endoscope position and the image superimposed display. In FIG. 4, an endoscope 302 is installed at a site to be a target region 402 of a patient 401. The relationship between the endoscope 302 and the segmentation image 403 is uniquely defined by MRI apparatus coordinates and displayed as a superimposed image. 404 (CASE 1).

  On the other hand, when the endoscope 302 is placed on the opposite side of the case 401 with respect to the patient 401 and the target 402 is depicted, the endoscope coordinates are also changed in the real space, and the segmentation image position is relatively displayed on the superimposed image. What has been changed to is redrawn (CASE 2).

  FIG. 5 is an explanatory diagram of the segmentation function. In FIG. 5, the 3D volume image is stored in the storage means in the personal computer 19 as DICOM data, which is a standard for medical digital images and communication, and is segmented as necessary.

  Here, assuming that three segmentations are performed, the DICOM data 501 is stored as one volume data in the segmentation 504. Similarly, the DICOM data 502 and 503 are stored in the segmentations 505 and 506, respectively. Here, since the DICOM data has coordinates conforming to the MRI apparatus 1, the segmentation images 510, 512, 511 (segmentation 504, 505) with respect to the position coordinates of the endoscope 302 when applied to surgery support. , 506) can be integrated, and can be superimposed and displayed on the endoscope image 507, respectively.

  FIG. 6 is a diagram illustrating a basic configuration example of the image superimposing software GUI. In FIG. 6, the operation is started by operating the 3D imaging button 611, the segmentation button 612, and the registration button 613 displayed on the display 601.

  A display 601 is a place 602 for displaying an endoscopic image, a place 603 for displaying a message, a place 604 for displaying a distance between surgical tools and various information, a place 605 for displaying segmentation and a surgical tool in three dimensions, and a place for performing an operation. Reference numeral 606 denotes a place 607 for selecting display / non-display of the segmentation area.

  Here, the endoscope video display unit 602 always displays the endoscope in the center (front), projects and displays the position of the surgical instrument 630, and also projects the segmentation images 608, 609, and 610 at relative positions. indicate. However, the display / non-display of the segmentation images 608, 609, and 610 can be selected at the location 607, and can be customized according to the operator's preference.

  The message 603 is changed according to the situation, and has a sound notification function in addition to the display at the time of a high-risk warning. The distance information can also be displayed as necessary. When the distance A display button 614 is pressed, information on the distance A is displayed on the distance information display unit 604, and when the distance B display button 615 is pressed, the distance information display unit is displayed. Information about the distance B is displayed at 604.

  Here, by setting a threshold value in advance using the setting change button 622, a warning display unit 640 displays a warning in red when the value is lower than the threshold. In the illustrated example, the threshold is specified as 15 mm. In addition, by pressing the alarm button 621 in advance, a notification with a warning sound can be made.

  By superimposing and displaying the surgical instrument and segmentation information on the endoscopic image, the amount of information necessary for the operation is increased, but it is projected and displayed, so that a three-dimensional sense of depth is not known.

  Therefore, the endoscope 302, the surgical instrument 630, and the segmentation regions 608, 609, and 610 are arranged on the three-dimensional display unit 605 in a three-dimensional absolute space so that three-dimensional information (depth information) can be drawn.

  FIG. 7 is a diagram showing a method of depicting a surgical route by treatment area simulation. The screen shown in FIG. 7 has the same basic configuration as the screen shown in FIG. 6, but here, the distance C display button 616 is pressed, and information 701 regarding the distance C is also displayed on the distance information display unit 604. Yes. Naturally, the distance and message displayed on the distance information display unit 604 and the message display unit 603 are also changed in real time in accordance with the surgical instrument position information.

  Here, a treatment simulation for the current needle position 630 is performed by depressing the treatment simulation button 617 (expected treatment region 702). Further, the treatment area 703 is displayed by depressing the treatment area display button 618, and the untreatment area 704 is displayed by depressing the untreatment area display button 619. The areas 703 and 704 are displayed in different colors.

  Further, a route to the untreated region 704 is simulated and displayed by pressing the route display button 620 (broken line 711). Also, the value of the calculation path (X, Y, Z direction and linear distance) is displayed (area 720). Since a virtual treatment region (predicted untreated region 712) is also displayed as necessary, the surgeon can perform actual treatment with reference to the simulation result.

  In FIG. 7, the areas 703 and 704 and the area 712 are displayed so as to overlap each other, but only the area 712 can be displayed on the screen and the other areas 703 and 704 can be configured not to be displayed.

  FIG. 9 is a diagram showing a GUI configuration when using the MRI guide together. The configuration of the clinical screen 901 illustrated in FIG. 9 includes an image display unit 902, a surgery support message unit 903, and buttons 904, 909, 912, and 915.

  First, before the operation, the 3DS scan button 904 is pressed to perform 3D imaging, and an axial image 905, a sagittal image 906, a colonial image 907, and a volume rendering image 908 are displayed on the screen.

  The segmentation button 909 is pushed down, and a specific region / target 911 is set using the 3D image 910 and the Volume Rendering image 908.

  If necessary, these functions can be used together by pressing down the ISC button 912 or the navigation button 915. By pressing the ISC button 912, a two-dimensional image including the surgical instrument 914 is displayed on the dedicated screen 913, and the segmentation area 911 and the surgical instrument position 914 can be displayed on the three-dimensional screen 910.

  The navigation button 915 is a function for displaying the surgical instrument 916 on the screen of the axial image 905, the sagittal image 906, the colonial image 907, and the volume rendering image 908 of the image display unit 902. Judgment can be made. In addition, there is a place where details of device information, patient information, various function information, and surgical tool information are displayed (place 1030).

  The high-function endoscope superimposing function can sufficiently exert its effect in both artificial and robotic environments and improve the accuracy of treatment. Further, since the superimposed image can be stored, it can be reviewed again after the operation, and can be described or recorded for the patient.

  As described above, according to the present invention, the planned treatment area scheduled for surgery is displayed on the screen, the area where treatment is actually completed is displayed separately from the untreated area, and the current surgical instrument position and untreated area are displayed. Since the operation route is displayed on one screen, it is possible to realize a medical image diagnostic apparatus capable of providing improved operation support.

  In addition, distance information such as the distance between the surgical instrument and the untreated area, the distance between the endoscope and the surgical instrument is also displayed, and when the distance falls below a certain value, it is configured to issue an alarm. Improvement of surgical support is being attempted.

  For this reason, the surgeon is freed from the labor of having to distinguish the screen image superimposition screen and various navigation screens distributed and displayed on a plurality of displays as necessary, and the surgeon can operate without switching the line of sight. Support information can be obtained, and treatment time can be shortened and treatment accuracy can be improved. In addition, the burden on the operator / patient can be reduced.

  In the above embodiment, the MRI apparatus has been described as an example. However, the present invention is applicable not only to the MRI apparatus but also to other medical image diagnostic apparatuses such as a CT apparatus.

It is a whole operation | movement flowchart of the surgery assistance operation | movement in one Embodiment of this invention. It is an operation | movement flowchart of the treatment area | region simulation in one Embodiment of this invention. It is a figure explaining the superimposition function of the endoscopic image | video and segmentation area | region in one Embodiment of this invention. It is explanatory drawing about the relative relationship of the endoscope position and image superimposition display in one Embodiment of this invention. It is explanatory drawing about the segmentation function in one Embodiment of this invention. It is a figure which shows GUI and basic composition in one Embodiment of this invention. It is a figure which shows the method of the surgical route drawing by the treatment area | region simulation in one Embodiment of this invention. 1 is a schematic configuration diagram of an MRI apparatus to which the present invention is applied. It is a figure which shows the GUI structure in one Embodiment of this invention.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... MRI apparatus, 3 ... Upper magnet, 5 ... Lower magnet, 7 ... Support | pillar, 9 ... Position detection device, 11 ... Arm, 13 ... Monitor 1, 14, .. Monitor 2, 15... Monitor support unit, 17... Reference tool, 19... Personal computer, 21. Infrared camera, 27 ... pointer, 29 ... operator, 33 ... cable, 34 ... video recording device, 35 ... reflective ball, 36 ... endoscope, 601 ... Display, 603 ... Message display section, 604 ... Distance information display section, 605 ... Three-dimensional display section, 606 ... Operation section, 630 ... Surgical instrument position, 702 ... Expected treatment area 703 ... Treatment area. 704 ... Untreated area, 711 ... Path to untreated area, 712 ... Expected untreated area

Claims (4)

In medical image diagnosis apparatus, a medical image diagnosis that has an imaging means for imaging the inside of a subject, a surgical instrument position detecting means for detecting the position of the surgical instrument, and display means for displaying an image acquired by the pre-Symbol imaging means, A device,
The specific region in the subject extracted using the image is identified as an untreated region and a treated region, and the inside of the subject corresponding to the position of the surgical tool detected by the surgical tool position detecting means A predicted therapeutic region that is predicted as a region of the target, a predicted untreated region that is predicted to be untreated at the position of the surgical tool detected by the surgical tool position detection means based on the untreated region and the predicted therapeutic region, A predicted route to the surgical tool corresponding to the untreated region is calculated, and the untreated region, the treated region, the predicted treated region, the predicted untreated region, and the predicted route are displayed on one screen of the display means. A medical image diagnostic apparatus characterized by: The surgical instrument position detecting means further detects the position of the endoscope,
Based on the extracted specific area and the detected position information of the surgical tool and endoscope, the specific area and the surgical tool, the specific area and the endoscope, the surgical tool and the endoscope , And the respective distances are calculated, and the calculated values are displayed on one screen of the display means.
The medical image diagnostic apparatus according to claim 1. The medical image diagnostic apparatus according to claim 2, wherein when the calculated distance is within a predetermined value, a display indicating an alarm is displayed on one screen of the display unit. The medical image diagnostic apparatus according to any one of claims 1 to 3, wherein the untreated area and the treated area are displayed in different colors.

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