JP5444422B2 - Intraoperative medical imaging system - Google Patents

Description

  The present invention relates to an intraoperative image diagnosis system or an image-assisted treatment system that obtains an image inside a living body of a patient during surgery, and particularly blood concentration on the patient's head during brain surgery such as a brain tumor. The present invention relates to an intraoperative medical image photographing system that acquires an image of an affected area while maintaining an intraoperative posture.

  Conventionally, various medical diagnostic imaging devices have been subjected to disinfection and sterilization measures in order to confirm the status of the affected area and the effects of surgery and treatment on patients undergoing surgery. In many cases, it is used due to the same usage support as that of image inspection and image diagnosis. In particular, ultrasonic diagnostic imaging equipment and endoscope equipment are housed in a single compact housing, so that the equipment that comes into contact with the patient is subjected to strict sterilization during surgery in various clinical departments. It has been used for intraoperative image diagnosis.

  On the other hand, a so-called large medical image apparatus such as a CT image apparatus, an X-ray angio apparatus, or an MR image apparatus is composed of a plurality of functional units including a patient table on which a target patient lies, and information on the position and azimuth of an affected area is as follows: Since it is obtained by a position detection mechanism that detects the relative position of the image information collection function unit and the patient table, each patient table (image diagnostic bed) is composed of a dedicated patient table that is paired with the image information collection function unit of the device. Has been.

  Therefore, in general, in the intraoperative image diagnosis and the confirmation of the therapeutic effect by these large image diagnosis apparatuses, from the surgical patient table having a predetermined intraoperative position corresponding to the surgical procedure for each department, each image diagnosis apparatus In order to collect image information, it has been necessary to obtain image diagnosis and a confirmation image by moving and transposing to a dedicated patient table of the image diagnostic apparatus which lies horizontally.

  This movement / replacement of the patient during the operation is not only troublesome for the operator, but also increases the burden for the patient during the operation. In order to reduce the burden of this replacement and the burden on the patient, the surgical / imaging diagnostic table has the same form and function as the dedicated patient table of the diagnostic imaging device for patients in general horizontal recumbent position surgery. Is separately provided, and during the operation, the medical image of the intraoperative patient placed on the dual-purpose table is obtained at the opposite position of the dedicated patient table of the diagnostic imaging apparatus (see, for example, Patent Document 1). .

  However, for patients undergoing surgery, especially in brain surgery such as brain tumors, there are important functional sites and blood vessels around the subject of surgery. Need to know exactly. Further, in a surgical operation on a local area of the cerebral spinal cord called a stereotaxic operation, in order to accurately approach the surgical site, the patient's head is fixed by a brain surgical bed and a head frame fixed thereto. Furthermore, in such a brain surgery, the operator has easy access to the affected area, and in order to minimize bleeding from the operation site of the patient, the back of the patient table (back of the bed) is tilted, It is usual to perform the operation with the patient's head fixed so as not to move by the head frame higher than the heart position. Therefore, in surgery in brain surgery, particularly intraoperative image inspection / diagnosis in stereotaxic surgery, it is important to acquire image data for a patient on a patient table that is fixed by a head frame and is in a tilted back position where the upper body is raised.

JP-A-9-220223

  The problem to be solved is that in the case of examination and diagnostic image acquisition using a CT image device, an X-ray angio device, etc., which is a so-called large medical image device, the target patient is not in the horizontal recumbent position which is a standard patient table. For example, in a patient with a back tilt position that raises the head in brain surgery and a head frame for brain localization, and a physical part of the device that forms an imaging-acceptable region (bore) Interference occurs, making it difficult to obtain desired patient diagnosis and examination images.

  On the other hand, for the intraoperative examination / diagnosis, it is not medically preferable to transfer a patient under operation to a standard patient table of a so-called large-sized medical image apparatus because the burden is great for the patient.

  In addition, for example, in brain surgery, since the target is a soft brain, there is a problem that a so-called brain shift causes a positional relationship different from the original situation to provide inappropriate information for examination and diagnosis. . Furthermore, the change and transfer of the patient table has a problem that the burden on the medical staff increases in terms of the operation of attaching and detaching the surgical instrument and the disinfection and sterilization operation.

  The present invention has been made in view of the conventional problems as described above, and in the operation of obtaining a CT examination image or an X-ray angio examination image during a brain surgery, an intraoperative operation in which a head frame is attached to a patient table in a tilted back position. It is an object of the present invention to provide an intraoperative medical imaging system that does not require a change in a patient's body position and a transfer of a patient table.

  In order to achieve the above object, an intraoperative medical imaging system according to claim 1 of the present invention is configured so that a patient can be transferred while maintaining a surgical position, and a fixing mechanism for fixing at a destination is provided. Surgical table means provided; an imaging bed provided separately from the surgical table means; an angio-photographing C-arm unit installed so as to be rotatable with respect to the floor; and angio photography attached to the ceiling A normal Ω arm, a surgical mode in which imaging is performed by positioning the C arm on the surgical table fixed by the fixing mechanism, and imaging is performed by positioning the C arm on the imaging bed side And a control means for switching a photographing mode.

  Further, in the intraoperative medical imaging system according to claim 2 of the present invention, the control means controls so as not to perform X-ray irradiation from the X-ray generation means attached to the Ω arm during the operation mode. What is characterized by being.

  Furthermore, in the intraoperative medical image photographing system according to claim 3 of the present invention, the control means switches between the operation mode and the normal photographing mode based on a fixing state by the fixing mechanism. Provide what you want.

  Furthermore, in the intraoperative medical image photographing system according to claim 4 of the present invention, the Ω arm unit includes a moving mechanism that moves along the ceiling, and the control means places the Ω arm unit in a parking position in the operation mode. The apparatus is characterized in that it is controlled to move to and stop.

  Furthermore, in the intraoperative medical imaging system according to claim 5 of the present invention, the control means detects at least one information of the position of the surgical table or the table tilt angle, and the C based on the detection result. Provided is a device characterized by changing the rotation angle of the arm portion.

  According to the present invention, it is possible to reduce the burden on the operator without changing the intraoperative position for the patient during the operation, and easily perform these medical images without depending on the skill and ability of the operator. Can be obtained and provided.

The block block diagram which shows 1st Embodiment of this application by CT imaging device. The schematic diagram which shows the condition of the action action | operation during the brain surgery in this embodiment. The top view which shows CT imaging | photography room and operation room where this embodiment was installed. The flowchart which shows the workflow in 1st this embodiment. The schematic diagram which shows the bore diameter and interference relationship of CT gantry, and a comparison table. The block block diagram which shows 2nd Embodiment of this application. The schematic diagram of the inclination mechanism of 2nd Embodiment of this application. The flowchart which shows the workflow in 2nd Embodiment. The block diagram which shows the structure of 3rd Embodiment of this application. The schematic diagram which showed the floor-standing C arm of this embodiment, and the operation bed where a patient lies. The top view (a) of an angio photography room and an operating room where this embodiment was installed, and the illustration (b) of the arrangement | positioning. The flowchart which shows the workflow of 3rd Embodiment of this application.

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

<Embodiment 1>
A first embodiment of the present invention will be described with reference to FIGS. FIG. 1 is a block diagram showing an embodiment of a surgical CT system of the present invention which is an intraoperative imaging system using a CT imaging apparatus. FIG. 2 is a schematic diagram showing from the side the state of action operation in the present embodiment during the brain surgery of the surgical CT system of the present invention. FIG. 3 shows an example of a plan view of a CT imaging room and an operating room when the present embodiment is installed in a medical institution such as a hospital.

  FIG. 4 is a flowchart showing a workflow from the time of moving from the operating room to the CT operating room to the time of returning to the original operating room for intraoperative CT image acquisition according to the present embodiment. FIG. 5A is a schematic diagram for comparing the interference relationship between the surgical table of the brain surgery patient in the conventional standard bore CT gantry and the large bore gantry of the present embodiment. FIG. 5B is a comparison table summarizing the relationship between the bore diameter and interference in the large bore setting of the present embodiment.

  As shown in FIG. 1, the main part of the present embodiment includes a CT system controller 1, a CT gantry 2, a surgical table 3, a CT scanner moving mechanism 17, a SW (switch) operation input unit 14, and an imaging condition setting input unit 16, A display monitor 20 and a CT image data storage / storage unit 21 are included. Further, the detailed configuration of each of these main parts is configured by a CT imaging function control unit 11, an image reconstruction processing unit 12, a CT intraoperative imaging control unit 13, and a standard / intraoperative switching control unit 15 in the CT system controller 1. . The CT gantry 2 includes an X-ray tube irradiation mechanism unit, an X-ray detection unit, and a scanner rotation control mechanism unit.

  As will be described later, the bore diameter of the CT gantry is preferably a large bore CT gantry configured with a bore diameter of 800 mm or more that is slightly larger than the general standard CT bore diameter of 700 mm.

  Furthermore, the surgical table is generally equipped with a head frame 33 that is compatible with brain surgery, and the patient lies in an inclined supine posture in which the head region value of the patient to be operated is higher than the heart. In the surgical table 3 of the present embodiment, the operating table vertical movement mechanism / position change mechanism control unit 31 that adjusts the vertical position and body position of a general patient, and a predetermined position for intraoperative CT examination after moving to the CT examination room 220 A surgical table fixing mechanism 36 for setting the surgical table 3 is provided. The surgical table 3 is connected with a surgical table manual control SW (switch) unit 35 for operating these mechanisms.

  When the CT gantry 2 is fixed at a standard fixed position and performs a general CT examination, a CT standard bed 223 on which a patient to be examined is placed, and a predetermined CT examination area for obtaining a general CT examination area. A CT standard bed moving mechanism 222 for moving to the position is provided in the CT imaging room 102. Further, in the present embodiment, the CT imaging room 220 is similarly provided with a surgical table fixing position confirmation unit 221 that fits with the surgical table fixing mechanism 36 that sets the surgical table 3.

  The CT gantry / surgical bed interference regarding the bore diameter of the CT gantry that can be applied to the surgical table on which the patient lies at the back tilt position that raises the head wearing the head frame to be examined. Inventor's simulation study on the problem is as follows. FIG. 5A shows a model of this simulation, and FIG. 5B summarizes the simulation results in a table.

The setting conditions in the examination of this interference are as follows for the simulation model shown in FIG.
1) The body posture during brain surgery is typically treated by inclining the backrest angle of the surgical bed by 15 to 30 degrees in order to suppress bleeding from the open head. Therefore, in the simulation calculation of interference and the like, the backrest angles were examined at 15 degrees and 30 degrees.

2) The CT scanner aperture (bore) diameter was examined at φ700 mm (existing standard bore diameter), 750 mm, 800 mm, 850 mm, and 900 mm.

3) Interference examination was performed on the assumption that the size of the head region including the patient's head fixing frame was a spherical shape having a diameter of 500 mm.

  Under these conditions, the evaluation was performed by interference between the surgical table or the shoulder of the patient and the bore cover of the CT gantry.

  As shown in the result table of FIG. 5B, the simulation results are as follows: a bore diameter of 800 mm or more when the backrest angle is 15 degrees, and a bore diameter of 900 mm when the backrest angle is 30 degrees. It was found that sufficient scans could be performed if acquisition was possible.

  Next, the operation and action of this embodiment will be described. As shown in FIG. 3, for example, a CT imaging room 220 in which a CT gantry 2 that is a CT scanner mechanism storage unit in this embodiment is movably installed and an operating room 210 in which a surgical table 3 is placed to perform a brain surgery are preferable. Are arranged next to each other. It is preferable that the wall 211 between these two chambers is provided with doors 211a and 211b that are provided with a passage 212 for the operation table 3 on which the patient 10 lies to move between the two chambers and are closed after the movement. In FIG. 3, devices and units equipped in a general CT imaging room or operating room such as an operation console and a surgical instrument device are complicated, and thus the display description is omitted.

  In addition, the CT image capturing apparatus 230 that captures a general CT diagnosis image by the CT gantry 2, the CT standard table 223, the CT system controller 1 and the like installed in the CT imaging room 220 performs intraoperative CT image capturing. If not, the standard / intraoperative switching control unit 15 of the CT system controller 1 is set to “standard” to function as a general CT image capturing apparatus. In the operation as a general CT image photographing apparatus in this “standard”, a CT gantry is installed in the CT photographing room 220 in FIG. Then, at the time of CT image shooting, the setting controlled by the CT system controller 1 is set so that the cantilever type CT standard (bed) table 223 is self-propelled toward the CT scanner and enters the bore of the CT gantry 2 ′. Made.

  Note that, depending on the model of the CT image capturing apparatus, there is also a “standard” image capturing method in which the CT gantry self-runs toward the CT standard (bed) table 223 side. In the description of this embodiment, regardless of whether the CT gantry 2 or the CT standard (bed) table 223 is self-propelled, the imaging movement direction of the head CT image imaging in “standard” imaging is from the top to the trunk side. The right side of the patient, which is the “normal” image display, that is, the display form of a general CT image, is displayed on the left side on the display screen. In other words, in the present embodiment, CT imaging for the purpose of image diagnosis is displayed with the prefix “standard” in relation to “heading” travel.

  Regarding the intraoperative CT image acquisition according to the present embodiment, the operation and operation of the surgical CT system, which is an intraoperative imaging system using a CT image device, will be described in detail with reference to FIG.

  A patient who requires CT imaging during surgery is equipped with a CT gantry 2 of a large bore CT scanner, which is a surgical CT system of this embodiment, capable of performing intraoperative CT imaging as shown in the plan view of FIG. In the operating room 210 provided adjacent to the CT imaging room 220 in which the apparatus is installed, it is preferable that the surgical treatment treatment is performed in terms of the medical environment for the operation and the transfer during CT imaging, The present embodiment will be described based on the arrangement of both chambers shown in FIG.

  While the patient 10 in the operating room 210 is undergoing brain surgery, the head frame 33 for securing and stabilizing the head operating field is mounted, and the patient 10 in the posture of the back tilted position that raises the head of the operation target. It is on a lying operating table (surgical table) 3. If the surgeon determines that intraoperative CT imaging is necessary for the patient 10 and decides to move to the CT imaging room 220, a part of the surgical instrument other than the head frame 33 applied to the patient 10 is removed. Remove and prepare for transfer. When this preparation is completed, the patient movement in step S11 shown in FIG. 4 is performed by moving the surgical table 3 on which the patient 10 is placed through the passage 212 to the CT imaging room 220.

  The surgical table 3 on which the patient 10 moved to the CT radiographing room 220 is placed is moved to a place where the surgical table fixing position confirmation unit 221 that is a predetermined installation position of the CT radiographing room 220 is provided, as shown in FIG. The surgical table fixing mechanism 36 of the surgical table 3 is fitted to the surgical table fixing position confirmation unit 221 in the direction in which the head of the patient 10 is on the CT gantry 2 side. By this fitting, fitting detection is activated, and the setting of the surgical bed in step S12 is confirmed by a signal issued from the surgical table fixing mechanism 36 to the standard / intraoperative switching control unit 15 of the CT system controller 1.

  Next, in step S14, a doctor in charge of surgery or CT imaging takes the height of the inclined shoulder pad of the surgical table 3 so that it is substantially the same height as the lower edge of the opening bore of the CT gantry 2. The height of the surgical table 3 is adjusted by operating the up / down operation switch of the surgical table manual control SW (switch) unit 35. In addition, the height adjustment may be performed by irradiating the vicinity of the shoulder pad portion of the surgical table 3 with the pointing light from the horizontal projector provided on the lower edge of the bore.

  When the setting of the surgical table 3 to the predetermined position and the predetermined height of the CT imaging room 220 is completed in steps S12 and S13, the “standard imaging mode” / “intraoperative imaging mode” of the SW (switch) operation input unit 14 is set in step S14. "The intraoperative imaging mode" is set in the standard / intraoperative switching control unit 15 by the switching SW. By switching to the “intraoperative imaging mode”, the CT gantry 2 moves on the rail 18 by an operation from the SW (switch) operation input unit 14 and a control signal from the CT system controller 1 to the CT scanner moving mechanism 17. It operates as a self-propelled CT scanner.

  In step S15, the CT gantry 2 as a self-propelled CT scanner is moved to a location shown in the figure as a CT gantry 2 'which is a little distanced on the patient's head side, which is the "intraoperative imaging standby position". It has become.

  The next steps S16 and S17 are steps for checking whether there is interference between the bore cover of the CT gantry 2 and the surgical table 3 in intraoperative CT imaging. First, in step S16, from the SW (switch) operation input unit 14 As a result, the CT gantry 2 is moved on the rail 18 in the direction of the patient's trunk (foot side) at a low speed. If the operator determines that interference occurs, the moving operation is stopped in step S17. After this stop, the process proceeds to step S18. In this step S18, the height of the surgical table 3 is changed to "up" so that interference can be avoided, and then returned to the original standby position. The presence or absence of head frame interference is checked, and the process returns to step S15.

  On the other hand, if it is determined in step S17 that there is no interference up to the desired imaging range, the process proceeds to step S19. In step S19, the trunk side of the patient 10 in which the interference condition of the CT gantry 2 / surgical table 3 is severe. The CT gantry 2 is positioned at the starting point of the intraoperative CT image photographing.

  In the next step S20, CT imaging is started while moving the CT gantry 2 mounted with the CT scanner along the rail 18 from the starting position toward the patient's head where the interference condition becomes milder. The CT image data is input to the image reconstruction processing unit 12 via the CT imaging function control unit 11 of the CT system controller 1.

  In the next step S21, in the image reconstruction processing unit 12 to which CT image data is input, the CT scanner movement direction in the above-described step S20 is the “foot placement” direction of the patient. The relative movement direction of the floor 2 is the same as that of “standard” shooting, but the left and right sides are reversed on the display image, so that this is reversed and image reconstruction is performed. The CT image data as a result of this image reconstruction is stored and saved in a data disk or the like of the CT image storage / save unit 21 connected to the CT system controller 1 in step S22. Then, when the CT scanner of the CT gantry 2 passes over the top of the patient 10, which is the end point of intraoperative CT image photography, the CT gantry 2 stops self-running.

  In step S23, if intra-operative CT image capturing under other conditions is necessary for the patient, the process returns to step S15, and the desired setting is performed again. On the other hand, when further intraoperative CT imaging is unnecessary, the procedure proceeds to step S24, and the surgical table fixing mechanism 36 of the surgical table 3 is detached from the surgical table fixing position confirmation unit 221 of the CT imaging room 220 and released, In step S25, the operation table 3 on which the patient 10 is placed is returned to the operation room 210, and the intraoperative CT image capturing is completed.

  The CT gantry 2 in steps S19 to S22 starts from the head of the patient 10 'lying on the surgical table 3 installed in the surgical table fixing position confirmation unit 221 in the CT imaging room. / The CT scanner moving mechanism 17 can be set so that the mandibular position of the patient 10 ′ in the trunk direction of the patient 10 ′ where the interference condition of the surgical table 3 becomes severe is the end point. This setting is made to the CT scanner moving mechanism 17 via the standard / intraoperative switching control unit 15 by an operation from the SW (switch) operation input unit 14.

  Further, in this case, the direction of self-running of the CT gantry 2 and the body posture direction of the target patient 10 are relatively the same as those of the “standard” imaging method of general CT imaging, so In this case, the left-right reversal process in the configuration may not be performed.

  It should be noted that the present embodiment can be similarly implemented as described above with respect to a patient having a limited tilted posture by a general bore diameter CT scanner, except for the configuration of the large bore CT scanner. Not too long.

  According to the present embodiment, since an intraoperative CT image can be quickly taken without changing the intraoperative position for a patient who is in a surgical position with a high head, such as a brain surgery, imaging is possible. Medical imaging can be performed with very little influence or invasiveness on symmetrical patients. In addition, the burden on the operator such as a doctor in charge of surgery and an engineer in charge of imaging is reduced, and these medical images can be easily obtained and provided without being affected by the skill and ability of the operator.

<Embodiment 2>
Another embodiment of an intraoperative imaging system for performing CT imaging during surgery in a tilted position with the patient's head raised is described.

  FIG. 6 is a block diagram showing a surgical CT system using a tilted CT gantry according to the second embodiment of the present invention. FIG. 7 is a schematic diagram showing the operating state of the tilt mechanism for the CT gantry 2 provided in the CT imaging room in the present embodiment. FIG. 8 is a flowchart showing a workflow from the time when moving from the operating room to the CT imaging room to the return to the original operating room for intraoperative CT imaging according to the second embodiment.

  As shown in FIG. 6, the main part of the second embodiment of the present invention includes a CT system controller 1, a CT gantry 2, a surgical table 3, a CT scanner moving mechanism 17, a SW (switch) operation input unit 14, and imaging conditions. A CT scanner tilting mechanism 225 for tilting and moving the CT scanner is added to the same components as those of the first embodiment including the setting input unit 16, the display monitor 20, and the CT image data storage / storing unit 21. Configured. The detailed configuration of each main part of the present embodiment configured in the same manner as in the first embodiment is the same as that in the first embodiment.

  In addition, the surgical table fixing mechanism 36 that sets the surgical table 3 at a predetermined position for intraoperative CT examination after moving to the operating table vertical movement mechanism / position change mechanism control unit 31 for adjusting the vertical position and body position of the patient and the CT examination room 220. Are similarly provided in the present embodiment.

  In this embodiment, as will be described later, the CT gantry can be applied without changing the tilted posture of the patient on the operation table 3 even if the CT gantry has a CT bore diameter of about 700 mm and a general standard diameter. .

  As shown in FIG. 3, the CT scanner tilting mechanism 225 provided in the present embodiment is positioned substantially at the center of the CT imaging room 220, and at the time of storage, an upper plane 225a on which a rail 18 on which the CT gantry 2 runs is laid. Is buried under the floor, forming the same surface as the floor surface of the CT imaging room 220. Further, the CT scanner tilting mechanism unit 225 sets the “intraoperative imaging mode” in the standard / intraoperative switching control unit 15 by the “standard imaging mode” / “intraoperative imaging mode” switching SW of the SW (switch) operation input unit 14. Then, the input of the tilt angle data is requested via the standard / intraoperative switching control unit 15.

  The required tilt angle data is the tilt angle θ1 set in the shoulder rest portion in which the patient 10 of the surgical table 3 is tilted. In response to this request, when data on the tilt angle of the surgical table 3 operated and set during the previous operation is input from the SW (switch) operation input unit 14, the CT scanner is connected via the standard / intraoperative switching control unit 15. The information is input to the tilt mechanism 225.

  By inputting this data, the CT scanner tilt mechanism 225 causes the CT table tilt mechanism 225 to use the CT standard bed 223 side edge of the upper plane 225a as the axis with the surgical table fixing position confirmation section 221 side edge of the upper plane 225a as an axis. When the angle between the upper flat surface 225a and the floor surface of the same room coincides with the inputted inclination angle data, the rising is stopped.

  In order to prevent the CT gantry 2 on the rail 18 from moving unexpectedly with the inclination of the upper plane 225a, a self-propelled mechanism such as a screw rod (not shown) is provided with a structure for locking and preventing overturning. Yes.

  Next, the operation and effect of this embodiment will be described with reference to FIG. 8 of a flowchart showing a workflow according to the second embodiment.

  The CT image capturing steps S31 to S34 according to the present embodiment are performed by the patient moving from the operating room 210 to the CT imaging room 220 in the same manner as steps S11 to S14 in the first embodiment described above. That is, the patient is moved to the CT imaging room together with the surgical table 3, set to a predetermined intraoperative imaging fixed position, and the CT apparatus is switched to the “intraoperative imaging mode”. The operation and operation of each part of the configuration of the present embodiment are also the same.

  The operation table 3 on which the patient 10 is placed is placed at a predetermined position in the CT imaging room 220, and in step S35, the inclination setting angle of the shoulder pad portion of the operation table 3 is read from the indicator, and this data is SW. (Switch) An instruction is input from the operation input unit 14. The indicator may be read automatically by an angle sensor or the like, and the result may be transmitted and input to the SW (switch) operation input unit 14.

  In step S36, this instruction input is input to the CT scanner tilting mechanism unit 225 via the standard / intraoperative switching control unit 15, and the side of the surgical table fixed position confirmation unit 221 on the upper plane 225a is mounted by the drive mechanism mounted thereon. The CT scanner tilt mechanism 225 raises the other side of the upper plane 225a around the axis, and rises until the angle between the upper plane 225a and the floor surface in the same room matches the input tilt angle data. ,Stop.

  In the next step S37, with the inclination maintained, the CT gantry 2 is moved along the traveling rail 18 at a gentle movement speed toward the surgical table 3 side, that is, below the inclination, and the gantry and the bed or the patient's head. Make sure that there is no interference with. When interference occurs, the movement of the CT gantry 2 is stopped, the process proceeds to step S38, the angle of inclination by the CT scanner inclination mechanism 225 is adjusted, and steps S36 and S37 are performed.

  If it can be confirmed in step S37 that there is no interference, the process proceeds to step S39. In step S39, the CT gantry 2 is temporarily returned to the intraoperative imaging start point on the patient's parietal side, and the CT gantry 2 is moved downward by the operation of the rear part 17 of the CT scan moving machine from the start position. CT imaging data is acquired. The acquired data is processed as CT image inspection data in the image reconstruction processing 12 via the CT intraoperative imaging control unit 13 (step S41).

  When the CT gantry 2 moves to the imaging end point position, the stop of the movement and the acquisition of CT image information are ended in step S40. Further, the reconstructed image data obtained by the CT scan is transferred and recorded in the CT image storage / storage unit 21 in step S42.

  If there is intraoperative CT imaging for the patient under different conditions, the process returns to step S35 in step S43, and the imaging is repeated with the patient condition set again. If there is no subsequent shooting, the process proceeds to step S44, and the tilt by the CT scanner tilt mechanism 225 is returned to the initial horizontal position on the floor surface.

  Thereafter, in step S45, the surgical table 3 is removed from the predetermined position for intraoperative imaging, and the patient 10 is returned to the original operating room 210 together with the surgical table 3 (step S46). This completes the intraoperative shooting.

  According to the present embodiment, for an operating patient who is taking a posture with a raised head, intraoperative CT images can be taken quickly without changing the intraoperative posture. Medical imaging can be performed with very little invasion. In addition, the burden on the operator such as a doctor in charge of surgery and an engineer in charge of imaging is reduced, and these medical images can be easily obtained and provided without being affected by the skill and ability of the operator.

  For the patient during the operation, the burden on the operator is reduced without changing the posture during the operation, and a composite image of these images can be easily provided without being influenced by the skill and ability of the operator. In addition, since the process for imaging a horizontal patient can be applied as it is to the system for imaging an image, there is an advantage that the system can be implemented with a process that does not increase the load.

<Embodiment 3>
An intraoperative medical imaging system that is a third embodiment of the present invention that performs X-ray angiography for acquiring X-ray fluoroscopic images during an operation in a tilted posture with the patient's head raised will be described below. .

  FIG. 9 is a block diagram showing a configuration of an intraoperative medical image photographing system according to the third embodiment of the present invention. FIG. 10 shows the operation of the X-ray fluoroscopic unit of the floor-mounted C-arm provided in the X-ray angio radiographing room and the surgical bed on which the patient to be subjected to intraoperative angiography lies in an inclined position in this embodiment. It is the schematic diagram which showed the condition of the action | operation.

  FIG. 11A shows a plan view of an angio photography room and an operating room installed in a medical institution such as a hospital, and FIG. 11B is an inclined view in the angio photography room of the present embodiment. It is an illustration which shows the condition of a patient's head angiography on a surgical bed. FIG. 12 is a flowchart showing a workflow from the time of moving from the operating room to the angio imaging room until returning to the original operating room for angio imaging during the operation according to the third embodiment.

  As shown in FIG. 9, the main parts of the intraoperative medical image photographing system of the present invention are an angio photographing system controller 5, an Ω (omega) arm portion 330, a C (sea) arm portion 340, a surgical table 3, SW (switch). The operation input unit 54, the photographing condition setting input unit 56, the display monitor 70, and the angio image data storage / storage unit 71 are configured. Further, a CT scanner tilting mechanism 225 is added.

  Further, the detailed configuration of each of these main parts is configured by an angiography system controller 5, an angiography function controller 51, an image display configuration processor 52, an intraoperative angio imaging controller 53, and a standard / intraoperative switching controller 55. The

  The Ω (omega) arm unit 330 and the C (sea) arm unit 340 include an Ω arm moving / rotating mechanism 331, an Ω arm imaging unit 332, a ceiling suspension unit 333, as in each of the standard X-ray angio imaging systems. , A C-arm moving / rotating mechanism 341, a C-arm imaging unit 342, and a floor-supporting column mechanism 343. X-rays are transmitted to the Ω arm unit 330 as control information for intraoperative angio imaging from the standard / intraoperative switching control unit 55. The irradiation interlock is configured to transmit and receive instructions to the C-arm unit 340 for 90-degree lateral rotation of the floor-standing column mechanism 343 in the surgical bed direction.

  The Ω arm unit 33 is a moving mechanism that slides the ceiling suspension unit 333 along the ceiling, a rotation mechanism that rotates the Ω arm movement / rotation mechanism 331 with respect to the ceiling suspension unit 333, and a sliding mechanism that rotates along the Ω arm unit. A rotation mechanism is provided.

  The C-arm unit 340 rotates the floor support column mechanism 343 around an axis perpendicular to the floor surface, and rotates the C-arm movement / rotation mechanism 341 around an axis horizontal to the floor surface. A rotation mechanism and a rotation mechanism that performs slide rotation movement along the C-arm portion are provided.

  The surgical table 3 is a surgical table that is equipped with a head frame 33 that is compatible with brain surgery and in which the patient lies in an inclined supine posture that makes the head region value of the patient to be operated higher than the heart. An operating table vertical movement mechanism / position change mechanism control unit 31 for adjusting the vertical position and body position, and a surgical table fixing mechanism 36 for setting the surgical table 3 at a predetermined position for intraoperative angio imaging after moving to the angio imaging room 320 are provided.

  The surgical table 3 is connected with a surgical table manual control SW (switch) unit 35 for operating these mechanisms.

  Next, the operation and action of this embodiment for performing angio shooting will be described. The angio imaging room 320 installed with the angio imaging system 50 in this embodiment and the operating room 210 for performing the brain surgery with the operating table 3 are preferably arranged next to each other as shown in FIG. The wall 311 sandwiching both the chambers is preferably provided with doors 311a and 311b which are provided with a passage 312 for the surgical table 3 on which the patient 10 lies to move between the two chambers and are closed after the movement.

  In FIG. 11A, devices and units equipped in a general angio radiographing room or operating room such as an operation console and a surgical instrument are complicated, and the display description is omitted.

  An angio imaging system that can also capture a general angio diagnostic image by the Ω arm unit 330 and the C arm unit 340, the angio imaging standard table 323, the angio imaging system controller 5, and the like installed in the angio imaging room 320. Reference numeral 50 denotes an Ω arm unit 330 as a general angio image photographing system by setting the standard / intraoperative switching control unit 55 of the angio photographing system controller 5 to “standard” when angiographic image photographing during the operation is not performed. The C-arm unit 340, the angio shooting standard table 323, etc. function.

  The operation of the “standard” as a general angio imaging system is as follows. The operation room adjacent to the center of the angio imaging room 320 shown in the plan view of FIG. 11A or the illustration of FIG. The C arm 340, the angiography standard table 323, and the Ω arm 330 that are aligned in parallel with the wall 311 that divides 210 are installed. During normal angio image shooting, the C-arm shooting unit 342 supported by the floor-standing column mechanism 343 of the floor-standing C-arm unit 340 includes a C-arm shooting unit 342 ′ and an angio shooting standard table illustrated in FIG. The X-ray angiography of the patient 10 ′ on the angiography standard table 323 is performed together with the Ω arm imaging unit 332 of the Ω arm unit 330.

  The operation and operation of the intraoperative medical image photographing system of the present invention will be described in detail with reference to the flowchart of FIG. 12 showing the workflow for the intraoperative angio image acquisition according to the present embodiment.

  An angio in which an angio imaging system 50 of the present embodiment in which an angio imaging in the present embodiment can perform an angio imaging as shown in the plan view of FIG. In the operating room 210 provided adjacent to the radiographing room 320, it is preferable to perform a surgical treatment procedure in terms of the medical environment for the operation and the transfer during angiographic imaging, as shown in FIG. This embodiment will be described based on the arrangement of both chambers shown.

  While the patient 10 in the operating room 210 is undergoing brain surgery, the head frame 33 for securing and stabilizing the head operating field is mounted, and the patient 10 in the posture of the back tilted position that raises the head of the operation target. It is placed on a lying surgical table (surgical couch) 3. When the surgeon determines that intra-angio imaging is necessary for the patient 10 and decides to move to the angiography room 320, the surgical instrument other than the head frame 33 applied to the patient 10 is removed, Prepare the transfer. When this preparation is completed, the patient is moved in step S51 shown in FIG. 12 through the passage 312 to the angio radiographing room 320 and the operation table 3 on which the patient 10 is placed.

  The surgical table 3 on which the patient 10 who has moved to the angio radiography room 320 is placed is a front surface in the advancing direction of the passage 312 and is provided with a surgical table fixing position confirmation unit 321 that is a predetermined installation position of the angio radiography room 320 As shown in FIG. 10, the surgical table fixing mechanism of the surgical table 3 is moved to the surgical table fixing position confirmation unit 321 in the direction in which the head side of the patient 10 becomes the floor supporting column mechanism 343 of the floor mounting C arm unit 340. 36 is fitted.

  By this fitting, the setting of the surgical bed in step S52 is confirmed by a signal issued from the surgical table fixing mechanism 36 to the standard / intraoperative switching control unit 55 of the angio imaging system controller 5.

  Next, in step S54, the doctor in charge of surgery or angiographic imaging takes the height of the patient's head on the surgical table 3 to be approximately the same as the rotation center of the C-arm imaging unit 342 of the C-arm unit 340. As described above, the height of the surgical table 3 is adjusted by operating the up / down operation switch of the surgical table manual control SW (switch) unit 35.

  In this step, in step S55, which will be described later, the target patient 3 may be irradiated with the pointing light from the irradiation aiming projector of the C-arm imaging unit 342, and the height adjustment may be performed based on this.

  When the setting of the surgical table 3 to the predetermined position and the predetermined height of the CT imaging room 220 is completed in steps S52 and S53, the “standard imaging mode” / “intraoperative imaging mode” of the SW (switch) operation input unit 14 is set in step S54. "The intraoperative imaging mode" is set in the standard / intraoperative switching control unit 15 by the switching SW. By switching to the “intraoperative imaging mode”, the Ω arm imaging unit 332 of the Ω arm unit 330 stops at a predetermined park position, and X-ray irradiation is interlocked.

  In the next step S55 together with this interlock, the C-arm moving / rotating mechanism 341 of the C-arm portion 340 is locked to the “standard angio C-arm setting position” of the floor support mechanism 343, and “intraoperative The C-arm photographing unit 342 is rotationally moved to a position rotated 90 degrees toward the passage 312 side, which is the “angio photographing C-arm setting position”.

  The next steps S56 and S57 are steps for checking whether interference between the C-arm imaging unit 342 and the surgical table 3 occurs during intraoperative angio imaging. First, in step S56, the C-arm moving / rotating mechanism 341 is operated by an operation from the SW (switch) operation input unit 14, and the C-arm imaging unit 342 moves around the patient's head at low speed. If the operator determines that interference occurs, the moving operation is stopped in step S57. After this stop, in step S58, the height of the surgical table 3 and the position / direction of the rotation axis of the C arm 340 are changed so that interference can be avoided in the C arm, and the process returns to step S55.

  Further, in this step 55, the tilt angle information of the surgical table 3 on which the patient 10 is placed is measured by an angle operation switch or angle sensor, and the C arm unit is connected via the standard / intraoperative switching control unit 55 of the system controller 5. This inclination angle information is transmitted to the moving / rotating mechanism 341.

  Based on this tilt angle information, the imaging opposing axis by the X-ray tube and detector of the C-arm imaging unit 342 is controlled to be perpendicular to the body axis of the patient maintaining the surgical position by the surgical table means. The condition of interference can be relaxed.

  On the other hand, if it is determined in step S57 that the C-arm moving / rotating mechanism 341 of the C-arm unit 340 performs a predetermined movement / rotation desired and there is no interference up to the predetermined range, the process proceeds to step S59.

  In step S59, the C-arm photographing unit 342 moved and rotated by the C-arm moving / rotating mechanism 341 of the C-arm unit 340 starts photographing an angio image. In step S60, the C-arm photographing unit 342 synchronizes with the photographing self-phase. A process of superimposing and recording in synchronization with an image from which another biological signal such as an electrocardiogram is acquired is performed by the image display configuration processing unit 52 via the intraoperative angio imaging control unit 53.

  In the next step S61, the result data of steps S59 and S60, that is, the output of the image display configuration processing unit 52 is displayed on the display monitor 70 and recorded as an angio shooting result in the angio image storage / save unit 71.

  In step S62, if intra-operative angio imaging according to other conditions is necessary for the same patient, the process returns to step S55 and the desired setting is performed again.

  On the other hand, when further intraoperative angio imaging is unnecessary, the procedure proceeds to step S63, the surgical table fixing mechanism 36 of the surgical table 3 is detached from the surgical table fixing position confirmation unit 321 of the angio imaging room 320, and released. In step S64, the surgical table 30 on which the patient 10 is placed is returned to the operating room 210, and intraoperative angio imaging is completed.

  According to the present embodiment, for an intraoperative patient who is taking a posture with a raised head, an intraoperative angio imaging can be performed quickly without changing the intraoperative posture, Medical imaging can be performed with very little invasion. In addition, the burden on the operator such as a doctor in charge of surgery and an engineer in charge of imaging is reduced, and these medical images can be easily obtained and provided without being affected by the skill and ability of the operator.

1 ... CT system controller,
2 ... CT gantry,
3 ... Surgery table (bed),
5 ... Angio shooting system controller,
10 ... Patient,
11 ... CT imaging function controller,
12: Image reconstruction processing unit,
13 ... CT intraoperative imaging control unit,
14 ... SW (switch) operation input section,
15 ... Standard / intraoperative switching control unit,
16 ... Shooting condition setting input section,
20: Display monitor,
21 ... CT image data storage and storage unit,
31 ... Operating table vertical movement mechanism / position change mechanism control unit,
33 ... head frame,
35 ... surgical table manual control SW (switch) part,
36 ... Surgical table fixing mechanism,
50 ... Angio image shooting system,
51 .. Angio shooting function control unit,
52 ... Image display configuration processing unit,
53 ... Intraoperative angio photography control unit,
54 ... SW operation input section,
55 ... Standard / intraoperative switching control unit,
56 ... Shooting condition setting input section,
70: Display monitor,
71 ... Angio image data storage and storage unit,
210 ... operating room,
211: a wall portion between the operating room and the CT imaging room,
211a, 211b ... doors
212 ... passage,
220 ... CT imaging room,
221: Surgery table fixing position confirmation unit,
222 ... CT standard bed moving mechanism,
223 ... CT standard bed,
225 ... CT scanner tilting mechanism,
320 ... Angio photography room,
322: Angio standard couch moving mechanism,
323 ... Angio standard sleeper,
330 ... Ω arm part,
331: Ω arm moving / rotating mechanism,
332... Ω arm photographing unit,
333: Ceiling suspension mechanism,
340 ... C-arm part,
341 ... C-arm moving / rotating mechanism,
342 ... C-arm imaging unit,
343: A floor support mechanism.

Claims (5)

Surgical table means configured to be able to transfer a patient in a state where the surgical position is maintained, and having a fixing mechanism for fixing at a moving destination;
A photographing bed provided separately from the surgical table means;
A C-arm unit for angio photography that is installed so as to be rotatable relative to the floor surface;
Ω arm for angio shooting attached to the ceiling,
Control means for switching between a surgical mode in which imaging is performed with the C-arm positioned on the surgical table fixed by the fixing mechanism and a normal imaging mode in which imaging is performed with the C-arm positioned on the imaging bed side When,
An intraoperative medical imaging system characterized by comprising:   2. The intraoperative medical imaging according to claim 1, wherein the control means controls so as not to perform X-ray irradiation from the X-ray generation means attached to the Ω arm during the operation mode. system.   The intraoperative medical image photographing system according to claim 1, wherein the control unit switches between the operation and the normal photographing mode based on a fixing state by the fixing mechanism. The Ω arm part includes a moving mechanism that moves along the ceiling,
2. The intraoperative medical imaging system according to claim 1, wherein the control unit controls the Ω arm unit to move to a parking position and stop in the operation mode.   The control means detects at least one information of a position of the surgical table or a table tilt angle, and changes a rotation angle of the C-arm unit based on the detection result. The intraoperative medical imaging system according to 1.