JP5513856B2 - X-ray diagnostic equipment - Google Patents

Description

  The present invention relates to an X-ray diagnostic apparatus that supports a guide wire operation by an operator.

  For example, as shown in Patent Document 1, there is an X-ray diagnostic apparatus that supports a guide wire operation by an operator. Patent Document 1 discloses a method of extracting the tip region of a guide wire from an image in order to reduce the burden on the operator and always displaying the extracted tip region at the center of the region of interest.

  Guidewires are used, for example, in the treatment of chronic total occlusion (CTO). The guide wire is used to penetrate a blood vessel in which CTO is generated. CTO penetration is performed by the operator's trial and error. For example, the surgeon penetrates the blood vessel by inserting and removing the guide wire many times at the CTO occurrence location while changing the approach direction of the guide wire. As described above, the technique for penetrating the CTO occurrence site largely depends on the experience of the operator. As another penetration method of the CTO occurrence location, there is a method of penetrating from the opposite side of the CTO via a collateral flow. However, collateral circulation often has complex routes. Therefore, it is also highly dependent on the operator's experience that the guide wire reaches the CTO occurrence location via the collateral circulation.

JP 2008-178686 A

  An object of the present invention is to provide an X-ray diagnostic apparatus that can improve the efficiency of a procedure using a guide wire.

An X-ray diagnostic apparatus according to a first aspect of the present invention includes an imaging mechanism having an X-ray tube and an X-ray detector for collecting a time-series X-ray image related to a subject, and the time-series X-ray image. an extraction unit repeatedly extracts the distal region of the guidewire from the one of the repeatedly extracted tip region, a storage unit for the trajectory of the extracted tip region within the period specified by the user remembers to, the storage And a display unit that displays the trajectory specified at a timing designated by the user.

  According to the present invention, it is possible to provide an X-ray diagnostic apparatus that can improve the efficiency of a procedure using a guide wire.

The functional block diagram of the X-ray diagnostic apparatus which concerns on embodiment of this invention. The figure which shows the one part external appearance of the X-ray diagnostic apparatus of FIG. 1 installed in the operating room. The figure which shows the typical flow of the memory | storage / display process of the locus | trajectory based on Example 1 performed under control of the system control part of FIG. The figure which shows an example of the live image containing a CTO generation | occurrence | production location (complete blockage area). FIG. 4 is a display example in step SA11 of FIG. 3 and shows a guide wire region and a plurality of trajectories displayed superimposed on a road map image. The figure which shows the typical flow of the memory | storage / display process of the locus | trajectory based on Example 2 performed under control of the system control part of FIG.

  Hereinafter, an X-ray diagnostic apparatus according to an embodiment of the present invention will be described with reference to the drawings.

  The X-ray diagnostic apparatus according to the present embodiment supports a guide wire operation by an operator such as a doctor or an engineer. A guide wire is a thin metal wire used to guide a catheter to a target site in cardiovascular examination or treatment. For example, a guide wire is used to penetrate a CTO generation site on a blood vessel. Since the blood vessel at the CTO occurrence site cannot be visually recognized on the image, the guide wire penetration operation is largely based on the experience and intuition of the operator. The X-ray diagnostic apparatus according to the present embodiment stores and displays information effective for the guide wire operation by the operator, thereby improving the efficiency of the guide wire operation.

  The X-ray diagnostic apparatus according to this embodiment can be applied to any procedure that requires a guide wire. However, in order to make the following description concretely, a CTO treatment, in which the application of the present technology is considered to be particularly clinically significant, will be described as a clinical application example.

  FIG. 1 is a functional block diagram of an X-ray diagnostic apparatus 1 according to the present embodiment. FIG. 2 is a diagram showing an appearance of a part of the X-ray diagnostic apparatus 1 installed in the procedure room. 1 is not shown in FIG. 2 because it is not installed in the operating room. As shown in FIG. 1, the X-ray diagnostic apparatus 1 has an imaging mechanism 10. The imaging mechanism 10 has a C arm 15 on which an X-ray tube 11 and an X-ray detector 13 are mounted. The C arm 15 supports the X-ray tube 11 and the X-ray detector 13 so as to be rotatable around the rotation axis A1 and to be slidable in a C shape around the slide axis A2.

  The X-ray tube 11 generates X-rays in response to application of a high voltage and supply of a fulfillment current from a high voltage generator (not shown). The generated X-rays pass through the subject placed on the bed 17. The X-ray detector 13 detects X-rays generated from the X-ray tube 11 and transmitted through the subject, and generates an image signal corresponding to the detected X-rays. The generated image signal is supplied to the A / D converter 31 of the image processing device 30. The X-ray detector 13 is composed of a flat panel detector (FPD) having a plurality of semiconductor detection elements arranged in a matrix. Instead of the FPD, the X-ray detector 13 may be composed of a combination of an image intensifier and a TV camera.

  An operation unit 19 is provided on the bed 17. The operation unit 19 inputs various instructions from an operator such as a doctor or an engineer to the image processing apparatus 30. As the operation unit 19, for example, various display devices such as a switch and a joystick are applicable.

  Further, a display unit 21 is provided in the operating room. The display unit 21 displays various images supplied from the image processing device 30. As the display unit 21, for example, a display device such as a CRT display, a liquid crystal display, an organic EL display, or a plasma display can be used as appropriate.

  The image processing apparatus 30 includes an A / D conversion unit 31, an interface unit 33, a road map image generation unit 35, an extraction unit 37, a storage control unit 39, a storage unit 41, a display control unit 43, a D / A conversion unit 45, and A system control unit 47 is included.

  The A / D converter 31 is connected to the X-ray detector 13. The A / D converter 31 digitizes the image signal output from the X-ray detector 13 and generates X-ray image data. A time-series X-ray image generated in real time is called a live image. Live image data is repeatedly generated during the live image collection period.

  The interface unit 33 is connected to a network such as a LAN (local area network). An X-ray computed tomography apparatus (hereinafter referred to as an X-ray CT apparatus) 100 and an image server 200 are connected to the network. The interface unit 33 loads CT image data from the X-ray CT apparatus 100 or the image server 200. The CT image data is, for example, a three-dimensional road map image including only the contrast blood vessel region or a CTA (angio) image including the contrast blood vessel region. The CT image data is stored in the storage unit 41. The contrast blood vessel region is a pixel region having a pixel value derived from a contrast agent injected into the blood vessel.

  The road map image generation unit 35 generates data of an image (hereinafter referred to as a road map image) in which only the contrast blood vessel region is depicted. Specifically, the road map image generation unit 35 generates a road map image by subtracting the mask image collected before the contrast agent injection from the contrast image collected after the contrast agent injection. The data of the contrast image and the data of the mask image are collected in advance before the live image collection. The generated road map image data is stored in the storage unit 41.

  The extraction unit 37 repeatedly extracts a guide wire region from a time-series live image. Note that the guide wire region is a pixel region having a pixel value derived from the guide wire. A known method is used as the extraction method. Further, the extraction unit 37 extracts the tip region of the guide wire from the live image. As the extraction method, for example, a method disclosed in Japanese Patent Application Laid-Open No. 2008-178686 and Japanese Patent Application Laid-Open No. H04-2332 is used.

  The storage control unit 39 temporarily stores in the storage unit 41 the image data and the position data of the tip region extracted within the storage period designated by the operator via the operation unit 19 in association with each other. The time-series tip region extracted during the storage period is a trajectory through which the tip region of the guide wire passes within the storage period. Here, the image data and position data of the tip region are collectively referred to as locus data. “Temporary” means the time until the next trajectory data is stored. Further, the storage control unit 39 causes the storage unit 41 to store the data of the trajectory temporarily stored in the storage unit 41 for a long time when an instruction is given to the storage unit for a long time via the operation unit 19. . On the other hand, the storage control unit 39 deletes the temporarily stored trajectory data from the storage unit 41 when the surgeon gives an instruction not to store for a long time via the operation unit 19. “Long term” means at least until the procedure is completed or until the operator gives a deletion instruction.

  The storage unit 41 stores data on the locus of the tip region. Specifically, the storage unit 41 stores trajectory data and a trajectory identifier in association with each other. The storage unit 41 can store data of a plurality of trajectories.

  The display control unit 43 reads the trajectory data at a timing designated by the operator via the operation unit 19 and displays the data on the display unit 21 via the D / A conversion unit 45. Specifically, the display control unit 43 causes the display unit 21 to display the trajectory superimposed on the road map image (or a three-dimensional road map image or a CTA image) in position alignment. Further, the display control unit 43 displays a live image on the display unit 21 or displays the guide wire region on the display unit 21 so as to overlap the road map image. The live image and the superimposed image of the guide wire region and the road map image are displayed on the display unit 21 in real time so that the surgeon can grasp the current guide wire position.

  The D / A conversion unit 45 is connected to the display unit 21. The D / A conversion unit 45 converts various image data into analog data and generates an image signal that can be displayed on the display unit 21. The display unit 21 displays an image corresponding to the image signal from the D / A conversion unit 45.

  The system control unit 47 controls each unit so as to realize various operations generally provided in the X-ray diagnostic apparatus 1 such as X-ray image capturing (perspective). Further, the system control unit 47 controls the storage / display processing of the trajectory unique to the present embodiment.

  Next, a process for storing and displaying a trajectory performed under the control of the system control unit 47 will be described. As described above, the storage period for temporarily storing the trajectory of the distal end region of the guide wire is designated by the operator via the operation unit 19. There are two types of storage periods. The first is the time interval from the start point to the end point specified by the operator. The second is a fixed period retroactive from the end point designated by the surgeon. This fixed period depends on the storage capacity of the memory for short-term storage included in the storage unit 41. In the present embodiment, the processing flow differs depending on the type of storage period. Hereinafter, an example of the operation of the storage / display process of the locus using the first storage period will be described in the first embodiment, and the operation example of the storage / display process of the locus using the second storage period will be described in the second embodiment. To do.

Example 1
FIG. 3 is a diagram illustrating a typical flow of a trajectory storage / display process according to the first embodiment performed in the CTO treatment. As shown in FIG. 3, when an operator gives an instruction to start collecting a live image via the operation unit 19, the system control unit 47 controls each unit to collect live image data (step SA1). Live image acquisition is typically performed in fluoroscopic mode. The X-ray fluoroscopic mode has a smaller X-ray dose than, for example, an imaging mode for acquiring a mask image or a contrast image. Although not shown in FIG. 3, when a live image is collected, a guide wire region is extracted from the live image by the extraction unit 37, and the extracted guide wire region is overlaid in alignment with the road map image by the display unit 21. Displayed together. Further, the live image may be displayed on the display unit 21 as it is. The surgeon advances the guide wire while observing the superimposed image and the live image. Note that step SA1 is repeatedly performed in the background until an instruction to end live image collection is given in step SA13.

  FIG. 4 is a diagram illustrating an example of a live image including a CTO occurrence location (completely closed section). During the procedure, the surgeon attempts to penetrate the CTO generation site with a guide wire. However, as shown in FIG. 4, at the CTO occurrence location, the blood vessel is completely occluded, so that the contrast blood vessel region is not drawn. Therefore, the operator performs trial and error by inserting and removing the guide wire many times while changing the approach direction of the guide wire. In this way, penetration of the CTO occurrence location with the guide wire requires a great deal of experience, technology, and intuition.

  The process of storing and displaying the trajectory visualizes this trial and error state. Specifically, the trajectory of the tip region of the guide wire actually operated by the surgeon is selectively recorded and displayed on the road map image. By observing the trajectory, the surgeon can visually grasp the direction in which the guide wire has advanced or has not advanced. This makes it easier for the surgeon to determine the next direction in which the guidewire should be advanced.

  When the live image is collected, the system control unit 47 waits for a recording start instruction to be input via the operation unit 19 (step SA2). For example, the surgeon presses a recording start instruction switch provided on the operation unit 19 at a timing at which recording of the distal end region of the guide wire is to be started, for example.

  When the recording start instruction switch is pressed (step SA2: YES), the system control unit 47 causes the extraction unit 37 to perform a tip region extraction process (step SA3). In step SA3, the extraction unit 37 extracts the tip region of the guide wire from the live image.

  When step SA3 is performed, the system control unit 47 causes the storage control unit 39 to perform temporary storage processing (step SA4). In step SA4, the storage control unit 39 temporarily stores the locus data (image data and position data) of the tip region extracted in step SA3 in the storage unit 41. The trajectory data is stored, for example, as a set of point sequences or as a line in which the points are interpolated.

  When step SA4 is performed, the system control unit 47 waits for a recording end instruction to be input via the operation unit 19 (step SA5). If it is determined that the recording end instruction has not been input (step SA5: NO), the system control unit 47 returns to step SA3 again. In this way, the system control unit 47 repeats the tip region extraction process (step SA3) and the temporary storage process (step S4) until a storage end instruction is input. For example, the surgeon presses a recording end instruction switch via the operation unit 19 at a timing when the recording of the distal end region of the guide wire is desired to end. As this timing, for example, a point in time when the guide wire is once pulled out from the CTO occurrence position can be considered.

  When a recording end instruction is input (step SA5: YES), the system control unit 47 causes the display control unit 43 to perform display processing (step SA6). In step SA6, the display control unit 43 reads the temporarily stored locus data from the storage unit 41, aligns the read locus with the road map image, and displays the locus on the display unit 21.

  When step SA6 is performed, the system control unit 47 waits for an instruction to store the trajectory for a long time via the operation unit 19 (step SA7). The surgeon observes the trajectory displayed in step SA6 and determines whether or not to store the trajectory data temporarily stored for a long time. When it is determined that the trajectory is to be stored for a long time, the surgeon presses a long-term memory switch provided in the operation unit 19, for example. On the other hand, when it is determined that the trajectory is not stored for a long time, the surgeon presses an erasure switch provided on the operation unit 19, for example.

  When the operator presses the erasure switch (step SA7: NO), the system control unit 47 causes the storage control unit 39 to perform erasure processing (step SA8). In step SA8, the storage control unit 39 deletes the temporarily stored locus data from the storage unit 41. When step SA8 is performed, the system control unit 47 proceeds to step SA13.

  On the other hand, when the operator presses the long-term storage switch (step SA7: YES), the system control unit 47 causes the storage control unit 39 to perform a long-term storage process (step SA9). In step SA9, the storage control unit 39 causes the storage unit 41 to store the trajectory data temporarily stored in the storage unit 41 for a long period of time. Typically, a storage area for temporary storage (short-term storage area) and a storage area for long-term storage are physically different. That is, the storage control unit 39 deletes the trajectory data from the short-term storage area in the storage unit 41 and stores it in the long-term storage area. At this time, the storage unit 41 stores the locus data and the identifier in association with each other. The surgeon can also select the display color of the trajectory stored for a long time via the operation unit 19. The storage unit 41 stores a code indicating the selected display color in association with the trajectory data. The display color is a combination of hue, brightness, and saturation.

  When step SA9 is performed, the system control unit 47 determines whether or not a trajectory display instruction has been issued via the operation unit 19 (step SA10). As the display instruction, for example, it is selected whether or not to display the trajectory displayed in step SA6 on the display unit 21 as it is. For example, the operation unit 19 is provided with a display button and a non-display button.

  When the display button is pressed, the system control unit 47 causes the display control unit 43 to perform display processing (step SA11). In step SA <b> 11, the display control unit 43 causes the display unit 21 to display the locus displayed in step SA <b> 6 so as to be superimposed on the road map image. The displayed trajectory can be arbitrarily switched between display and non-display via the operation unit 19.

  FIG. 5 is a display example in step SA12, and shows a guide wire region GR and a plurality of trajectories KR1 and KR2 displayed in an overlapping manner on the road map image. The guide wire region GR is extracted from the live image in real time and is displayed at the position of the guide wire at that time. The guide wire region GR in FIG. 5 is located in front of the CTO occurrence location. One end of the trajectories KR1 and KR2 corresponds to the tip region when the recording start instruction is given, and the other end corresponds to the tip region when the recording end instruction is given. The first trajectory KR1 corresponds to, for example, a trajectory with a poor progress. The second trajectory KR2 corresponds to, for example, a trajectory with good progress. The first trajectory KR1 and the second trajectory KR2 are trajectories relating to different periods during the same procedure. In order to facilitate observation of the trajectory, the display unit 21 may enlarge and display the region of interest designated via the operation unit 19. If the locus is included in the region of interest, the display unit 21 displays the locus in an enlarged manner.

  On the other hand, when the non-display button is pressed, the system control unit 47 causes the display control unit 43 to perform non-display processing (step SA12). In step SA12, the display control unit 43 deletes the trajectory displayed in step SA6 from the screen. The erased locus can be arbitrarily switched between display and non-display via the operation unit 19.

  In step SA10 described above, whether or not to display the locus displayed in step SA6 is selected. However, the present embodiment is not limited to this. For example, a trajectory to be displayed may be selected from a plurality of trajectories stored in the storage unit 41. In this case, for example, the surgeon selects an identifier of the locus to be displayed via the operation unit 19. The display control unit 43 searches the storage unit 41 using the selected identifier as a keyword, and reads the locus data and the display color code associated with the selected identifier. Then, the display control unit 43 displays the read locus on the display unit 21 in a display color corresponding to the read code. There may be one or more trajectories displayed at a time. In the case of displaying a plurality, it is preferable to display the display colors separately for the trajectory with good progress and the trajectory with poor progress. For example, a trajectory with good progress may be displayed in blue, and a trajectory with poor progress may be displayed in red. By color-coding according to the progress in this way, it is expected to help determine the direction in which the guide wire should be advanced.

  When step SA8, step SA11, or step SA12 is performed, the system control unit 47 waits for an instruction to end live image collection through the operation unit 19 (step SA13). If it is determined that the live image collection end instruction has not been given (step SA13: NO), the system control unit 47 proceeds to step SA2. Then, the system control unit 47 repeats Step SA2 to Step SA13 again.

  On the other hand, when the surgeon gives an instruction to end the live image collection via the operation unit 19 in step SA13 (step SA13: YES), the system control unit 47 controls each unit to stop the live image collection and The storage / display process is terminated.

(Example 2)
FIG. 6 is a diagram illustrating a typical flow of a locus storage / display process according to the second embodiment performed under the control of the system control unit 47. As shown in FIG. 6, when an operator gives an instruction to start collecting a live image via the operation unit 19, the system control unit 47 controls each unit to collect live image data (step SB1). Since the live image collection operation is the same as that of the first embodiment, description thereof is omitted.

  When the live images are collected, the system control unit 47 causes the extraction unit 37 to perform the tip region extraction process (step SB2). In step SB2, the extraction unit 37 extracts the tip region of the guide wire from the live image.

  When step SB2 is performed, the system control unit 47 causes the storage control unit 39 to perform temporary storage processing (step SB3). In step SB3, the storage control unit 39 temporarily stores in the storage unit 41 the locus data of the tip region extracted in step SB3. The trajectory data is stored in a memory for short-term storage in the storage unit 41. The memory for short-term storage can store time-series live image data for a storage period (for example, 1 to 30 seconds). When the memory is full, the latest live image data is overwritten on the oldest live image data. That is, the latest live image data is always stored in the memory.

  When step SB3 is performed, the system control unit 47 waits for an instruction for starting reverse playback to be input via the operation unit 19 (step SB4). The reverse reproduction is to display the tip region temporarily stored in the storage unit 41 in order from the time when the start instruction is given. By replaying the trajectory in this way, the operator is prompted to determine whether or not to store the replayed trajectory for a long time. The reverse playback start instruction is made, for example, by pressing a reverse playback start switch provided on the operation unit 19.

  When the reverse playback start switch is pressed (step SB4: YES), the system control unit 47 causes the display control unit 43 to perform reverse playback display processing (step SB5). In step SB5, the display control unit 43 reads the image data and position data of the tip region from the short-term storage memory of the storage unit 41. Then, the display control unit 43 controls the display unit 21 to display the read image of the front end region in a position-aligned manner on the road map image in order from the time point when the reverse reproduction start instruction is given. The playback speed in reverse playback can be arbitrarily set by the operator via the operation unit 19 such as 1 × speed, 2 × speed, or 0.5 × speed.

  When step SB5 is performed, the system control unit 47 waits for a reverse playback stop instruction to be input (step SB6). The reverse playback stop instruction is made, for example, by pressing a reverse playback stop switch provided on the operation unit 19. For example, when the start point of the required trajectory is displayed, the surgeon presses the reverse playback stop switch.

  When the reverse playback stop switch is pressed, the system control unit 47 waits for a long-term storage instruction to be issued via the operation unit 19 (step SB7). When the reverse playback stop switch is pressed, the display unit 21 displays, for example, a trajectory from the reverse playback start point to the stop point. For example, the surgeon observes this trajectory and determines whether or not to memorize it for a long time. When it is determined that the trajectory is stored for a long time, the surgeon presses a long-term memory switch provided in the operation unit 19, for example. On the other hand, when it is determined that the trajectory is not stored for a long time, the surgeon presses an erasure switch provided on the operation unit 19, for example.

  When the operator presses the erase switch (step SB7: NO), the system control unit 47 causes the storage control unit 39 to perform an erasure process (step SB8). In step SB8, the storage control unit 39 deletes the temporarily stored locus data from the storage unit 41. When step SB8 is performed, the system control unit 47 proceeds to step SB13.

  On the other hand, when the operator presses the long-term storage switch (step SB7: YES), the system control unit 47 causes the storage control unit 39 to perform a long-term storage process (step SB9). In step SB9, the storage control unit 39 causes the storage unit 41 to store the trajectory data temporarily stored in the storage unit 41 for a long period of time. As described above, in the second embodiment, when the live image is collected, the locus data of the tip region is automatically stored. For this reason, the second embodiment can cope with the need for memory after the guide wire is invaded.

  When step SB9 is performed, the system control unit 47 performs processing subsequent to step SB10. Since the processing from step SB10 to step SB13 is the same as the processing from step SA10 to step SA13, description thereof will be omitted.

  Above, description of Example 1 and Example 2 is complete | finished.

  As described above, the X-ray diagnostic apparatus 1 according to the present embodiment can selectively and temporarily store the trajectory of the guide wire operated by the operator according to the operator's judgment. The X-ray diagnostic apparatus 1 can selectively store the trajectory temporarily stored in accordance with the judgment of the surgeon for a long period of time and display it at a timing designated by the surgeon to support the guide wire operation. it can. As described above, according to this embodiment, the result of trial and error of the guide wire operation can be stored and displayed. For example, the following effects can be obtained by clinical application of this technique to a CTO penetration procedure. First, since it is possible to display a trajectory when the progress is good and a trajectory when the trial is bad, it becomes a support material for determining the approach direction of the guide wire. Thereby, the time of trial and error of an operator can be reduced. Moreover, the same effect can be acquired also when penetrating CTO from the reverse side through the collateral circulation path which has a complicated path | route. In addition, it is possible to prevent the guide wire from penetrating into a pseudo lumen called a pseudo-cavity (in a dissecting aneurysm, a cavity generated in the blood vessel separately from the original cavity due to dissociation of the blood vessel wall). Due to these effects, the X-ray diagnostic apparatus 1 according to the present embodiment can shorten the time for penetrating the CTO with a guide wire. In addition, the burden on the subject can be reduced by shortening the procedure time, and the exposure time of the subject can be reduced.

  Thus, the X-ray diagnostic apparatus 1 according to the present embodiment enables the efficiency of the procedure using the guide wire.

  Note that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the constituent elements without departing from the scope of the invention in the implementation stage. In addition, various inventions can be formed by appropriately combining a plurality of components disclosed in the embodiment. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, constituent elements over different embodiments may be appropriately combined.

  As described above, according to the present invention, it is possible to provide an X-ray diagnostic apparatus that can improve the efficiency of a procedure using a guide wire.

  DESCRIPTION OF SYMBOLS 1 ... X-ray diagnostic apparatus, 10 ... Imaging | photography mechanism, 11 ... X-ray tube, 13 ... X-ray detector, 15 ... C arm, 17 ... Bed, 19 ... Operation part, 21 ... Display part, 30 ... Image processing apparatus, DESCRIPTION OF SYMBOLS 31 ... A / D conversion part, 33 ... Interface part, 35 ... Road map image generation part, 37 ... Extraction part, 39 ... Storage control part, 41 ... Storage part, 43 ... Display control part, 45 ... D / A conversion part 47. System control unit

Claims (9)

An imaging mechanism having an X-ray tube and an X-ray detector for collecting time-series X-ray images of the subject;
An extraction unit that repeatedly extracts the tip region of the guide wire from the time-series X-ray image;
And the repeating of the extracted tip region and locus remembers tip region extracted within the period specified by the user storage unit,
A display unit for displaying the stored locus at a timing designated by the user;
An X-ray diagnostic apparatus comprising:   The X-ray diagnosis apparatus according to claim 1, wherein the period is between a start time point and an end time point specified by a user.   The X-ray diagnostic apparatus according to claim 1, wherein the display unit displays the locus in a superimposed manner on a blood vessel image related to the subject.   The X-ray diagnostic apparatus according to claim 3, wherein the display unit enlarges and displays a region of interest set on the blood vessel image and the locus on the region of interest.   The storage unit erases the trajectory when an instruction is given from the user to not store for a long period, and stores the trajectory for a long period when an instruction is issued from the user to store for a long period. The X-ray diagnostic apparatus according to claim 1.   The X-ray diagnosis apparatus according to claim 5, wherein the storage unit stores a plurality of loci for a plurality of different periods designated by a user for a long period of time.   The X-ray diagnosis apparatus according to claim 6, wherein the display unit displays the plurality of trajectories with mutually different hue, luminance, and saturation.   The X-ray diagnostic apparatus according to claim 1, wherein the display unit displays the trajectory retroactively from the end point of the period to the start point. The X-ray diagnostic apparatus according to claim 3 , wherein the blood vessel image is a difference image between a mask image and a contrast image, or a CT image generated by an X-ray computed tomography apparatus.

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