JP5531239B2 - Puncture support system - Google Patents

Description

  The present invention relates to a system for supporting puncturing under an ultrasonic guide, and more particularly, using an ultrasonic tomographic image acquired by an ultrasonic diagnostic apparatus to puncture a target in a target tissue in the body. The present invention relates to a puncture support system for performing simply and quickly.

  Puncture into the patient's body tissue is used in various medical situations, for example, central venous puncture for transfusion by inserting a catheter into a vein and transcutaneous treatment for liver cancer and breast cancer Etc. are used. Such puncture is performed by a doctor's hand while visually observing an ultrasonic tomographic image of a patient's body tissue acquired by an ultrasonic diagnostic apparatus. At this time, it is necessary to ensure that the puncture needle reaches the target and stop, but since the position of the puncture needle in the ultrasonic tomographic image is difficult to see, It is difficult to grasp the relationship, and skill is required for a doctor to perform puncture accurately.

  By the way, Patent Document 1 discloses an ultrasonic diagnostic apparatus capable of displaying a route of a puncture needle from a body surface toward a target in the body on an ultrasonic tomographic image. An insertion portion guide that guides the insertion position of the puncture needle is provided on the side portion of the probe used in the ultrasonic diagnostic apparatus, and the insertion portion guide includes a plurality of insertion holes into which the puncture needle is inserted. ing. In the ultrasonic diagnostic apparatus of Patent Document 1, a doctor sets a puncture route that connects the position of the insertion guide and the target position while visually observing the ultrasonic tomographic image, and displays it on the ultrasonic tomographic image. In accordance with the display, the puncture needle is inserted by the doctor's hand through the insertion hole at a position where the puncture route can be punctured.

JP 2004-298476 A

  However, in the invention of Patent Document 1, a doctor must manually set a puncture route while viewing an ultrasonic tomographic image. Thereby, after setting the puncture route, if the probe moves with respect to the patient and the target moves even slightly in the ultrasonic tomographic image, the puncture route must be set again, which is troublesome. The puncture cannot be performed quickly. Therefore, while setting the puncture route, it is necessary for the doctor to keep the probe stationary at the same position while maintaining the same posture with respect to the patient for a relatively long time. Will bring pain to both. In addition, the doctor needs to operate the keyboard and mouse for setting the puncture route while keeping the probe resting on the patient's body surface. The operation is forced, and simple and quick puncture cannot be performed.

  The present invention has been devised by paying attention to such a problem, and an object of the present invention is to provide a puncture support system that can automatically reach a target with a puncture needle with a simple operation. .

(1) To achieve the above object, the present invention provides an ultrasonic diagnostic apparatus for acquiring an ultrasonic tomographic image of a body part under the skin in contact with the probe by bringing the probe into contact with the patient's skin. A puncture support system for puncturing a target in a target tissue existing in the body part based on the ultrasonic tomographic image,
Probe position and orientation detection means for detecting the position and orientation of the probe, and the ultrasonic wave obtained from the probe at the position and orientation to the position and orientation of the probe detected by the probe position and orientation detection means By associating tomographic images, a three-dimensional position detecting means for obtaining a three-dimensional position of a target set in the target tissue, a puncture needle operating means for operating a puncture needle for puncturing the target, An operation control means for controlling the operation of the puncture needle operation means so that the puncture needle reaches the target based on the three-dimensional position of the target detected by the three-dimensional position detection means. Adopted.

(2) Moreover, it further comprises target tissue specifying means for specifying the preset target tissue from the ultrasonic tomographic image,
The three-dimensional position detection means obtains a three-dimensional position of each component of the target tissue specified by the target tissue specifying means from a plurality of the ultrasonic tomographic images obtained by moving the probe, A configuration in which the three-dimensional position of the target is obtained from the three-dimensional position of the constituent part can be employed.

(3) Furthermore, a patient position / posture detection means for detecting the position and posture of a fixed part of the patient is further provided,
In the three-dimensional position detection unit, the detection results of the probe position / posture detection unit and the patient position / posture detection unit correspond to the ultrasonic tomographic image obtained at that time, thereby obtaining the three-dimensional position of the target. It is also preferable to adopt a configuration that requires

  (4) Further, the puncture needle operating means is integrally attached to the probe, and adopts a configuration in which the puncture needle is operably provided within a range within the ultrasonic tomographic image obtained by the probe. It is preferable to do.

  According to the present invention, in order to obtain an ultrasonic tomographic image in which a target tissue having a portion to be punctured is reflected, a doctor simply performs an operation of moving the probe within a predetermined range on the patient's skin. Puncture can be performed automatically. That is, the three-dimensional position of the target is automatically obtained from the ultrasonic tomographic image obtained by moving the probe and the position and orientation of the probe at that time, and the puncture needle is made to reach the three-dimensional position. In addition, the puncture needle operating means operates. Therefore, it is not necessary to set a puncture line by a doctor's hand as in Patent Document 1, and it is possible to perform puncture simply and quickly in the manner of acquiring an ultrasonic tomographic image at a suitable position.

  In particular, with the configuration as described in (3) above, even when the patient moves and the three-dimensional position of the target changes after the three-dimensional position of the target is obtained, the accurate three-dimensional position of the target can be obtained. It is possible to automatically puncture following the movement of the patient.

  Also, according to the configuration of (4), the puncture needle operating means is sufficient with a configuration of three degrees of freedom that can freely move on the two-dimensional plane of the ultrasonic tomographic image, and the structure of the puncture needle operating means is simplified. Thus, the puncture needle operating means can be made compact. For this reason, even if the puncture needle operation means is integrated with the probe, it can be configured so as not to hinder the probe operation by the doctor's hand.

The schematic block diagram of the puncture assistance system which concerns on this embodiment. The conceptual diagram of the ultrasonic tomographic image for demonstrating operation | movement of the puncture needle in an ultrasonic tomographic image.

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

  FIG. 1 shows a schematic configuration diagram of a puncture support system according to the present embodiment. In this figure, a puncture support system 10 is a system that automatically performs puncture, which is a medical act of inserting a puncture needle N from a patient's body surface toward a target T in a patient's body, based on an ultrasonic tomographic image. is there. This puncture support system 10 includes an ultrasonic diagnostic apparatus 11 that can acquire an ultrasonic tomographic image of a subcutaneous body part, and a target by operating a puncture needle N based on the ultrasonic tomographic image acquired by the ultrasonic diagnostic apparatus 11. The puncture assisting robot 12 performs puncture at T.

  The ultrasonic diagnostic apparatus 11 includes a probe 15 (ultrasonic probe) that transmits ultrasonic pulses and receives echoes in contact with a patient's skin S, and a probe 15 that receives signals from the probe 15. A tomographic image generation unit 17 that generates an ultrasonic tomographic image (B mode) of the body part H under the skin S that is in contact with the monitor 18 that displays the ultrasonic tomographic image generated by the tomographic image generation unit 17 is provided. It has a known structure.

  The puncture assisting robot 12 holds the probe 15 and the puncture needle N, respectively, and the doctor 15 can manually move the probe 15 to obtain an ultrasonic tomographic image, while the puncture needle N moves. It is a hand-held robot that can automatically

  The puncture assisting robot 12 includes a probe holder 20 that holds the probe 15, a puncture needle operating device 22 that is provided integrally with the probe holder 20, and that functions as a puncture needle operating means that holds and operates the puncture needle N. A marker 24 that is attached to the probe holder 20 and generates infrared rays, a three-dimensional position measuring device 25 that measures the position and posture of the marker 24, and various processes and commands for operating the puncture needle operating device 22 And a command device 26.

  The probe holder 20 is located in the vicinity of the probe mounting portion 30 to which the probe 15 is detachably mounted, a grip 31 for an operator such as a doctor to grip, and a part of the grip 31. A push button type switch 33 that is provided and issues an operation command for the puncture needle N, and a marker fixing unit 35 that is attached to the probe mounting unit 30 and fixes the marker 24 so as not to move with respect to the probe 15 are provided.

  The puncture needle operating device 22 includes various members such as various motors and links not shown in the figure so that the puncture needle N can move within a predetermined range of space relative to the probe 15 held by the probe holder 20. It is configured by a mechanism.

  Specifically, the puncture needle operation device 22 operates with three degrees of freedom so that the puncture needle N can move within a range in the ultrasonic tomographic image of the body part H under the skin S with which the probe 15 contacts. The puncture needle N is movable as follows. That is, as shown in FIG. 2, the tip of the puncture needle N is movable in the left-right direction (the direction of arrow A in the figure) in the ultrasonic tomographic image G, and is imaged by the movement. It is possible to adjust the insertion position of a target tissue P (for example, an organ such as a blood vessel or an organ or a cancer cell) to be punctured in the body part H. The puncture needle N has a distal end that can be moved in the vertical direction (in the direction of arrow B in the figure) in the ultrasonic tomographic image G, and adjustment of the insertion depth into the target tissue P by the movement. Is possible. Furthermore, the tip of the puncture needle N is rotatable in the direction around the axis perpendicular to the ultrasonic tomographic image G (in the direction of arrow C in the figure). Adjustment is possible.

  The three-dimensional motion measurement device 25 is fixedly arranged so as not to move so as to be able to receive infrared rays generated from the marker 24, and measures the position and posture of the marker 24 in real time from the state of receiving infrared rays from the moving marker 24. A known configuration is possible. In other words, the three-dimensional motion measuring device 25 sequentially obtains the three-dimensional position and posture of the marker 24 in the absolute coordinate system with a predetermined fixed point as the origin, and the marker 24 has an unchanged position and posture with respect to the probe 15. For this reason, the three-dimensional position and orientation of the probe 15 are uniquely determined from the three-dimensional position and orientation of the marker 24. Therefore, the marker 24 and the three-dimensional motion measurement device 25 constitute probe position / orientation detection means for sequentially detecting the position and orientation of the probe 15 in the absolute coordinate system.

  The probe position / orientation detection means is not limited to detection by the marker 25 and the three-dimensional motion measurement device 25 as long as the position and orientation of the probe 15 in the absolute coordinate system can be sequentially detected. Can also be adopted.

  The processing command device 26 is constituted by a computer including an arithmetic processing device such as a CPU and a storage device such as a memory and a hard disk, and a program for causing the computer to function as the following units is installed.

  That is, the processing command device 26 includes target tissue specifying means 40 for specifying a portion of a target tissue P such as a blood vessel or an organ such as a puncture target or a cancer cell from the acquired ultrasonic tomographic image, Using the position and orientation of the probe 15 measured by the three-dimensional motion measuring device 25, the three-dimensional position detecting means 41 for obtaining the three-dimensional position of the target T in the target tissue P and the target obtained by the three-dimensional position detecting means 41 Based on the three-dimensional position of T, there is provided an operation control means 42 for controlling the operation of the puncture needle operating device 22 so that the puncture needle N reaches the target T.

  In the target tissue specifying means 40, when an operator such as a doctor designates a desired target tissue P from among a plurality of target tissues P stored in advance in the processing command device 26, the obtained ultrasonic tomographic image is displayed. By the image processing, the part of the target tissue P is specified from various tissues shown in the ultrasonic tomographic image. The image processing here uses matching with a template related to the target tissue P stored in advance, or by using the result in the color Doppler mode when the ultrasonic diagnostic apparatus 11 includes the color Doppler mode. A known technique for automatically specifying an organ such as a blood vessel or an organ or a target tissue P such as a cancer cell from an ultrasonic tomographic image obtained by imaging the body part H is used.

  In the present invention, as the target tissue specifying means 40, various image processing techniques are applied as long as the target tissue P designated by the operator can be automatically specified from the acquired ultrasonic tomographic images. It is possible.

  In the three-dimensional position detection means 25, for each part constituting the target tissue P in the ultrasonic tomographic image specified by the target tissue specifying means 40, 3 in the absolute coordinate system is determined from the position and orientation of the probe 15 at that time. The dimension position is obtained by calculation. That is, for each part of the target tissue P specified in the obtained ultrasonic tomographic image, two-dimensional coordinates in the image coordinate system are specified, and from the measurement values obtained by the three-dimensional motion measuring device, a conversion formula stored in advance is used. The three-dimensional position in the absolute coordinate system of each part of the target tissue P is obtained. Further, when the operator touches the probe 15 at a plurality of positions on the patient's skin S, the same calculation process is performed on the ultrasonic tomographic images acquired at each position, and in the absolute coordinate system of each part of the target tissue P. By accumulating the three-dimensional position, the three-dimensional shape of the target tissue P in the predetermined space region is specified.

  The target T in the target tissue P that reaches the tip of the puncture needle N is stored in advance corresponding to the target tissue P, and the three-dimensional position detection unit 25 identifies the three-dimensional shape of the target tissue P. Then, the three-dimensional position of the target T is automatically obtained by calculation.

  For example, when the target tissue P is a blood vessel, a portion on the center line of the blood vessel lumen portion is set as the target T, and the position of the target T is specified as follows from the portion on the center line. The That is, the center line (axis line) of the blood vessel lumen portion is obtained from the previously obtained three-dimensional shape of the blood vessel, and the operation command device 22 is considered from the current position of the probe 15 in consideration of the operation range of the puncture needle operation device 22. 26, the position on the center line of the blood vessel lumen portion that can be reached when the operator inserts at the insertion angle inputted in advance is determined as the target T, and the three-dimensional position of the target T is specified.

  When the target tissue P is a cancer cell, the center portion of the cancer cell is set as the target T, and the coordinates of the absolute coordinate system at the center point are obtained from the three-dimensional shape of the cancer cell obtained previously. The three-dimensional position of the target T is obtained.

  In the operation control means 42, the insertion line L to the target T (see FIG. 2) from the three-dimensional position of the target T obtained by the three-dimensional position detection means 41 and the preset insertion angle of the puncture needle N. And the operation of the puncture needle operating device 22 is controlled so that the puncture needle N passes through the insertion line L, reaches the target T, and stops.

  Next, a puncturing operation using the puncture support system 10 will be described by taking puncture into a blood vessel as an example.

  First, an operator such as a doctor grasps the grip 31 by hand, moves the probe 15 within a predetermined range while contacting the patient's skin S, searches for a blood vessel for puncturing, and looks at the monitor 18. When the part to be punctured appears on the ultrasonic tomographic image, the movement of the probe 15 is stopped. At this time, the tomographic image generation means 17 of the ultrasonic diagnostic apparatus 11 sequentially generates ultrasonic tomographic images of the body part H under the skin S with which the probe 15 contacts, and the ultrasonic tomographic image is monitored. 18 is projected. The operator inputs a puncture angle (for example, 15 degrees) into the target T to the puncture assisting robot 12 in advance.

  The following processing is performed on the ultrasonic tomographic images sequentially generated as the probe 15 moves. That is, the position and orientation of the probe 15 in the absolute coordinate system are measured by the three-dimensional motion measuring device 25, and the ultrasonic tomography obtained by the probe 15 at the position and orientation is measured. Match images. Further, the target tissue specifying means 40 specifies each component part (blood vessel wall part, blood vessel lumen part) of the blood vessel from the obtained ultrasonic tomographic image. The three-dimensional position detection means 41 converts each point (pixel) in the ultrasonic tomographic image at each component part of the blood vessel from the image coordinate system to the absolute coordinate system for each obtained ultrasonic tomographic image. A three-dimensional position of each point is obtained. By accumulating these three-dimensional positions, the three-dimensional shape of the blood vessel is specified, and the target T is specified from the position on the center line of the blood vessel lumen portion. That is, by acquiring many ultrasonic tomographic images by moving the probe 15, a large number of three-dimensional positions of each constituent part of the blood vessel are obtained, and by storing these three-dimensional positions for each constituent part, the blood vessel wall part And the three-dimensional shape of the blood vessel lumen portion is specified, the target T is specified from the center line of the blood vessel lumen portion, and the three-dimensional coordinates of the target T are obtained.

  Then, the insertion line L of the puncture needle N in the absolute coordinate system is automatically set so that the tip of the puncture needle N reaches the target T at a preset insertion angle. Thereafter, when the operator presses the switch 33 provided on the grip 31, the puncture needle operating device 22 operates while being controlled by the operation control means 42 so that the puncture needle N moves on the insertion line L. In other words, the puncture needle operating device 22 causes the puncture needle N to be inserted into the skin S from the outside of the body and automatically move to the target T, and puncture the target T at a preset insertion angle. .

  Even if the operator stops the operation of the probe 15 and the probe 15 moves unexpectedly and the target T slightly deviates on the ultrasonic tomographic image, it is within the movable range of the puncture needle N by the puncture needle operating device 22. As long as the three-dimensional position of the target T in the absolute coordinate system is specified, the puncture needle N moves on the previously specified puncture line L by the operation control of the puncture needle operation device 22 by the operation control means 42. It will be.

  Further, when the three-dimensional position of the blood vessel changes due to the patient moving or the like, the probe 15 is moved within a predetermined range in the manner of searching for the target T again in the ultrasonic tomographic image. By a similar procedure, a new puncture line L is constructed again, and the target T can be punctured by the puncture needle operating device 22.

  Therefore, according to such an embodiment, the operation of the probe 15 for acquiring an ultrasonic tomographic image is manually performed by an operator such as a doctor, while the operation of the puncture needle N to the target is performed by a puncture needle operating device. 22 automatically. For this reason, the operator can simply puncture the target T by the puncture assisting robot 12 simply by performing an operation of scanning the body surface with the probe 15 in order to search for the puncture target T existing in the body part H. The operator can eliminate the trouble of controlling the operation of the puncture needle N while viewing the ultrasonic tomographic image.

  In addition, since the operation of the puncture needle N is controlled within the range reflected in the ultrasonic tomographic image, the operator can visually recognize the puncture needle N on the ultrasonic tomographic image and not only can the operator confirm the puncture but also the puncture. Since the operation with the needle operation device 22 is only three degrees of freedom, the hand-held puncture assisting robot 12 can be reduced in size and weight.

  The puncture target T may be arbitrarily set manually. For example, by inputting the insertion position and the insertion angle to the processing command device 26, it is possible to calculate the three-dimensional position of the target T from the previously determined three-dimensional shape of the target tissue P. In addition, by observing the ultrasonic tomographic image obtained each time the operator moves the probe 15 on the monitor 18 and clicking the puncture part in the ultrasonic tomographic image with an unillustrated mouse or the like at the operator's judgment, A target T can also be set. In this case, since the position and orientation of the probe 15 when the clicked ultrasonic tomographic image is obtained are detected, the three-dimensional coordinates of the target T are obtained without obtaining the three-dimensional shape of the target tissue P. Therefore, the target tissue specifying means 40 can be omitted. Furthermore, a portion shown in the center of the ultrasonic tomographic image can be set as the target T. In this case, when the operator moves the probe 15 by hand and a portion to be punctured appears in the center of the ultrasonic tomographic image. The puncture needle N may be operated by pressing the switch 33. Even in this case, it is possible to obtain the three-dimensional coordinates of the target T without obtaining the three-dimensional shape of the target tissue P, as in the case of clicking the puncture portion in the ultrasonic tomographic image with a mouse or the like. The target tissue specifying means 40 can be omitted.

  In addition, patient position / posture detection means for detecting the position and posture of a fixed part of the patient is provided, and the three-dimensional position detection means 41 determines the probe 15 and the probe 15 based on the detection results of the probe position / posture detection means and the patient position / posture detection means. The three-dimensional position of the target T may be obtained by associating the ultrasonic tomographic images obtained at these positions and postures with the respective positions and postures of the fixed part of the patient. The patient position / posture detecting means can be exemplified by the same configuration as the marker 24 and the three-dimensional motion measuring device 25. The marker 24 is fixed to the body surface portion of the patient near the puncture portion, and the position of the marker 24 is determined. And the position and posture of the body surface part of the patient to which the marker 24 is fixed are obtained by measuring the posture with the three-dimensional motion measuring device 25. In this way, even after the insertion line L is set, even when the three-dimensional position of the target tissue P changes due to reasons such as movement of the patient, the probe 15 is not moved again within the predetermined range. The puncture needle operating device 22 can operate the puncture needle N following the movement of the patient.

  Furthermore, as shown in FIG. 2, it is also possible to display the simulation by superimposing the automatically set insertion line L in the ultrasonic tomographic image G. In this case, the operator can more specifically grasp the puncture image on the target T while viewing the ultrasonic tomographic image G. As a result, for example, the operator can easily grasp whether or not there is a tissue that cannot pass the puncture needle N in the middle of the insertion line L. In this case, the operator can change the insertion position, It becomes easy to make a judgment such as resetting T to another position.

  Further, a force sense presentation device (not shown) may be provided on the grip 31 and a means for determining whether or not the target T is outside the movable range of the puncture needle N by the puncture needle operating device 22 may be provided. In this configuration, when the target T exists outside the movable range of the puncture needle N, the probe holder 20 and the puncture needle operating device 22 are moved by the force sense presentation device so that the target T is positioned within the movable range. The sense of force is presented to the operator in the direction to be moved. By doing so, the operator can move the probe holder 20 and the puncture needle operating device 22 to a puncturable position in a short time by the operator's hand, and quick puncturing is further possible. Here, by generating a sound without using the force sense presentation device, the operator may be notified by voice of the position where the probe holder 20 and the puncture needle operating device 22 can be punctured to the target T. Good.

  Furthermore, in the above-described embodiment, the puncture needle operating device 22 is integrated with the probe holder 20 to enable operation with three degrees of freedom. However, the present invention is not limited to this, and the puncture needle operating device 22 is connected to the probe holder 20. It is also possible to adopt a structure that is separated and can operate with a higher degree of freedom.

  Further, the target tissue specifying unit 40 and the three-dimensional position detecting unit 41 may be provided on the ultrasonic diagnostic apparatus 11 side without being provided on the puncture support robot 12 side.

  In addition, the configuration of each part of the apparatus in the present invention is not limited to the illustrated configuration example, and various modifications are possible as long as substantially the same operation is achieved.

DESCRIPTION OF SYMBOLS 10 Puncture support system 15 Probe 22 Puncture needle operating device (puncture needle operating means)
24 marker (probe position and orientation detection means)
25 3D motion measurement device (probe position and orientation detection means)
40 target tissue specifying means 41 three-dimensional position detecting means 42 operation control means G ultrasonic tomographic image H internal part N puncture needle P target tissue S skin T target

Claims (3)

Based on the ultrasonic tomographic image from the ultrasonic diagnostic apparatus that acquires an ultrasonic tomographic image of the body part under the skin in contact with the probe by contacting the probe with the skin of the patient, the probe is present in the body part. A puncture support system for puncturing a target in a target tissue,
Probe position and orientation detection means for detecting the position and orientation of the probe, and the ultrasonic wave obtained from the probe at the position and orientation to the position and orientation of the probe detected by the probe position and orientation detection means By associating tomographic images, a three-dimensional position detecting means for obtaining a three-dimensional position of a target set in the target tissue, a puncture needle operating means for operating a puncture needle for puncturing the target, Based on the three-dimensional position of the target detected by the three-dimensional position detection means, an operation control means for controlling the operation of the puncture needle operation means so that the puncture needle reaches the target ; A patient position and posture detection means for detecting the position and posture ;
In the three-dimensional position detection unit, the detection results of the probe position / posture detection unit and the patient position / posture detection unit correspond to the ultrasonic tomographic image obtained at that time, thereby obtaining the three-dimensional position of the target. puncture support system and obtaining a. A target tissue specifying means for specifying the target tissue set in advance from the ultrasonic tomographic image;
The three-dimensional position detection means obtains a three-dimensional position of each component of the target tissue specified by the target tissue specifying means from a plurality of the ultrasonic tomographic images obtained by moving the probe, The puncture support system according to claim 1, wherein a three-dimensional position of the target is obtained from a three-dimensional position of a constituent part. The puncture needle operating means is integrally attached to the probe, and is provided so that the puncture needle can operate within a range within the ultrasonic tomographic image obtained by the probe. Or the puncture assistance system of 2 description.

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