JP5779027B2 - Ultrasonic therapy device - Google Patents

Description

  The present invention relates to an ultrasonic therapy apparatus that irradiates a lesioned part to be treated and denatures it by heat, and in particular, divides a treatment area into a plurality of areas, and sets the treatment ultrasonic power according to the divided areas. The present invention relates to a variable ultrasonic therapy apparatus.

  High-intensity focused ultrasound treatment (HIFU: High Intensity Focused) in which lesions such as tumors, blood clots, and cerebral infarction are irradiated with ultrasound and the lesions are denatured (eg, cauterized or destroyed) by heat. Ultrasound) method is known. In the HIFU method, it is possible to perform treatment with low invasiveness by increasing the density of focused ultrasound power irradiated to a lesion from a treatment ultrasound probe. For example, treatment of prostate cancer or the like can be performed with less invasive treatment by placing a therapeutic ultrasound probe in the rectum. In addition, treatment such as brain tumor can be performed with low invasiveness by placing a therapeutic ultrasound probe on the outer skin of the head.

  As an example of ultrasonic therapy using such a HIFU method, the ultrasonic therapeutic apparatus disclosed in Patent Document 1 has two roles of generating continuous wave therapeutic ultrasonic waves and pulsed wave imaging ultrasonic waves. And an ultrasonic transmission unit that drives and controls the ultrasonic probe. The ultrasound transmitter includes a power source that drives the therapeutic ultrasound probe to generate focused ultrasound. Furthermore, the ultrasonic treatment apparatus includes a urethral catheter that reflects ultrasonic waves, and a magnetic resonance imaging (MRI) apparatus that monitors a treatment region by the HIFU method. On the other hand, Non-Patent Document 1 has a report examining MRI imaging parameters for a HIFU treatment area.

  In general, in the HIFU method, the treatment parameters such as the amplitude of the ultrasonic electric signal for driving the treatment ultrasound probe, the amplitude change pattern, the treatment ultrasound irradiation time, and the like are adjusted individually or in combination, and the lesion site The therapeutic ultrasonic power applied to the treatment area is controlled.

Special Table 2000-507857

Christakis Damianou, Kleanthis Ioannides, Venos Hadjisavvas, Nicos Mylonas, Andreas Couppis, and Demitris Iosif. In Vitro and In Vivo Brain Ablation Createdby High-Intensity Focused Ultrasound and Monitored by MRI. IEEE transactions on ultrasonics, ferroelectrics, and frequency control. Vol. 56, no. 6, JUNE 2009

  However, in the conventional HIFU method, the treatment ultrasonic power is set to be constant regardless of the center or the edge of the treatment area, so that the treatment ultrasonic wave applied to the edge of the treatment area There is a problem that adjacent normal tissues suffer from side effects such as damage. Conversely, even in a normal region adjacent to the periphery of the treatment region, a lesion area such as a cancer tissue may be infiltrated, so the margin region is within a certain range of the region adjacent to the periphery of the treatment region. Is set to irradiate therapeutic ultrasound including the margin area. The margin area is set, for example, to a width of about 5 mm or a margin rate (for example, 10%).

  By the way, in order to avoid the problem of invasiveness of the normal tissue adjacent to the marginal part, there is a problem that if the treatment ultrasonic power is lowered uniformly, the treatment time becomes long and the patient is burdened. Further, when performing the HIFU method, it is conceivable to adjust the therapeutic ultrasonic power applied to the treatment region for each irradiation position, but it is not practical because the burden on the operator adjusting the therapeutic ultrasonic power is large.

  The problem to be solved by the present invention is to reduce the burden on the operator by making it possible to automatically adjust the treatment ultrasonic power according to the position of the treatment region.

  The ultrasonic treatment apparatus of the present invention that solves the above-mentioned problem basically involves moving a three-dimensional treatment region set in an image including a lesion portion depicted on a monitor from the edge of the treatment region toward the center. Divide into multiple three-dimensional divided areas. And the treatment ultrasonic power irradiated for every division area is adjusted according to the distance from the edge of a treatment area. That is, the treatment area is subdivided (blocked), and the treatment ultrasonic power is automatically adjusted according to the distance from the edge for each of the subdivided blocks. Here, the treatment ultrasonic power refers to the ultrasonic energy irradiated to the treatment site determined by the treatment parameters such as the amplitude, the irradiation time, and the irradiation pattern of the treatment ultrasonic wave supplied to the treatment ultrasonic probe.

  Thereby, for example, a treatment ultrasonic power lower than that of the divided region including the center of the treatment region is irradiated onto a divided region including the edge of the treatment region (hereinafter referred to as a “edge region”). Then, a high therapeutic ultrasonic power is applied to a divided region on the center side of the treatment region (hereinafter referred to as a center region) according to the distance from the edge. Further, the therapeutic ultrasonic power lower than that of the peripheral region is irradiated to the margin region outside the peripheral edge of the therapeutic region. Thereby, it is possible to reduce the burden on the surgeon related to the adjustment of the therapeutic ultrasonic power, and to provide an ultrasonic therapeutic apparatus that is practical and easy to use. In addition, side effects such as damage to the normal tissue in the margin area can be reduced.

  The treatment area is divided in consideration of the type and size of a lesion such as a tumor, and the reference of the treatment ultrasonic power to be irradiated for each divided area is set in advance by an operator who is a user. Furthermore, according to the present invention, a sufficiently high therapeutic ultrasonic power can be applied to the central divided region excluding the edge of the treatment region, so that necessary treatment can be performed in a relatively short time. Can reduce the burden on the patient.

  Specifically, the ultrasonic treatment apparatus of the present invention includes a monitor on which an image (two-dimensional or three-dimensional image) including a treatment site of a patient imaged by a medical imaging apparatus is displayed, and a treatment site of the patient. A treatment ultrasound probe that irradiates treatment ultrasound, a treatment region dividing unit that divides a treatment region set in an image including the treatment site depicted on the monitor into a plurality of divided regions from the edge toward the center; The treatment ultrasonic power setting unit that adjusts the treatment ultrasonic power to be irradiated for each divided region according to the distance from the edge of the treatment region, and the treatment ultrasonic power setting unit that is adjusted for each divided region And a therapeutic ultrasonic power control unit that controls the therapeutic ultrasonic power irradiated from the therapeutic ultrasonic probe based on the therapeutic ultrasonic power.

  Moreover, the ultrasonic therapy apparatus of the present invention is based on a three-dimensional volume that can be treated by one irradiation of therapeutic ultrasonic power set for each divided region, and one or a plurality of three-dimensional divided regions. Develop a treatment plan that includes the position of irradiation. And the guidance image information which shows the position and direction of a treatment ultrasonic probe which irradiates a treatment ultrasonic wave to the irradiation position of a treatment plan, and an ultrasonic focusing position (irradiation position) is displayed on a monitor. In this case, as the guidance image information, image information of at least one of an arrow and a numerical value indicating the position and orientation of the therapeutic ultrasound probe and the ultrasound focusing position can be used. Further, a simulated image indicating the position and orientation of the therapeutic ultrasonic probe detected by the position detector and the ultrasonic focusing position is displayed superimposed on the image including the therapeutic part of the monitor.

  Thereby, for example, the surgeon moves the therapeutic ultrasound probe so as to match the guidance image information while observing the position and orientation of the therapeutic ultrasound probe in the simulated image displayed on the monitor and the ultrasound focusing position. Since the ultrasonic focusing position of the therapeutic ultrasonic probe can be easily adjusted to the irradiation position according to the treatment plan, an extremely convenient ultrasonic therapeutic apparatus can be provided. It should be noted that the moving operation of the therapeutic ultrasound probe can be automatically moved by a robot equipped with three orthogonal axes and a manipulator capable of moving around each axis, instead of the method used by the operator. . According to this, the irradiation position can be accurately controlled without increasing the proficiency level of the operation of moving the therapeutic ultrasound probe.

  Furthermore, the division region of the treatment region of the present invention can include a margin region set in advance in a region adjacent to the outside of the edge of the treatment region. In this case, the treatment ultrasonic power setting unit Preferably, the therapeutic ultrasonic power applied to the margin region is set lower than the therapeutic ultrasonic power applied to the marginal region.

  Further, in the guidance image information, a treatment path image (arrow) indicating the position and orientation of the treatment ultrasound probe can be displayed, or numerical information can be displayed. In addition, the treated irradiation position can be recorded in the memory. In the numerical information, the position and orientation of the therapeutic ultrasound probe, the distance to the irradiation position, and the like are displayed numerically.

  In addition, the ultrasonic therapy apparatus of the present invention can be configured to include a magnetic resonance imaging apparatus (MRI apparatus), an X-ray CT apparatus, an ultrasonic imaging apparatus, and other medical imaging apparatuses as medical imaging apparatuses. Moreover, it can comprise and comprise an ultrasonic imaging apparatus which images the patient's ultrasonic tomographic image located in the imaging space of the MRI apparatus or the X-ray CT apparatus. For example, in the case of an MRI apparatus, MR image reconstruction unit that acquires three-dimensional volume image data (for example, T1-weighted image, T2-weighted image) and reconstructs a two-dimensional and / or three-dimensional image including a treatment region. And a display control unit that displays the two-dimensional and / or three-dimensional images reconstructed by the MR image reconstruction unit on the monitor. An X-ray CT apparatus or an ultrasonic apparatus can also be configured in the same manner as the MRI apparatus.

  In addition, information on the remaining treatment area is obtained from the volume image data before and after the treatment, and the position and orientation of the therapeutic ultrasound probe for treating the remaining treatment area and the irradiation position are obtained and displayed on the monitor or the like for the operator. A re-treatment feedback function can be provided. As a result, it is possible to three-dimensionally analyze the control of treatment progress and treatment progress information to identify the remaining treatment area, and to present information on the presence or absence of additional treatment.

  According to the present invention, the treatment ultrasonic power can be automatically adjusted according to the position of the treatment region, so that the burden on the operator can be reduced.

1 is an overall configuration diagram of an embodiment of an ultrasonic therapy apparatus of the present invention. It is a whole block diagram of the ultrasonic device of embodiment of FIG. It is a detailed block diagram of the HIFU controller which is the characteristic part of embodiment of FIG. It is a figure explaining the HIFU method. It is a figure explaining the guidance image information of a therapeutic ultrasound probe. It is a figure explaining an example of the procedure which divides a treatment field into a plurality of division fields. It is a figure explaining an example of the method of dividing the treatment area of a blood vessel into a plurality of divided areas. It is a figure explaining an example of the method of performing the smoothing process of the boundary of each division area after implementing the division method of FIG. It is a figure explaining the method of setting the treatment ultrasonic power of a division area according to the distance from the center of a treatment area. It is a flowchart which shows the process sequence of the ultrasonic therapy apparatus of FIG. It is a figure which shows an example of the ultrasonic tomographic image and MR tomographic image in the ultrasonic therapy apparatus of embodiment of FIG. It is a figure which shows the example of a display of the graphical user interface (GUI) before the surgery in the ultrasonic therapy apparatus of embodiment of FIG. It is a figure which shows the example of a display of the graphical user interface (GUI) in the surgery in the ultrasonic therapy apparatus of embodiment of FIG. It is a figure which shows the example of a display of the graphical user interface (GUI) after the surgery in the ultrasonic therapy apparatus of embodiment of FIG.

  Hereinafter, an ultrasonic therapy apparatus according to an embodiment of the present invention will be described in detail with reference to the accompanying drawings. As shown in FIG. 1, the ultrasonic therapy apparatus of this embodiment includes an ultrasonic apparatus 1, an MRI apparatus 2, an operator monitor 3, and a position detection system 4. The ultrasonic device 1 incorporates a function of capturing an ultrasonic tomographic image and a function of ultrasonic therapy. The ultrasonic apparatus 1 includes an ultrasonic apparatus main body 11, an ultrasonic monitor 12, an ultrasonic probe 13, and a pointer 14 that constitutes a position detector for the ultrasonic probe 13. The ultrasonic probe 13 is formed by integrating an ultrasonic probe 13a that transmits and receives ultrasonic waves for imaging an ultrasonic tomographic image and a therapeutic ultrasonic probe 13b that irradiates therapeutic ultrasonic waves.

  The MRI apparatus 2 is, for example, a vertical magnetic field type permanent magnet MRI apparatus, and includes an upper magnet 21 and a lower magnet 22 that generate a vertical static magnetic field, a support 23 that connects these magnets and supports the upper magnet 21, a bed 24, A computer 25, an MR control unit 26, and a video recording device 27 are included. In addition, the MRI apparatus 2 includes a gradient magnetic field generation unit (not shown) that generates the oblique magnetic field in a pulsed manner, an RF transmitter (not shown) for causing magnetic resonance in the patient 50 in the static magnetic field lying on the bed 24, and An RF receiver (not shown) that receives a magnetic resonance signal from the patient 50 is provided.

  Detection information on the position and orientation of the pointer 14 detected and calculated by the infrared camera 41 is input to the computer 25 through the cable 28 as position data on the position and orientation of the ultrasonic probe 13. The computer 25 converts the position and orientation detection information of the pointer 14 to the MR image position data of the MRI apparatus 2 and transmits it to the MR control unit 26. The MR image position data is reflected in the imaging section of the imaging sequence, and the MR image acquired in the new imaging section is displayed on the surgeon monitor 3. The MR image is simultaneously recorded in the video recording device 27. Incidentally, since the pointer 14 functions as a tomographic plane indicating device, the pointer 14 can be attached to a puncture needle or the like so that the position and orientation of the puncture needle are always taken as an imaging section. In this case, a cross section always including the needle is displayed on the monitor 3. The MR control unit 26 includes a workstation and is connected to the computer 25, and controls an RF transmitter, an RF receiver, and the like (not shown) of the MRI apparatus 2.

  The video recording device 27 stores volume image data including a lesion portion related to a treatment site of the patient 50 acquired before surgery. That is, for example, volume image data obtained by shifting a plurality of slice image slices orthogonal to the body axis of the patient 50 in the body axis direction is stored. In the present embodiment, volume image data acquired by the MRI apparatus 2 is stored. However, the present invention is not limited to this, and it goes without saying that the volume image data acquired by the X-ray CT or the ultrasonic apparatus 1 may be used. Yes. The volume image data stored in the video recording device 27 is attached with coordinate data converted into a coordinate system of the reference tool 42 of the position detection system 4 or coordinate data that can be converted. The computer 25 is configured to generate a volume rendering image (hereinafter referred to as a three-dimensional image) based on the volume image data by a known volume rendering method and display the volume rendering image on the surgeon monitor 3. Yes.

  In the illustrated example, the surgeon monitor 3 includes two display screens 3a and 3b, and is rotatably supported by the upper magnet 21 of the MRI apparatus 2 via the monitor support unit 31. And the posture can be adjusted freely. The position detection system 4 includes two infrared cameras 41, a light emitting diode (not shown) that emits infrared light, and a reference tool 42. Further, the position detection system 4 is rotatably supported by the upper magnet 21 of the MRI apparatus 2 so that the posture can be freely changed via the support arm 43. The reference tool 42 includes three reflecting spheres 44 and is provided on the side surface of the upper magnet 21. Thereby, the position detection system 4 detects the position and orientation (orientation) of the pointer 14 which is a tomographic plane indicating device, and links the coordinate system of the infrared camera 41 and the coordinate system of the MRI apparatus 2.

  The ultrasonic apparatus main body 11 of the ultrasonic apparatus 1 is connected to a computer 25 that controls the MRI apparatus 2. The ultrasonic tomographic image obtained by the ultrasonic probe 13a of the ultrasonic probe 13 to which the pointer 14 is attached is not only displayed on the dedicated ultrasonic monitor 12, but also transferred to the computer 25, where image processing is performed and the operation is performed. It can be displayed on the monitor 3 for the person. That is, a tomographic image of the patient 50 imaged by the ultrasonic probe 13 a held by the operator is displayed on the ultrasonic monitor 12. The tomographic position of the tomographic image can be indicated by the pointer 14 attached to the ultrasonic probe 13a, and the tomographic image of the position and inclination detected by the pointer 14 is displayed on the operator monitor 3. The ultrasonic probe 13 is formed of a non-magnetic material such as ceramic that can be operated even in the magnetic field of the MRI apparatus 2.

  Here, the detailed configuration of the ultrasonic apparatus 1 will be described with reference to FIG. The ultrasonic apparatus main body 11 includes a HIFU controller 110, an ultrasonic transmission / reception unit 111, an ultrasonic image configuration unit 112, an ultrasonic control unit 113, and a control panel that is an interface with a user, which are characteristic units of the present embodiment. 114. The ultrasonic transmission / reception unit 111 is connected to the ultrasonic probe 13a of the ultrasonic probe 13, and the reflected echo signal received by the ultrasonic probe 13a is input to the ultrasonic image construction unit 112. Yes. The ultrasonic control unit 113 controls the ultrasonic transmission / reception unit 111, the ultrasonic image construction unit 112, and the HIFU controller 110. The control panel 114 gives an instruction to the ultrasonic control unit 113.

  With this configuration, the ultrasound apparatus main body 11 uses a reflected echo signal obtained by transmitting and receiving ultrasound from the ultrasound probe 13a into the patient 50, and performs two-dimensional or three-dimensional diagnosis on the diagnosis site. An ultrasonic image can be generated and displayed on the ultrasonic monitor 12 or the operator monitor 3. In addition, it is possible to perform treatment by irradiating the patient 50 with therapeutic ultrasonic waves from the HIFU controller 110 via the therapeutic ultrasonic probe 13b and denatured the lesioned part of the irradiated part with heat.

  In the present embodiment, an example has been described in which the ultrasound probe 13a for capturing an ultrasound tomographic image and the treatment ultrasound probe 13b for irradiating the treatment ultrasound are separately provided. However, the present invention is not limited to this, and the same vibrator can be used for imaging an ultrasonic tomographic image and for irradiation with therapeutic ultrasonic waves. In this case, the HIFU controller 110 reduces the ultrasonic power applied to the patient 50 when operating for imaging, and increases the ultrasonic power applied to the patient 50 when operated for therapeutic ultrasound. The drive signal is switched to a pulse wave or a continuous wave, and the amplitude of the ultrasonic drive signal is controlled. In the present embodiment, the ultrasound imaging apparatus and the ultrasound treatment apparatus are configured as one ultrasound apparatus, but can be configured separately.

  FIG. 3 shows a detailed configuration diagram of the HIFU controller 110. The HIFU controller 110 includes a treatment region setting unit 111, a treatment region dividing unit 112, a treatment ultrasonic power setting unit 113, a treatment plan formulation unit 114, and a treatment ultrasonic power. A control unit 115 and a therapeutic ultrasound probe guiding unit 116 are provided. The HIFU controller 110 includes a HIFU power supply unit 117, a HIFU memory 118, and a bus 119 that performs signal transmission between the units. The ultrasonic control unit 17 and the computer 25 of the MRI apparatus 2 are communicably connected to the bus 119. Although not shown, the HIFU power supply unit 117 includes a therapeutic ultrasound signal generator for irradiating therapeutic ultrasound within the patient 50, and is connected to the therapeutic ultrasound probe 13b. The HIFU controller 110 configured as described above is operated in accordance with a control command from the ultrasonic control unit 17.

  Here, with reference to FIG. 4, the outline | summary of the treatment procedure by the HIFU controller 110 is demonstrated. As shown in FIG. 4A, the focused ultrasound 131 irradiated from the therapeutic ultrasound probe 13b is focused on a target 132 which is a preset ultrasound focusing position. As shown in FIG. 4B, the three-dimensional region that is thermally denatured by one irradiation of the focused ultrasound 131 is a region having a diameter Φ of 5 to 10 mm perpendicular to the irradiation depth direction. Note that the three-dimensional region that is actually heat-denatured is not a sphere, but a rugby ball-like region having a circular cross section and a length in the irradiation depth direction. Therefore, when performing treatment with the focused ultrasound 131, as shown in FIG. 4C, the position of the target 132, which is the irradiation position of the treatment ultrasound, is sequentially moved in two dimensions and three dimensions. The focused ultrasound 131 is irradiated on the entire treatment area 133 and a margin area described later. Here, focus visualization can be performed by a well-known ARFI (Acoustic Radiation Force Impulse) (see Non-Patent Document 2). According to ARFI, since an actual affected area in a living tissue can be calculated for an ideal ablation area, a three-dimensional measurement planned area can be calculated by performing three-dimensional measurement.

Palmeri ML, Wang MH, Dahl JJ, Frinkley KD, et al. Quantifyinghepatic shear modulus in vivo using acoustic radiation force. Ultrasound inMedicine & Biology 2008; 34: 546-58.

  Next, with reference to FIG. 5, the ultrasonic treatment by the HIFU controller 110 will be described separately for the processing operations of the respective units in FIG. First, the operator applies the ultrasonic probe 13 to the outer skin of the head, for example, for treating the patient. Thus, when an ultrasonic tomographic image is captured by the ultrasonic probe 13a, the computer 25 cuts out an MR image corresponding to the ultrasonic tomographic image from the volume image data stored in the video storage device 27. As shown in FIG. 5, a navigation image 130 including three orthogonal cross-sectional images of an axial image, a sagittal image, and a coronal image is displayed on the operator monitor 3. The surgeon monitor 3 can display a three-dimensional image created by volume rendering as one of the navigation images 130.

  The treatment region setting unit 111 sets an outline by drawing an outline on the outer edge of the treatment region 133 based on the navigation image 130 including the treatment site displayed on the operator's monitor 3. Similarly, the surgeon draws and sets the outline of the warning area 134 on the navigation image 130. On the navigation image 130, a simulated image 135 indicating the position and orientation of the therapeutic ultrasound probe 13b is superimposed and displayed by the function of the therapeutic ultrasound probe guiding unit 116 described later. The simulated image 135 on the navigation image 130 includes a target 132 that is the irradiation position of the therapeutic ultrasound probe 13b.

  The treatment area dividing unit 112 divides the treatment area set in the image including the treatment site depicted on the operator monitor 3 into a plurality of divided areas from the edge toward the center, and outside the edge of the treatment area. An adjacent margin area is set.

  With reference to FIG. 6, the method of one Embodiment which divides a treatment area | region into several division area is demonstrated. For example, it is assumed that the treatment region 502 is set as a contour line automatically or by the treatment region setting unit 111 based on an MR image obtained by imaging the abdomen 501 with an MRI apparatus. In the example of FIG. 6, the treatment area 502 is divided into two parts, a center area 503 and a margin area 504, and further divided into margin areas 505 adjacent to the margin area 504. This setting is automatically set based on the treatment area 502 set by the user, or is set from the control panel 18 by a method. In the figure, the size of one area indicated by a circle of the center area 503, the edge area 504, and the margin area 505 can be set to, for example, 30 to 40 mm, but can be modified by one ultrasonic irradiation. It can also be divided on the basis of a diameter of 5 to 10 mm. According to this, the divided area is divided more finely, and a highly accurate treatment effect can be obtained accordingly.

  That is, in the embodiment of FIG. 6, the treatment region dividing unit uses the treatment region contour line set in the orthogonal three-axis cross-sectional image drawn on the surgeon monitor as the treatment region edge, and the inner region of the contour edge. The area that is filled with a reference circle with a preset diameter, and that is filled with the reference circle that touches the contour edge is the divided area of the edge part, and the area inside the divided area of the edge part is divided as the divided area of the center part. ing. In addition, a region that is filled with a reference circle that touches the outside of the outline of the treatment region is divided as a margin region. Then, the therapeutic ultrasonic power setting unit can adjust the therapeutic ultrasonic power corresponding to each divided region using the reference circle as the irradiation position of one therapeutic ultrasonic wave.

  Here, with reference to FIG. 7 and FIG. 8, other embodiment of the division method of a treatment area | region is described. The present embodiment is an example in which blood vessels are used to divide into a plurality of divided regions. As in FIG. 6, the treatment region setting unit 111 identifies the blood vessel 603 in the treatment region 602 based on an image obtained by imaging the abdomen 601 with the MRI apparatus. Then, for example, the treatment region dividing unit 112 divides and sets the treatment region 602 into a blood vessel region 605, a marginal region 606, and margin regions 607 and 608. Further, smoothing processing is performed inside to reset the blood vessel region 706, the edge region 707, and the margin region 708.

  As shown in FIG. 8, the therapeutic ultrasonic power setting unit 113 sets therapeutic ultrasonic power for each of the divided regions according to the distance from the edge of the therapeutic region. In the example of FIG. 8, the edge region 707 is set as a medium intensity region, the blood vessel region 706 is set as a high intensity region of therapeutic ultrasonic power, and the margin region 708 is set as a low intensity region. And according to the intensity of the set therapeutic ultrasonic power, the display form (for example, hue, blinking, display mark, etc.) of each divided region is made different so that the operator can easily see the difference. Can do. Furthermore, when the target 132 enters any one of the divided regions, the display form can be changed according to the intensity of the therapeutic ultrasonic power set in the region. The treatment ultrasonic power setting unit 113 increases the treatment ultrasonic power to be irradiated for each divided region according to the distance from the edge of the treatment region, and reduces and sets the margin region according to the distance from the edge. It is supposed to be.

  That is, according to the embodiment of FIG. 7 and FIG. 8, the treatment region dividing unit preliminarily contacts the blood vessel region inside the blood vessel wall of the orthogonal three-axis cross-sectional image depicted on the operator monitor and the outside of the blood vessel wall. The area is divided into the divided areas including the edge area filled with the reference circle having the set diameter. In addition, the treatment area dividing unit divides an area filled with a reference circle in contact with the outside of the edge area as a margin area. Then, the therapeutic ultrasonic power setting unit can adjust the therapeutic ultrasonic power corresponding to each divided region using the reference circle as the irradiation position of one therapeutic ultrasonic wave.

  FIG. 9 shows a setting example of therapeutic ultrasonic power of the weak intensity area 1201, the medium intensity area 1202, and the high intensity area 1203 divided into three divided areas. FIG. 9A shows an example in which the therapeutic ultrasonic power is increased and set according to the distance from the outer edge of the weak intensity area 1201 that is the margin area to the edge (outer edge of the medium intensity area 1202). FIG. 5B shows an example in which the treatment ultrasonic power is changed according to the distance from the edge (outer edge of the medium intensity region 1202) to the outer edge of the center region (high intensity region 1203). FIG. 7C shows an example in which the treatment ultrasonic power is changed according to the distance from the outer edge of the central region (high intensity region 1203) to the center of the treatment region. As can be seen from the figure, the therapeutic ultrasound power is set to the same value at the boundary between the intensity regions. The intensity pattern from the center of the therapeutic ultrasonic power in each divided region is set in advance by the user. However, the intensity pattern from the center of the therapeutic ultrasound power can be changed even during treatment.

  The treatment plan formulation unit 114 performs one or a plurality of irradiations for each divided region based on a volume that can be treated by one irradiation of the therapeutic ultrasonic power for each divided region set by the therapeutic ultrasonic power setting unit 113. The treatment plan including the position is drawn up. The treatment plan is formulated including the treatment ultrasound irradiation direction (path) and the distance to the irradiation position.

  The therapeutic ultrasonic power control unit 115 controls the therapeutic ultrasonic power irradiated from the therapeutic ultrasonic probe 13b for each divided region divided by the therapeutic region dividing unit 112 according to the setting of the therapeutic ultrasonic power setting unit 113. It has become.

  The therapeutic ultrasound probe guiding unit 116 is a guided image showing the position, orientation, and ultrasonic focusing position of the therapeutic ultrasound probe 13b that irradiates the treatment ultrasound to the irradiation position according to the treatment plan formulated by the treatment plan formulation unit 114. A navigation image 130 including information is created and displayed on the surgeon monitor 3 as shown in FIG. In addition, a simulated image indicating the position and orientation of the therapeutic ultrasound probe 13b detected by the pointer 14 and the ultrasound focusing position is created and displayed superimposed on the image including the treatment site of the operator monitor 3. Yes. That is, for example, the therapeutic ultrasound probe guiding unit 116 performs treatment by irradiating the lesioned part of the patient 50 fixed on the bed 24 with therapeutic ultrasound using the therapeutic ultrasound probe 13b. The position and orientation of the therapeutic ultrasound probe 13b are detected by the computer 25 based on the positions and orientations of the pointers 14 detected by the two infrared cameras 41 attached to the position detection system 4, and the therapeutic ultrasound probe is detected. It is transmitted to the guide unit 116. Since the pointer 14 is attached to the ultrasonic probe 13, the position and orientation of the ultrasonic tomographic image are detected. The computer 25 cuts out the MR tomographic image corresponding to the ultrasonic tomographic image input from the position detection system 4 from the volume image data and displays it on the operator monitor 3. Further, a three-dimensional image at the same position is reconstructed and displayed on the operator monitor 3. The therapeutic ultrasound probe guiding unit 116 has a function of automatically reducing the therapeutic ultrasonic power or issuing a warning when the target 132 on the navigation image 130 enters the warning area 134. The warning can be performed by changing the display form (color or blinking) of the target 132 or the warning area 134, or by a warning sound.

Next, a treatment procedure using the ultrasonic treatment apparatus of the present embodiment will be described with reference to the flowchart of FIG.
(S101)
Using the MRI apparatus 2, a plurality of two-dimensional MR tomographic images including a lesion to be treated are shifted in the body axis direction of the patient 50 to obtain volume image data and stored in the video recording apparatus 27. Further, the three-dimensional image is reconstructed and stored in the video recording device 27. This process is executed by the computer 25 of the MRI apparatus 2, but the following processes of S <b> 102 to S <b> 115 are performed by the cooperation of the computer 25 and the HIFU controller 110.
(S102)
Based on the detection signal of the position and orientation of the pointer 14 transmitted from the HIFU controller 110, the computer 25 obtains the position and orientation of the ultrasonic tomographic image captured by the ultrasonic probe 13a, and sends it to the video recording device 27. An MR tomographic image corresponding to the ultrasonic tomographic image is reconstructed from the stored three-dimensional volume image data and is displayed on the operator monitor 3. That is, the operator's monitor 3 is made to draw the navigation image 130 including the orthogonal three-section image including the treatment area and the three-dimensional image by moving the ultrasonic probe 13a. Then, the treatment region setting unit 111 sets the treatment region 133 based on the navigation image 130, automatically by image processing, or according to a designation input from the control panel 18 of the ultrasonic apparatus 1. The set treatment area is stored in the HIFU memory 118 as three-dimensional coordinate data. Next, the treatment region dividing unit 112 divides the set treatment region 133 into a plurality of divided regions according to the distance from the center. The divided areas are stored in the HIFU memory 118 for each divided area as three-dimensional coordinate data.
(S103)
Further, the treatment area dividing unit 112 sets a margin area adjacent to the outside of the edge area of the treatment area 133 and stores it in the HIFU memory 118 as three-dimensional coordinate data.
(S104)
The therapeutic ultrasonic power setting unit 113 sets the therapeutic ultrasonic power for each divided region and the therapeutic ultrasonic power for the margin region, and sets therapeutic parameters related to the therapeutic ultrasonic power as necessary. The therapeutic ultrasonic power setting unit 113 stores the therapeutic ultrasonic power set for each irradiation position in the HIFU memory 118 in association with the divided area and the margin area.
(S105)
The treatment plan formulation unit 114 formulates a treatment plan. That is, a treatment plan including each three-dimensional divided region and one or a plurality of irradiation positions in the margin region is formulated. Further, the position, orientation, and target 132 of the therapeutic ultrasound probe 13b that irradiates the therapeutic ultrasound to the irradiation position of the treatment plan are obtained for each irradiation position. The prepared treatment plan stores the position, orientation, and ultrasonic focus position of the therapeutic ultrasonic probe that irradiates the therapeutic ultrasonic wave for each irradiation position in the HIFU memory 118.
(S106)
Here, a device for monitoring the biological information of the patient 50 (eg, abnormal rise in blood pressure, heart rate, sweating, body temperature, etc. or loss of consciousness) is attached as necessary.
(S107)
The therapeutic ultrasound probe guidance unit 116 activates a surgical support guidance function such as navigation.
(S108)
Up to S107 is the preparation stage before the ultrasonic treatment (before the operation), and the operation of the ultrasonic treatment is started in S108.

(S109)
The operation is performed by the therapeutic ultrasonic probe guide 116. The therapeutic ultrasonic probe guiding unit 116 follows the change in the position and orientation of the therapeutic ultrasonic probe 13b, and displays a simulated image 135 of the therapeutic ultrasonic probe 13b and the target 132 that is the irradiation position on the navigation image 130 as a graphical user. The image is superimposed and displayed on the operator monitor 3 which is an interface (GUI).

(S110)
The treatment ultrasound probe guiding unit 116 reads the treatment plan from the HIFU memory 118, and guides the guide image information indicating the position, orientation, and irradiation position of the treatment ultrasound probe 13b that irradiates the treatment ultrasound for each irradiation position. It is displayed superimposed on the monitor 3. As the guidance image information, at least one of image information of an arrow (reference numeral 1038 in FIG. 13) indicating the position, orientation, and irradiation position of the therapeutic ultrasound probe 13b and numerical information can be used. For example, the surgeon observes the therapeutic ultrasound probe 13b and the target 132 in the simulated image 135 displayed on the surgeon monitor 3, and adjusts the treatment ultrasound to the arrow (reference numeral 1038 in FIG. 13) that is guide image information. The probe 13b is moved. Thereby, since the target 132 of the therapeutic ultrasound probe 13b can be easily aligned with the irradiation position (reference numeral 1015 in FIG. 13) according to the treatment plan, the usability can be extremely improved.
(S111)
As a result of the guidance of the treatment ultrasonic probe 13b, the navigation image 130 confirms the coincidence between the position of the target 132 of the simulated image 135 and the irradiation position of the treatment plan (reference numeral 1015 in FIG. 13). Prepare for. That is, the HIFU controller 110 identifies the position of the target 132 as the current irradiation position, and determines which area in the treatment area is to be treated.
(S112)
The therapeutic ultrasonic power control unit 115 reads out and controls the therapeutic ultrasonic power corresponding to the current irradiation position from the HIFU memory 118 of the therapeutic ultrasonic power setting unit.
(S113)
The therapeutic ultrasonic power control unit 115 controls therapeutic parameters such as the amplitude, irradiation time, and irradiation pattern of the therapeutic ultrasonic wave supplied to the therapeutic ultrasonic probe 13b, and sets the therapeutic ultrasonic power set by the therapeutic ultrasonic power setting unit 113. Control is performed so that the sonic power is output from the therapeutic ultrasound probe 13b to the irradiation position. An irradiation pattern is a temporal change pattern of an irradiation sequence of therapeutic ultrasonic power. In other words, after irradiating a high-power ultrasonic wave called a triggered pulse instantaneously and generating bubbles in the living tissue at the irradiation position, a weak ultrasonic power is applied to cause a cavitation action. It is an irradiation pattern at the time of implementing the well-known method of degenerating a lesioned part. Degeneration of the treatment area at the time of treatment is monitored by an MR image displayed on the operator monitor 3.
(S114)
The computer 25 of the MRI apparatus 2 confirms the therapeutic effect by ultrasonic therapy.
(S115)
Then, it is determined whether there is a remaining treatment area. Specifically, an MR image captured using a contrast agent before treatment and an MR image after treatment are acquired, and a difference image between these images is obtained and displayed on the surgeon monitor 3 to thereby display a treated region. Since the remaining treatment area can be visualized, it is possible to determine the treatment effect. If there is a remaining treatment area, the process returns to S109 to repeat the ultrasonic treatment additional processing.

  Here, FIG. 11 shows an example of a tomographic image when the ultrasonic apparatus 1 and the MRI apparatus 2 are alternately imaged. When the surgeon applies the ultrasonic probe 13 a to the patient 50 and picks up an ultrasonic tomographic image 136 including the treatment site, the ultrasonic tomographic image 136 is displayed on the ultrasonic monitor 12 and the operator monitor 3. That is, the computer 25 cuts out the MR tomographic image corresponding to the ultrasonic tomographic image 136 from the volume image data, and displays the MR tomographic image 137 on the operator monitor 3 as described above. Here, when the operator moves the ultrasonic probe 13a in accordance with the treatment site, the ultrasonic tomographic image 136 and the MR tomographic image 137 follow this, and the ultrasonic monitor 12 and the operator monitor. 3 display image changes.

  In this way, as shown in FIG. 11, it is possible to obtain the ultrasonic tomographic image 136 by the ultrasonic probe 13a and the MR tomographic image 137 at the same position as the ultrasonic tomographic image 13a. Information can be acquired. As one application of the high-speed imaging sequence of the MRI apparatus 2, a real-time dynamic imaging method called fluoroscopy (fluoroscopic imaging) is being clinically applied. In fluoroscopy, by repeating imaging and image reconstruction with a period of about 1 second or less, it can be used to extract the dynamics of internal tissues and to grasp the position of an instrument inserted from the outside like a fluoroscopic imaging. A dynamic image can be generated and displayed. This application is also applied to three-dimensional high-speed imaging.

  Below, with reference to FIGS. 12-14, an example of embodiment of the graphical user interface (GUI) before the operation by ultrasonic therapy, during an operation, and an after operation is demonstrated. FIG. 12 is an example of a GUI screen 900 displayed on the operator monitor 3 (3a, 3b) during simulation before surgery. The GUI screen 900 includes a navigation image 900a, a treatment plan information screen 900b, and various operation button screens.

  When the 3D imaging button 901 of the MRI apparatus 2 on the GUI screen 900 is pressed, the computer 25 is activated, and the Axial cross-sectional image 910, Sagittal cross-sectional image 911, and Coronal of MR images corresponding to the ultrasonic tomographic image indicated by the pointer 14 are operated. The cross-sectional image 912 and the three-dimensional image 913 are reconstructed and displayed on the navigation image 900a. In addition, when the treatment area drawing button 902 on the GUI screen 900 is pressed, the treatment area setting unit 111 and the treatment area dividing unit 112 of the HIFU controller 110 operate. The treatment area setting unit 111 sets a treatment area according to a command input from a tool such as a mouse on the control panel 18 or automatically. Thereby, the treatment area 921 is displayed on the treatment plan information screen 900b. Next, the treatment region dividing unit 112 is activated to divide the set treatment region 921 into a plurality of divided regions (segmentation), and the treatment plan information screen 900b is divided into two divided regions 922 and 923 and a margin. An area 924 is displayed. Here, the divided area 922 is a central divided area, and the divided area 923 is an edge divided area. The boundaries between the divided areas 922 and 923 and the margin area are displayed by outlines. In this case, as described with reference to FIG. 8, the divided areas 922 and 923 and the margin area can be displayed in different display forms by color-coded display or the like.

  The treatment plan information screen 900b includes, as treatment information, for example, the difference between the tumor region and the treatment region (distance in all axial directions), the treatment elapsed time and the remaining treatment time, the diameter / radius of the lesion / treatment region, and the treatment interval. Time, alarm, and other treatment information is displayed. Furthermore, during the actual operation, the progress of the operation can be displayed, and in addition to the treatment progress / biological information on the treatment plan information screen 900b, the difference between the tumor region and the treatment region can also be displayed in real time as log information. .

  By pressing the treatment ultrasonic power input button 903, the treatment ultrasonic power for each of the regions 922, 923, and 924 related to the treatment region 921 can be input and set.

  When the HIFU treatment plan (probe position calculation) button 904 is pressed, the treatment plan formulation unit 114 operates to formulate a treatment plan as described above. The formulated treatment plan is displayed on the treatment plan information screen 900b. The contents of the treatment plan information screen 900b can be browsed various information from different viewpoints / angles. Immediately before the treatment, when the HIFU treatment plan button 904 is pressed, the treatment ultrasonic probe guiding unit 116 is activated, and the target 132, the simulated image 135 of the treatment ultrasonic probe 13b, and the irradiation path 136 are navigation images on the GUI screen 900. It is drawn at 900a. The position and orientation of the treatment ultrasound probe 13b in the simulated image 135 and the irradiation path 136 are corrected according to the treatment ultrasound power, and the result is displayed on the navigation image 900a. The result is stored in the HIFU memory. 118. That is, because the irradiation path 136 is refracted according to the therapeutic ultrasonic power, it is corrected accordingly.

  Further, by pressing the contraindication information button 905 in the operation button screen area of the GUI screen 900 and inputting patient-specific information such as an arrhythmia and an artificial heart, for example, the operation start button 906 is pressed to perform surgery (treatment). It will start. As a result, devices such as the therapeutic ultrasonic probe 13b necessary for the treatment, the surgical support functions such as the therapeutic ultrasonic power control unit 115, and the therapeutic ultrasonic probe guiding unit 116 operate in conjunction with each other.

  FIG. 13 shows an example of a GUI screen 1000 during surgery. The left side is a treatment state image 1000a using an ultrasound image, and the right side is a navigation image 1000b using an MR image. The operation button screen during the operation includes an ISC button 1001, a biological information button 1002, a navigation button 1003, an ARFI (planned treatment area) 1004, an area (range) information button 1005, a warning information button 1006, a treatment start button 1007, and image information. A button 1008, a log button 1009, and an evaluation / analysis button 1010 are provided. The treatment is performed by image guidance by pressing the biological information button 1002 and the navigation button 1003. When the biometric information button 1002 is pressed, detailed information on patient information and surgery information is displayed in the biometric information image 1025 of the treatment state image 1000a. The treatment is performed according to the formulated treatment plan, and is performed while correcting the guide image information 1038 of the planned irradiation path indicated by the arrow formulated as necessary.

  In the treatment state image 1000a, a pre-treatment image 1011, a treatment-in-progress (real time) image 1013, and a post-treatment (real-time) image 1017 are displayed. Although not shown, various treatment parameters such as the depth and frequency of the treatment ultrasound irradiation position can be understood. Further, the pre-treatment image 1011 shows the treatment planned area 1012, the treatment-in-progress image 1013 shows the ultrasonic irradiation path 1014, the irradiation position 1015, and the treatment influence spread area 1016, and the post-treatment image 1017 shows the treatment-treated areas 1018 and 1019. It is like that. The treatment scheduled area 1012 is displayed including a margin area calculated in advance.

  Note that by pressing the ARFI button 1004 immediately before treatment, the ultrasonic irradiation width 1014 and the planned irradiation position 1015 are drawn in advance according to the treatment plan. In addition, an influence spread area 1016 that may affect the surrounding tissue of the planned irradiation position 1015 can be displayed. This depicts a range that indirectly affects the living body, and alerts the influence spreading area 1016 not to reach the normal tissue as much as possible. Various warning information can also be displayed on the post-treatment image 1017 by pressing the area information button 1005. For example, a previously treated area 1018 that has been treated in the past is displayed in a superimposed manner, and if the area exceeds the scheduled treatment area 1012 or if an abnormality occurs in the patient, an area information button 1005 having a function for issuing a warning is automatically displayed. It also has a function to turn on / off.

  On the other hand, orthogonal three-axis cross-sectional images 1031 to 1033 of the MRI image are displayed in the navigation image 1000b. A simulated image 135 indicating the position of the therapeutic ultrasound probe 13b can be superimposed and displayed on these orthogonal three-axis cross-sectional images 1031 to 1033. Furthermore, the target 132 corresponding to the therapeutic ultrasound probe 13b can be displayed. The GUI screen 1000 can also change the treatment state image 1000a and the navigation image 1000b. The treatment region 1012 including the margin region, the target 132, and the influence spreading region 1016 can also be superimposed on the orthogonal three-axis cross-sectional images 1031 to 1033, and the irradiation position and irradiation route according to the simulated image 135 of the real space and the treatment plan. The surgery is performed using the guide image information 1038 indicating the above. The therapeutic ultrasonic power can be changed as appropriate by depressing the therapeutic ultrasonic power input button 903. The guidance image information 1038 can also display a list of each divided region or each irradiation position according to the treatment plan by numerical information. In conjunction with the treatment start button 1007, an image information button 1008, a log button 1009, and a treatment evaluation / analysis button 1010 can be turned on. Of course, these operation buttons can be manually turned on / off as required.

  When the image information button 1008 and the evaluation / analysis button 1010 are turned on (pressed), it is possible to display pre-treatment and pre-treatment information and differential images before and after treatment. Thereby, the progress of treatment and the presence or absence of residual treatment are displayed as image information. In addition, when the log button 1009 is turned on, log information on the progress of treatment performed in the past can be displayed, whereby the content of treatment progress can be reviewed.

  In addition, treatment progress images are displayed on the orthogonal three-axis cross-sectional images 1031 to 1033, and the treated region and the remaining treatment region are superimposed on the treatment region 1012 and the like on the navigation image 130. The treatment area immediately before (recently) is displayed in a superimposed manner. As an additional function of the treatment plan information screen 920, there is also a function of calculating a treatment path for the remaining treatment area, and guidance image information 1038 related to an irradiation route to the remaining treatment area can be automatically calculated. Further, when treatment is performed in the imaging space of the MRI apparatus, an MR tomographic image in the same cross section as the ultrasonic tomographic image can be captured by pressing the ISC button 1001, and can be displayed on a separate screen. . On the MR image, a treatment region, a margin region, and a treatment planned region (irradiation region) by ARFI are displayed in the same manner, and images having different tissue contrasts are displayed. An advantage of the MR tomographic image is that it can be imaged to the deep part of the patient's body. Thus, the surgeon can visually observe the previous treatment state image 1000a, move the treatment ultrasonic probe 13b, and perform additional treatment. Information before and after treatment can display ultrasonic images 1011 and 1017, orthogonal three-axis cross-sectional images 1031 to 1033, and a three-dimensional image 1034. In addition to these images, surgery information 1025 can also be displayed.

  FIG. 14 shows an example of a GUI screen 1100 after surgery. The left side is a navigation image 1100a based on MR images, and the right side is a treatment evaluation / analysis image 1100b based on MR images. By pressing the MRI 3D imaging button 1101 on the operation button screen during surgery, an Axial cross-sectional image 1111, a sagittal cross-sectional image 1112, a coronal cross-sectional image 1113, and a three-dimensional image 1114 are reconstructed and displayed. Further, when the contrast agent button 1102 is pressed, a navigation image 1100a and a treatment evaluation / analysis image 1100b are displayed as a contrast MR image and a treatment region 1012 calculated in advance and a treated region 1015 actually treated are displayed. In the treatment evaluation / analysis image 1100b, an enlarged pre-MRI contrast image 1121, an enlarged post-MRI contrast image 1123, a difference image 1127, and a patient information / surgical information image 1129 are displayed. As is well known, the three-dimensional image 1114 can be arbitrarily rotated and displayed, and can be easily viewed by erasing (or making transparent) the surrounding tissue. Further, by pressing a patient information button 1103, patient information before and after treatment can be displayed.

  On the other hand, by pressing the surgery information button 1104, log information such as the past number of treatments, time, ratio, schedule of remaining number of treatments, and the like can be displayed. In the pre-MRI contrast image 1121, the irradiation region 1122 is depicted with a high signal, and the treatment region 1012 and the irradiation position 1015 by HIFU are depicted from the post-MRI contrast image 1123, respectively.

  Further, when a difference (residual treatment region rendering) button 1105 is pressed, a difference region 1128 between the treatment region 1012 and the irradiation position 1015 is calculated, and a difference image 1127 is displayed. The surgeon determines whether to perform retreatment from the difference image 1127 and the operation information image 1129, and presses the retreatment plan button 1106 when it is determined that it is necessary. At that time, on the Axial cross-sectional image 1111, the Sagittal cross-sectional image 1112, the Coronal cross-sectional image 1113, and the three-dimensional image 1114, the difference region 1128 is displayed as an additional treatment region instead of the treatment region 1012, and treatment ultrasound for additional treatment The position and orientation of the probe 13b and the irradiation path are automatically calculated and depicted on the navigation image 1000b of the GUI screen 1000. Also in this case, the guidance image information 1038 indicating the irradiation route shown in FIG. 13 is corrected according to the treatment ultrasonic power, and the result is displayed on the navigation image 1000b. If there is no problem, the additional treatment 1107 is started. If additional treatment is not performed in consideration of various conditions even if there is a remaining treatment area, the end button 1108 is pressed to end treatment.

  DESCRIPTION OF SYMBOLS 1 ... Ultrasonic device, 2 ... MRI apparatus, 3, 3a, 3b ... Operator monitor, 4 ... Position detection system, 11 ... Ultrasonic device main body, 12 ... Ultrasonic monitor, 13 ... Ultrasonic probe, 13a ... Ultrasonic Probe, 13b ... therapeutic ultrasonic probe, 14 ... pointer, 15 ... ultrasonic transmission / reception unit, 16 ... ultrasonic image construction unit, 17 ... ultrasonic control unit, 18 ... control panel, 110 ... HIFU controller, 25 ... computer 42 ... Reference tool, 26 ... MR control unit, 27 ... Video recording device, 50 ... Patient

Claims (13)

A monitor on which an image including a treatment site of a patient imaged by a medical imaging device is displayed;
A therapeutic ultrasound probe that irradiates the treatment site of the patient with therapeutic ultrasound; and
A treatment region dividing unit that divides a treatment region set in an image including the treatment site depicted on the monitor into a plurality of divided regions from the edge toward the center;
A treatment ultrasound power setting unit for adjusting treatment ultrasound power to be irradiated for each of the divided regions according to a distance from the edge of the treatment region;
A therapeutic ultrasonic power control unit that controls the therapeutic ultrasonic power irradiated from the therapeutic ultrasonic probe based on the therapeutic ultrasonic power adjusted by the therapeutic ultrasonic power setting unit for each divided region; An ultrasonic therapy device.   The ultrasonic therapy apparatus according to claim 1, wherein the therapeutic ultrasonic power setting unit sets the ultrasonic power of the divided region in accordance with a distance from the edge. A position detector mounted on the therapeutic ultrasound probe for detecting the position and orientation of the therapeutic ultrasound probe relative to the patient;
A treatment plan including one or a plurality of irradiation positions for each divided region based on a region that can be treated by one irradiation of the therapeutic ultrasonic power set for each divided region by the therapeutic ultrasonic power setting unit A treatment planning department that formulates
Treatment that displays on the monitor guided image information indicating the position, orientation, and ultrasound focusing position of the treatment ultrasound probe that irradiates the treatment ultrasound to the irradiation position of the treatment plan formulated by the treatment plan formulation unit An ultrasonic probe guide,
The ultrasonic therapeutic apparatus according to claim 1, wherein the therapeutic ultrasonic power control unit controls the therapeutic ultrasonic power irradiated from the therapeutic ultrasonic probe for each irradiation position. The divided region includes a margin region set in advance in a region adjacent to the outside of the edge of the treatment region,
The said therapeutic ultrasonic power setting part sets the said therapeutic ultrasonic power irradiated to the said margin area | region lower than the said therapeutic ultrasonic power irradiated to the said division | segmentation area | region of the edge. The ultrasonic therapy apparatus according to any one of the above. The therapeutic ultrasonic probe guide unit displays a simulated image indicating the position, orientation, and ultrasonic focusing position of the therapeutic ultrasonic probe detected by the position detector, overlaid on an image including the therapeutic part of the monitor. The ultrasonic therapy apparatus according to claim 3 . The induction image information of the therapeutic ultrasound probe derived unit, in claim 3, wherein the treatment position of the ultrasonic probe, at least one of image information of arrows and numbers indicating the direction and the ultrasound focusing position The ultrasonic therapy apparatus as described. The ultrasonic therapy apparatus according to claim 4 , wherein a boundary between the divided region and the margin region is displayed by a contour line. The ultrasonic therapy apparatus according to claim 4, wherein the divided area and the margin area are displayed so as to be distinguishable in different display forms. The treatment area dividing unit uses the outline of the treatment area set in the orthogonal three-axis cross-sectional image depicted on the monitor as the edge of the treatment area, and sets the inner area of the outline to a predetermined diameter. A region filled with a reference circle and filled with the reference circle in contact with the contour line is set as a divided region at the edge, and a region inside the divided region at the edge is set as a divided region at the center. The ultrasonic therapy apparatus according to claim 4 .   The ultrasonic treatment apparatus according to claim 9, wherein the treatment region dividing unit divides a region filled with the reference circle in contact with an outside of the contour line of the treatment region as the margin region. The treatment region dividing unit includes a blood vessel region inside the blood vessel wall of the orthogonal three-axis cross-sectional image depicted on the monitor, and a marginal region filled with a reference circle having a preset diameter in contact with the outside of the blood vessel wall The ultrasonic treatment apparatus according to claim 4 , wherein the ultrasonic treatment apparatus is divided into the divided regions including:
  The ultrasonic treatment apparatus according to claim 11, wherein the treatment region dividing unit divides a region filled with the reference circle that is in contact with an outer side of the edge region as the margin region. The said treatment ultrasonic power setting part adjusts the treatment ultrasonic power according to each said division | segmentation area by making the said reference | standard circle into the irradiation position of one treatment ultrasonic wave. Ultrasonic therapy device.

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