JP5889095B2 - Puncture planning support apparatus, medical image apparatus, and ultrasonic diagnostic apparatus - Google Patents

Description

  The present invention relates to a puncture plan support apparatus, a medical image apparatus, and an ultrasonic diagnostic apparatus that assist an operator who inserts a puncture needle into a subject.

  A puncture needle may be inserted into a subject in order to collect biological tissue (biopsy) or perform radio-frequency ablation (RFA). When inserting the puncture needle, it is necessary not to damage a blood vessel or the like. In addition, if there is a bone on the insertion path, the insertion will be hindered. Therefore, before the puncture is performed, the puncture route of the puncture needle is determined avoiding the blood vessels and bones. For example, Patent Document 1 describes performing a planning echo for determining a puncture path of a puncture needle while viewing a real time ultrasonic image.

JP 2011-229837 A

  However, the insertion route determination and puncture may be performed on different days. In this case, for those who are not familiar with puncturing, in order to insert the puncture needle into the insertion path determined by the planning echo, ultrasonic waves at which position and at any angle with respect to the surface of the subject are used. In some cases, it may be difficult to grasp whether the probe should be contacted.

  The invention made in order to solve the above-mentioned problems is based on the ultrasonic wave on the body surface of the subject when the puncture needle is inserted based on a predetermined insertion path of the puncture needle into the subject. A puncture plan support apparatus comprising a probe arrangement image setting unit for displaying a probe arrangement image indicating a recommended arrangement of probes.

  According to the above aspect of the invention, since the probe arrangement image is displayed, it is possible to easily grasp at what position and at what angle the ultrasonic probe should be brought into contact with the surface of the subject. .

It is a figure which shows the puncture plan assistance apparatus, medical imaging device, and ultrasonic diagnostic apparatus of 1st embodiment of this invention. It is a block diagram which shows the structure of the puncture plan assistance apparatus shown in FIG. It is a block diagram which shows the structure of the ultrasonic diagnosing device shown in FIG. It is a figure which shows the ultrasonic probe with which the 1st magnetic sensor was attached by the puncture guide jig | tool. It is a block diagram which shows the structure of the display control part in the ultrasonic diagnosing device shown in FIG. It is a flowchart which shows the process of a treatment plan. It is a figure which shows the display part on which the MRI image in which the outline of the tumor was marked was displayed. It is a flowchart which shows the process of determination of a needle point position. It is a figure which shows the display part with which the cautery range and the three-dimensional MRI image were displayed. It is a figure which shows the display part of the state in which the cautery range was overlaid on the three-dimensional tumor image. It is a figure which shows the state by which the tumor image was covered by the several ablation range. It is explanatory drawing of the setting of an insertion plan path | route. It is a figure which shows the determined planned insertion path | route. It is a figure which shows the display part on which the probe arrangement | positioning image was displayed. It is explanatory drawing of the setting of a probe arrangement | positioning image. It is a flowchart which shows the process in the case of inserting the said puncture needle into a subject and performing cauterization. It is a figure which shows the display part on which the ultrasonic image and the MRI image were displayed side by side. It is a figure which shows the display part on which the positional relationship image was displayed. It is a figure which shows the display part on which the positional relationship image was displayed. It is a figure which shows the display part on which the locus | trajectory image which shows the locus | trajectory of a puncture needle was displayed. It is a figure which shows the display part on which the locus | trajectory image which shows the locus | trajectory of a puncture needle was displayed. It is a figure which shows the puncture plan assistance apparatus, medical image apparatus, and ultrasonic diagnostic apparatus of 2nd embodiment of this invention. It is a block diagram which shows the structure of the control part in the ultrasonic diagnosing device of 2nd embodiment. In 2nd embodiment, it is a flowchart which shows the process in the case of inserting the said puncture needle into a subject and performing cauterization. It is a figure which shows the other examples of a puncture plan assistance apparatus, a medical imaging device, and an ultrasound diagnosing device.

Hereinafter, embodiments of the present invention will be described.
(First embodiment)
First, a first embodiment will be described with reference to FIGS. As shown in FIG. 1, the puncture plan support apparatus 100 of this example receives the medical image data of the subject acquired by the medical image apparatus 200, and performs a puncture plan based on this medical image data. The medical image apparatus 200 is, for example, an MRI (Magnetic Resonance Imaging) apparatus or an X-ray CT (Computed Tomography) apparatus. Then, based on the puncture plan performed by the puncture plan support apparatus 100, the ultrasound diagnostic apparatus 300 displays an ultrasound image of the subject and performs puncture. In this example, a case where ablation treatment for a tumor is performed by irradiating a radio wave from a puncture needle 42 (see FIG. 3 or the like) described later will be described as an example.

  The puncture plan support apparatus 100 is, for example, a workstation, and may be a general-purpose personal computer. The puncture plan support apparatus 100 includes a control unit 1, a storage unit 2, an input unit 3, and a display unit 4, as shown in FIG.

  The control unit 1 includes an extraction unit 11, an ablation range setting unit 12, a planned insertion path setting unit 13, and a probe arrangement image setting unit 14. The extraction unit 11 extracts a tumor in the medical image data. This tumor is an ablation target by the puncture needle 42. Details will be described later.

  The ablation range setting unit 12 sets an ablation range R by the puncture needle 42. The planned insertion path setting unit 13 sets the planned insertion path W of the puncture needle 42 in the medical image displayed on the display unit 4 based on the medical image data. The probe arrangement image setting unit 14 causes the display unit 4 to display a probe arrangement image P indicating a recommended arrangement of ultrasonic probes on the body surface of the subject. Details of each will be described later. The ablation range setting unit 12 is an example of an embodiment of the ablation range setting unit in the present invention. The planned insertion path setting unit 13 is an example of an embodiment of a planned insertion path setting unit according to the present invention. The probe arrangement image setting unit 14 is an example of an embodiment of a probe arrangement image setting unit in the present invention.

  Incidentally, the probe arrangement image P is an image showing an ultrasonic probe, a puncture guide jig, a puncture needle, and a magnetic sensor (see FIG. 14). The position of the magnetic sensor in the probe arrangement image P (position in the coordinate system of medical image data) is stored in the storage unit 2.

  The storage unit 2 is an HDD (Hard Disk Drive), a memory, or the like. The input unit 3 includes a keyboard and a mouse. The display unit 4 is an LCD (Liquid Crystal Display), a CRT (Cathode Ray Tube), or the like.

  Next, the ultrasonic diagnostic apparatus 300 will be described with reference to FIG. The ultrasonic diagnostic apparatus 300 includes an ultrasonic probe 31, a transmission / reception unit 32, an echo data processing unit 33, a display control unit 34, a display unit 35, an operation unit 36, a control unit 37, and a storage unit 38.

  The ultrasonic probe 31 includes a plurality of ultrasonic transducers (not shown) arranged in an array. The ultrasonic transducer 31 transmits ultrasonic waves to the subject, and an echo signal thereof. Receive. The ultrasonic probe 31 is an example of an embodiment of an ultrasonic probe in the present invention.

  The ultrasonic probe 31 is provided with a first magnetic sensor 39 composed of, for example, a Hall element. The first magnetic sensor 39 detects the magnetism generated from the magnetism generating unit 40 constituted by, for example, a magnetism generating coil. A detection signal in the first magnetic sensor 39 is input to the display control unit 34. The detection signal in the first magnetic sensor 39 may be input to the display control unit 34 via a cable (not shown), or may be input to the display control unit 34 wirelessly. The first magnetic sensor 39 and the magnetism generator 40 are for detecting the position and inclination of the ultrasonic probe 31 (arrangement of the ultrasonic probe 31) as will be described later.

  The first magnetic sensor 39 is attached to a puncture guide jig 41 attached to the ultrasonic probe 31. As shown in FIG. 4, two first magnetic sensors 39 are attached in this example.

  A puncture needle 42 (not shown in FIG. 4) is attached to the puncture needle guide jig 41. Therefore, the puncture needle 42 is attached to the ultrasonic probe 31 via the puncture guide jig 41.

  The puncture needle 42 is provided with a second magnetic sensor 43 that detects magnetism generated from the magnetism generator 40. The second magnetic sensor 43 is provided, for example, in the hollow portion of the distal end portion of the puncture needle 42 formed in a cylindrical shape. The magnetism generator 40 and the second magnetic sensor 43 are for detecting the position of the distal end portion of the puncture needle 42 provided with the second magnetic sensor 43.

  The transmission / reception unit 32 supplies an electrical signal for transmitting ultrasonic waves from the ultrasonic probe 31 under a predetermined scanning condition to the ultrasonic probe 31 based on a control signal from the control unit 37. The transmission / reception unit 32 performs signal processing such as A / D conversion and phasing addition processing on the echo signal received by the ultrasonic probe 31, and sends the echo data after the signal processing to the echo data processing unit 33. Output.

  The echo data processing unit 33 performs processing for creating an ultrasound image on the echo data output from the transmission / reception unit 32. For example, the echo data processing unit 33 performs B mode processing including logarithmic compression processing, envelope detection processing, and the like to create B mode data.

  As shown in FIG. 5, the display control unit 34 includes an arrangement calculation unit 341, a distance calculation unit 342, and a display image control unit 343. Based on the magnetic detection signal from the first magnetic sensor 39, the arrangement calculation unit 341 is configured to obtain information on the position and inclination of the ultrasonic probe 31 in the three-dimensional space with the magnetic generation unit 40 as the origin (hereinafter, “ "Probe arrangement information"). Furthermore, the arrangement calculation unit 341 calculates position information of the echo data in the three-dimensional space based on the probe arrangement information.

  Further, the arrangement calculation unit 341 calculates position information of the distal end portion of the puncture needle 42 in the three-dimensional space based on the magnetic detection signal from the second magnetic sensor 43. The position of the distal end portion of the puncture needle 42 is detected by the second magnetic sensor 43, the magnetism generator 40, and the arrangement calculator 341.

  The distance calculation unit 342 calculates a distance Dd between the position of the first magnetic sensor 39 attached to the ultrasonic probe 31 in the three-dimensional space and the position of the magnetic sensor in the probe arrangement image P. In addition, the distance calculation unit 342 calculates a distance Ddd between the position of the second magnetic sensor 43 and the needle tip NT of the puncture needle set in the treatment plan described later. Details will be described later.

  The display image control unit 343 scan-converts the B-mode data into B-mode image data using a scan converter (Scan Converter). Then, the display image control unit 343 causes the display unit 35 to display a B mode image based on the B mode image data. Further, the display image control unit 343 displays an MRI image together with the B mode image.

  In addition, the display image control unit 343 displays a positional relationship image X (FIG. 18, FIG. 18) indicating the positional relationship between the position of the ultrasonic probe 31 and the probe arrangement image P when displaying a real-time ultrasonic image. 19) is displayed on the display unit 35. The display image control unit 343 is an example of an embodiment of a positional relationship image display control unit in the present invention.

  Further, the display image control unit 343 displays a trajectory image T (FIGS. 20 and 21) indicating the trajectory of the puncture needle 42 inserted into the subject.

  The display unit 35 includes an LCD (Liquid Crystal Display), a CRT (Cathode Ray Tube), or the like. The operation unit 36 includes a keyboard and a pointing device (not shown) for an operator to input instructions and information.

  The control unit 37 includes a CPU (CentRal Processing Unit). The control unit 37 reads the control program stored in the storage unit 38 and executes functions in each unit of the ultrasonic diagnostic apparatus 1.

  Now, the operation of this example will be described. Here, the action when the tumor is cauterized by radiating radio waves from the puncture needle 42 will be described. First, a treatment plan for ablation treatment is made by the puncture plan support apparatus 100. This will be specifically described based on the flowchart of FIG.

  First, in step S1, volume data (volume data) of an MRI image or an X-ray CT image acquired in advance by the medical imaging apparatus 200 for a subject to be treated is stored in the storage unit 2 of the puncture plan support apparatus 100. Remember. Here, the volume data of the MRI image is stored in the storage unit 2. The volume data of the MRI image includes T1-weighted image, T2-weighted image, contrast image data, and the like.

Next, in step S2, a tumor is extracted from the MRI image stored in the storage unit 2. Specifically, as shown in FIG. 7, in the two-dimensional MRI image MG _2D displayed on the display unit 4, the operator traces the outline of the tumor using the mouse or the like of the input unit 3 and marks the marking M. Set. The operator performs marking on the MRI image having a plurality of cross sections for each of two directions orthogonal to each other.

  Next, in step S3, the extraction unit 11 performs an interpolation operation based on the marking on the plurality of cross sections by the operator, and extracts the three-dimensional shape of the tumor. Further, the extraction unit 11 displays the extracted tumor on the display unit 4.

  Next, in step S4, when the operator wants to change the three-dimensional shape of the displayed tumor, the operator performs non-approval input in the input unit 3 ("NO" in step S4). When non-approval is input in step S4, the process returns to step S2 to perform marking again, and the tumor is extracted in step S3.

  On the other hand, when there is no problem with the displayed three-dimensional shape of the tumor, the operator inputs approval in the input unit 3 (“YES” in step S4).

  Incidentally, when there are a plurality of tumors to be ablated, the processes of steps S2 to S4 are performed for all of them.

  When approval is input in step S4, in step S5, the planned insertion path of the puncture needle 42 and the position of the needle tip when cauterization is performed are determined. Determination of the planned insertion path and the needle tip position in step S5 will be described based on the flowchart of FIG. First, in step S51, the operator inputs the type of the puncture needle 42, the ablation temperature, and the ablation time at the input unit 3. The input type, ablation temperature, and ablation time of the puncture needle 42 are stored in the storage unit 2.

  Next, in step S52, the ablation range setting unit 12 calculates the ablation range R by calculating the size of the ablation range based on the type of the puncture needle, the ablation temperature, and the ablation time input in step S51. It is displayed on the display unit 4. As shown in FIG. 9, the cautery range R is displayed in three dimensions, specifically, in a spherical shape. The cautery range setting unit 12 causes the cautery range R to be displayed at a predetermined position on the display unit 4. Thus, the ablation range R is automatically displayed, which is convenient for the operator.

Incidentally, in FIG. 9, a symbol MG _3D is a three-dimensional MRI image based on the volume data of the MRI image, and a symbol C is a three-dimensional image of the tumor extracted by the extraction unit 11 in the three-dimensional MRI image MG _3D (hereinafter referred to as “three-dimensional MRI image”). "Tumor image"). In FIG. 9, the three-dimensional MRI image MG _3D is simplified and shown as a cube.

  When the ablation range R is displayed in step S52, the operator superimposes the ablation range R on the tumor image C using the input unit 3 in step S53 as shown in FIG. The operator sets the ablation range R so that the ablation range R includes the tumor image C. More specifically, the operator sets the ablation range R so that the tumor image C has a safety margin. The set ablation range R may be stored in the storage unit 2 together with position information in the coordinate system of the MRI image.

  In step S53, the size of the ablation range R may be adjusted by changing the type of the puncture needle 42, the ablation temperature, and the ablation time so that the ablation range R includes the tumor image C. Further, as shown in FIG. 11, a plurality of ablation ranges R may be displayed so that the ablation range R includes the tumor image C, and the tumor image C may be covered by the plurality of ablation ranges R (FIG. 11). In two dimensions. When a plurality of ablation ranges R are displayed, numbers (“1” to “4” in the figure) may be set for each ablation range R as shown in FIG. This number may be stored in association with the cautery range R.

Incidentally, in FIG. 11, only the tumor image C and the ablation range R are shown, and the three-dimensional MRI image MG _3D is not shown.

  The ablation range setting unit 12 may notify that when one or more ablation ranges R include a tumor image C (or a range obtained by adding a safety margin to the tumor image C). Good. For example, the ablation range setting unit 12 changes the color of the outline of the ablation range R depending on whether the ablation range R includes the tumor image C or not. You may alert | report that it contains.

  If there are a plurality of tumors to be ablated, in step S53, the set ablation range R may be given an identification mark such as letters such as letters or numbers.

  When the cautery range R is set in step S53, the planned insertion path W is set in step S54. This planned insertion path W is a target path for inserting the puncture needle 42 into the subject.

  The setting of the planned insertion path W will be specifically described with reference to FIGS. Incidentally, in FIG. 12 and FIG. 13, for convenience of explanation, a two-dimensional image is shown, but the planned insertion path may be set in a three-dimensional image.

  The insertion planned route setting unit 13 receives, for example, an identification mark (number, alphabet, etc.) of a specific ablation range R set to a specific tumor image C (not shown in FIGS. 12 and 13) in the MRI image MG. Then, a line l connecting the cautery range R and the pointer Pt displayed on the display unit 4 is displayed. A line l connects the center O (not shown) of the circle (or sphere) of the ablation range R and the tip of the pointer Pt, and further, the line I of the ablation range R is opposite to the pointer Pt. It is a line segment drawn to the part that intersects the contour. A portion where the contour of the ablation range R and the line 1 intersect on the opposite side of the pointer Pt with respect to the center O is a needle tip position NT (see FIG. 13) of the puncture needle 42 at the time of ablation.

  The planned puncture setting unit 13 displays the line l in a different color according to the distance between the line l and the vascular and bone that should be avoided to puncture the puncture needle 42. The planned insertion path setting unit 13 calculates distances between the vessels and bones specified in the volume data of the MRI image and a plurality of locations on the line l, and the line l in a color corresponding to the smallest distance. Is displayed. For example, the planned insertion path setting unit 13 displays the line l in red when the line l intersects a vessel or bone. Further, when the distance D between the line l and the blood vessel or bone is 0 <D ≦ d1, the planned insertion path setting unit 13 displays the line l in yellow and D> d1 The line l is displayed in green. d1 is set to a distance at which the puncture needle 42 can be safely inserted in relation to a blood vessel or a bone.

  The operator moves the pointer Pt, searches for a place where the line l is displayed in green, and performs an input for determining the planned insertion path W. Thereby, the puncture planned path W is easily set avoiding the blood vessel and the bone. When the planned insertion path W is determined, the position of the needle tip of the puncture needle 42 at the time of cauterization is determined. For example, when the planned insertion path W is determined to be the line l shown in FIG. 13, the needle tip is determined at the position of the symbol NT. The position information in the coordinate system of the determined MRI image of the line l (scheduled insertion path W) and the needle tip NT is stored in the storage unit 2.

  When there are a plurality of tumors to be ablated, the process of step S5 is performed on each tumor. When a plurality of ablation ranges R are set for one tumor, the process of step S5 is performed on each ablation range R. When the planned insertion path W and the position of the needle tip NT are determined in step S5, the process proceeds to step S6. In step S <b> 6, the operator inputs the type of ultrasonic probe 31 used for cauterization treatment at the input unit 3. The type of the input ultrasonic probe 31 is stored in the storage unit 2.

  Next, in step S7, as shown in FIG. 14, the probe arrangement image setting unit 14 causes the display unit 4 to display the probe arrangement image P. The probe arrangement image P is a recommended arrangement (puncture position) of the ultrasonic probe 31 on the body surface of the subject when the puncture needle 42 is inserted, that is, an image showing a recommended position and angle of the ultrasonic probe 31. It is.

  The probe arrangement image P includes an image 31 ′ of the type of ultrasonic probe 31 input in step S6. The probe arrangement image P includes an image 41 ′ of the puncture guide jig 41 stored in advance and an image 39 ′ of the first magnetic sensor 39 attached to the puncture guide jig 41. Further, the probe arrangement image P includes an image 42 ′ of the puncture needle 42. By displaying such a probe arrangement image P, it is possible to easily know the position and angle of the ultrasonic probe 31 when the puncture needle 42 is inserted. Incidentally, the position and angle of the ultrasonic probe 31 that can be known by the operator here are the position and angle in relation to the shape of the tissue in the MRI image of the subject.

The probe arrangement image P is displayed on the body surface S of the subject in the three-dimensional MRI image MG _3D . An ablation range R is displayed on the three-dimensional MRI image MG _3D . The probe arrangement image P is placed on the body surface S at a predetermined position and angle. The probe arrangement image setting unit 14 displays the probe arrangement image P based on the planned insertion path W of the puncture needle 42 with respect to the subject. Specifically, as shown in FIG. 15, the probe placement image setting unit 14 plans to insert a puncture needle that is the intersection of the planned insertion path W determined in step S5 and the body surface S of the subject. Based on the point Ip and the angle of the planned insertion path, the position and angle of the probe placement image P are set and displayed. The probe arrangement image setting unit 14 determines the position of the puncture needle 42 relative to the ultrasonic probe 31 determined by the type of the ultrasonic probe 31, the type of the puncture guide jig 41, and the attachment angle of the puncture needle in the puncture guide jig 41. With reference to the angle, the position and angle of the probe arrangement image P are set so that the insertion position and insertion direction of the puncture needle 42 coincide with the planned insertion path W.

  The position and angle of the set probe arrangement image P on the body surface S are stored in the storage unit 2. Further, positional information of the image of the first magnetic sensor 39 ′ in the coordinate system of the MRI image is also stored in the storage unit 2.

  Next, a process in the case where cauterization is performed by inserting the puncture needle 42 into the subject will be described based on the flowchart of FIG. First, in step S11, the information stored in step S7 and the volume data of the MRI image are stored in the storage unit 38 of the ultrasonic diagnostic apparatus 300. The position of the needle tip NT stored in step S5 is also stored in the storage unit 38.

Next, in step S12, transmission / reception of ultrasonic waves is started by the ultrasonic probe 31, an echo signal is acquired, and a real-time ultrasonic image UG is displayed on the display unit 35 as shown in FIG. Further, a two-dimensional MRI image MG _2D based on the volume data of the MRI image is displayed on the display unit 35 along with the ultrasonic image UG.

Next, in step S13, alignment processing between the coordinate system of the ultrasonic image UG and the coordinate system of the MRI image MG _2D is performed. Specifically, the operator moves the cross section of one or both images while comparing the ultrasonic image UG displayed on the display unit 6 and the MRI image MG _2D , so that the ultrasonic wave of the same cross section is obtained. The image UG and the MRI image MG _2D are displayed. The cross section of the ultrasonic image UG is moved by changing the position of the ultrasonic probe 31. The cross section of the MRI image MG _2D is moved by operating the operation unit 36 and inputting an instruction to change the cross section.

Whether the cross sections are the same or not is determined, for example, by referring to a characteristic part by the operator. When the ultrasonic image UG and the MRI image MG _2D for the same cross section are displayed, the operator designates an arbitrary point of the ultrasonic image UG using the trackball of the operation unit 36 or the like. Also, the operator also specifies in the MRI image MG _2D points seems to specified points in the same position in the ultrasound image UG. The operator designates such points for a plurality of points.

Here, the data of the MRI image MG _2D has position information. Therefore, by specifying a point it seems to be the same position in the as described above with the ultrasound image UG and the MRI image MG _2D, corresponding positions of the coordinate system and the MRI image MG _2D coordinate system of the ultrasound image UG is Identified. Then, by specifying a plurality of corresponding points between the coordinate system of the ultrasonic image UG and the coordinate system of the MRI image MG _2D , the coordinate system of the ultrasonic image UG and the coordinate system of the MRI image MG _2D Coordinate conversion is possible. This completes the alignment process.

When the alignment is completed in step S13, the display image control unit 343 displays the MRI image MG _2D for the cross section corresponding to the position of the echo signal calculated by the arrangement calculation unit 341 together with the real-time ultrasonic image UG. Display based on volume data. Thus, the ultrasound image UG and MRI image _{MG 2D} of the same cross-section in a subject is displayed.

  In step S14, the operator refers to the positional relationship image X displayed on the display unit 35 by the display image control unit 343 and moves the ultrasonic probe 31 to the step, as shown in FIGS. Arrange at the puncture position by placing it at the recommended position and angle displayed in S7.

  The positional relationship image X will be described. The positional relationship image X is an image showing the positional relationship between the position of the ultrasonic probe 31 and the probe arrangement image P. More specifically, the positional relationship image X corresponds to the distance Dd between the first magnetic sensor 39 attached to the ultrasonic probe 31 and the image 39 ′ of the first magnetic sensor 39 in the probe arrangement image P. It is an image which has a display form.

  Here, the position coordinates of the first position sensor 39 attached to the ultrasonic probe 31 are position coordinates in the coordinate system of the ultrasonic image UG. On the other hand, the position coordinates of the image 39 ′ of the first magnetic sensor 39 in the probe arrangement image P are the position coordinates in the coordinate system of the MRI image MG. The distance calculation unit 342 performs coordinate conversion between the coordinate system of the ultrasonic image UG and the coordinate system of the MRI image, and calculates the distance Dd. The display image control unit 343 displays the positional relationship image X based on the distance Dd.

  The positional relationship image X consists of two figures corresponding to the two first magnetic sensors 39. Specifically, the positional relationship image X has a square shape or a cross shape. In the positional relationship image X, the square area increases as the distance Dd increases, and the square area decreases as the distance Dd decreases. When the distance Dd is zero, that is, when the position of the first magnetic sensor 39 attached to the ultrasonic probe 31 and the position of the image 39 ′ of the first magnetic sensor 39 in the probe arrangement image P coincide with each other, the positional relationship The image X has a cross shape as shown in FIG. Thus, when the positional relationship image X has a cross shape, the ultrasonic probe 31 is disposed at the puncture position.

The display image control unit 343 displays the three-dimensional MRI image MG _3D and the probe arrangement image P (see FIG. 14) before the step S14 (for example, between the step S11 and step S12). May be displayed. This can be used as a reference when the operator places the ultrasonic probe 31 at the puncture position.

  When the operator places the ultrasonic probe 31 at the puncture position in step S14, the operator inserts the puncture needle 42 into the subject in step S15. The operator inserts the puncture needle 42 up to the position of the needle tip NT determined in step S5.

  As shown in FIG. 20, the display image control unit 343 displays a trajectory image T indicating the trajectory of the puncture needle 42 inserted into the subject on the ultrasonic image UG. The trajectory image T includes a line Tl indicating the insertion path of the puncture needle 42 and an indicator Tn indicating the needle tip of the puncture needle 42. The indicator Tn is a figure having an area corresponding to the distance Ddd between the needle tip of the puncture needle 42 and the needle tip NT determined in step S5. Specifically, like the positional relationship image X, the indicator Tn is a square or a cross. The indicator Tn has a quadrangular area that increases as the distance Ddd increases, and a quadrangular area that decreases as the distance Ddd decreases. When the distance Ddd is zero, that is, when the needle tip of the ultrasonic probe 31 matches the needle tip NT determined in step S5, the indicator Tn has a cross shape as shown in FIG.

  The position information of the needle tip NT determined in step S5 is position information in the coordinate system of the MRI image, and is stored in the storage unit 38 in step S11. The position information of the needle tip NT stored in the storage unit 38 is coordinate-converted into position information in the coordinate system of the ultrasonic image UG. The distance calculation unit 342 calculates the position of the puncture needle 42 calculated based on the position of the needle tip NT coordinate-converted into position information in the coordinate system of the ultrasonic image UG and the detection signal of the second magnetic sensor 43. The distance Ddd is calculated based on the position information of the needle tip. Then, the display image control unit 343 displays the indicator Tn based on the distance Ddd.

  In step S15, when the puncture needle 42 is inserted to the position of the needle tip NT determined in step S5, ablation treatment is performed by irradiating a radio wave from the puncture needle 42 in step S16.

  When there are a plurality of ablation treatment targets, the processing of steps S14 to S16 is performed for each treatment target. In this case, before performing the processing of steps S14 to S16 for each treatment target, the type of the puncture needle 42 according to each treatment target, the ablation time, the type of the ultrasonic probe 31 input in step S6, etc. Information necessary for the ablation treatment may be displayed on the display unit 35. Thereby, the operator can know information necessary for the ablation treatment.

  According to this example described above, puncture planning and insertion of the puncture needle 42 can be performed more easily than before.

(Second embodiment)
Next, a second embodiment will be described. Hereinafter, the same components as those in the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted.

  In this example, as shown in FIG. 22, the ultrasonic diagnostic apparatus 300 ′ has the puncture plan support apparatus 100. Specifically, as shown in FIG. 23, the control unit 37 of the ultrasonic diagnostic apparatus 300 ′ of this example is similar to the control unit 1 of the puncture plan support apparatus 100 of the first embodiment, and the extraction unit 11, the cauterization. A range setting unit 12, a puncture scheduled path setting unit 13, and a probe placement image setting unit 14 are provided. Moreover, the memory | storage part 2, the input part 3, and the display part 4 of the puncture plan assistance apparatus 100 of 1st embodiment correspond to the memory | storage part 38, the operation part 36, and the display part 35 of the said ultrasonic diagnostic apparatus 300 in this example. .

  Also in this example, treatment planning is performed in the ultrasonic diagnostic apparatus 300 by basically the same processing as steps S1 to S7 shown in FIG. 6 and steps S51 to S54 shown in FIG. However, in the step S1, the volume data of the MRI image is stored in the storage unit 38 of the ultrasonic diagnostic apparatus 300.

  Moreover, in this example, the process of step S12-S16 shown in FIG. 24 is performed, and ablation treatment is performed. The flowchart in FIG. 24 is the same as the flowchart in FIG. 16 except that the process in step S11 of the flowchart in FIG. 16 is not performed.

  Also by this example described above, the same effect as the first embodiment can be obtained.

  As mentioned above, although this invention was demonstrated by the said embodiment, of course, this invention can be variously implemented in the range which does not change the main point. For example, as shown in FIG. 25, the puncture planning apparatus 100 may be included in the medical image apparatus 200. Further, in each of the above embodiments, the cauterization treatment has been described as an example, but the present invention may be applied when performing a biopsy.

DESCRIPTION OF SYMBOLS 2 Memory | storage part 12 Ablation range setting part 13 Insertion plan route setting part 14 Probe arrangement | positioning image setting part 31 Ultrasound probe 100 Puncture plan assistance apparatus 200 Medical image apparatus 300 Ultrasonic diagnostic apparatus P Probe arrangement | positioning path | route R range

Claims (10)

A probe arrangement image setting unit for displaying a probe arrangement image indicating a recommended arrangement of the ultrasonic probe on the body surface of the subject when the puncture needle is inserted is provided , and the probe arrangement image setting unit includes the ultrasonic probe. Referring to the position and angle of the puncture needle with respect to the subject, the insertion position and the insertion direction of the puncture needle with respect to the subject coincide with a preset insertion path of the puncture needle into the subject. Thus, the puncture plan support apparatus characterized by displaying the probe arrangement image . The probe arrangement image setting unit is configured so that the insertion position and insertion direction of the puncture needle coincide with the planned insertion point of the puncture needle and the angle of the planned insertion path on the body surface of the subject. The puncture plan support apparatus according to claim 1, wherein the probe arrangement image is displayed.   The puncture plan support apparatus according to claim 1, further comprising a storage unit that stores position information of the probe arrangement image in the medical image data of the subject.   A planned insertion path setting unit is provided that sets the planned insertion path based on the position of the ablation range by radio waves emitted from the puncture needle and the position to be avoided by the puncture needle. The puncture plan assistance apparatus as described in any one of Claims 1-3.   The puncture plan support apparatus according to claim 4, further comprising a cautery range setting unit that sets the cautery range based on a type of the puncture needle, an ablation temperature, and an ablation time.   6. The puncture plan support apparatus according to claim 5, wherein the ablation range setting unit notifies the fact when the ablation range includes at least an ablation target.   A medical image apparatus comprising the puncture plan support apparatus according to any one of claims 1 to 6.   An ultrasonic diagnostic apparatus comprising the puncture plan support apparatus according to any one of claims 1 to 6.   The positional relationship image display control part which displays the positional relationship image which shows the positional relationship of the position of the ultrasonic probe which the said ultrasonic diagnostic apparatus has, and the position of the said probe arrangement | positioning image memorize | stored is provided. 8. The ultrasonic diagnostic apparatus according to 8.   The ultrasonic diagnostic apparatus according to claim 9, wherein the positional relationship image is an image having a display form corresponding to a distance between the ultrasonic probe and the probe arrangement image.