JP5922491B2 - Surgery support device - Google Patents

Description

  The present invention relates to a surgery support apparatus. In particular, the present invention relates to a surgery support apparatus that performs surgery support through a medical image of a subject displayed on a display.

  In recent years, an interventional system using a medical imaging apparatus (modality) includes an angiography apparatus, fluoroscopic apparatus, CT (Computed Tomography) apparatus, SPECT (Single photon emission computed tomography) apparatus, PET. (Positron emission tomography) apparatus and MRI (magnetic resonance imaging) apparatus.

  In an MRI apparatus or the like, since it is necessary to perform a medical procedure in a narrow space of an imaging apparatus, an operation support apparatus using a remote apparatus is performed. As a surgical support method for a remote device, Patent Document 1 performs tactile feedback on the remote device, and makes an operation of image-assisted therapy such as puncture of an operator (doctor) closer to an actual puncture procedure. A two-dimensional display monitor is used for observing the puncture treatment.

JP 2005-510289 A

  However, a surgeon needs skill to perform a puncture treatment while observing a two-dimensional monitor in a three-dimensional space by remote control. In other words, the two-dimensional tomographic image used for surgical support has a completely different impression from the incision image of the affected part that is visible to the naked eye of the surgeon during the operation, and is not always realistic enough to provide sufficient surgical support. . For this reason, the operation support method using a remote device has a problem that only an operator who has received a predetermined training can support the operation. For this reason, there is a strong demand for the surgeon to operate the subject with a more realistic surgical support.

Therefore, the present invention provides a surgery support apparatus that can be remotely operated with a realistic image.
The surgical operation support device according to the first aspect places a subject on a cradle, moves the subject placed on the cradle into the bore, and then images the subject to obtain a real-time image of the subject and a plurality of images. It has a modality including an image reconstruction unit that reconstructs a three-dimensional volume image composed of slice planes. Furthermore, the surgery support apparatus detects an appearance imaging apparatus that three-dimensionally images the subject outside the bore, and the position of the subject placed on the cradle with respect to the modality and the position of the simulated surgical tool held by the doctor. A projection device that three-dimensionally projects a composite image obtained by superimposing a three-dimensional volume image photographed by a subject and a modality photographed by an appearance photographing device, based on the position of the subject detected by the position detection device A position measuring unit that calculates a distance and a moving direction of the simulated surgical tool based on a position where the position detecting device detects the simulated surgical tool, and a bore based on the distance and moving direction calculated by the position measuring unit. And a manipulator for manipulating a true surgical tool having the same shape as the simulated surgical tool.

A surgery support device according to a second aspect is the surgery support device according to the first aspect, further including a two-dimensional display unit that two-dimensionally displays a slice plane and a real-time image.
The surgery support device according to the third aspect is the surgery support device according to the first to second aspects, wherein a reference member is attached to the outer periphery of the modality, and the position detection device determines the distance and direction from the reference member. Detect and identify the 3D coordinate position of the modality.
The surgery support apparatus according to the fourth aspect is the surgery support apparatus according to the first to third aspects, wherein the modality is an MRI apparatus, a CT apparatus, or a nuclear medicine diagnosis apparatus, and the simulated surgical tool emits infrared light or visible light. A light emitting element (LED) that emits light or a reflective element (an object such as a mirror) that reflects light is attached, and the position detection device detects the position of the light emitting element or the reflective element by optics.
The surgery support device according to the fifth aspect is the surgery support device according to the first to third aspects, wherein the modality is a CT device or a nuclear medicine diagnosis device, and the simulated surgical tool is a magnetic generating element that generates magnetism ( Permanent magnet or electromagnet) is attached, and the position detection device detects the position of the magnetism generating element by magnetism.

The surgery support apparatus according to a sixth aspect is the surgery support apparatus according to the first to fifth aspects, and includes an image cooperation switch for the simulated surgical tool to start projecting a real-time image.
The operation support apparatus according to a seventh aspect is the operation support apparatus according to the first aspect to the sixth aspect, and further includes an operation interlocking switch for starting the manipulation of the true operation tool by the simulated operation tool.
An operation support apparatus according to an eighth aspect is the operation support apparatus according to any one of the first to seventh aspects, wherein a laser light source for irradiating a virtual line to a projection image obtained by three-dimensional projection of a simulated surgical tool on a projection apparatus is provided. Have.

A surgery support apparatus according to a ninth aspect is the surgery support apparatus according to the first to sixth aspects, in which the appearance photographing apparatus acquires a three-dimensional image and coordinates using a plurality of cameras.
A surgery support apparatus according to a tenth aspect is the surgery support apparatus according to any one of the first to seventh aspects, in which the projection device projects a three-dimensional image by a technique such as a hologram.

  The surgical operation support device of the present invention can perform image-assisted treatment while observing a subject projected in three dimensions on a remote operation and a two-dimensional monitor when using a true surgical instrument by remote operation. Is possible. For this reason, even an operator who is not skilled in remote control can perform an operation with a realistic image.

1 is a perspective view of a surgery support apparatus 100. FIG. 1 is a configuration diagram of a surgery support apparatus 100. FIG. 2 is a side view of the surgery support apparatus 100. FIG. 3 is an MR image showing an arbitrary cross section including a target TG displayed on the display unit 30. FIG. 3 is a flowchart of the surgery support apparatus 100. It is the figure which showed the method of three-dimensional projection from the pre-MRI data PMD which performed MRI imaging | photography with the imaging center RP, and the method of displaying two-dimensionally. It is the figure which projected the external appearance of the virtual subject image VHB and the three-dimensional organ image VNG. It is explanatory drawing at the time of moving the virtual needle | hook 74. FIG. It is the figure which illustrated the time-dependent change of MR image of one cross section (XY cross section) image | photographed at high speed.

  Hereinafter, a surgical operation support apparatus 100 using an MRI apparatus will be described as the best mode for carrying out the invention. In addition, the surgery assistance apparatus 100 of this embodiment is demonstrated by the example using an MRI apparatus. However, the present invention can also be applied to an operation support apparatus using a CT apparatus, a SPECT apparatus, a PET apparatus, an angio apparatus, or the like other than the MRI apparatus.

<Configuration of Surgery Support Device 100>
FIG. 1 is a perspective view of an operation support apparatus 100 using an MRI apparatus, FIG. 2 is a configuration diagram of the operation support apparatus 100, and FIG. 3 is a side view of the operation support apparatus 100. As shown in FIGS. 1 to 3, the surgery support apparatus 100 mainly includes a magnet system 10, a table 11, a cradle 12, an operation unit 20, a display unit 30, a calculation unit 40, a three-dimensional camera device 50, and a three-dimensional projection. A device 60, a three-dimensional position measuring device 70, and a manipulator 80 are included. In the three axes shown in the figure, the major axis direction of the cradle 12 shown in the figure is the Z axis direction, the minor axis direction is the X axis, and the gravity direction is the Y axis.

  As shown in FIG. 2, the magnet system 10 includes a main magnetic field coil unit 15, a gradient coil unit 16, and an RF coil unit 17. Each of these coil portions has a substantially cylindrical shape, and is arranged coaxially with each other in a substantially columnar bore 13 (inspection space). The gradient coil drive unit 102 is connected to the gradient coil unit 16, and the RF coil drive unit 103 and the data collection unit 104 are connected to the RF coil unit 17. The pulse sequence control unit 101 is connected to the gradient coil driving unit 102, the RF coil driving unit 103, and the data collection unit 104.

  The main magnetic field coil unit 15 forms a static magnetic field in the internal space of the magnet system 10. The direction of the static magnetic field is substantially parallel to the direction of the body axis of the subject HB and forms a horizontal magnetic field. The main magnetic field coil unit 15 is generally configured using a superconducting coil, but may be configured using a permanent magnet or the like without being limited to the superconducting coil.

  The gradient coil unit 16 has three types of gradients for imparting gradients to the static magnetic field strength formed by the main magnetic field coil unit 15 in the three axes orthogonal to each other, that is, in the direction of the slice axis, the phase axis, and the frequency axis. Generate a magnetic field. In order to make it possible to generate such a gradient magnetic field, the gradient coil unit 16 includes three gradient coils (not shown). The gradient coil drive unit 102 connected to the gradient coil unit 16 gives a drive signal to the gradient coil unit 16 to generate a gradient magnetic field. The gradient coil drive unit 102 has three systems of drive circuits (not shown) corresponding to the three systems of gradient coils in the gradient coil unit 16.

  The RF coil unit 17 forms a high-frequency magnetic field for exciting spins in the body of the subject HB in the static magnetic field space. Formation of a high-frequency magnetic field is called transmission of an RF excitation signal, and the RF excitation signal is called an RF pulse. The RF coil drive unit 103 connected to the RF coil unit 17 gives a drive signal to the RF coil unit 17, and the RF coil unit 17 transmits an RF pulse based on the drive signal. An electromagnetic wave generated by the excited spin, that is, a nuclear magnetic resonance signal is received by the RF coil unit 17. The data collection unit 104 connected to the RF coil unit 17 collects the nuclear magnetic resonance signals received by the RF coil unit 17 as digital data.

  The pulse sequence control unit 101 drives the gradient coil driving unit 102 and the RF coil driving unit 103 according to the imaging conditions input by the operator, that is, the imaging protocol. For example, the pulse sequence control unit 101 controls the gradient coil driving unit 102 and the RF coil driving unit 103 in accordance with sequence information called for a desired imaging section by an imaging protocol.

  When the imaging protocol for high-speed imaging is called, the pulse sequence control unit 101 repeats transmission of RF pulses and reception of nuclear magnetic resonance signals in units of seconds or milliseconds, and captures real-time MR images. In this high-speed imaging, when the insertion needle ND is punctured into the body of the subject HB, the real-time position of the insertion needle ND can be grasped. In addition, in high-speed imaging, not only a two-dimensional imaging section but also three-dimensional high-speed imaging using difference data is performed, and a desired section is reformatted and displayed.

  The table 11 moves in the vertical direction (Y-axis direction). The cradle 12 is installed on the top of the table 11, moves in the horizontal direction (Z-axis direction), and moves inside and outside the bore 13 at the center of the magnet system 10. As shown in FIG. 3, the subject HB is placed on the cradle 12 and conveyed into the bore 13 in accordance with the imaging region.

  The display unit 30 includes a liquid crystal screen, an organic EL screen, or the like. The display unit 30 is connected to the calculation unit 40. The display unit 30 can display a GUI operation screen, an MR image reconstructed (reformatted) based on a nuclear magnetic resonance signal, and the like. In general, the display unit 30 is installed at two positions: a position where an operator (a medical radiation technician or a clinical technician) can observe, and a position where an operator can observe. The operator confirms whether the MR image is displayed in a desired cross section and sequence. The surgeon adjusts the position and angle of the virtual needle 74 while observing the MR image.

  The operation unit 20 includes a keyboard having a pointing device. The operation unit 20 is connected to the calculation unit 40. The operation unit 20 is operated by the operator via the display unit 30. The operation unit 20 may arrange a touch panel on the display unit 30 instead of a keyboard or the like.

  The calculation unit 40 includes a control unit 41, a storage unit 42, a two-dimensional image processing unit 43, and a three-dimensional image processing unit 44, and executes various data processes and programs.

  The control unit 41 receives the nuclear magnetic resonance signal from the data collection unit 104 and stores the nuclear magnetic resonance signal in the storage unit 42. The control unit 41 also controls the pulse sequence control unit 101 and the like of the MRI apparatus. Further, the control unit 41 is connected to the three-dimensional camera device 50, the three-dimensional projection device 60, the three-dimensional position measurement device 70, and the manipulator 80, and controls them.

  The storage unit 42 stores various imaging protocols of the MRI apparatus, various programs such as the MRI apparatus or the three-dimensional camera apparatus 50. The storage unit 42 also stores two-dimensional and three-dimensional image data obtained by image reconstruction of the nuclear magnetic resonance signals collected by the data collection unit 104 or three-dimensional appearance data captured by the three-dimensional camera device 50.

  The two-dimensional image processing unit 43 reconstructs an arbitrary cross-sectional two-dimensional MR image based on the two-dimensional arbitrary cross-sectional nuclear magnetic resonance signal sent from the data collection unit 104. Further, based on the nuclear magnetic resonance signal of the three-dimensional voxel sent from the data collection unit 104, a two-dimensional MR image of an arbitrary cross section is reconstructed.

  The three-dimensional image processing unit 44 reconstructs a three-dimensional appearance MR image at a desired signal intensity based on the nuclear magnetic resonance signals collected in three dimensions. The three-dimensional appearance MR image is a three-dimensional image showing the internal appearance of the subject HB in the internal organ of the subject HB by setting a signal intensity threshold (hereinafter referred to as a three-dimensional organ image VNG). 7). The three-dimensional organ image VNG of the present embodiment shows the surface shape of the internal organ of the subject HB.

  The three-dimensional camera device 50 shown in FIGS. 2 and 3 has a three-dimensional camera calculation unit 51. The three-dimensional camera calculation unit 51 calculates the appearance and contour coordinates of the subject HB by photographing the appearance of the subject HB on the cradle 12 with a plurality of cameras (not shown). The 3D appearance data calculated by the 3D camera calculation unit 51 is transferred to the storage unit 42.

  The three-dimensional projection device 60 has a three-dimensional projection control unit 61. The three-dimensional projection control unit 61 uses the three-dimensional appearance data of the subject HB calculated by the three-dimensional camera device 50 to use a method such as a hologram to obtain a three-dimensional image of the subject HB (hereinafter referred to as a virtual subject image VHB). (Refer to FIG. 7) is projected onto the table 11 at an equal magnification. In addition, the three-dimensional projection device 60 projects the three-dimensional organ image VNG of the subject HB created by the three-dimensional image processing unit 44 using a method such as a hologram at an equal magnification. The virtual subject image VHB and the three-dimensional organ image VNG are both projected at the same magnification, and the contour coordinates of the virtual subject image VHB and the three-dimensional organ image VNG are corrected so as to match. The virtual subject image VHB is projected translucently so that the three-dimensional organ image VNG can be observed.

  The three-dimensional position measurement device 70 includes a three-dimensional position measurement unit 71 and a position detection unit 73. The position detection unit 73 of the three-dimensional position measurement device 70 is, for example, an optical compound eye camera using an infrared camera. The position detection unit 73 detects the reference tool 72, the virtual needle 74, and the subject HB.

  The reference tool 72 is a spherical marker MK installed on the wall surface of the surgery support apparatus 100 and is used for linking the coordinate system of the three-dimensional position measurement apparatus 70 and the coordinate system in the bore 13 of the magnet system 10. As shown in FIG. 3, the virtual needle 74 that is a simulated surgical tool is provided with a spherical marker MK. A spherical marker MK is attached to a part of the subject with respect to the subject.

  The position detection unit 73 detects a sphere marker MK installed on the reference tool 72, a plurality of sphere markers MK installed on the virtual needle 74, and a marker MK attached to the subject. As the three-dimensional position measuring device 70, for example, POLARIS sold by Northern Digital Inc. can be used, and XYZ coordinate values of about 0.3 mm can be measured.

  The three-dimensional position measurement unit 71 calculates a reference position based on the sphere marker MK installed on the reference tool 72. The three-dimensional position measurement unit 71 also determines the three-dimensional coordinate position of the tip of the virtual needle 74 and the direction of the tip of the virtual needle 74 based on the plurality of spherical markers MK provided on the virtual needle 74 detected by the position detection unit 73. Is calculated. An image cooperation switch 78 that synchronizes the two-dimensional image processing unit 43 and displays a real-time image on the display unit 30 is attached to a part of the virtual needle 74. In addition, an operation interlocking switch 79 that interlocks the manipulator 80 that holds the insertion needle ND is attached to a part of the virtual needle 74.

  The three-dimensional position measurement unit 71 links the coordinate system of the three-dimensional position measurement device 70 and the coordinate system of the surgery support apparatus 100 and transmits the coordinate data to the calculation unit 40. In addition, the three-dimensional position measurement unit 71 transmits the information on the three-dimensional position and tip direction of the virtual needle 74 to the calculation unit 40.

  Note that the plurality of markers MK shown in the figure are constituted by a spherical reflecting sphere that reflects infrared rays or a light emitting body such as an LED that emits infrared rays. For example, three sphere markers MK are installed on the marker MK installed on the reference tool 72, and three sphere markers MK are installed on the marker MK installed on the virtual needle 74.

  A laser light source 75 is installed at the tip of the virtual needle 74. As the laser light source 75, visible laser light 75L (see FIG. 6) different from the light emitter used for the spherical marker MK is used. The laser light 75L emitted from the laser light source 75 shows an extension line on which the virtual needle 74 is directed, and is visible to the operator.

  The three-dimensional position and tip orientation information of the virtual needle 74 is used when reconstructing an acquired three-dimensional MR image or performing MRI imaging of a cross-section of a real-time MR image. Further, the information on the three-dimensional position of the virtual needle 74 and the direction of the tip thereof is used for synchronization with the insertion needle ND installed in the manipulator 80.

  Since the surgical operation support apparatus 100 of this embodiment uses an MRI apparatus, an optical position detection unit 73 is used. However, a magnetic field type position receiving unit can be used as long as it is a surgical support device that uses a CT device, a SPECT device, a PET device, or an angio device.

  The manipulator 80 is attached to the housing or ceiling of the magnet system 10 as shown in FIG. 1 or FIG. The manipulator 80 includes a manipulator control unit 81 and an articulated drive arm 82. The manipulator control unit 81 controls the drive arm 82 in synchronization with the position information of the virtual needle 74 and the direction of the tip measured by the three-dimensional position measurement device 70. The insertion needle ND is attached to the tip of the drive arm 82. The insertion needle ND matches the three-dimensional position and tip direction of the virtual needle 74, and further synchronizes with the movement of the virtual needle 74 when the virtual needle 74 moves.

  In the manipulator 80, when the operator presses an operation interlocking switch 79 (see FIG. 3) provided on the virtual needle 74, the operation of the virtual needle 74 and the driving arm 82 are interlocked. That is, after the operation interlock switch 79 is pressed, the insertion needle ND is synchronized with the movement of the virtual needle 74. In the present embodiment, the virtual needle 74 is used as a simulated surgical tool and the insertion needle ND is used as a true surgical tool. However, other treatment and treatment tools may be used. For example, the present invention can be applied to tweezers, forceps, or a scalpel as a simulated surgical tool and a true surgical tool.

  FIG. 4 is a diagram showing an arbitrary cross section of the MR image displayed on the display unit 30. The two-dimensional image processing unit 43 reconstructs an image of a two-dimensional arbitrary cross section based on two-dimensional high-speed MR imaging or three-dimensional MR imaging that was previously captured. The four cross-sectional views displayed on the display unit 30 are an XY plane perpendicular to the virtual needle 74, an OB plane horizontal to the virtual needle 74, a YZ plane perpendicular to the body axis of the subject HB, and a body axis of the subject HB. XZ plane parallel to the XZ plane. The XY plane, OB plane, YZ plane, and XZ plane of the subject HB are planes including a target TG such as a tumor.

  In particular, when the insertion needle ND synchronizes with the movement of the virtual needle 74, the operator operating the virtual needle 74 is shown in FIG. 4 in order to confirm where the insertion needle ND is in the subject HB. As described above, it is preferable to display four sectional views or at least a horizontal OB surface on the display unit 30 in real time by two-dimensional high-speed MR imaging. When the image linkage switch 78 or the operation linkage switch 79 is turned on, the two-dimensional image processing unit 43 starts two-dimensional high-speed MR imaging.

  In the display unit 30 in FIG. 4, the insertion needle ND actually inserted into the subject HB is displayed. Further, since the position of the target TG is specified by prior diagnosis or the like, as shown in FIG. 4, the target TG may be displayed by being colored and superimposed on four cross-sectional views displayed in real time.

<Flowchart of Surgery Support Device 100>
FIG. 5 is a flowchart of the surgery support apparatus 100 that performs image support therapy.

  In step S11, the operator places the subject HB on the cradle of the MR apparatus. The operator raises the bed and places the subject HB placed thereon at a predetermined height (Y-axis position). In the major axis direction (Z-axis direction) of the subject HB, the desired treatment range is arranged in the vicinity of the virtual center VP (see FIG. 3). The virtual center VP indicates a reference Z-axis position with a laser pointer or the like.

  In step S <b> 12, the operator images the subject HB with the three-dimensional camera device 50. The three-dimensional camera images the appearance of the subject HB (see FIG. 3), and the three-dimensional appearance data is stored in the storage unit 42 as a virtual subject image VHB. In FIG. 3, the whole body of the subject HB is imaged, but a method of approximately imaging the treatment range may be used. In addition, the operator confirms the position of the subject HB with the three-dimensional position measurement device 70.

  In step S13, the operator moves the cradle so that the virtual center VP comes to the imaging center RP, and performs MRI imaging at the imaging center RP in the bore 13 (see FIG. 3). Since the amount of movement of the cradle is determined, the operator moves the virtual center VP to the photographing center RP by pressing a movement switch (not shown) once. By this MRI imaging, the three-dimensional image processing unit 44 reconstructs a three-dimensional organ image VNG showing the internal appearance of the subject HB of the internal organ of the subject HB. The three-dimensional organ image VNG is stored in the storage unit 42.

  FIG. 6 is a diagram showing a method for three-dimensional projection from pre-MRI data PMD obtained by MRI photographing at the photographing center RP and a method for two-dimensional display. The pre-MRI data PMD is stored in the storage unit 42. The pre-MRI data is used to create a three-dimensional organ image VNG or to reconstruct a two-dimensional cross section image. The three-dimensional organ image VNG is projected by the three-dimensional projection device 60. In addition, the two-dimensional image processing unit 43 displays a multi-section image reconstructed from the pre-MRI data PMD on the display unit 30.

  In step S14, the three-dimensional projection device 60 projects the appearance of the virtual subject image VHB imaged in step S12 and the 3D organ image VNG imaged in step S12 at a position centered on the virtual center VP.

  Here, a virtual subject image VHB projected by the three-dimensional projection apparatus 60 using FIG. 7 (displayed by a broken line) and a three-dimensional organ image VNG of the subject HB created from the pre-MRI data PMD (displayed by a solid line) ).

  The three-dimensional projection control unit 61 of the three-dimensional projection device 60 corrects and projects the virtual subject image VHB and the three-dimensional organ image VNG so as to be actual size. Further, the three-dimensional projection control unit 61 uses the virtual center VP acquired by the three-dimensional camera device 50 based on the position of the subject HB measured by the three-dimensional position measurement device 70 and the virtual center VP of the virtual subject image VHB. Correct so that it overlaps with. Furthermore, the three-dimensional organ image VNG imaged at the imaging center RP is also projected so as to overlap the virtual center VP. Although the subject HB has moved into the bore 13, the virtual subject image VHB and the three-dimensional organ image VNG are projected onto the virtual center VP. For this reason, the surgeon can observe the virtual subject image VHB with a sense of presence, and can also observe the state of the organ.

  Next, when the surgeon picks up the virtual needle 74 in step S <b> 15, the position of the virtual needle 74 and the direction of the virtual needle 74 are measured by the three-dimensional position measuring device 70. Then, the surgeon moves the virtual needle 74 to the body surface of the virtual subject image VHB and turns on the image linkage switch 78 to synchronize the coordinates of the virtual needle 74 and the two-dimensional image processing unit 43.

  As shown in FIG. 4, the operator confirms the target TG from the YZ plane and the XZ plane of the subject HB around the target TG, and reconstructs an image in conjunction with the coordinates of the virtual needle 74. The virtual needle 74 is moved so that the XY plane and the OB plane overlap the target TG. The coordinates and angle of the virtual needle 74 are measured by the three-dimensional position measuring device 70 and transmitted to the two-dimensional image processing unit 43 in real time. The two-dimensional image processing unit 43 reconstructs an image of the virtual line 76 that is an extension line of the virtual needle 74 and an arbitrary cross section, and causes the display unit 30 to display the image.

  In step S <b> 16, the virtual needle 74 turns on the laser light source 75 at the tip, and projects the laser light 75 </ b> L onto the extension line to which the virtual needle 74 is directed. The surgeon can confirm the laser beam 75L that shines toward the virtual subject image VHB, and can confirm the insertion point of the subject HB (see FIG. 7). In addition, the operator can confirm whether the laser beam 75L is directed to the target TG of the three-dimensional organ image VNG. Note that the three-dimensional image processing unit 44 can display not only the appearance of the three-dimensional organ image VNG but also the appearance of the target TG by changing the threshold value of the signal intensity of the pre-MRI data PMD.

  In step S17, the operator confirms the optimal position and angle of the virtual needle 74. For example, the plurality of reformatted images display the two cross sections based on the virtual needle 74 and the target TG shown in FIG. 4 and the two cross sections centered on the target TG. In the two cross sections based on the virtual needle 74 and the target TG, drawing is performed by changing the color of the virtual line 76 indicated by the laser light 75L. Thereby, the surgeon can easily confirm the position and angle of the virtual needle 74. Explaining with one cross section with the virtual needle 74 and the target TG as a reference, as shown in FIG. 8, the two-dimensional image processing unit 43 shows an XY1 cross section with the virtual needle 74a and the target TG as a reference and a virtual line 76a. draw. When the virtual needle 74a moves to the position of the virtual needle 74b on the XY1 cross section, the two-dimensional image processing unit 43 draws the virtual line 76b to indicate the insertion direction of the virtual needle 74b. When the virtual needle 74a moves to the position of the virtual needle 74c, the two-dimensional image processing unit 43 draws an XY2 cross section with the virtual needle 74c and the target TG as a reference, and a virtual line 76c, and the virtual needle 74c. Indicates the insertion direction.

  In step S18, when the operator determines the insertion position and insertion angle, the operator turns on the operation interlocking switch 79 with the manipulator 80. When the operation interlocking switch 79 is turned on, the manipulator 80 is driven and the movement of the virtual needle 74 and the movement of the insertion needle ND are synchronized. Since driving of the manipulator 80 involves invasion of the subject HB, the position information on the body surface of the virtual subject image VHB projected by the three-dimensional projection device 60 and the virtual needle 74 measured by the three-dimensional position measurement device 70 are used. When the tip of the virtual needle 74 enters the body surface of the virtual subject image VHB, a safety device such as a warning sound or a permission switch is installed and the subject HB is not prepared due to malfunction. Prevent invasion.

  In step S19, when the virtual needle 74 reaches the insertion point, the pulse sequence control unit 101 repeats transmission of an RF pulse and reception of a nuclear magnetic resonance signal in units of seconds or milliseconds, and captures a real-time MR image. . The predetermined section is determined by the operator or the operator, and the surgery support apparatus 100 performs high-speed imaging with a section based on the virtual needle 74. The display unit 30 also displays the insertion needle ND together with the virtual line 76.

  In step S20, the operator advances the virtual needle 74 to the target TG while confirming the real-time MR image. In synchronization with the operation of the virtual needle 74, the insertion needle ND is inserted into the body of the subject HB. Usually, the surgeon has the subject HB hold his / her breath when inserting the insertion needle ND. The surgeon starts insertion when the target TG comes to an appropriate position on the cross section displayed by high-speed imaging while holding the subject HB. FIG. 9 is a diagram illustrating a change with time of an MR image of one section (XY section) taken at high speed. As shown in FIG. 9A, when the insertion needle ND contacts the body surface, the body surface is distorted. As shown in FIG. 9B, when the insertion needle ND contacts the organ, the organ is also distorted. Depending on the organ, the position and distance of the target TG in the Z-axis direction may be shifted as well as being distorted. For this reason, the surgeon confirms the real-time MR image and advances the virtual needle 74 to the target TG as shown in FIG. 9C while adjusting the approach direction of the virtual needle 74. When the virtual needle 74 reaches the target TG, the insertion needle ND also reaches the target TG.

  In step S <b> 21, the operator turns off the interlock switch and releases the interlock of the manipulator 80. After releasing the interlock, the operator releases the fixation of the insertion needle ND fixed by the manipulator 80. The operator discharges the subject HB out of the bore 13, and the operator performs a desired treatment. For example, the desired treatment is drug injection, tissue aspiration, and the like. The surgeon removes the insertion needle after the treatment.

  As described above, the optimal embodiment of the present invention has been described in detail. However, as will be apparent to those skilled in the art, the present invention can be implemented with various modifications and variations within the technical scope thereof. For example, in the present embodiment, in step S19, a real-time MR image is taken after the virtual needle 74 reaches the insertion point. However, in step S18, a real-time MR image may be taken as soon as the operator operation interlocking switch 79 is turned on. Alternatively, a real-time MR image may be taken as soon as the image linkage switch 78 is turned on in step S15.

10 ... Magnet system (MRI system)
DESCRIPTION OF SYMBOLS 11 ... Table, 12 ... Cradle, 13 ... Bore 15 ... Main magnetic field coil part, 16 ... Gradient coil part, 17 ... Coil part 20 ... Operation part, 30 ... Display part 40 ... Calculation part, 41 ... Control part 42 ... Memory | storage part 43 ... 2D image processing unit 44 ... 3D image processing unit 50 ... 3D camera device 51 ... 3D camera operation unit 60 ... 3D projection device 61 ... 3D projection control unit 70 ... 3D position measurement device 71 ... 3D Original position measuring unit 72 ... Reference tool 73 ... Position detecting unit 74 ... Virtual needle (simulated surgical tool)
75 ... Laser light source 75L ... Laser light
76 ... Virtual line 78 ... Image linkage switch, 79 ... Motion interlock switch 80 ... Manipulator 81 ... Manipulator control unit 82 ... Drive arm 100 ... Surgery support device 101 ... Pulse sequence control unit, 102 ... Gradient coil drive unit 103 ... Coil Drive unit 104 ... Data collection unit HB ... Subject MK ... Marker ND ... Insert needle (true surgical instrument)
PMD ... Pre-MRI data RP ... Imaging center TG ... Target VHB ... Virtual subject image VNG ... Three-dimensional organ image VP ... Virtual center

Claims (10)

A subject is placed on a cradle, the subject placed on the cradle is moved into the bore, and then the subject is photographed to obtain a real-time image of the subject and a three-dimensional image comprising a plurality of slice planes. A modality comprising an image reconstruction unit for reconstructing a volume image;
An external appearance photographing device for photographing the subject in three dimensions outside the bore;
A position detection device for detecting the position of the subject placed on the cradle with respect to the modality and the position of a simulated surgical tool held by a doctor;
Based on the position of the subject detected by the position detection device, a projection that three-dimensionally projects a composite image obtained by superimposing the subject imaged by the appearance photographing device and the three-dimensional volume image sensed by the modality Equipment,
Based on the position at which the position detection device detects the simulated surgical tool, a position measuring unit that calculates a distance and a moving direction of the simulated surgical tool;
A manipulator for manipulating a true surgical instrument having the same shape as the simulated surgical instrument in the bore, based on the distance and moving direction calculated by the position measuring unit;
An operation support apparatus comprising:   The surgery support apparatus according to claim 1, further comprising a two-dimensional display unit that two-dimensionally displays the slice surface and the real-time image. A reference member is attached to the outer periphery of the modality,
The surgery support device according to any one of claims 1 to 2, wherein the position detection device identifies a three-dimensional coordinate position of the modality by detecting a distance and a direction from the reference member. The modality is an MRI apparatus, CT apparatus or nuclear medicine diagnostic apparatus;
The simulated surgical instrument has a light emitting element (LED) that emits infrared light or visible light or a reflective element (an object such as a mirror) that reflects light,
The surgery support apparatus according to any one of claims 1 to 2, wherein the position detection device detects a position of the light emitting element or the reflection element by optics. The modality is a CT device or a nuclear medicine diagnostic device;
The simulated surgical instrument has a magnetism generating element for generating magnetism,
The surgery support device according to any one of claims 1 to 3, wherein the position detection device detects a position of the magnetism generating element by magnetism.   The surgery support apparatus according to any one of claims 1 to 5, wherein the simulated surgical instrument includes an image linkage switch that starts projection of the real-time image.   The surgery support apparatus according to any one of claims 1 to 6, wherein the simulated surgical tool includes an operation interlocking switch that starts manipulating the true surgical tool.   The surgery support apparatus according to any one of claims 1 to 7, wherein the simulated surgical instrument includes a laser light source for irradiating a virtual line to a projection image three-dimensionally projected on the projection apparatus.   The surgery support apparatus according to any one of claims 1 to 8, wherein the appearance photographing apparatus acquires a three-dimensional image and coordinates using a plurality of cameras.   The surgery support apparatus according to any one of claims 1 to 9, wherein the projection apparatus projects a three-dimensional image by a hologram technique.