JP6333575B2 - Puncture support device - Google Patents

Description

  The present invention relates to a puncture assisting apparatus for simply and reliably performing puncture on a target site in a patient's body.

  Conventionally, ablation therapy using radio waves or microwaves with a puncture needle has been widely used for abdominal liver tumors. Since the liver tumor is located deep from the body surface, it is difficult to detect the liver tumor with an image with a rough ultrasonic image, and it is necessary to insert a puncture needle into the tumor avoiding the ribs and lungs. In addition, when the cauterization is repeated, minute bubbles generated by the cauterization make it difficult to observe the ultrasonic image. Therefore, the present inventors obtain a real-time MR image of a patient using a vertical open MR device instead of a conventional ultrasonic image for detection of a liver tumor and determination of a puncture route of a puncture needle, A puncture assisting robot that automatically tracks a target specified in advance is installed between magnets of a vertical open MR device, and the reconstructed image obtained by reconstructing the MR image and the 3D image acquired before the procedure is referred to. Thus, a technique for puncturing a needle into a tumor was developed (Non-patent Document 1).

  However, the vertical open MR apparatus has a great advantage that the affected part can be directly accessed. However, since it is expensive to purchase and maintain, the vertical open MR apparatus is only popular in some medical sites. In addition, the MR image obtained by the vertical open MR apparatus has a disadvantage that the image quality is inferior to that of the MR image obtained by a general tunnel MR apparatus. Therefore, in a medical site where a vertical open MR apparatus is not installed, treatment using a tunnel MR apparatus and a puncture assisting robot is performed according to the procedure shown in FIG.

  First, a patient is pit-in into a tunnel type MR apparatus (hereinafter simply referred to as an MR apparatus), and a high-definition 3D image of the patient is captured (S1). Subsequently, a 3D image is displayed on the monitor screen, and coordinates (target coordinates) of a target site such as a tumor are determined (S2). Subsequently, the patient is pit-out from the MR apparatus, and the information on the determined target coordinates is transmitted to the puncture support robot installed in the vicinity of the MR apparatus. The tip position is made to coincide with the virtual target site, and a tomographic image of two orthogonal planes along the puncture path is cut out from the 3D image, and the reconstructed image is displayed on the monitor and presented to the operator (S3). Based on the reconstructed image, the surgeon determines an optimal puncture route free from obstacles such as ribs and lungs (S4). Subsequently, the surgeon actually inserts the puncture needle to the specified depth (S5).

  At this time, when the organ moves due to patient respiration or the puncture needle slips on the surface of the organ when the puncture angle is small, the puncture needle may be bent and the needle tip may not reach the target site. However, the patient is in a pit-out state from the MR apparatus, and the surgeon cannot confirm the position of the puncture needle in real time with the MR image. Therefore, after the insertion is completed, it is necessary to pit the patient into the MR apparatus again with the puncture needle inserted, and to perform imaging to confirm the needle tip position (S6). If the needle tip position is not appropriate (NO in S7), the patient is pit-out from the MR apparatus, the puncture needle is inserted again (S8), and step S7 is repeated. On the other hand, when the needle tip position is appropriate (NO in S7), the patient is pit-out from the MR apparatus to perform treatment such as cauterization (S9). Thereafter, S3 to S9 are repeated until there is no unprocessed part (NO in S10).

Shigeaki Morikawa and 9 others, “Development and clinical application of a puncture assisting robot for MR image-guided liver tumor microwave coagulation”, Japanese Society of Computer Aided Surgery, November 2007, p. 35-36

  In the above treatment procedure, when the operator inserts the puncture needle into the patient (S5), the position of the needle tip cannot be confirmed in real time. It is necessary to confirm the destination position (S6). As a result, if the needle tip position is not appropriate (NO in S7), it is necessary to insert the puncture needle again (S8), and pit the patient into the MR apparatus again (S6). Thus, since it is necessary to take an MR image every time the needle tip position is confirmed, there is a problem that the burden on the operator and the patient is heavy.

  The present invention has been made to solve the above problems, and an object of the present invention is to provide a puncture assisting device for quickly, simply, and reliably performing treatment such as cauterization by puncture.

  The puncture assisting device according to the present invention is made to solve the above-described problem, and the puncture needle is placed on the basis of the coordinates of the target site of the patient and the puncture route determined based on the 3D image of the patient. A puncture needle holding means for directing to a target site, an ultrasonic probe for acquiring an ultrasonic tomographic image of the patient including the puncture route by contacting the skin of the patient, and an ultrasonic for displaying the ultrasonic tomographic image A sonic image display device.

  In the puncture assisting device, it is preferable that the puncture needle holding means holds the ultrasonic probe so as to be rotatable around the puncture needle.

  In the puncture assisting apparatus, it is preferable that the puncture needle holding means holds the ultrasonic probe in a state where a directivity axis of the ultrasonic probe is inclined by a predetermined range with respect to the puncture needle.

  In the puncture assisting device, the angle in the predetermined range is preferably 0 to 10 °.

  In the puncture assisting device, the 3D image is preferably taken by an MR device or a CT device.

  In the puncture assisting device, the MR device may be a tunnel type MR device.

  In the puncture assisting apparatus, it is preferable that the puncture needle holding means is a puncture assisting robot capable of RCM control.

  According to the present invention, it is unnecessary to pit-in the patient again into the MR apparatus every time the needle tip position is confirmed, and treatment such as cauterization with a puncture needle can be performed quickly and easily.

It is a block diagram which shows the structure of the puncture assistance apparatus which concerns on one Embodiment of this invention. It is an enlarged view of the holding | maintenance part of a puncture assistance robot, (a) is the top view seen from the top, (b) is a side view. It is an expanded side view of the said holding | maintenance part. It is a flowchart which shows the procedure of the ablation treatment in one Embodiment of this invention. It is a schematic diagram showing an example of an ultrasonic image. It is a schematic diagram showing an example of an ultrasonic image. It is a flowchart which shows the procedure of the conventional ablation treatment.

  Embodiments of the present invention will be described below with reference to the accompanying drawings.

  FIG. 1 is a block diagram showing a configuration of a puncture assisting apparatus 1 according to an embodiment of the present invention. The puncture support device 1 is provided in the vicinity of the tunnel-type MR device 2 and includes a puncture support robot 3, an ultrasonic probe 4, an arithmetic processing device 5, and an ultrasonic image display device 6.

  The MR apparatus 2 can take a high-definition 3D image (MR image) of a patient by measuring magnetic resonance signals from nuclei such as hydrogen and phosphorus in the body of the patient who has been pit-in.

  The puncture assisting robot 3 is made of a nonmagnetic material and includes an arm 31 that can rotate with two degrees of freedom. A holding portion 32 for attaching the ultrasonic probe 4 and the puncture needle 7 is connected to the end portion of the arm 31. The puncture assisting robot 3 has a three-axis ultrasonic motor (not shown) attached to the pedestal, and the orientation of the holding portion 32 is a sum of two orthogonal axes in the horizontal direction and one axis in the vertical direction. It is possible to adjust in the direction of three axes. With these configurations, the puncture assisting robot 3 can freely change the puncture angle while matching the tip position of the virtual puncture needle 7 for which the length before puncture is designated with the designated predetermined position. (Remote-Center-of-Motion) control is possible.

  The ultrasonic probe 4 is in contact with the patient's skin and transmits ultrasonic pulses and receives echoes. Thereby, the ultrasonic probe 4 can acquire an ultrasonic tomographic image of the patient including the puncture route of the puncture needle 7. As will be described later, the ultrasonic probe 4 is attached to the holding portion 32 so that the circumference of the puncture needle 7 can be rotated by 180 °. The acquired ultrasonic tomographic image is displayed on the ultrasonic image display device 6.

  FIG. 2 is an enlarged view of the holding portion 32 shown in FIG. 1, (a) is a plan view seen from above, and (b) is a side view. The holding part 32 is connected to the end of the arm 31 and includes a probe gripping part 321 for gripping the ultrasonic probe 4 and an insertion part 322 for inserting the puncture needle 7. The probe grip 321 is detachably connected to the arm 31 and is formed in a rectangular frame shape. The size of the rectangular frame is substantially equal to the outer shape of the ultrasonic probe 4, and the ultrasonic probe 4 can be gripped by inserting the ultrasonic probe 4 into the frame and tightening the screw 323. The insertion part 322 is a through-hole formed in one side of the rectangular frame constituting the probe gripping part 321. When the diameter of the puncture needle 7 is smaller than the diameter of the through hole, a collet having an outer diameter equal to the diameter of the through hole and an inner diameter equal to the diameter of the puncture needle 7 is inserted into the through hole.

  When the longitudinal direction of the through hole constituting the insertion portion 322, that is, the longitudinal direction of the puncture needle 7 inserted through the insertion portion 322 is defined as the Z direction, and the plane perpendicular to the Z direction is defined as the XY plane, FIG. As indicated by the broken line, the probe gripping portion 321 can rotate 180 ° along the XY plane around the insertion portion 322. Thereby, the ultrasonic probe 4 gripped by the probe gripping portion 321 can rotate around the puncture needle 7 by 180 °.

  As shown in FIG. 2B, the probe grip 321 is connected to the arm 31 in parallel to the XY plane. Therefore, the ultrasonic probe 4 gripped by the probe gripping portion 321 has an ultrasonic directional axis parallel to the longitudinal direction of the puncture needle 7.

  FIG. 3 is a side view showing a modified example of the holding portion 32, and the shape of the probe gripping portion 321 is different from that of the probe gripping portion 321 shown in FIG. The probe gripping portion 321 shown in FIG. 3 is inclined by an angle θ1 with respect to the XY plane, and 0 <θ1 ≦ 10 ° is desirable. Furthermore, it is desirable to prepare a plurality of probe gripping portions 321 having different angles θ1 and to select a probe gripping portion 321 having an optimal shape according to the relative position between the patient's body surface and the arm 31. Thereby, the ultrasonic probe 4 can always be brought into close contact with the patient's body surface.

  The arithmetic processing device 5 performs processing of 3D images from the MR device 2, operation control of the puncture support robot 3, and the like, and includes a target coordinate determination unit 51, an operation control unit 52, and a reconstructed image generation unit 53. ing. Since the vicinity of the MR apparatus 2 is a high magnetic field environment, the arithmetic processing apparatus 5 is desirably provided at a position away from the MR apparatus 2.

  The target coordinate determination unit 51 has a function of determining the coordinates of the target site of the patient. Specifically, when the 3D image received from the MR apparatus 2 is displayed on a monitor (not shown) and the operator designates a target site in the 3D image, the target coordinate determination unit 51 is based on the designated position in the 3D image. Then, the coordinates (target coordinates) of the virtual target region in the patient bed provided with the puncture assisting robot 3 are calculated and determined.

  The operation control unit 52 outputs a control signal for controlling the puncture support robot 3. The puncture assisting robot 3 is attached with an optical position sensor (not shown) that measures the relative position between the patient pit-out from the MR apparatus 2 and the puncture needle 7. The operation control unit 52 collates the relative position information of the patient and the puncture needle 7 transmitted from the position sensor with the target coordinates determined by the target coordinate determination unit 51. Thereby, the operation control unit 52 performs RCM control of the puncture assisting robot 3 so that the puncture needle 7 always points to the target site of the patient who is pit-out.

  The reconstructed image generation unit 53 does not require a registration process using a marker pasted on the body surface, and includes a position marker attached to the magnet, a position marker attached to the patient bed, and a position marker of the puncture assisting robot 3. The coordinate system is integrated so that the tip position of the puncture needle 7 of the puncture assisting robot 3 matches the virtual target site, and a tomographic image of two orthogonal planes along the puncture path is cut out from the 3D image, and a monitor (not shown) The reconstructed image is displayed on the screen and presented to the operator. Based on the reconstructed image, the surgeon determines the shortest route having no important structure such as an obstacle, blood vessel, or bile duct between the body surface and the target site as the puncture route. The puncture assisting robot 3 maintains the direction of the puncture needle 7 when determining the puncture route.

  The ultrasonic image display device 6 is installed in the vicinity of the patient bed, and displays an ultrasonic tomographic image acquired by the ultrasonic probe 4. Thereby, the surgeon can insert the puncture needle 7 while referring to the ultrasonic tomographic image while confirming the position of the target site and the real-time position of the puncture needle 7.

  With reference to FIG. 4, the procedure of the microwave coagulation therapy using the puncture assistance apparatus 1 which concerns on this embodiment is demonstrated.

  First, a patient is pit-in in the MR apparatus 2 and a high-definition 3D image of the patient is captured (S11). The 3D image is transmitted to the arithmetic processing unit 5, and the target coordinate determination unit 51 determines the coordinates of the target part (target coordinates) (S12). Subsequently, the patient is pit-out from the MR apparatus 2, and the motion control unit 52 controls the puncture assisting robot 3 based on the determined target coordinates. Thereby, the puncture assisting robot 3 makes the tip position of the puncture needle 7 coincide with the virtual target site. In conjunction with the direction of the puncture needle 7, the reconstructed image generation unit 53 cuts out two tomographic images along two puncture paths from the 3D image, displays the reconstructed image on the monitor, and presents it to the operator. (S13). Based on the reconstructed image, the surgeon determines an optimal puncture route free from obstacles such as ribs and lungs (S14). The puncture assisting robot 3 maintains the direction of the puncture needle 7 when determining the puncture route.

  Subsequently, the puncture assisting robot 3 approaches the patient by an arbitrary distance while maintaining the direction, presses the ultrasonic probe 4 held by the holding unit 32 against the patient's body surface, and performs ultrasonic waves near the operator. An ultrasonic tomographic image is displayed on the image display device 6 (S15). The puncture distance is determined by subtracting the distance approaching the body surface from the initially set needle length. Thus, the surgeon can insert the puncture needle 7 while referring to the ultrasonic tomographic image while confirming the position of the target site and the real-time position of the puncture needle 7 (S16). Even when the puncture needle 7 is bent during the insertion and the pointing direction is deviated from the target site, the operator can control the pointing direction by rotating the puncture needle 7 in the axial direction. Therefore, the tip of the puncture needle 7 can reliably reach the target site. Therefore, treatment such as ablation can be performed immediately (S17). Thereafter, S13 to S17 are repeated until there is no unprocessed part (NO in S18).

  As described above, in this embodiment, since the puncture needle 7 can be inserted with reference to the ultrasonic tomographic image displayed on the puncture needle 7 in real time, the tip of the puncture needle 7 can be reliably targeted. The site can be reached. There is no need to repeatedly pit the patient into the MR apparatus 2 every time the needle tip position is confirmed as in the prior art. Therefore, ablation treatment with a puncture needle can be performed quickly and easily, which contributes to reducing the burden on the patient and the operator.

  Further, in the present embodiment, as shown in FIG. 2A, the holding unit 32 of the puncture assisting robot 3 can hold the ultrasonic probe 4 around the puncture needle 7 so as to be rotatable by 180 °. Therefore, the ultrasonic probe 4 can be brought into close contact with the skin regardless of the angle of the arm 31 of the puncture assisting robot 3 with respect to the patient's body surface.

  Further, as shown in FIG. 3, the holding unit 32 is configured to hold the ultrasonic probe 4 while being inclined with respect to the puncture needle 7 by an angle θ1 (for example, 0 to 10 °) within a predetermined range. ing. Thereby, in the ultrasonic tomographic image, the position of the puncture needle 7 can be confirmed from a shallower position on the body surface. Hereinafter, the reason will be described with reference to FIG. 5 and FIG.

FIG. 5 shows the case where the ultrasonic probe 4 and the puncture needle 7 are pressed perpendicularly to the body surface (that is, the angle of the holding part 32 with respect to the XY plane of the probe holding part 321 as shown in FIG. 2B). 2 shows an ultrasonic tomographic image of the case where the ultrasonic probe 4 and the puncture needle 7 are held in a state where is 0 °. In the figure, P1 is the contact position between the ultrasonic probe 4 and the body surface, P2 is the insertion position of the puncture needle 7, T is the target site, and A1 is the pointing axis of the ultrasonic probe 4. The directional axis A1 is parallel to the longitudinal direction of the puncture needle 7, and the distance between the contact position P1 and the insertion position P2 is d1. The imaging range of the ultrasound probe 4 is a region that expands in a fan shape from the contact position P1, and is displayed in the ultrasound tomographic image of the puncture needle 7 when the angle formed by one edge of the imaging range and the body surface is θ2. The part is D1 = d1 · tan θ2 from the body surface.
It becomes a deeper part.

  FIG. 6 shows an ultrasonic tomographic image when the ultrasonic probe 4 and the puncture needle 7 are pressed against the body surface in a state where the ultrasonic probe 4 is inclined by the angle θ1 with respect to the puncture needle 7. In the figure, P3 is a contact position between the tilted ultrasonic probe 4 and the body surface, and A2 is a directional axis of the tilted ultrasonic probe 4. In FIG. 6, the entire ultrasonic tomographic image is shown tilted for convenience.

Assuming that the angle formed by one edge of the imaging range and the body surface is θ3, the portion displayed in the ultrasonic tomographic image of the puncture needle 7 is D2 = d2 · tan θ3 from the body surface.
It becomes a deeper part. As described above, since the ultrasonic probe 4 is inclined by the angle θ1 with respect to the puncture needle 7, if the distance between the contact position P3 and the insertion position P2 is d2, d2 <d1. Further, since the angle formed by the directional axis A1 and the directional axis A2 is θ1, θ3 = θ2−θ1 <θ2. Therefore, D2 <D1. That is, the position of the puncture needle 7 in a shallower region in the ultrasonic tomographic image can be confirmed as compared with the case where the ultrasonic probe 4 is not inclined with respect to the puncture needle 7.

  The present invention is not limited to the above-described embodiment, and various modifications are possible within the scope of the claims, and a form obtained by appropriately combining technical means disclosed in the embodiment is also included in the present invention. Included in the technical scope.

  In the above embodiment, the MR apparatus 2 is a tunnel type MR apparatus. However, the present invention is not limited to this. For example, a vertical open MR apparatus may be used. Regardless of whether the MR apparatus is a tunnel type or an open type, the MR image may be captured only once at S11.

  In the above embodiment, the MR apparatus is used to capture a high-definition 3D image. However, the apparatus is not particularly limited as long as the apparatus can capture a 3D image. For example, a 3D image may be captured using a CT apparatus instead of the MR apparatus. This makes it possible to perform ablation treatment of a liver tumor by puncture even at a medical site where a CT apparatus is installed. Also in this aspect, the CT image needs to be captured only once at the first time shown in S11. In particular, since the CT image capture involves radiation exposure, the number of CT image acquisitions is reduced to the minimum necessary. As a result, the exposure of the patient and the operator can be minimized.

  In the above embodiment, the puncture assisting robot is used to hold the puncture needle 7. However, if the tip of the puncture needle 7 can always be directed to the target site, the puncture needle other than the puncture assist robot is used. A holding means may be used.

  Furthermore, only the target site may be cut out from the reconstructed image, and the target site may be synthesized at a corresponding position in the ultrasonic tomographic image. Thereby, since the target site | part in an ultrasonic tomographic image is displayed clearly, surgery becomes still easier.

  The present invention is applicable not only to the treatment of liver tumors, but also to the treatment of all affected areas in the body as long as treatment by puncture is possible. It can also be applied to accurate biopsy by puncture.

1 Puncture support device 2 MR device 3 Puncture support robot (puncture needle holding means)
321 Probe gripping part 322 Insertion part 323 Screw 4 Ultrasonic probe 5 Arithmetic processing unit 51 Target coordinate determination part 52 Operation control part 53 Reconstructed image generation part 6 Ultrasound image display apparatus 7 Puncture needle

Claims (7)

Based on the 3D image of the patient acquired by the 3D image capturing apparatus, and the target coordinate determining means for determining the coordinates of the target site of the patient,
A position sensor for measuring the relative position of the patient and the puncture needle;
Operation control means for collating the coordinates of the relative positions of the patient and the puncture needle with the coordinates of the target site of the patient and generating a control signal for directing the puncture needle to the target site;
A puncture needle holding means that operates by receiving the control signal and directs the puncture needle to the target site;
A tomography cut out from the 3D image along the extending direction of the puncture needle by integrating the coordinate system of the position marker attached to the 3D image imaging device, the stage on which the patient is placed, and the puncture needle holding means Reconstructed image generating means for generating a reconstructed image, which is an image for an operator to determine a puncture path based on the image;
An ultrasonic probe for acquiring an ultrasonic tomographic image of the patient including the puncture path by contacting the patient's skin;
An ultrasonic image display device for displaying the ultrasonic tomographic image;
Equipped with a,
The biopsy needle holding means such that said stretching direction coincides with the puncture route, that holds the orientation of the puncture needle, puncture support device.   The puncture support device according to claim 1, wherein the puncture needle holding means holds the ultrasonic probe rotatably around the puncture needle.   The puncture support device according to claim 1 or 2, wherein the puncture needle holding means holds the ultrasonic probe in a state in which a directing axis of the ultrasonic probe is inclined by a predetermined range with respect to the puncture needle.   The puncture assisting device according to claim 3, wherein the angle in the predetermined range is 0 to 10 °.   The puncture assisting device according to any one of claims 1 to 4, wherein the 3D image is taken by an MR device or a CT device.   The puncture assisting device according to claim 5, wherein the MR device is a tunnel type MR device.   The puncture support device according to any one of claims 1 to 6, wherein the puncture needle holding means is a puncture support robot capable of RCM control.