JP6351994B2 - X-ray equipment - Google Patents

Description

  The present embodiment as one aspect of the present invention relates to an X-ray apparatus that performs X-ray fluoroscopy.

  Conventionally, in a medical field such as a medical examination, radiation (typically, X-rays) is irradiated to an imaging region of a subject, and an intensity distribution of the radiation that has passed through the imaging region is detected to obtain an image of the imaging region. X-ray devices are widely used.

  2. Description of the Related Art In recent years, the use of an X-ray apparatus to perform surgery by inserting a cord-like insertion instrument composed of a thin cord-like member into the body due to advantages such as low invasiveness to a subject has been remarkably widespread. Examples of cord-like insertion devices that are inserted into the body include electrode catheters, ablation catheters, and catheters such as microcatheters (including guide wires introduced with the catheters). In general, since a catheter absorbs X-rays more easily than a human body, it is observed as a black thin line on an X-ray image.

  An example of a surgery in which a catheter is used is catheterization under fluoroscopy. Under fluoroscopic catheterization, a catheter is inserted into the body from the femoral artery or the like, and treatment is performed by guiding the catheter to the affected area while referring to a fluoroscopic image displayed in real time. The surgeon must guide the catheter to the affected part through an appropriate route through the blood vessel stretched like a maze. The operation for that is performed by manipulating the portion of the catheter that is outside the body. Thus, skilled procedures are required for catheterization under fluoroscopy.

  The catheter can be easily recognized in the fluoroscopic image, but the branch and stenosis site of the blood vessel cannot be recognized (the part where the calcification has occurred may be faintly seen). Therefore, the path of the catheter is confirmed each time by frequently letting the contrast medium flow out from the catheter into the body and observing the staining appearing for only a few seconds.

  In addition, a technique for suppressing the movement of a wire image in a fluoroscopic image displayed in real time in an operation performed by inserting a wire is disclosed (see, for example, Patent Document 1).

JP 2011-156321 A

  In conventional X-ray fluoroscopic catheterization, if the contrast medium is frequently discharged into the body to confirm the course of the catheter, the contrast medium is only a few seconds, so the path of the catheter is confirmed within that time. To do this, the surgeon needs considerable skill. Moreover, since the contrast agent imposes a load on the kidney function and the like, the amount to be used on the human body is limited.

  In particular, in aortic valve replacement (TAVR / TAVI) and arrhythmia ablation treatment (EP), which is a treatment method in which an electrode catheter is inserted into the part causing arrhythmia and a high-frequency current is passed to burn the cause part. It is necessary to confirm the course of the catheter in accordance with the movement (beat) of the heart while performing X-ray fluoroscopy of the region including the heart. Since it is necessary to recommend a catheter while predicting the subsequent movement of the heart after the contrast medium is frequently discharged into the body and the position is grasped, it is particularly necessary for the operator to be skilled.

  Furthermore, in renal denervation catheterization, it is necessary to check the course of the catheter in accordance with the movement of the kidney (respiration movement) while performing fluoroscopy of the region including the kidney, and the skill of the operator is required.

X-ray apparatus of this embodiment, in order to solve the above problems, by performing granulation shadow perspective, the contrast fluoroscopic image producing means for producing a contrast fluoroscopic images of a plurality of frames, in contrast fluoroscopic images of a plurality of frames, Contrast fluoroscopic image registration means for registering the phase information collected together with the contrast fluoroscopy in the storage unit in association with each other, non-contrast fluoroscopic image generation means for generating non-contrast fluoroscopic images by performing non- contrast fluoroscopy, and the storage Based on a plurality of contrast fluoroscopic images registered in the unit, a contrast fluoroscopic image acquisition means for acquiring a contrast fluoroscopic image of a frame corresponding to the phase information of the non-contrast fluoroscopic image, the non-contrast fluoroscopic image, and the acquired Subtraction processing means for generating a subtraction image by performing subtraction processing on the contrast-enhanced fluoroscopic image, and superimposing the subtraction image on the non-contrast fluoroscopic image To generate a superimposed image, having a superimposition processing means for displaying the superimposed image to the display unit.

Schematic which shows the external appearance structure of the X-ray apparatus of this embodiment. Schematic which shows the structure of the X-ray apparatus of this embodiment. The block diagram which shows the function of the X-ray apparatus of this embodiment. The figure for demonstrating the production | generation of a 2nd contrast fluoroscopic image set. The figure for demonstrating a subtraction process. The figure which shows an example of a superimposed image. The figure for demonstrating the detection of an arrhythmia. The flowchart which shows operation | movement of the X-ray apparatus of this embodiment.

  The X-ray apparatus of this embodiment is demonstrated with reference to an accompanying drawing.

  FIG. 1 is a schematic view showing an external structure of the X-ray apparatus of the present embodiment. FIG. 2 is a schematic diagram showing the configuration of the X-ray apparatus of the present embodiment.

  FIG. 1 shows an X-ray apparatus 1 having an overhead traveling Ω arm and a floor-standing C arm, an injector I, and an ECG (electrocardiogram) measuring instrument E. FIG. 2 shows an X-ray apparatus 1 having only an overhead traveling C-arm (undertube type). Hereinafter, as shown in FIG. 2, description will be made using an X-ray apparatus 1 having only the overhead traveling C-arm.

  The X-ray apparatus 1 generally includes a holding device 2, a high voltage supply device 3, a bed device 4, a controller 5, an operating room display unit 6, a speaker 7, an operating room input unit 8, and a DF (digital fluorescence) device (workpiece). Station) 9. The holding device 2, the high voltage supply device 3, the bed device 4, the controller 5, the operating room display unit 6, the speaker 7, and the operating room input unit 8 are generally installed in a surgical operating room (examination / treatment room). Is done. On the other hand, the DF device 9 is installed in a control room adjacent to the surgical operating room. The X-ray apparatus 1 is not limited to the overhead traveling type Ω arm and floor-standing type C arm shown in FIG. 1 or the overhead traveling type C arm shown in FIG. Only an arm or only a floor-standing C-arm may be provided. The X-ray apparatus 1 may be an X-ray apparatus including an overtube type C-arm.

  The holding device 2 includes a slide mechanism 21, a vertical axis rotation mechanism 22, a suspension arm 23, a C arm rotation mechanism 24, a C arm 25, an X-ray irradiation device 26, and an X-ray detection device 27.

  The slide mechanism 21 includes a Z-axis direction rail 211, an X-axis direction rail 212, and a carriage 213. The slide mechanism 21 slides in the horizontal direction integrally with the vertical axis rotation mechanism 22, the suspension arm 23, the C arm rotation mechanism 24, the C arm 25, the X-ray irradiation device 26, and the X-ray detection device 27 under the control of the controller 5. Let

  The Z-axis direction rail 211 extends in the Z-axis direction (the long axis direction of the top plate 41) and is supported by the ceiling.

  The X-axis direction rail 212 extends in the X-axis direction (short axis direction of the top plate 41) and is supported by the Z-axis direction rail 211 via rollers (not shown) at both ends thereof. The X-axis direction rail 212 is moved in the Z-axis direction on the Z-axis direction rail 211 under the control of the controller 5.

  The carriage 213 is supported by the X-axis direction rail 212 via a roller (not shown). The carriage 213 is moved on the X-axis direction rail 212 in the X-axis direction under the control of the controller 5.

  Since the X-axis direction rail 212 that supports the carriage 213 can move in the Z-axis direction on the Z-axis direction rail 211, and the carriage 213 can move in the X-axis direction on the X-axis direction rail 212, the carriage 213 can be In the surgical operation room, it can move in the horizontal direction (X-axis direction and Z-axis direction).

  The vertical axis rotation mechanism 22 is rotatably supported by the carriage 213. The vertical axis rotation mechanism 22 rotates the suspension arm 23, the C arm rotation mechanism 24, the C arm 25, the X-ray irradiation device 26, and the X-ray detection device 27 as a unit in the vertical axis rotation direction under the control of the controller 5.

  The suspension arm 23 is supported by the vertical axis rotation mechanism 22.

  The C arm rotation mechanism 24 is rotatably supported by the suspension arm 23. The C-arm rotation mechanism 24 rotates the C-arm 25, the X-ray irradiation device 26, and the X-ray detection device 27 together in the rotation direction with respect to the suspension arm 23 under the control of the controller 5.

  The C-arm 25 is supported by the C-arm rotation mechanism 24, and the X-ray irradiation device 26 and the X-ray detection device 27 are arranged opposite to each other with the subject S as the center. A rail (not shown) is provided on the back surface or side surface of the C arm 25, and the C arm 25 is irradiated with X-rays under the control of the controller 5 through the rail sandwiched between the C arm rotation mechanism 24 and the C arm 25. The device 26 and the X-ray detection device 27 are integrally moved in the arc direction of the C arm 25.

  The X-ray irradiation device 26 is provided at one end of the C arm 25. The X-ray irradiation device 26 is provided so as to be able to move back and forth under the control of the controller 5. The X-ray irradiation device 26 includes an X-ray tube (X-ray source) 261 and a movable aperture device 262.

  The X-ray tube 261 receives supply of high voltage power from the high voltage supply device 3 and generates X-rays according to the condition of high voltage power.

  The movable diaphragm device 262 movably supports a diaphragm blade made of a substance that shields X-rays at the X-ray irradiation port of the X-ray tube 261 under the control of the controller 5. Note that a radiation quality adjustment filter (not shown) for adjusting the quality of the X-rays generated by the X-ray tube 261 may be provided on the front surface of the X-ray tube 261.

  The X-ray detection device 27 is provided at the other end of the C arm 25 so as to face the X-ray irradiation device 26. The X-ray detection device 27 is provided so as to be able to move back and forth under the control of the controller 5. The X-ray detection apparatus 27 includes an FPD (Flat Panel Detector) 271 and an A / D (analog to digital) conversion circuit 272.

  The FPD 271 has a plurality of detection elements arranged in two dimensions. Between the detection elements of the FPD 271, the scanning lines and the signal lines are arranged so as to be orthogonal to each other. Note that a grid (not shown) may be provided on the front surface of the FPD 271. In order to improve the contrast of the X-ray image by absorbing the scattered radiation incident on the FPD 271, the grid is alternately arranged with a grid plate formed of lead or the like having a large X-ray absorption and easily transmitted aluminum or wood. Is done.

  The A / D conversion circuit 272 converts the projection data of the time-series analog signal (video signal) output from the FPD 271 into a digital signal and outputs it to the DF device 9.

  The X-ray detection device 27 is an I.I. I. (Image intensifier) -TV system may be used. I. I. -In the TV system, X-rays transmitted through the subject S and directly incident X-rays are converted into visible light, and brightness is doubled in the process of light-electron-light conversion to obtain highly sensitive projection data. The optical projection data is converted into an electrical signal by using a CCD (charge coupled device) image sensor.

  The high voltage supply device 3 can supply high voltage power to the X-ray tube 261 of the X-ray irradiation device 26 under the control of the controller 5.

  The bed apparatus 4 includes a bed main body (not shown) supported on the floor surface and a top board (catheter table) 41 supported by the bed main body. Under the control of the controller 5, the couch device 4 causes the top board 41 to slide (X and Z axis directions), move up and down (Y axis direction), and roll. The top 41 can mount the subject S. In addition, although the holding | maintenance apparatus 2 demonstrates the case where the X-ray irradiation apparatus 26 is an undertube type located below the top plate 41, the X-ray irradiation apparatus 26 is an overtube type located above the top plate 41. There may be some cases.

  The controller 5 includes a CPU (central processing unit) and a memory (not shown). The controller 5 controls the movement of the holding device 2 and the couch device 4 according to the control of the DF device 9, as well as the X-ray irradiation device 26, the X-ray detection device 27, and the high voltage supply device 3 for fluoroscopic imaging. Control the behavior.

  The operating room display unit 6 displays an image together with character information and scales of various parameters. As the operating room display unit 6, a display device such as a liquid crystal display can be used.

  The speaker 7 is a device that generates sound such as music and voice by changing an electrical signal from a microphone 97 described later into physical vibration.

  The operating room input unit 8 is mainly a keyboard and a mouse that can be operated by an operator such as an assistant, and an input signal according to the operation is sent to the controller 5.

  The DF device 9 is configured based on a computer, and is a device that performs operation control of the entire X-ray device 1, image processing related to a fluoroscopic image and a captured image acquired by the holding device 2, and the like. The DF device 9 includes a system control unit 91, an X-ray image generation unit 92, an X-ray image processing unit 93, an X-ray image storage unit 94, a control room display unit 95, a control room input unit 96, and a microphone 97.

  The system control unit 91 includes a CPU and a memory (not shown). The system control unit 91 controls the controller 5 and each unit 92 to 97.

  The X-ray image generation unit 92 performs logarithmic conversion processing (LOG processing) on the projection data output from the A / D conversion circuit 272 of the holding device 2 under the control of the system control unit 91 and performs addition processing as necessary. Then, data of an X-ray image (a fluoroscopic image and a captured image (DA image)) is generated.

  The X-ray image processing unit 93 performs image processing on the X-ray image generated by the X-ray image generation unit 92 under the control of the system control unit 91. Examples of image processing include enlargement / gradation / spatial filter processing on data, minimum / maximum value tracing processing of data accumulated in time series, and addition processing for removing noise. The data after the image processing by the X-ray image processing unit 93 is output to the operating room display unit 6 and the control room display unit 95, and is also stored in a storage device such as the X-ray image storage unit 94.

  The control room display unit 95 displays an image together with character information and scales of various parameters. As the control room display unit 95, as with the operating room display unit 6, a display device such as a liquid crystal display can be used.

  The control room input unit 96 is a keyboard and a mouse that can be operated by an operator, and an input signal according to the operation is sent to the system control unit 91.

  The microphone 97 is a device that collects ambient sounds and converts them into electrical signals.

  The injector I is generally installed in a surgical operating room. The injector I is a contrast agent for a catheter such as an electrode catheter, an ablation catheter, and a microcatheter (not shown) inserted into an affected part from an artery at the base of the foot, wrist, elbow or the like of the subject S according to the control of the controller 5. Is a device for injecting. The catheter includes a guide wire that is introduced with the catheter.

  The ECG measuring instrument E is mainly used in contact with the body surface near the heart of the subject S. The ECG measuring device E measures a time-series ECG signal (electrocardiogram signal), and digitally converts the ECG signal. The ECG measuring instrument E is constituted by a non-volatile semiconductor memory or the like, and includes a memory (not shown) that temporarily stores a digitally converted ECG signal. The ECG signal stored in the memory is sent to the DF device 9.

  FIG. 3 is a block diagram showing functions of the X-ray apparatus 1 of the present embodiment.

  When the system control unit 91 of the DF device 9 shown in FIG. 1 executes the program, as shown in FIG. 3, the X-ray device 1 has a holding / bed device installation unit 91a, a contrast fluoroscopic image generation unit 91b, and a contrast fluoroscopic image. It functions as registration means 91c, non-contrast fluoroscopic image generation means 91d, contrast fluoroscopic image acquisition means 91e, subtraction processing means 91f, and superimposition processing means 91g. Note that some or all of the units 91 a to 91 g as functions of the DF device 9 may function in the controller 5. In addition, some or all of the units 91 a to 91 g as functions of the X-ray apparatus 1 may be provided as hardware in the X-ray apparatus 1.

  The holding / bed apparatus installation means 91a places the subject S on the top board 41 (shown in FIG. 2), and then changes the X-ray irradiation position and angle to the operating room input unit 8 (shown in FIG. 2). The instruction received from the controller 5 is received via the controller 5, and the holding device 2 and the couch device 4 (both shown in FIG. 2) are moved via the controller 5 in accordance with the instruction to hold the holding device 2 and the couch device at arbitrary positions. 4 has a function to install (position). For example, the holding / bed apparatus setting means 91a slides at least one of the slide mechanism 21 and the top board 41 (both shown in FIG. 2) via the controller 5 in order to adjust the X-ray irradiation position. Position. In addition, for example, the holding / bed apparatus setting unit 91a may adjust the X-ray irradiation angle via the controller 5 through the vertical axis rotation mechanism 22, the C arm rotation mechanism 24, and the C arm 25 (all of which are shown in FIG. 2). At least one of them is rotated or the C arm 25 is moved in a circular arc.

  The contrast fluoroscopic image generation unit 91b receives an instruction input from the operating room input unit 8 (illustrated in FIG. 2) via the controller 5, operates the injector I via the controller 5 in accordance with the instruction, and performs the test on the subject S. It has a function of causing a contrast medium to flow into the subject S from the tip of a catheter (not shown) introduced into (shown in FIG. 2). Further, the contrast fluoroscopic image generation means 91b operates the X-ray detection device 27 and the high voltage supply device 3 (both shown in FIG. 2) via the controller 5 in the state where the contrast agent exists in the subject S. It has a function to execute X-ray fluoroscopy (contrast fluoroscopy). Further, the contrast fluoroscopic image generation unit 91b has a function of controlling the X-ray image generation unit 92 and the X-ray image processing unit 93 to generate a multi-frame fluoroscopic image (contrast fluoroscopic image) by contrast fluoroscopy. Here, the contrast fluoroscopic image generation unit 91b may start the contrast fluoroscopy in synchronization with the start of the flow of the contrast medium into the subject S, or at an arbitrary timing after the flow of the contrast medium into the subject S. Contrast fluoroscopy may be started.

  The contrast fluoroscopic image registration means 91c acquires the ECG signal obtained by the ECG measuring device E, and associates the ECG signal (phase information) with the contrast fluoroscopic image generated by the contrast fluoroscopic image generation means 91b to obtain an X-ray image. It has a function of registering in the storage unit 94. In the X-ray image storage unit 94, a plurality of frames of contrast fluoroscopic images (contrast medium fluoroscopic image set) for at least one cardiac cycle, in which electrocardiographic waveforms based on time-series ECG signals are associated, are registered.

  The non-contrast fluoroscopic image generation means 91d receives an instruction input from the operating room input unit 8 (shown in FIG. 2) via the controller 5 in a state where no contrast agent is present in the subject S, and the controller according to the instruction 5, the X-ray detection device 27 and the high-voltage supply device 3 (both shown in FIG. 2) are operated to perform X-ray fluoroscopy (non-contrast fluoroscopy). The non-contrast fluoroscopic image generation means 91d has a function of controlling the X-ray image generation unit 92 and the X-ray image processing unit 93 to generate a non-contrast fluoroscopic image (non-contrast fluoroscopic image) as a real-time image. .

  The contrast fluoroscopic image acquisition means 91e is a contrast fluoroscopic image of a frame corresponding to the cardiac phase based on the current ECG signal obtained by the ECG measuring device E based on the contrast fluoroscopic image set stored in the X-ray image storage unit 94. Has a function of acquiring (reading). The contrast fluoroscopic image acquisition unit 91e may acquire a contrast fluoroscopic image of a frame that matches the cardiac phase of the non-contrast fluoroscopic image from the contrast fluoroscopic image set (in the case of the following formula (1)), or the contrast fluoroscopic image set. From this, a plurality of frames of contrast fluoroscopic images close to the cardiac phase of the non-contrast fluoroscopic images may be obtained, and the obtained contrast fluoroscopic images of the plurality of frames may be interpolated to obtain a contrast fluoroscopic image after interpolation (the following formula (2) )in the case of). This is because in the latter case, the heart rate of the subject S may differ between contrast-enhanced fluoroscopy and non-contrast-enhanced fluoroscopy.

  During non-contrast fluoroscopy by the non-contrast fluoroscopic image generating means 91d, the ECG signal is constantly monitored. Therefore, the contrast fluoroscopic image obtaining unit 91e continuously records the heart rate during non-contrast fluoroscopy based on the ECG signal, and the past heart rate during non-contrast fluoroscopy (average heart rate in a plurality of past cardiac cycles). Is calculated. Then, the contrast fluoroscopic image acquisition unit 91e determines whether the past average heart rate during non-contrast fluoroscopy is different from the heart rate during contrast fluoroscopy.

  When the past average heart rate (BPMr) during non-contrast fluoroscopy and the heart rate (BPMc) during contrast fluoroscopy satisfy the following equation (1), the registered contrast fluoroscopic image set is a non-contrast fluoroscopic image: It has a sufficient number of frames to reproduce. In this case, the contrast fluoroscopic image acquisition unit 91e determines that interpolation using a plurality of frames of contrast fluoroscopic images having close cardiac phases is not necessary. Then, the contrast fluoroscopic image acquisition unit 91e acquires, from the registered contrast fluoroscopic image set, a contrast fluoroscopic image of a frame whose cardiac phase matches the non-contrast fluoroscopic image.

[Equation 1]
BPMr ≦ BPMc (1)

  On the other hand, when the past average heart rate (BPMr) during non-contrast fluoroscopy and the heart rate (BPMc) during contrast fluoroscopy satisfy the following equation (2), the registered contrast fluoroscopic image set is non-contrast It does not have a sufficient number of frames to reproduce a fluoroscopic image. In this case, the contrast fluoroscopic image acquisition unit 91e determines that interpolation using a plurality of frames of contrast fluoroscopic images having close cardiac phases is necessary. This interpolation processing may be performed in real time by morphing processing or the like, or a second contrast fluoroscopic image set obtained by resampling the first contrast fluoroscopic image set generated by the contrast fluoroscopic image generating means 91b with a fine frame is preliminarily stored in X. It may be registered in the line image storage unit 94. In the latter case, the contrast fluoroscopic image acquisition unit 91e acquires, from the second contrast fluoroscopic image set, a contrast fluoroscopic image of a frame whose cardiac phase matches the non-contrast fluoroscopic image.

[Equation 2]
BPMr> BPMc (2)

  FIG. 4 is a diagram for explaining generation of the second contrast fluoroscopic image set.

  The upper part of FIG. 4 shows a first contrast fluoroscopic image set generated by the contrast fluoroscopic image generation unit 91b (shown in FIG. 3) after the region including the heart is contrast-transparent. The first contrast fluoroscopic image set is loosely associated with the electrocardiogram waveform shown in the middle part of FIG. When the first contrast fluoroscopic image set is resampled, a second non-contrast fluoroscopic image set whose cardiac phase is finer than that of the first contrast fluoroscopic image set is obtained as shown in the lower part of FIG. The second contrast fluoroscopic image set is closely associated with the electrocardiographic waveform shown in the middle of FIG.

  Returning to the description of FIG. 3, the subtraction processing unit 91f performs a subtraction process on the non-contrast fluoroscopic image generated by the non-contrast fluoroscopic image generation unit 91d and the contrast fluoroscopic image of the frame acquired by the contrast fluoroscopic image acquisition unit 91e. And a function of generating a subtraction image as a real-time image.

  Here, only simple subtraction processing may leave bone contour portions or contrast medium dust, so processing for extracting a pure contrast portion is necessary. As a method for extracting a contrast portion, for example, there are the following methods. For each frame of the subtraction image, pixels having a signal equal to or greater than a certain threshold are extracted, and are limited to only pixels having a certain area or greater.

  FIG. 5 is a diagram for explaining the subtraction process.

  The upper part of FIG. 5 shows a contrast fluoroscopic image set when a region including the heart registered in advance is subjected to contrast fluoroscopy. According to the contrast fluoroscopic images of a plurality of frames included in the contrast fluoroscopic image set, the contrast of the contrast agent changes and the size of the dyed portion changes. By subtracting a non-contrast fluoroscopic image (not shown) from a contrast fluoroscopic image of a frame whose cardiac phase matches that of the non-contrast fluoroscopic image, a subtraction image as shown in the middle of FIG. 5 is obtained. The lower part of FIG. 5 shows an electrocardiogram waveform corresponding to a contrast fluoroscopic image set and a subtraction image.

  Returning to the description of FIG. 3, the superimposition processing unit 91g superimposes the subtraction image generated by the subtraction processing unit 91f on the non-contrast fluoroscopic image generated by the non-contrast fluoroscopic image generation unit 91d and displays the superimposed image in real time. It has the function to generate as. Furthermore, the superimposition processing unit 91g stores the superimposed image in the X-ray image storage unit 94 or displays it on the operating room display unit 6. By generating the subtraction image and the superimposed image in accordance with the generation of the non-contrast perspective image by the non-contrast perspective image generation unit 91d, the displayed superimposed image is updated.

  FIG. 6 is a diagram illustrating an example of a superimposed image.

  FIG. 6 shows a superimposed image in a case where the region including the heart is subjected to contrast fluoroscopic / non-contrast fluoroscopy. As shown in FIG. 6, the superimposed image includes a stained portion C included in the subtraction image and a catheter image K included in the non-contrast fluoroscopic image. By superimposing and displaying the superimposed image, a plurality of superimposed images are displayed as moving images. The plurality of superimposed images constituting the moving image always include a contrast portion.

  Returning to the description of FIG. 3, an example in which the past average heart rate during non-contrast fluoroscopy differs from the heart rate during contrast fluoroscopy includes the case of including an arrhythmia. If an arrhythmia occurs, the frame of the contrast fluoroscopic image set may be inappropriate. Accordingly, when the contrast fluoroscopic image acquisition unit 91e detects an arrhythmia during non-contrast fluoroscopy based on the ECG signal obtained by the ECG measuring device E, the contrast fluoroscopic image acquisition unit 91e displays an additional display to that effect and a frame before the frame where the arrhythmia is detected. At least one of display of the corresponding superimposed image and switching of display from the superimposed image to the non-contrast perspective image is performed.

  The contrast fluoroscopic image acquisition unit 91e detects an arrhythmia based on the timing of the next R wave predicted based on the past heart rate tendency during non-contrast fluoroscopy and the timing of the actually measured R wave. For example, the contrast fluoroscopic image obtaining unit 91e detects an arrhythmia by actually measuring an R wave at a timing greatly deviating from the past average heart rate during non-contrast fluoroscopy.

  FIG. 7 is a diagram for explaining detection of arrhythmia.

  As shown in FIG. 7, the past heart rate (average heart rate in 4 cardiac cycles in FIG. 7) during non-contrast fluoroscopy is obtained. If the R wave r2 appears at a timing delayed from the R wave r1 (broken line) at the next timing predicted based on the past average heart rate at a timing more than the threshold, it is determined that an arrhythmia has occurred.

  Subsequently, the operation of the X-ray apparatus 1 of the present embodiment will be described with reference to FIGS. 2 and 8.

  FIG. 8 is a flowchart showing the operation of the X-ray apparatus 1 of the present embodiment.

  After placing the subject S on the top 41, the X-ray apparatus 1 positions the holding device 2 and the bed apparatus 4 at arbitrary positions according to instructions for changing the X-ray irradiation position and angle (step ST1). . The X-ray apparatus 1 operates the injector I to cause the contrast medium to flow into the subject S from the tip of a catheter (not shown) introduced into the subject S, and the X-ray detection device 27 and the high voltage supply device 3. To start contrast fluoroscopy (step ST2).

  The X-ray apparatus 1 controls the X-ray image generation unit 92 and the X-ray image processing unit 93 to generate a contrast fluoroscopic image of a plurality of frames by contrast fluoroscopy (step ST3). The X-ray apparatus 1 acquires the ECG signal obtained by the ECG measuring instrument E, and registers the ECG signal in the X-ray image storage unit 94 in association with the contrast fluoroscopic image generated in Step ST3 (Step ST4). .

  The X-ray apparatus 1 determines whether or not a contrast fluoroscopic image set for one cardiac cycle (contrast fluoroscopic image set for at least one cardiac cycle) has been registered in step ST4 (step ST5). If YES in step ST5, that is, if it is determined that a contrast fluoroscopic image set for one cardiac cycle has been registered, the X-ray apparatus 1 ends the contrast fluoroscopy started in step ST2 (step ST6). The line detection device 27 and the high voltage supply device 3 are operated to start non-contrast fluoroscopy (step ST7). On the other hand, if the determination in step ST5 is NO, that is, if it is determined that a contrast fluoroscopic image set for one cardiac cycle is not registered, the X-ray apparatus 1 returns to the operation in step ST3.

  Subsequent to step ST7, the X-ray apparatus 1 controls the X-ray image generation unit 92 and the X-ray image processing unit 93 to generate a non-contrast fluoroscopic image by non-contrast fluoroscopy (step ST8). The X-ray apparatus 1 acquires the ECG signal obtained by the ECG measuring instrument E simultaneously with Step ST8, and acquires the acquired ECG based on the contrast fluoroscopic image set registered in the X-ray image storage unit 94 at Step ST4. A contrast fluoroscopic image of a frame corresponding to the cardiac phase based on the signal is acquired (step ST9). In step ST9, the X-ray apparatus 1 matches the cardiac phase based on the acquired ECG signal from the plurality of contrast fluoroscopic images included in the contrast fluoroscopic image set registered in the X-ray image storage unit 94. A contrast fluoroscopic image is acquired. Alternatively, in step ST9, the X-ray apparatus 1 is close to a cardiac phase based on an ECG signal acquired from a plurality of frames of contrast fluoroscopic images included in the contrast fluoroscopic image set registered in the X-ray image storage unit 94. A contrast fluoroscopic image of a plurality of frames is obtained, and one contrast fluoroscopic image is obtained by interpolating the contrast fluoroscopic images of a plurality of frames.

  The X-ray apparatus 1 performs subtraction processing on the non-contrast fluoroscopic image generated in step ST8 and the contrast fluoroscopic image of the frame acquired in step ST9 to generate a subtraction image (step ST10). The X-ray apparatus 1 superimposes the subtraction image generated in step ST10 on the non-contrast fluoroscopic image generated in step ST8 to generate a superimposed image as a real-time image (step ST11). The X-ray apparatus 1 displays the superimposed image (shown in FIG. 6) generated in step ST11 on the operating room display unit 6 as a real-time image (step ST12).

  The X-ray apparatus 1 determines whether or not to end the non-contrast fluoroscopy started in step ST7 (step ST13). If the determination in step ST13 is YES, that is, if it is determined that non-contrast fluoroscopy is to be ended, the X-ray apparatus 1 ends the operation. On the other hand, if the determination in step ST13 is NO, that is, if it is determined not to end non-contrast fluoroscopy, the X-ray apparatus 1 returns to the operation in step ST8.

  According to the prior art, the contrast fluoroscopic image generated in step ST8 is updated and displayed as a real-time image. However, according to the X-ray apparatus 1 of the present embodiment, the superimposed image generated in step ST11 is updated and displayed as a real-time image.

  When the subject S is subjected to fluoroscopic catheterization while the operations of steps ST8 to ST13 are repeated, the surgeon always refers to the superimposed image that is updated and displayed and includes the contrast portion. The treatment can be performed by guiding the catheter to the affected area. In particular, even in aortic valve replacement (TAVR / TAVI) and arrhythmia ablation treatment (EP), the operator performs non-contrast fluoroscopy of the region including the heart, and stains that match the movement (beat) of the heart. The course of the catheter can be determined while checking the shadow.

  Note that the case where the X-ray apparatus 1 of the present embodiment performs subtraction processing based on electrocardiogram synchronization has been described as an example. However, the X-ray apparatus 1 of the present embodiment can also be applied to subtraction processing based on respiratory synchronization. For example, the contrast fluoroscopic image registration unit 91c registers the contrast fluoroscopic image generated by the contrast fluoroscopic image generation unit 91b in the X-ray image storage unit 94 in association with the respiratory phase measured by a measuring instrument (not shown). . Then, the contrast fluoroscopic image acquisition unit 91e acquires a contrast fluoroscopic image of a frame corresponding to the current respiratory phase obtained by the measuring instrument based on the contrast fluoroscopic image set stored in the X-ray image storage unit 94 ( read out). According to such a configuration, in renal denervation catheterization, the course of the catheter can be determined while performing non-contrast fluoroscopy of the region including the kidney while confirming the staining that matches the movement of the kidney.

  According to the X-ray apparatus 1 of the present embodiment, the surgeon can display an image in an arbitrary phase by displaying a superimposed image in which an electrocardiogram-synchronized or respiratory-synchronized stained part is superimposed on a real-time non-contrast fluoroscopic image The shape information can be grasped, and the procedure at the time of treatment, which greatly depends on the skill and experience of the operator, can be simplified. In addition, according to the X-ray apparatus 1 of the present embodiment, once a contrast agent is administered into the body of the subject S, the contrast fluoroscopic image set at that time can be repeatedly used. The dose of the contrast agent can be reduced.

  Although several embodiments of the present invention have been described above, these embodiments are presented as examples and are not intended to limit the scope of the invention. These novel embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the scope of the invention. These embodiments and modifications thereof are included in the scope and gist of the invention, and are included in the invention described in the claims and the equivalents thereof.

DESCRIPTION OF SYMBOLS 1 X-ray apparatus 2 Holding | maintenance apparatus 4 Bed apparatus 5 Controller 6 Operating room display part 9 DF apparatus 26 X-ray irradiation apparatus 27 X-ray detection apparatus 91 System control part 91a Holding | supporting / bed apparatus installation means 91b Contrast fluoroscopic image generation means 91c Contrast fluoroscopy Image registration means 91d Non-contrast perspective image generation means 91e Contrast perspective image acquisition means 91f Subtraction processing means 91g Superimposition processing means

Claims (5)

Contrast fluoroscopic image generation means for performing contrast fluoroscopy and generating a multi-frame contrast fluoroscopic image;
Contrast fluoroscopic image registration means for registering, in the storage unit, the cardiac phases collected together with the contrast fluoroscopy, in association with the multi-frame contrast fluoroscopic images,
A non-contrast fluoroscopic image generation means for performing non-contrast fluoroscopy and generating a non-contrast fluoroscopic image;
Based on the contrast fluoroscopic images of said plurality of frames registered in the storage unit, and the contrast fluoroscopic image acquisition means for acquiring a contrast fluoroscopic image of the frame corresponding to the cardiac phase of the non-contrast fluoroscopic image,
Subtraction processing means for generating a subtraction image by performing subtraction processing on the non-contrast fluoroscopic image and the acquired contrast fluoroscopic image;
Superimposing processing means for generating a superimposed image by superimposing the subtraction image on the non-contrast fluoroscopic image, and displaying the superimposed image on a display unit;
I have a,
The contrast fluoroscopic image acquisition means determines whether to interpolate the contrast fluoroscopic images of the plurality of frames by comparing a past average heart rate during the non-contrast fluoroscopy and a heart rate during the contrast fluoroscopy. If it is determined that interpolation is to be performed, a plurality of frames of contrast fluoroscopic images that are close to the cardiac phase of the non-contrast fluoroscopic images are acquired from the plurality of frames of contrast fluoroscopic images registered in the storage unit. Interpolating a plurality of contrast fluoroscopic images, to obtain a contrast fluoroscopic image of a frame corresponding to the cardiac phase of the non-contrast fluoroscopic image,
X-ray device. The contrast fluoroscopic image acquisition means detects an arrhythmia based on the cardiac phase during the non-contrast fluoroscopy ,
The X-ray apparatus according to claim 1 . The contrast fluoroscopic image acquisition means detects the arrhythmia based on a next R wave timing R wave predicted based on a past heart rate tendency during the non-contrast fluoroscopy and an actually measured R wave timing. to,
The X-ray apparatus according to claim 2 . The contrast fluoroscopic image acquisition means, when detecting the arrhythmia, additional display to that effect, display of a superimposed image corresponding to a frame before the frame where the arrhythmia was detected, and the non-contrast fluoroscopic image from the superimposed image performing at least one of the display to switch to,
The X-ray apparatus according to claim 2 or 3 . An X-ray irradiation device, an X-ray detection device, and a holding device including a support unit that supports the X-ray irradiation device, and a device setting unit that positions the bed device on which the subject is placed;
The contrast fluoroscopic image generation means performs the contrast fluoroscopy by controlling the X-ray irradiation apparatus and the X-ray detection apparatus in the state after the positioning,
The non-contrast fluoroscopic image generation means performs the non-contrast fluoroscopy by controlling the X-ray irradiation apparatus and the X-ray detection apparatus in the state after the positioning .
The X-ray apparatus as described in any one of Claims 1 thru | or 4 .