JP7114263B2 - Medical image diagnosis device and X-ray irradiation control device - Google Patents

Description

An embodiment of the present invention relates to a medical image diagnostic apparatus and an X-ray irradiation control apparatus.

The purpose of improving treatment efficiency by using different types of medical image diagnostic equipment such as X-ray diagnostic equipment, ultrasonic diagnostic equipment, X-ray CT (Computed Tomography) equipment, and magnetic resonance imaging equipment. There are medical imaging systems that have a plurality of medical imaging apparatuses of different types. For example, when interventional therapy using a catheter is performed, an X-ray diagnostic device and an ultrasonic diagnostic device are used together.

An X-ray diagnostic apparatus transmits X-rays into a subject and forms a transmitted image. As a means for acquiring an X-ray image, there are an "imaging mode" in which relatively strong X-rays are emitted and a "perspective mode" in which relatively weak X-rays are emitted. The doctor inserts the catheter into the patient while confirming the catheter inside the blood vessel by X-ray irradiation in imaging mode or fluoroscopy mode. After the catheter reaches the affected area, the affected area is photographed from all angles with X-rays. Treatment of the identified diseased area is then carried out by means of a catheter. In order not to overlook lesions that cannot be confirmed by X-ray fluoroscopy and radiography, a method of identifying affected areas by using an ultrasonic diagnostic apparatus in combination is attracting attention.

In particular, in the case of catheter treatment for pediatric patients, the amount of X-ray irradiation and the irradiation time must be kept lower than in the case of adult patients in order to avoid exposure to radiation. Even in such a case, the combined use of the X-ray diagnostic apparatus and the ultrasonic diagnostic apparatus is effective.

JP 2014-54425 A

The problem to be solved by the present invention is to reduce the X-ray exposure of the operator during the procedure.

A medical image diagnostic apparatus according to an embodiment includes a changing unit and a display control unit. The changing means controls to change the X-ray irradiation conditions according to the positional relationship between the X-ray irradiation region and the non-imaging target during X-ray imaging. The display control means causes the display unit to display an X-ray image generated according to X-ray imaging and an ultrasonic image generated according to ultrasonic imaging.

1 is a schematic diagram showing the configuration of a medical image diagnostic system according to a first embodiment; FIG. FIG. 2 is a diagram showing the appearance of the medical image diagnostic system according to the first embodiment; FIG. 3 is a flowchart showing a first operation example of the medical image diagnostic system according to the first embodiment; 4 is a diagram showing an example of a superimposed image in the medical image diagnostic system according to the first embodiment; FIG. FIG. 5 is a diagram for explaining the positional relationship between an X-ray irradiation area and a non-imaging target in the medical image diagnostic system according to the first embodiment; FIG. 6 is a flowchart showing a second operation example of the medical image diagnostic system according to the first embodiment; FIG. 7 is a diagram showing, as a flowchart, a third operation example of the medical image diagnostic system according to the first embodiment; FIG. 8 is a flowchart showing a fourth operation example of the medical image diagnostic system according to the first embodiment; FIG. 9 is a diagram showing, as a flowchart, a fifth operation example of the medical image diagnostic system according to the first embodiment; FIG. 10 is a flowchart showing a sixth operation example of the medical image diagnostic system according to the first embodiment; FIG. 11 is a schematic diagram showing the configuration of a medical image diagnostic system according to a second embodiment; FIG. 12 is a schematic diagram showing the configuration of a medical image diagnostic system according to a third embodiment;

Hereinafter, embodiments of a medical image diagnostic apparatus and an X-ray irradiation control apparatus will be described in detail with reference to the drawings.

(First embodiment)
FIG. 1 is a schematic diagram showing the configuration of a medical image diagnostic system according to the first embodiment. FIG. 2 is a diagram showing the appearance of the medical image diagnostic system according to the first embodiment.

1 and 2 show a medical image diagnostic system 1 according to a first embodiment. A medical image diagnostic system 1 includes an ultrasonic diagnostic apparatus 10 and an X-ray diagnostic apparatus 50 as a medical image diagnostic apparatus according to the first embodiment. For example, the X-ray diagnostic device 50 is an X-ray cardiovascular device, a so-called Angio device.

An ultrasonic diagnostic apparatus 10 is provided with an ultrasonic probe 11 , an apparatus body 12 , an input interface 13 and a display 14 . In some cases, the configuration of only the device main body 12 is called an ultrasonic diagnostic device, and the configuration in which at least one of the ultrasonic probe 11, the input interface 13, and the display 14 is added to the device main body 12 is called an ultrasonic diagnostic device. It is sometimes called In the following description, a case will be described in which the ultrasonic diagnostic apparatus is configured to include all of the ultrasonic probe 11, the apparatus main body 12, the input interface 13, and the display 14. FIG.

The ultrasonic probe 11 has a plurality of micro vibrators (piezoelectric elements) on its front surface, and transmits and receives ultrasonic waves to and from a region including a scan target, for example, a region including a lumen. Each transducer is an electroacoustic transducer, and has a function of converting an electric pulse into an ultrasonic pulse during transmission and converting a reflected wave into an electric signal (receiving signal) during reception. The ultrasonic probe 11 is configured to be compact and lightweight, and is connected to the device body 12 via a cable (or wireless communication).

The ultrasonic probe 11 is classified into a linear type, a convex type, a sector type, and the like depending on the scanning method. In addition, the ultrasonic probe 11 has a 1D array probe in which a plurality of transducers are arranged one-dimensionally (1D) in the azimuth direction, and a two-dimensional (2D) array probe in the azimuth and elevation directions. ) can be classified into a 2D array probe in which a plurality of transducers are arranged. Note that the 1D array probe includes a probe in which a small number of transducers are arranged in the elevation direction.

Here, when 3D scanning, that is, volume scanning, is performed, a 2D array probe having scanning methods such as a linear type, a convex type, and a sector type is used as the ultrasonic probe 11 . Alternatively, when volume scanning is performed, a 1D probe having a linear, convex, sector, or other scanning method and a mechanism for mechanically swinging in the elevation direction is used as the ultrasonic probe 11. be done. The latter probes are also called mecha 4D probes.

The device main body 12 includes a transmission/reception circuit 31 , a B-mode processing circuit 32 , a Doppler processing circuit 33 , an image generation circuit 34 , an image memory 35 , a network interface 36 , a processing circuit 37 and a storage circuit 38 . The circuits 31 to 34 are configured by an application specific integrated circuit (ASIC) or the like. However, it is not limited to that case, and all or part of the functions of the circuits 31 to 34 may be implemented by the processing circuit 37 executing a program.

The transmission/reception circuit 31 has a transmission circuit and a reception circuit (not shown). The transmission/reception circuit 31 controls transmission directivity and reception directivity in transmission/reception of ultrasonic waves under the control of the processing circuit 37 . Although a case where the transmitting/receiving circuit 31 is provided in the device main body 12 will be described, the transmitting/receiving circuit 31 may be provided in the ultrasonic probe 11 or may be provided in both the device main body 12 and the ultrasonic probe 11. good.

The transmission circuit has a pulse generator circuit, a transmission delay circuit, a pulsar circuit, and the like, and supplies drive signals to the ultrasonic transducers. A pulse generation circuit repeatedly generates rate pulses for forming a transmitted ultrasound wave at a predetermined rate frequency. The transmission delay circuit sets the delay time for each piezoelectric transducer necessary for focusing the ultrasonic waves generated from the ultrasonic transducers of the ultrasonic probe 11 into a beam and determining the transmission directivity. given for each rate pulse that occurs. Also, the pulsar circuit applies a drive pulse to the ultrasonic transducer at a timing based on the rate pulse. The transmission delay circuit arbitrarily adjusts the transmission direction of the ultrasonic beam transmitted from the piezoelectric transducer surface by changing the delay time given to each rate pulse.

The receiving circuit has an amplifier circuit, an A/D (Analog to Digital) converter, an adder, etc., receives an echo signal received by the ultrasonic transducer, and performs various processing on this echo signal to obtain an echo signal. Generate data. The amplifier circuit amplifies the echo signal for each channel and performs gain correction processing. The A/D converter A/D-converts the gain-corrected echo signal and gives the digital data a delay time necessary to determine the reception directivity. The adder adds the echo signals processed by the A/D converter to generate echo data. The addition processing of the adder emphasizes the reflection component from the direction corresponding to the reception directivity of the echo signal.

Under the control of the processing circuit 37, the B-mode processing circuit 32 receives the echo data from the receiving circuit, performs logarithmic amplification, envelope detection processing, etc., and converts data ( 2D or 3D data). This data is commonly referred to as B-mode data.

Under the control of the processing circuit 37, the Doppler processing circuit 33 frequency-analyzes the velocity information from the echo data from the receiving circuit, extracts the blood flow and tissue by the Doppler effect, and obtains the moving state information such as the average velocity, variance, and power. is extracted for multiple points (two-dimensional or three-dimensional data). This data is commonly called Doppler data.

Under the control of the processing circuit 37, the image generation circuit 34 generates, as image data, an ultrasound image expressed in a predetermined luminance range based on the echo signal received by the ultrasound probe 11. FIG. For example, the image generation circuit 34 generates, as an ultrasound image, a B-mode image representing the intensity of the reflected wave in luminance from the two-dimensional B-mode data generated by the B-mode processing circuit 32 . In addition, the image generation circuit 34 converts the two-dimensional Doppler data generated by the Doppler processing circuit 33 into an ultrasound image to generate an average velocity image, a variance image, a power image, or a combination of these images. Generate color Doppler images.

The image memory 35 includes a two-dimensional memory, which is a memory having a plurality of memory cells in two axial directions per frame and having memory cells for a plurality of frames. A two-dimensional memory serving as the image memory 35 stores, as two-dimensional image data, one or more frames of ultrasound images generated by the image generating circuit 34 under the control of the processing circuit 37 .

Under the control of the processing circuit 37, the image generation circuit 34 performs three-dimensional reconstruction for performing interpolation processing as necessary on the ultrasound images arranged in the two-dimensional memory as the image memory 35, thereby obtaining an image. An ultrasonic image is generated as volume data in a three-dimensional memory as the memory 35 . A known technique is used as the interpolation processing method.

The image memory 35 may also include a three-dimensional memory, which is a memory having a plurality of memory cells in three axial directions (X-axis, Y-axis, and Z-axis directions). The three-dimensional memory as the image memory 35 stores the ultrasonic image generated by the image generation circuit 34 under the control of the processing circuit 37 as volume data.

The network interface 36 implements various information communication protocols according to the form of the network. The network interface 36 connects the apparatus main body 12 and external devices such as the X-ray diagnostic apparatus 50 according to these various protocols. An electrical connection or the like via an electronic network can be applied to this connection. Here, the term "electronic network" refers to all information communication networks using telecommunication technology, including wireless/wired LANs (Local Area Networks) of hospital backbones, Internet networks, telephone communication networks, and optical fiber communication networks. , cable communication networks, satellite communication networks, Wifi, and Bluetooth®.

Network interface 36 may also implement various protocols for contactless wireless communication. In this case, the device main body 12 can directly transmit/receive data to/from the ultrasonic probe 11 without going through a network, for example.

The processing circuit 37 means a dedicated or general-purpose CPU (Central Processing Unit), MPU (Micro Processor Unit), or GPU (Graphics Processing Unit), as well as an ASIC, a programmable logic device, or the like. Examples of programmable logic devices include simple programmable logic devices (SPLDs), complex programmable logic devices (CPLDs), and field programmable gate arrays (FPGAs). mentioned.

Also, the processing circuit 37 may be composed of a single circuit, or may be composed of a combination of a plurality of independent circuit elements. In the latter case, the memory circuit 38 may be provided individually for each circuit element, or a single memory circuit 38 may store programs corresponding to functions of a plurality of circuit elements.

The storage circuit 38 is composed of a semiconductor memory device such as a RAM (Random Access Memory), a flash memory, a hard disk, an optical disk, or the like. The storage circuit 38 may be configured by portable media such as USB (Universal Serial Bus) memory and DVD (Digital Video Disk). The storage circuit 38 stores various processing programs (including not only application programs but also an OS (Operating System) and the like) used in the processing circuit 37 and data necessary for executing the programs. Also, the OS may include a GUI (Graphical User Interface) that uses graphics extensively to display information on the display 14 for the operator and allows basic operations to be performed through the input interface 13 .

The input interface 13 includes circuitry for inputting signals from an input device operable by the sonographer D2 and the input device. Input devices include trackballs, switches, mice, keyboards, touchpads that perform input operations by touching the scanning surface, touch screens that integrate display screens and touchpads, non-contact input circuits using optical sensors, and an audio input circuit or the like. When the ultrasonic technician D2 operates the input device, the input interface 13 generates an input signal according to the operation and outputs it to the processing circuit 37. FIG.

The display 14 is composed of a general display output device such as a liquid crystal display or an OLED (Organic Light Emitting Diode) display. The display 14 also includes a GPU (Graphics Processing Unit), a VRAM (Video RAM), and the like. The display 14 displays an ultrasonic image (for example, a live image) requested by the processing circuit 37 for display output under the control of the processing circuit 37 .

The position sensor 15 detects a plurality of pieces of position information of the ultrasonic probe 11 in chronological order and outputs them to the apparatus body 12 . As the position sensor 15 , there are a sensor attached to the ultrasonic probe 11 and a sensor provided separately from the ultrasonic probe 11 . The latter sensor is an optical sensor that captures images of characteristic points of the ultrasonic probe 11 to be measured from a plurality of positions, and detects each position of the ultrasonic probe 11 by the principle of triangulation. The case where the position sensor 15 is the former sensor will be described below.

The position sensor 15 is attached to the ultrasonic probe 11 , detects its own position information, and outputs it to the apparatus body 12 . The positional information of the position sensor 15 can also be regarded as the positional information of the ultrasonic probe 11 . The position information of the ultrasonic probe 11 includes the position and orientation (tilt angle) of the ultrasonic probe 11 . For example, the orientation of the ultrasonic probe 11 can be detected by a magnetic field transmitter (not shown) sequentially transmitting three-axis magnetic fields and the position sensor 15 sequentially receiving the magnetic fields. The position sensor 15 includes a 3-axis gyro sensor that detects 3-axis angular velocity in 3-dimensional space, a 3-axis acceleration sensor that detects 3-axis acceleration in 3-dimensional space, and a 3-axis geomagnetism in 3-dimensional space. A so-called nine-axis sensor including at least one of three-axis geomagnetic sensors may be used.

The X-ray diagnostic apparatus 50 includes a high voltage supply device 51, an X-ray irradiation device 52, an X-ray detection device 53, an input interface 54, a display 55, a network interface 56, a processing circuit 57, a storage circuit 58, and a C-arm 59 (Fig. 2 2), and a bed 60 (shown only in FIG. 2).

The high voltage supply device 51 supplies high voltage power to the X-ray tube of the X-ray irradiation device 52 under the control of the processing circuit 57 .

The X-ray irradiation device 52 is provided at one end of the C-arm 59 . The X-ray irradiation device 52 is provided with an X-ray tube (X-ray source) and a movable aperture device. The X-ray tube is supplied with high voltage power from the high voltage supply device 51 and generates X-rays according to the conditions of the high voltage power. Under the control of the processing circuit 57, the movable diaphragm device movably supports diaphragm blades made of a substance that shields X-rays at the X-ray irradiation port of the X-ray tube. A radiation quality adjustment filter (not shown) for adjusting the radiation quality of X-rays generated by the X-ray tube may be provided on the front surface of the X-ray tube.

The X-ray detection device 53 is provided at the other end of the C-arm 59 so as to face the X-ray irradiation device 52 . Under the control of the processing circuit 57, the X-ray detection device 53 can move along the SID (Source-Image Distance) direction, that is, move back and forth. Under the control of the processing circuit 57, the X-ray detection device 53 can operate along the rotation direction centering on the SID direction, that is, rotate.

The input interface 54 has a configuration equivalent to that of the input interface 13 . When the input interface 54 is operated by an operator D (manipulator D1, ultrasound technician D2, assistant, etc.) in the treatment room, an operation signal is sent to the processing circuit 57 .

The display 55 has a configuration equivalent to that of the display 14 . The display 55 displays an ultrasonic image generated by ultrasonic imaging and an X-ray image generated by X-ray imaging. For example, the display 55 displays a superimposed image (for example, shown in FIG. 4) in which an ultrasonic image is superimposed on an X-ray image, or displays an X-ray image and an ultrasonic image side by side.

The network interface 56 has a configuration equivalent to that of the network interface 36 .

The processing circuit 57 has a configuration equivalent to that of the processing circuit 37 .

The memory circuit 58 has a configuration equivalent to that of the memory circuit 38 .

The C-arm 59 supports the X-ray irradiation device 52 and the X-ray detection device 53 so as to face each other. The C-arm 59 is capable of rotating in an arc direction, that is, rotating in the CRA (Cranial View) direction and rotating in the CAU (Caudal View) direction under the control of the processing circuit 57 or according to manual operation. . In addition, the C-arm 59 rotates around the fulcrum, that is, rotates in the direction of LAO (Left Anterior Oblique View) and rotates in the direction of RAO (Right Anterior Oblique View) under the control of the processing circuit 57 or according to manual operation. corresponds to rotation. The rotation of the C-arm 59 in the arc direction corresponds to the rotation in the LAO direction and the rotation in the RAO direction, and the rotation of the C-arm 59 around the fulcrum corresponds to the rotation in the CRA direction and the rotation in the CAU direction. You may have the structure corresponding to.

2, the C-arm structure provided in the X-ray diagnostic apparatus 50 shows the case where the X-ray irradiation apparatus 52 is an under table positioned below the top plate of the bed 60. As shown in FIG. However, it is not limited to that case, and the X-ray irradiation device 52 may be an overtable positioned above the top plate. Also, the C-arm 59 may be replaced by an Ω-arm, or may be combined with an Ω-arm.

The bed 60 has a top plate on which an object to be examined, for example, a patient P can be placed. Under the control of the processing circuit 57, the top board can move along the X-axis direction, that is, slide in the left-right direction. Under the control of the processing circuit 57, the top plate can move along the Y-axis, that is, slide in the vertical direction. Under the control of the processing circuitry 57, the tabletop can move along the Z-axis, ie, slide in the head-foot direction. In addition, the tabletop can also be rolled and tilted under the control of the processing circuit 57 .

Next, functions of the medical image diagnostic system 1 will be described.

The processing circuit 37 implements the ultrasonic imaging function U by reading out and executing a program stored in the storage circuit 38 or directly incorporated in the processing circuit 37 . A case where the function U functions in software will be described below as an example, but the function U may be realized by a circuit such as an ASIC provided in the ultrasonic diagnostic apparatus 10 .

The ultrasonic imaging function U includes a function of controlling the transmission/reception circuit 31, B-mode processing circuit 32, Doppler processing circuit 33, image generation circuit 34, and image memory 35 to execute ultrasonic imaging. The ultrasound imaging function U also includes a function of displaying an ultrasound image generated according to ultrasound imaging on the display 14 and a function of transmitting it to the X-ray diagnostic apparatus 50 via the network interface 36 .

The processing circuit 57 reads out and executes a program stored in the storage circuit 58 or directly incorporated in the processing circuit 57 to perform the X-ray imaging function R, the first change function Q1, the second change function Q2. , and the display control function Q3. A case where the functions R and Q1 to Q3 function in terms of software will be described below as an example. may be implemented.

The X-ray imaging function R includes a function of controlling the high voltage supply device 51, the X-ray irradiation device 52, and the X-ray detection device 53 to perform X-ray imaging. The X-ray imaging function R also includes a function of displaying an X-ray image generated according to X-ray imaging on the display 55 together with an ultrasonic image transmitted from the ultrasonic diagnostic apparatus 10 . X-ray photography includes X-ray photography in a fluoroscopic mode and X-ray photography in an imaging mode. Here, the imaging mode means a mode in which relatively strong X-rays are irradiated to obtain an X-ray image with clearer contrast, and the fluoroscopic mode means a continuous or pulsed irradiation of relatively weak X-rays. mode.

The first change function Q1 includes a function of controlling to change the X-ray irradiation conditions according to the positional relationship between the X-ray irradiation area and the non-imaging target during X-ray imaging by the X-ray imaging function R. The first change function Q1 is, based on an X-ray image generated according to X-ray imaging, an X-ray irradiation region and non-imaging targets (for example, an operator D1, an ultrasound technician D2, and an operator D such as an assistant). The positional relationship with the hand, the ultrasonic probe 11, etc.) is specified. Identification of non-imaging targets based on the X-ray image may be performed by pattern matching technology. Alternatively, the first change function Q1 is based on the position information (position and angle) of the ultrasonic probe 11 and the position information (position and angle) of the X-ray diagnostic apparatus 50 (for example, C arm 59), X-ray A positional relationship between an irradiation area and a non-imaging target is specified. Based on the position information of the ultrasonic probe 11, the positions of the hands of the operator D1, the ultrasonic operator D2, and the operator D such as an assistant can be estimated.

The first change function Q1 acquires encoder information from a rotary encoder attached to rollers for rotating the C-arm 59 . Then, the first changing function Q1 calculates position information regarding the C-arm 59 based on the acquired encoder information. The positional information of the X-ray diagnostic apparatus 50 is not limited to the positional information of the C-arm 59 . For example, the positional information of the X-ray diagnostic apparatus 50 may include the positional information of the X-ray irradiation device 52 (including the movable aperture device) and the X-ray detection device 53 . In that case, the first change function Q1 acquires encoder information from a rotary encoder attached to a roller for operating the X-ray irradiation device 52 and the X-ray detection device 53 in the SID direction.

The second change function Q2 includes a function of controlling to change the X-ray irradiation conditions according to the state of ultrasonic imaging during X-ray imaging by the X-ray imaging function R. For example, the second change function Q2 controls to change the X-ray irradiation conditions according to the freeze state or unfreeze state of live display of ultrasound images obtained by ultrasound imaging. Here, the X-ray irradiation conditions are also called X-ray conditions. For example, the X-ray irradiation conditions include the tube voltage and tube current of the X-ray irradiation device 52, the irradiation time, the incident dose, and the like.

Note that the processing circuit 57 may implement at least one of the first change function Q1 and the second change function Q2. The case where the processing circuit 57 implements the first change function Q1 will be described later with reference to FIGS. 3 to 8, and the case where the processing circuit 57 implements the second change function Q2 will be described later with reference to FIGS. 9 and 10. do.

The display control function Q3 acquires from the ultrasonic diagnostic apparatus 10 an ultrasonic image generated according to ultrasonic imaging by the ultrasonic imaging function U, and also acquires an X-ray image generated according to X-ray imaging by the X-ray imaging function R. Including the ability to retrieve. The display control function Q3 also includes a function of displaying the acquired ultrasound images and X-ray images on the display 55 . For example, the display control function Q3 generates a superimposed image in which an ultrasound image is superimposed on an X-ray image, and causes the display 55 to display the superimposed image. Also, for example, the display control function Q3 causes the display 55 to display an X-ray image and an ultrasound image. The following description assumes that the former, that is, the display control function Q3 generates a superimposed image.

Next, operations of the medical image diagnostic system 1 will be described. The medical image diagnostic system 1 is applied to SHD (Structural Heart Disease) when interventional treatment using a catheter is performed. The medical image diagnostic system 1 is applied to the case of proceeding with intervention treatment by making full use of not only X-ray images obtained from the X-ray diagnostic apparatus 50 but also ultrasonic images obtained from the ultrasonic diagnostic apparatus 10. be done.

For example, the medical image diagnostic system 1 is used for catheter treatment for mitral regurgitation (MR) using a MitralClip. In that case, an operator such as a doctor checks the blood flow status by transesophageal echocardiography (TEE) on an ultrasound image while grasping the positional relationship between a device such as a clip and the heart tissue during X-ray imaging. , device placement.

(First operation example according to the first embodiment)
FIG. 3 is a diagram showing a first operation example of the medical image diagnostic system 1 as a flowchart. In FIG. 3, numerals attached to "ST" indicate respective steps of the flow chart. FIG. 4 is a diagram showing an example of a superimposed image.

The X-ray imaging function R of the X-ray diagnostic apparatus 50 controls the high voltage supply device 51, the X-ray irradiation device 52, the X-ray detection device 53, etc., and starts X-ray imaging in the fluoroscopic mode for the patient P. (step ST1).

Further, the ultrasonic imaging function U of the ultrasonic diagnostic apparatus 10 controls the ultrasonic probe 11 and the like to start ultrasonic imaging of the patient P (step ST2). The display control function Q3 acquires an X-ray image generated according to the X-ray imaging started in step ST1 and an ultrasonic image generated according to the ultrasonic imaging started in step ST2, and acquires the X-ray image and the ultrasonic image. A sound wave image is displayed on the display 55 . For example, the display control function Q3 generates a superimposed image in which an X-ray image is superimposed on an ultrasonic image, and causes the display 55 to display the superimposed image.

When generating a superimposed image, positional information of the ultrasonic probe 11 on the ultrasonic diagnostic apparatus 10 side and positional information on the C-arm 59 or the like on the X-ray diagnostic apparatus 50 side are used to align both. For example, while specifying the focal position of the X-ray irradiation device 52 provided at one end of the C-arm 59 as the viewpoint position in rendering (volume rendering, surface rendering, etc.) processing of volume data of an ultrasonic image, from the focal position, The imaging direction toward the center position of the X-ray detector 53 provided at the other end of the C-arm 59 is specified as the line-of-sight direction in rendering processing of the volume data of the ultrasonic image. Then, the volume data of the ultrasonic image is subjected to rendering processing based on the specified viewpoint position and line-of-sight direction, and superimposed on the X-ray image.

The first change function Q1 analyzes an X-ray image of a predetermined frame generated according to X-ray imaging in the fluoroscopy mode started in step ST1, and adds a non-imaging object (for example, operator D1) to the X-ray irradiation area. , ultrasonic engineer D2, and operator's hands such as an assistant, the ultrasonic probe 11, etc.) have entered (step ST3).

If the determination in step ST3 is YES, that is, if it is determined that a non-imaging object has entered the X-ray irradiation area, the X-ray imaging function R controls the high voltage supply device 51 and is started in step ST1. X-ray imaging in the fluoroscopy mode is stopped (interrupted) (step ST4). FIG. 4A shows an example of a superimposed image when the determination in step ST3 is NO, and FIG. 4B shows an example of a superimposed image when the determination in step ST3 is YES. The images shown in FIGS. 4A and 4B are images in which the ultrasonic image IU is superimposed on the X-ray image IX including the catheter image C. FIG. In FIG. 4B, it is determined that a non-imaging object has entered the X-ray irradiation area.

Returning to the description of FIG. 3, the first change function Q1 determines whether or not the non-imaging object has retreated from the X-ray irradiation area based on the position information of the ultrasonic probe 11 and the position information of the C-arm 59. It judges (step ST5). This is because the evacuation of the non-imaging object cannot be determined based on the image analysis because the X-ray imaging is interrupted in the determination of step ST5.

FIG. 5 is a diagram for explaining the positional relationship between the X-ray irradiation area and the non-imaging target.

FIG. 5A shows the X-ray irradiation area W when the X-ray irradiation device 52 is located under the top plate of the bed 60. FIG. FIG. 5B shows the X-ray irradiation area W when the X-ray irradiation device 52 is above the top plate of the bed 60 .

As shown in FIGS. 5A and 5B, the positional information of the X-ray irradiation area W is a three-dimensional area calculated from the positional information regarding the C-arm 59. FIG. The X-ray irradiation area W is a three-dimensional area based on the focal position O of the X-ray irradiation device 52 and positions F1 to F4 on the detection surface of the X-ray detection device 53 determined by the movable aperture device. Further, the positional information of the operator D (the operator D1, the ultrasound technician D2, etc.) may be directly detected by an image sensor such as kinect (registered trademark), or may be detected by the position sensor 15 of the ultrasonic probe 11. It may be estimated by location information.

Returning to the description of FIG. 3, if the determination in step ST5 is YES, that is, if it is determined that the non-imaging object has retreated from the X-ray irradiation area, the X-ray imaging function R controls the high voltage supply device 51. Then, the X-ray imaging in the fluoroscopy mode interrupted in step ST4 is resumed (step ST6). The display control function Q3 causes the display 55 to display an X-ray image generated according to the X-ray imaging restarted in step ST6 and an ultrasonic image generated according to the ultrasonic imaging started in step ST2. For example, the display control function Q3 generates a superimposed image in which an X-ray image is superimposed on an ultrasonic image, and causes the display 55 to display the superimposed image.

The X-ray imaging function R determines whether or not to end the X-ray imaging in the fluoroscopy mode started in step ST1 or the X-ray imaging in the fluoroscopy mode restarted in step ST6 (step ST7). If the determination in step ST7 is YES, that is, if it is determined that the X-ray imaging in the fluoroscopic mode should be terminated, the X-ray imaging function R resumes the X-ray imaging in the fluoroscopic mode started in step ST1 or restarts in step ST6. Then, X-ray imaging in the fluoroscopy mode is completed (step ST8).

The ultrasonic imaging function U determines whether or not to end the ultrasonic imaging started in step ST2 (step ST9). If the determination in step ST9 is YES, that is, if it is determined to end the ultrasonic imaging, the ultrasonic imaging function U ends the ultrasonic imaging started in step ST2 (step ST10).

If the determination in step ST3 is NO, that is, if it is determined that a non-imaging object has not entered the X-ray irradiation area, the X-ray imaging function R performs X-ray imaging in the fluoroscopy mode started in step ST1, or Then, it is determined whether or not the X-ray imaging in the fluoroscopy mode restarted in step ST6 is finished (step ST7).

If the determination in step ST5 is NO, that is, if it is determined that the non-imaging object has not retreated from the X-ray irradiation area, the first change function Q1 will cause a frame in which the non-imaging object has retreated from the X-ray irradiation area to appear. The determination in step ST5 is repeated until.

If the determination in step ST7 is NO, that is, if it is determined that the X-ray imaging in the fluoroscopic mode is not to end, the first changing function Q1 changes the X-ray image generated according to the X-ray imaging in the fluoroscopic mode in the next frame. is analyzed to determine whether or not a non-imaging object has entered the X-ray irradiation area (step ST3).

If the determination in step ST9 is NO, that is, if it is determined not to end the ultrasound imaging, the ultrasound imaging function U repeats the determination in step ST9 until an instruction to end imaging is received.

According to the first operation example of the medical image diagnostic system 1 shown in FIG. Since X-ray irradiation can be interrupted and restarted according to the result, it is possible to reduce the X-ray exposure of the non-imaging target during the period from the interruption of X-ray irradiation to the restart. Further, according to the first operation example of the medical image diagnostic system 1, there is an effect that cooperation and control of the ultrasonic diagnostic apparatus 10 and the X-ray diagnostic apparatus 50 are facilitated.

(Second operation example according to the first embodiment)
FIG. 6 is a diagram showing a second operation example of the medical image diagnostic system 1 as a flowchart. In FIG. 6, numerals attached to "ST" indicate respective steps of the flow chart. 6 differs from FIG. 3 in that the X-ray image is not analyzed.

In FIG. 6, steps that are the same as those shown in FIG. 3 are denoted by the same reference numerals, and description thereof will be omitted.

The first change function Q1 determines whether or not a non-imaging object has entered the X-ray irradiation area based on the position information of the ultrasonic probe 11 and the position information of the C-arm 59 (step ST13). The positional relationship between the X-ray irradiation area and the non-imaging target is as described with reference to FIG.

According to the second operation example of the medical image diagnostic system 1 shown in FIG. Since X-ray irradiation can be restarted, it is possible to reduce the X-ray exposure of non-imaging targets during the period from interruption to restart of X-ray irradiation. Further, according to the second operation example of the medical image diagnostic system 1, there is an effect that cooperation and control of the ultrasonic diagnostic apparatus 10 and the X-ray diagnostic apparatus 50 are facilitated.

(Third operation example according to the first embodiment)
FIG. 7 is a diagram showing a third operation example of the medical image diagnostic system 1 as a flowchart. In FIG. 7, numerals attached to "ST" indicate respective steps of the flow chart. 7 differs from FIGS. 3 and 6 in that X-ray imaging is performed in imaging mode instead of X-ray imaging in fluoroscopic mode.

In FIG. 7, steps that are the same as those shown in FIGS. 3 and 6 are denoted by the same reference numerals, and description thereof will be omitted.

The X-ray imaging function R of the X-ray diagnostic apparatus 50 controls the high voltage supply device 51, the X-ray irradiation device 52, the X-ray detection device 53, etc., and starts X-ray imaging in the imaging mode for the patient P. (step ST21).

If the determination in step ST3 is YES, that is, if it is determined that a non-imaging target has entered the X-ray irradiation area, the X-ray imaging function R controls the high voltage supply device 51 to set the X-ray irradiation conditions. Change, that is, X-ray imaging in the imaging mode started in step ST21 is switched to X-ray imaging in fluoroscopic mode (step ST24). According to step ST24, unlike step ST4, fluoroscopic images of a plurality of frames can be acquired, so that the operator can go back and observe the frames frame by frame. The display control function Q3 causes the display 55 to display an X-ray image generated by X-ray imaging in the fluoroscopy mode after switching in step ST24 and an ultrasonic image generated by ultrasonic imaging started in step ST2. .

The first change function Q1 analyzes the X-ray image of the predetermined frame generated by the X-ray imaging in the fluoroscopy mode after switching in step ST24, and determines whether or not the non-imaging object has retreated from the X-ray irradiation area. It judges (step ST25). If the determination in step ST25 is YES, that is, if it is determined that the non-imaging target has retreated from the X-ray irradiation area, the X-ray imaging function R controls the high voltage supply device 51 to set the X-ray irradiation conditions. Change, that is, X-ray imaging in the fluoroscopy mode after switching in step ST24 is switched to X-ray imaging in the imaging mode (step ST26). The display control function Q3 causes the display 55 to display an X-ray image generated by X-ray imaging in the imaging mode after switching in step ST26 and an ultrasonic image generated by ultrasonic imaging started in step ST2. .

According to the third operation example of the medical image diagnostic system 1 shown in FIG. Since the irradiation conditions can be changed, X-ray exposure to non-imaging targets can be reduced while the X-ray intensity is suppressed. Further, according to the third operation example of the medical image diagnostic system 1, there is also an effect that cooperation and control of the ultrasonic diagnostic apparatus 10 and the X-ray diagnostic apparatus 50 are facilitated.

Incidentally, according to the third operation example of the medical image diagnostic system 1 shown in FIG. 7, the positional information of the device is not required. However, in FIG. 7, as in step ST4 (illustrated in FIGS. 3 and 6), the X-ray imaging function R may interrupt the X-ray imaging in the imaging mode started in step ST21 (step ST24). . In this case, the first change function Q1 determines whether or not the non-imaging target has withdrawn from the X-ray irradiation area based on the position information of the apparatus (step ST25), and the X-ray imaging function R supplies a high voltage. The device 51 is controlled to resume X-ray imaging in the imaging mode interrupted at step ST24 (step ST26).

(Fourth operation example according to the first embodiment)
FIG. 8 is a diagram showing a fourth operation example of the medical image diagnostic system 1 as a flowchart. In FIG. 8, numerals attached to "ST" indicate respective steps of the flow chart. FIG. 8 is different from FIG. 7 in that the X-ray image is not analyzed.

In FIG. 8, steps that are the same as those shown in FIGS. 3, 6 and 7 are denoted by the same reference numerals, and description thereof will be omitted.

According to the fourth operation example of the medical image diagnostic system 1 shown in FIG. 8, the positional relationship between the X-ray irradiation area and the non-imaging object is specified based on the position information, and the X-ray irradiation conditions are changed according to the result. Therefore, X-ray exposure of non-imaging targets can be reduced while the X-ray intensity is suppressed. Further, according to the fourth operation example of the medical image diagnostic system 1, there is an effect that cooperation and control of the ultrasonic diagnostic apparatus 10 and the X-ray diagnostic apparatus 50 are facilitated.

(Fifth operation example according to the first embodiment)
FIG. 9 is a diagram showing a fifth operation example of the medical image diagnostic system 1 as a flowchart. In FIG. 9, numerals attached to "ST" indicate respective steps of the flow chart. 5 differs from FIGS. 3 and 6 to 8 in that the X-ray irradiation conditions of the X-ray diagnostic apparatus 50 are changed according to the state of the ultrasonic diagnostic apparatus 10. FIG.

In FIG. 9, steps that are the same as those shown in FIGS. 3 and 5 to 8 are denoted by the same reference numerals, and description thereof will be omitted.

The second change function Q2 determines whether or not the live display of the ultrasonic image obtained by the ultrasonic imaging started in step ST2 has been frozen (step ST43). For example, the second change function Q2 determines whether or not the live display of the ultrasound image has been frozen based on the operation of the input interface 13 by the ultrasound technician D2 holding the ultrasound probe 11 . When the live display of the ultrasonic image is frozen, X-ray imaging is interrupted (step ST4). Here, when the X-ray imaging is interrupted by the instruction to freeze the live display of the ultrasonic image, the ultrasonic wave is superior to the X-ray. The case where ultrasound is dominant means, for example, when inserting a catheter in a coronary artery or when observing the prognosis of a clamped state of a valve after indwelling a MitralClip.

The second change function Q2 determines whether or not the freeze in step ST43 has been canceled and the live display of the ultrasonic image obtained by ultrasonic imaging has been unfrozen (step ST45). For example, the second change function Q2 determines whether or not the live display of the ultrasound image has been unfrozen based on the operation of the input interface 13 by the ultrasound technician D2 holding the ultrasound probe 11 .

Here, when X-ray imaging is restarted by an instruction to unfreeze live display of an ultrasonic image, X-rays are superior to ultrasonic waves. When X-rays are dominant, for example, when a catheter is inserted from the lower extremity into the coronary artery of the heart, when injecting a contrast agent occasionally, when confirming the direction of movement of the catheter at the coronary artery bifurcation, and when the mitral It means when a device such as MitralClip is placed in the valve. The determination as to whether or not X-rays are dominant may be based on the operation of the foot switch for instructing X-ray irradiation. On the other hand, whether the ultrasonic wave is superior or not is determined based on the state in which the ultrasonic probe 11 is left in the air, the state in which the ultrasonic image does not include the image of the affected area of the patient P, or the body surface of the patient P from the ultrasonic probe 11. , that is, based on whether the ultrasonic image includes the patient P's affected area.

According to the fifth operation example of the medical image diagnostic system 1 shown in FIG. 9, the state of the ultrasonic diagnostic apparatus 10 can be identified, and X-ray irradiation can be interrupted and restarted based on the result. It is possible to reduce X-ray exposure of non-imaging targets until restarting. Further, according to the fifth operation example of the medical image diagnostic system 1, there is an effect that cooperation and control of the ultrasonic diagnostic apparatus 10 and the X-ray diagnostic apparatus 50 are facilitated.

(Sixth example of operation according to the first embodiment)
FIG. 10 is a diagram showing a sixth operation example of the medical image diagnostic system 1 as a flowchart. In FIG. 10, numerals attached to "ST" indicate respective steps of the flow chart. 10 differs from FIG. 9 in that X-ray imaging is performed in imaging mode instead of X-ray imaging in fluoroscopic mode.

In FIG. 10, steps that are the same as those shown in FIGS. 3 and 6 to 9 are denoted by the same reference numerals, and description thereof will be omitted.

According to the sixth operation example of the medical image diagnostic system 1 shown in FIG. 10, the state of the ultrasonic diagnostic apparatus 10 is specified, and the X-ray irradiation conditions can be changed based on the result, so the X-ray intensity is suppressed. It is possible to reduce X-ray exposure of non-imaging subjects during the period. Further, according to the sixth operation example of the medical image diagnostic system 1, there is an effect that cooperation and control of the ultrasonic diagnostic apparatus 10 and the X-ray diagnostic apparatus 50 are facilitated.

In the above description, the functions Q1 to Q3 are described as being realized by the processing circuit 57 of the X-ray diagnostic apparatus 50, but are not limited to this case. For example, all or part of the functions Q1 to Q3 may be implemented by the processing circuit 37 of the ultrasonic diagnostic apparatus 10, or may be implemented by an apparatus other than the ultrasonic diagnostic apparatus 10 and the X-ray diagnostic apparatus 50. It may be A case in which all of the functions Q1 to Q3 are implemented by the processing circuit 37 of the ultrasonic diagnostic apparatus 10 will be described below using FIG. A case implemented by a processing circuit of an X-ray irradiation control device other than the diagnostic device 50 will be described with reference to FIG.

(Second embodiment)
FIG. 11 is a schematic diagram showing the configuration of a medical image diagnostic system according to the second embodiment.

FIG. 11 shows a medical image diagnostic system 1A according to the second embodiment. A medical image diagnostic system 1A includes an ultrasonic diagnostic apparatus 10A as a medical image diagnostic apparatus according to the second embodiment, and an X-ray diagnostic apparatus 50A.

In FIG. 11, the same members as in FIG. 1 are denoted by the same reference numerals, and descriptions thereof are omitted.

The processing circuit 37 of the ultrasonic diagnostic apparatus 10A implements an ultrasonic imaging function U, a first change function Q1, a second change function Q2, and a display control function Q3 by executing programs. The processing circuit 57 of the X-ray diagnostic apparatus 50A implements the X-ray imaging function R by executing a program.

The functions U, R, Q1 to Q3 have been described in the first embodiment with reference to FIGS. 1 to 10, so description thereof will be omitted.

According to the medical image diagnostic system 1A shown in FIG. 11, the positional information and the state of the ultrasonic diagnostic apparatus 10 are specified, and based on the result, the X-ray irradiation is interrupted or restarted, or the X-ray irradiation conditions are changed. Therefore, X-ray exposure of non-imaging targets can be reduced. Further, according to the medical image diagnostic system 1A, there is also an effect that cooperation and control of the ultrasonic diagnostic apparatus 10A and the X-ray diagnostic apparatus 50A are facilitated.

(Third embodiment)
FIG. 12 is a schematic diagram showing the configuration of a medical image diagnostic system according to the third embodiment.

FIG. 12 shows a medical image diagnostic system 1B according to the third embodiment. A medical image diagnostic system 1B includes an ultrasonic diagnostic apparatus 10B, an X-ray diagnostic apparatus 50B, and an X-ray irradiation control apparatus 80 according to the third embodiment. The X-ray irradiation control device 80 is connected so as to be able to communicate with the ultrasonic diagnostic device 10B and the X-ray diagnostic device 50B.

In FIG. 12, the same members as those in FIG. 1 are assigned the same reference numerals, and description thereof is omitted. In addition, the ultrasonic diagnostic apparatus 10B includes an ultrasonic probe 11, an apparatus main body 12, an input interface 13, a display 14, and a position sensor, similarly to the ultrasonic diagnostic apparatuses 10 (shown in FIG. 1) and 10A (shown in FIG. 11). Although the sensor 15 is provided, illustration of the configuration other than the network interface 36 and the processing circuit 37 is omitted. Similarly, the X-ray diagnostic apparatus 50B, like the X-ray diagnostic apparatuses 50 (shown in FIG. 1) and 50A (shown in FIG. 11), includes a high voltage supply device 51, an X-ray irradiation device 52, and an X-ray detection device 53. , an input interface 54, a display 55, a network interface 56, a processing circuit 57, and a storage circuit 58. Configurations other than the network interface 56 and the processing circuit 57 are omitted from the drawing.

The X-ray irradiation control device 80 comprises a network interface 86 , processing circuitry 87 and storage circuitry 88 . The X-ray irradiation control apparatus 80 may include an input interface having the same configuration as the input interfaces 13 and 54 (shown in FIG. 1) and a display having the same configuration as the displays 14 and 55 (shown in FIG. 1). good.

The processing circuit 37 of the ultrasonic diagnostic apparatus 10B implements the ultrasonic imaging function U by executing a program. The processing circuit 57 of the X-ray diagnostic apparatus 50B implements the X-ray imaging function R by executing a program.

The processing circuit 87 of the X-ray irradiation control device 80 reads out and executes a program stored in the storage circuit 88 or directly incorporated in the processing circuit 87 to perform the first change function Q1 and the second change function Q1. Q2 and the display control function Q3 are realized. A case where the functions Q1 to Q3 function in terms of software will be described below as an example. good too.

The functions U, R, Q1 to Q3 have been described in the first embodiment with reference to FIGS. 1 to 10, so description thereof will be omitted.

According to the medical image diagnostic system 1B shown in FIG. 12, the positional information and the state of the ultrasonic diagnostic apparatus 10 are identified, and based on the result, the X-ray irradiation is interrupted or restarted, or the X-ray irradiation conditions are changed. Therefore, X-ray exposure of non-imaging targets can be reduced. Further, according to the medical image diagnostic system 1B, the X-ray irradiation control device 80 is used to facilitate cooperation and control of the ultrasonic diagnostic apparatus 10B and the X-ray diagnostic apparatus 50B.

According to at least one embodiment described above, X-ray exposure of the operator during the procedure can be reduced.

The ultrasonic imaging function U is an example of ultrasonic imaging means. The X-ray imaging function R is an example of X-ray imaging means. The first change function Q1 and the second change function Q2 are examples of change means. The display control function Q3 is an example of display control means.

It should be noted that although several embodiments of the invention have been described, these embodiments are provided by way of example 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 modifications 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 scope of the invention described in the claims and equivalents thereof.

1, 1A, 1B Medical image diagnostic systems 10, 10A, 10B Ultrasonic diagnostic devices 37, 57, 87 Processing circuits 50, 50A, 50B X-ray diagnostic device 80 X-ray irradiation control device Q1 First change function Q2 Second change function Q3 Display control function

Claims (6)

changing means for controlling to change the X-ray irradiation conditions according to the positional relationship between the X-ray irradiation area and the non-imaging target during X-ray imaging;
display control means for displaying an X-ray image generated according to the X-ray imaging and an ultrasonic image generated according to the ultrasonic imaging on a display unit;
has
The changing means changes the X-ray irradiation region and the non-imaging object based on position information of an arm supporting the X-ray irradiation unit and the X-ray detection unit and position information of the ultrasonic probe as the non-imaging object. to identify the positional relationship with
Medical diagnostic imaging equipment. When the X-ray photography is X-ray photography in a fluoroscopic mode,
The changing means changes the X-ray irradiation conditions by interrupting the X-ray imaging.
The medical image diagnostic apparatus according to claim 1 . When the X-ray imaging is X-ray imaging in an imaging mode,
The changing means changes the X-ray irradiation conditions by changing the imaging mode to a fluoroscopy mode or canceling the X-ray imaging.
The medical image diagnostic apparatus according to claim 1 . an X-ray irradiation unit that emits X-rays for the X-ray imaging;
an X-ray detection unit that detects the X-rays;
X-ray imaging means for controlling the X-ray irradiation unit and the X-ray detection unit to perform the X-ray imaging;
4. The medical image diagnostic apparatus according to any one of claims 1 to 3 , further comprising: Ultrasonic imaging means for controlling an ultrasonic probe to perform the ultrasonic imaging;
4. The medical image diagnostic apparatus according to any one of claims 1 to 3 , further comprising: An X-ray irradiation control device communicably connected to an ultrasonic diagnostic device and an X-ray diagnostic device,
changing means for controlling to change the X -ray irradiation conditions according to the positional relationship between the X-ray irradiation area and the non-imaging target during X-ray imaging;
display control means for displaying an X-ray image generated according to the X-ray imaging and an ultrasonic image generated according to the ultrasonic imaging on a display unit;
has
The changing means changes the X-ray irradiation region and the non-imaging object based on position information of an arm supporting the X-ray irradiation unit and the X-ray detection unit and position information of the ultrasonic probe as the non-imaging object. to identify the positional relationship with
X -ray irradiation controller.

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