JP7125703B2 - MEDICAL DEVICE, METHOD AND PROGRAM FOR CONTROLLING MEDICAL DEVICE - Google Patents

Description

TECHNICAL FIELD Embodiments of the present invention relate to a medical device, a method of controlling a medical device, and a program.

2. Description of the Related Art There is known a therapeutic apparatus that irradiates a patient (subject) with a therapeutic beam such as a heavy particle beam or radiation. The affected part of the subject, that is, the part irradiated with the treatment beam may move due to respiration, heartbeat, bowel movements, and the like. A gated irradiation method and a tracking irradiation method are known as treatment methods corresponding to this.

When a therapeutic beam is irradiated to an affected area that moves due to respiration, it is necessary to synchronize the irradiation with the respiratory phase of the subject. Respiratory phase gating techniques include an external respiratory gating technique and an internal respiratory gating technique. The external respiratory gating method is a method of grasping the respiratory phase using the output values of various sensors attached to the subject's body. The internal respiration gating method is a method of grasping the respiratory phase based on the fluoroscopic image of the subject. Processing using respiratory phase locking is performed by a medical device that controls a therapeutic device. The treatment apparatus irradiates the affected area with a treatment beam synchronized with the respiratory phase of the subject under the control of the medical apparatus.

Depending on the condition of the patient and the condition of the treatment apparatus on the day of treatment, the treatment may take a long time and the burden on the subject may become large, and further reduction of the burden is desired.

Japanese Patent Application Laid-Open No. 2017-144000

The problem to be solved by the present invention is to provide a medical device, a control method for the medical device, and a program that can reduce the physical burden on a subject during treatment based on internal respiratory gating.

A medical device according to an embodiment has an acquisition unit, a first identification unit, a second identification unit, a control unit, and a display unit. The acquisition unit acquires a plurality of fluoroscopic images of the subject. The first specifying unit specifies the two-dimensional position of the target position of the subject on the plurality of fluoroscopic images. The second identifying unit identifies the three-dimensional position of the target position based on the target positions on the plurality of fluoroscopic images. a two-dimensional mode in which, when the two-dimensional position is within a predetermined two-dimensional irradiation permission range, the control unit outputs an irradiation permission signal for instructing irradiation to a treatment apparatus that irradiates a treatment beam to the subject; Switching to a three-dimensional mode in which an irradiation permission signal is output to the treatment apparatus when the dimensional position is within a predetermined three-dimensional irradiation permission range. The display unit displays a screen including an image in which at least one of the two-dimensional irradiation permitted range or the three-dimensional irradiation permitted range and the target position are superimposed on a plurality of fluoroscopic images.

According to this embodiment, it is possible to provide a medical device, a method for controlling the medical device, and a program that can reduce the physical burden on a subject in treatment based on internal respiratory gating.

The block diagram of the treatment system containing a medical device. FIG. 4 is a diagram showing an example of an interface image in markerless tracking mode displayed by the input/display unit of the medical device; 1 is a first flowchart showing an example of the flow of processing executed by a medical device; A second flowchart showing an example of the flow of processing executed by the medical device. FIG. 11 is a diagram showing changes in display modes of the first button, the second button, and the third button; The figure which shows the example of a display of the 4th button, the 5th button, and the 6th button in markerless tracking mode. A third flowchart showing an example of the flow of processing executed by the medical device. FIG. 4 is a diagram showing an example of an interface image IM in marker tracking mode displayed by the input/display unit of the medical device; A fourth flowchart showing an example of the flow of processing executed by the medical device. A fifth flowchart showing an example of the flow of processing executed by the medical device. The figure which shows the example of a display of the 4th button, the 5th button, and the 6th button in marker tracking mode. A sixth flowchart showing an example of the flow of processing executed by the medical device. FIG. 10 is a diagram showing an example of an image comparing determination results using two-dimensional positions and three-dimensional positions; The figure which shows an example of the graph which shows the displacement of three coordinates which show a three-dimensional position.

Hereinafter, a medical device, a method for controlling the medical device, and a program according to embodiments will be described with reference to the drawings. In addition, "based on XX" in the present application means "based on at least XX", and includes the case of being based on another element in addition to XX. Moreover, "based on XX" is not limited to the case of using XX directly, but also includes the case of being based on what has been calculated or processed with respect to XX. "XX" is an arbitrary element (for example, arbitrary information).

<Configuration>
FIG. 1 is a configuration diagram of a treatment system 1 including a medical device 100. As shown in FIG. The treatment system 1 includes a treatment device 10 and a medical device 100. FIG. The therapeutic apparatus 10 irradiates a subject to be treated with a therapeutic beam according to instructions from the medical apparatus 100 .

The treatment apparatus 10 includes a bed 11 , radiation sources 12 - 1 and 12 - 2 , detectors 13 - 1 and 13 - 2 , an irradiation gate 14 , a sensor 15 and a treatment apparatus side controller 20 . In the following, a hyphen and a number following it indicate whether it is radiation for fluoroscopy or a fluoroscopy image from which set of radiation source and detector. In addition, description will be made by omitting hyphens and subsequent numerals in the symbols as appropriate.

A subject P to be treated is fixed on the bed 11 . The radiation source 12-1 irradiates the subject P with radiation r-1. The radiation source 12-2 irradiates the subject P with radiation r-2 from an angle different from that of the radiation source 12-1. Radiation r-1 and r-2 are examples of electromagnetic waves, for example X-rays. This is assumed below.

Radiation r-1 is detected by detector 13-1, and radiation r-2 is detected by detector 13-2. The detectors 13-1 and 13-2 are, for example, flat panel detectors (FPDs), image intensifiers, color image intensifiers, and the like. The detector 13-1 detects the energy of the radiation r-1, digitally converts it, and outputs a fluoroscopic image TI-1 obtained by the digital conversion to the medical device 100. FIG. The detector 13-2 detects the energy of the radiation r-2, digitally converts it, and outputs a fluoroscopic image TI-2 obtained by the digital conversion to the medical device 100. FIG. Although the therapeutic device 10 shown in FIG. 1 comprises two sets of radiation sources 12 and detectors 13, the therapeutic device 10 may comprise three or more sets of radiation sources 12 and detectors 13. FIG.

The irradiation gate 14 irradiates the subject P with the treatment beam B in the treatment stage. The therapeutic beam B includes, for example, heavy particle beams, X-rays, γ-rays, electron beams, proton beams, neutron beams, and the like. Although the treatment device 10 shown in FIG. 1 includes one irradiation portal 14 , the treatment device 10 may have multiple irradiation portals 14 .

The sensor 15 is attached to the body of the subject P and detects movement of the body surface due to the subject's P breathing. The sensor 15 outputs detection results to the medical device 100 . Based on the motion detected by sensor 15, medical device 100 obtains the subject's P external respiratory phase. Sensor 15 is, for example, a pressure sensor.

The treatment apparatus side controller 20 operates the radiation sources 12-1 and 12-2, the detectors 13-1 and 13-2, and the irradiation gate 14 according to control signals from the medical apparatus 100. FIG.

The medical apparatus 100 includes an integrated control unit 110, an input/display unit 120, an input operation acquisition unit 122, a display control unit 124, an acquisition unit 130, a reference image creation unit 132, a marker detection unit 134, an image A processing unit 136 , a target position specifying unit 140 , an output control unit 150 , a gating window adjustment unit 152 and a storage unit 160 are provided. General control unit 110, input operation acquisition unit 122, display control unit 124, acquisition unit 130, reference image creation unit 132, marker detection unit 134, image processing unit 136, target position identification unit 140, output control unit 150, and gating window A part or all of the adjustment unit 152 may be implemented by a hardware processor such as a CPU (Central Processing Unit) or a GPU (Graphics Processing Unit) executing a program (software) stored in the storage unit 160. good. In addition, some or all of these components are hardware such as LSI (Large Scale Integration circuit), ASIC (Application Specific Integrated Circuit), FPGA (Field-Programmable Gate Array), GPU (Graphics Processing Unit). (including circuitry), or by cooperation of software and hardware.

A function of each part of the medical device 100 will be described. In the description of the medical device 100, the processing for the fluoroscopic image TI is performed on both the fluoroscopic images TI-1 and TI-2 in parallel or sequentially unless otherwise noted. The general control unit 110 centrally controls the functions of the medical device 100 .

The input/display unit 120 includes, for example, a display device such as an LCD (Liquid Crystal Display), an organic EL (Electroluminescence) display device, an LED (Light Emitting Diode) display, and an input device that receives an input operation by an operator. The input/display unit 120 may be a touch panel in which a display device and an input device are integrated, or may be provided with an input device such as a mouse or a keyboard.

The input operation acquisition unit 122 acquires details of an operation performed on the input/display unit 120 and outputs the acquired details of the operation to the overall control unit 110 . The display control unit 124 causes the input/display unit 120 to display an image in accordance with an instruction from the overall control unit 110 . The instruction from the overall control unit 110 is an instruction to display the results of processing by the reference image creation unit 132, the marker detection unit 134, the image processing unit 136, the target position identification unit 140, the output control unit 150, or the gating window adjustment unit 152. , and an instruction to display the content of the operation acquired by the input operation acquiring unit 122 . The display control unit 124 causes the input/display unit 120 to display an interface image for receiving an instruction to start each of the treatment preparation stage and the treatment beam B irradiation stage. It should be noted that displaying an image includes generating image elements based on a calculation result and allocating previously created image elements to a display screen.

The acquisition unit 130 acquires the fluoroscopic image TI from the therapeutic device 10 . Also, the acquisition unit 130 acquires the detection result of the sensor 15 . Acquisition unit 130 acquires three-dimensional volume data based on a tomographic image of subject P from a medical examination apparatus (not shown). When the device image TI is used as a reference image for target position identification, the reference image creation unit 132 generates a reference image used for target position identification based on the fluoroscopic image TI acquired by the acquisition unit 130. . The marker detection unit 134 detects the positions of markers used for marker tracking in the fluoroscopic image TI. These will be detailed later.

The image processing unit 136 performs image processing such as deformable registration and DRR (Digitally Reconstructed Radiograph) image generation. Deformable registration is a process of developing position information specified in 3D volume data at a certain point in time-series 3D volume data into 3D volume data at another point in time. A DRR image (reconstructed image) is a virtual fluoroscopic image generated by applying radiation from a virtual radiation source to three-dimensional volume data.

The target position specifying section 140 as a first and second specifying section specifies the target position in the fluoroscopic image TI. The target may be an affected area of the subject P, that is, a position to be irradiated with the treatment beam B, or may be a marker or a characteristic portion of the subject P. FIG. A feature point is a position or region such as the diaphragm, heart, or bone, in which a difference from the surrounding points appears relatively clearly in the fluoroscopic image TI. is. The target position may be a single point, or may be an area having a two-dimensional or three-dimensional extent.

The output control section 150 outputs an irradiation permission signal to the treatment apparatus 10 based on the target position specified by the target position specifying section 140 . For example, in the gated irradiation method, the output control unit 150 outputs a gate-on signal to the treatment apparatus 10 when the target position is positioned within the gating window. A gating window is an area defined in a planning stage, which will be described later, and is an area set in a two-dimensional plane or a three-dimensional space. A gating window is an example of an irradiation permitted range. The gate-on signal is a signal that instructs the subject P to be irradiated with the therapeutic beam B, and is an example of an irradiation permission signal. The following description is based on these assumptions. The therapeutic apparatus 10 irradiates the therapeutic beam B when the gate-on signal is output from the medical apparatus 100 , and does not irradiate the therapeutic beam B when the gate-on signal is not output from the medical apparatus 100 . The permitted irradiation range (gating window) is not limited to being set fixedly, but may be defined as a region that moves following the movement of the affected area.

The gating window adjuster 152 adjusts the position or size of the gating window set in the planning stage. The user determines whether or not to adjust the gating window based on the position and movement of the diseased part, the characteristic part, or the marker on the fluoroscopic image TI of the subject P. The gating window is adjusted by the user operating the medical device 100 .

The storage unit 160 is realized by, for example, RAM (Random Access Memory), ROM (Read Only Memory), HDD (Hard Disk Drive), flash memory, or the like. In addition to the programs described above, the storage unit 160 stores time-series three-dimensional CT images (hereinafter referred to as 4DCT images), perspective images TI, detection results of the sensor 15, and the like.

A flow of treatment in the treatment system 1 will be described. The treatment system 1 can perform treatment by switching between three modes, for example, markerless tracking and marker tracking, which are internal respiratory gating, and external respiratory gating. In marker tracking, the medical device 100 tracks the position of the marker embedded in the body of the subject P and determines the timing of irradiating the treatment beam B to the affected area. In markerless tracking, the medical device 100 tracks the position of the diseased part or characteristic part of the subject P, and determines the timing of irradiating the diseased part with the treatment beam B. FIG. In external respiratory gating, the medical device 100 determines the timing of irradiating the treatment beam B to the affected area based on the detection result of the sensor 15 attached to the subject P. FIG. Hereinafter, processing using markerless tracking is referred to as a markerless tracking mode (first mode), processing using marker tracking is referred to as a marker tracking mode (second mode), and processing using external respiratory gating is referred to as an external respiratory gating mode (third mode). ).

Markerless tracking includes methods using template matching and machine learning. A case where the template matching method is adopted for markerless tracking and the gated irradiation method is adopted for the irradiation method will be described below. The medical device 100 may be switchable between the template matching method and the method using machine learning.

<Treatment flow (markerless tracking mode)>
The markerless tracking mode (first mode) will be described below.

[Planning stage]
CT imaging of the subject P is performed in the planning stage of the markerless tracking mode. In CT imaging, the subject P is imaged from various directions for each of various respiratory phases. A 4DCT image is generated based on the results of CT imaging. A 4DCT image is obtained by arranging n three-dimensional CT images (an example of the three-dimensional volume data described above) in time series. The period obtained by multiplying this n by the time interval of the CT images in time series is set, for example, so as to cover the period during which the respiratory phase changes by one cycle. A 4DCT image is stored in the storage unit 160 .

A doctor, radiologist, or the like (hereafter referred to as a user) determines the contour of the object in at least one CT image among the n CT images included in the 4DCT image, and inputs it to the medical apparatus 100 . Targets whose outlines are determined include a tumor that is an affected area, characteristic points near the affected area, organs that the treatment beam B is not desired to be irradiated, and the like. The image processing unit 136 defines the contour of the object in each CT image by performing deformable registration on the CT images in which the contour of the object is not defined. A treatment plan is then determined by the user. The treatment plan defines the location, direction, and amount of treatment beam B to be applied to the affected area based on the set contour information. It is determined according to the treatment method such as tracking irradiation method. A part or all of the processing in the planning stage may be executed by an external device. For example, the process of generating 4DCT images may be performed by a CT machine. Treatment plan information representing the treatment plan is stored in the storage unit 160 .

Here, an area defined by the contour of the tumor, the center of gravity of the area, the position of the characteristic part of the subject P, or the like is the target position. Furthermore, in the treatment plan, it is determined at which position the treatment beam B can be applied if the target position is present. When the contour is set by the deformable registration, margins are automatically or manually set for the target position, and gating windows are set to reflect the margins. This margin is for absorbing device and positioning errors.

A region defined by the outline of a tumor or a characteristic location, the center of gravity of the region, or a region near the center of gravity is an ROI (Region Of Interest). A margin may be set to the ROI when the ROI is set by deformable registration. This margin is added to suppress the effects of errors and positioning errors that occur in the treatment device 10, and is added outside the region and center of gravity so that the ROI is wide. Information indicating the set ROI is stored in the storage unit 160 . When the contour of the tumor and the contour of the characteristic location are defined as ROIs, the image processing unit 136 extracts temporal changes in the relative positions of the tumor and the characteristic location from the 4DCT images, and extracts the time series of the relative positions. Information indicating the ROI may be stored in the storage unit 160 . The image processing unit 136 sets a three-dimensional region obtained by adding a margin to the ROI as a gating window. When setting the gating window, the margin set for the ROI may be a predetermined size or a size input by the user.

A gating window is defined as a three-dimensional space based on the three-dimensional shape of the lesion or feature in the CT image. A gating window defined as a three-dimensional space is also called a three-dimensional gating window (three-dimensional irradiation permitted range). For example, the gating window is defined as a three-dimensional space obtained by adding a predetermined margin to the three-dimensional shape of the diseased part or characteristic part. The position and shape of the affected area when irradiated with the treatment beam B are the position and shape of the affected area in one of the 4DCT images. For example, the gating window is determined based on the position and shape of the affected area in the CT image of the expiration phase, or the position and shape of the feature location in the CT image of the expiration phase. The expiratory phase refers to the phase of a CT image obtained when the subject P has fully exhaled. In treatment planning, an appropriate gating window can be selected according to the condition of the subject, such as a gating window based on the affected area and a gating window based on the characteristic location.

The gating window may be installed not only at one place in the most expiratory portion of the expiratory phase, but also at a plurality of places. For example, in the most exhaled part, if the affected part is close to an important organ (organ at risk: OAR) that does not need to be irradiated with the treatment beam B, the gate is used when it is necessary to avoid irradiation of the treatment beam B to the important organ. It is effective to divide the window into multiple parts and install it.
Moreover, when both the gating window based on the affected part and the gating window based on the characteristic part are set, the two gating windows may be used in combination. For example, it may be possible to select a method such as irradiating the treatment beam B when both the positions of the diseased part and the diaphragm are within the gating window.

[Positioning stage]
In the positioning stage, the bed position is adjusted. A subject P is laid on a bed 11 and fixed to the bed 11 with a shell or the like. The operator visually confirms the position and posture of the subject P, and moves the subject P together with the bed 11 to a position where the treatment beam B emitted from the irradiation gate 14 is likely to hit the affected area. The operator roughly adjusts the position of the bed 11 . After the coarse adjustment, images are taken that are used to fine tune the couch position. For example, when a 3D-2D registration is performed, a perspective image TI is taken. The fluoroscopic image TI is captured, for example, at the timing when the subject P has completely exhaled. Since the position of the bed 11 has been roughly adjusted, the fluoroscopic image TI includes an image of the affected area of the subject P and its vicinity. The obtained fluoroscopic image TI is stored in the storage unit 160 .

When 3D-2D registration is performed, in the positioning phase, using the positions of the radiation sources 12-1, 12-2 and the detectors 13-1, 13-2, respectively, and the treatment plan for the subject P, A DRR image is generated from the three-dimensional volume data. The position of the bed 11 is finely adjusted based on the DDR image and the perspective image TI. The position of the bed 11 is finely adjusted by repeating the photographing of the fluoroscopic image TI, the calculation of the bed movement amount, and the movement of the bed 11 .

[Preparation stage (Part 1)]
After the positioning phase a preparatory phase takes place. In the preparation stage, a DRR image for each phase is created from the 4DCT image. Creation of DRR images may be performed any time after the 4DCT images are taken. A position or region projected from the gating window set in the treatment plan is set as the gating window in the created DRR image. The treatment apparatus 10 captures a fluoroscopic image TI for creating a reference image. The therapeutic apparatus 10 captures a plurality of fluoroscopic images TI, for example, over a period corresponding to two respirations of the subject P. While the subject takes a deep breath, the external respiratory waveform of the subject P is acquired in synchronization with the fluoroscopic image TI. The acquired external respiratory waveform is displayed on the input/display unit 120 by the display control unit 124 . A tracking value based on the respiratory phase of the subject P obtained from the external respiratory waveform is associated with the captured fluoroscopic image TI.

In the preparation stage (Part 1), the medical device 100 learns the relationship between the fluoroscopic image TI and the target position from the DRR image and the target position information on the DRR image. Additionally, user modification of the target location is accepted by the medical device 100 . Based on the tracking values, the medical device 100 selects one or more templates (reference images) from the fluoroscopic images TI used when learning the target position. The template may be obtained by cutting out a characteristic part of the fluoroscopic image TI. Learning of the target position may be performed at any timing from the planning stage to the treatment stage. For example, when a template is created from the fluoroscopic image TI for the first half of the fluoroscopic image TI for two breaths of the subject P, the template is used to obtain the target with the fluoroscopic image TI for the second half of the breath. You can check if you can track it. At that time, the display control unit 124 may display the gating window set on the DRR image on the fluoroscopic image TI.

If the gating window is set for the characteristic part in addition to the diseased part, the target position identifying unit 140 may identify the position of the characteristic part in the fluoroscopic image TI. The target position specifying unit 140 may acquire a user's operation indicating which of the affected part or the characteristic part is to be selected as the target position PT, and determine the target position PT according to the user's operation.

Also, in the preparation stage (1), the gating window is adjusted. The target position identifying section 140 uses the template generated by the reference image generating section 132 to allocate the target position PT to the fluoroscopic image TI. The overall control unit 110 causes the input/display unit 120 to display the target position PT and the gating window superimposed on the fluoroscopic image TI. Further, the overall control unit 110 causes the input/display unit 120 to display the target position and the gating window superimposed on the DRR image. The position of the gating window superimposed on the fluoroscopic image TI is calculated based on the target position PT specified by the target position specifying unit 140 and the relative position between the target position and the gating window at the time of treatment planning. .

The user confirms the positions and relative positions of the target position PT and the gating window based on the confirmation image displayed on the input/display unit 120 . The confirmation image is an image including a fluoroscopic image TI on which the target position PT and the gating window are superimposed, and a DRR image on which the target position and the gating window are superimposed. The confirmation image may be an image including either the fluoroscopic image TI or the DRR image. The user determines whether or not to adjust the gating window based on the confirmation image. When the feature point is selected as the target position, the user determines whether or not the gating window needs to be adjusted based on the relative position between the target position PT and the affected area, and the movement amount of the target position PT and the affected area associated with respiration. to decide. When the user determines that the gating window needs to be adjusted, the input operation acquisition unit 122 acquires an operation for adjusting the gating window from the input/display unit 120 . The gating window adjuster 152 adjusts the gating window according to the acquired operation.

The input operation acquisition unit 122 acquires an operation for changing the position or shape of the gating window from the input/display unit 120 . The gating window adjustment unit 152 changes the shape of the gating window on the fluoroscopic image TI and the DRR image according to the acquired operation. The gating window adjustment unit 152 calculates the three-dimensional shape of the gating window from the changed shape of the gating window. The gating window adjustment unit 152 stores the calculated three-dimensional shape of the gating window in the storage unit 160 as the three-dimensional shape of the gating window after adjustment. The medical device 100 uses the adjusted gating window for subsequent processing. The accuracy of the gating window can be improved by the user's confirmation of the target position and adjustment of the gating window. In the adjustment of the gating window, the gating window may be superimposed on the DRR images generated from the CT images corresponding to each slice of the 4DCT images, and displayed superimposed on the time-series DRR images. By comparing the gating window on the time-series DRR image and the gating window on the fluoroscopic image, the user can check the relationship between the change in the target position and the gating window accompanying respiration, and adjust the gating window. can improve the accuracy of

[Preparation stage (Part 2)]
Then, imaging of the fluoroscopic image TI is started again. The target position specifying unit 140 performs matching with a template for the fluoroscopic images TI input in time series, and assigns target positions PT to the fluoroscopic images TI. The display control unit 124 causes the input/display unit 120 to display the fluoroscopic image TI as a moving image, and superimposes the target position PT on the frame of the fluoroscopic image TI to which the target position PT is assigned. As a result, a doctor or the like confirms the tracking result of the target position.

The target position specifying section 140 specifies the target position PT as a two-dimensional position and a three-dimensional position. A two-dimensional position is represented using coordinates on the perspective image TI. A three-dimensional position is expressed using coordinates in a predetermined three-dimensional coordinate system. The three-dimensional position is represented, for example, using a three-dimensional coordinate system with the isocenter of the treatment beam B as the origin. The target position specifying unit 140 calculates the coordinates of the three-dimensional position of the target position PT based on the coordinates on the fluoroscopic images TI-1 and TI-2 and the positions of the radiation source 12 and the detector 13. FIG.

The display control unit 124 causes the input/display unit 120 to display an image in which the specified target position PT is superimposed on the perspective image TI. The target position PT is displayed by a point indicating the position of the center of gravity of the affected area, a line indicating the outline of the affected area, or the like. By superimposing the target position PT on the fluoroscopic image TI input in time series by the medical device 100, the user can confirm the movement of the target accompanying respiration of the subject P and track the position. The display control unit 124 also causes the input/display unit 120 to display the gating window projected onto the DRR image so as to be superimposed on the fluoroscopic image TI. A region obtained by projecting the three-dimensional space indicated by the gating window onto the fluoroscopic image TI or a boundary line of the region is displayed as a gating window superimposed on the fluoroscopic image TI.

The output control section 150 acquires the target position PT specified by the target position specifying section 140 . The output control section 150 determines whether or not the target position PT is within the gating window. In the treatment stage, which will be described later, the output control unit 150 outputs a gate-on signal to the treatment apparatus 10 when the target position PT is within the gating window. Determination of whether or not the target position PT is within the gating window includes determination using the two-dimensional position of the target position and determination using the three-dimensional position of the target position. The user selects whether to use two-dimensional positions or three-dimensional positions.

When determining whether or not the target position PT is within the gating window using the two-dimensional position of the target position (two-dimensional mode), the output control unit 150 converts the three-dimensional space indicated by the gating window into the perspective image TI. Calculate the areas projected onto -1 and TI-2. The calculated area is a two-dimensional gating window (two-dimensional irradiation permitted range). For example, the output control unit 150 may include a two-dimensional position on the fluoroscopic image TI-1 in the region projected onto the fluoroscopic image TI-1, and a region projected onto the fluoroscopic image TI-2. 2-D position is included, then the target position is determined to be within the gating. That is, when there is no location indicated by the target position outside the two-dimensional gating window, the output control section 150 determines that the target position is within the gating. The output control unit 150 determines that the target position is not within the gating when the location indicated by the target position exists outside the two-dimensional gating window.

When determining whether or not the target position PT is within the gating window using the three-dimensional position of the target position PT (three-dimensional mode), the output control unit 150 controls the three-dimensional space indicated by the three-dimensional gating window. contains the 3D position. When the three-dimensional space indicated by the gating window includes the three-dimensional position, that is, when the point indicated by the target position PT does not exist outside the three-dimensional space indicated by the gating window, the output control unit 150 controls the target Determine that the position PT is within the gating. The output control unit 150 determines that the target position PT is not within the gating when the location indicated by the target position PT exists outside the calculated area.

The output control unit 150 outputs to the display control unit 124 the determination result, that is, information indicating whether or not the target position PT is within the gating window. The display control unit 124 changes the display color of the gating window displayed on the input/display unit 120 according to the determination result. Specifically, the display control unit 124 changes the display color of the gating window when the target position PT is within the gating in both images. In addition to changing the display color of the gating window, the display control unit 124 may cause the input/display unit 120 to display information indicating that the target position PT is within the gating. The display control unit 124 changes the display color of the gating window superimposed on the fluoroscopic image TI according to the determination result by the output control unit 150, so that the user can confirm the output timing of the gate-on signal.

[Treatment stage]
In the treatment stage, the output control unit 150 outputs a gate-on signal to the treatment apparatus 10 when the target position is within the gating window for both the fluoroscopic images TI-1 and TI-2. As a result, the treatment beam B is irradiated onto the affected area of the subject P, and treatment is performed. In addition, when the target position is the position of the affected part, the treatment beam B is irradiated when the tracked target position is within the gating window, and when the target position is the position of the characteristic part of the subject P is irradiated with the treatment beam B when the position of the affected part derived from the target position falls within the gating window based on the relationship between the target position and the position of the affected part learned in advance. Note that the treatment beam B may be irradiated to the position of the affected part by these combined methods. That is, the position of the diseased part and the position of the characteristic part are set as target positions, respectively, and the treatment beam B is irradiated when the diseased part falls within the first gating window and the characteristic part falls within the second gating window. You may do so.

[Display screen]
The processing of the medical device 100 to support the flow of treatment described above will now be described. FIG. 2 is a diagram showing an example of the interface image IM in the markerless tracking mode displayed by the input/display unit 120 of the medical device 100. As shown in FIG. The interface image IM includes areas A1-1, A1-2, A2, A3, A4, A5, A6 and A7.

In the area A1-1, a fluoroscopic image TI-1 is displayed, and a gating window GW and a target position PT are superimposed on the fluoroscopic image TI-1. In the area A1-2, a fluoroscopic image TI-2 is displayed, and a gating window GW and a target position PT are superimposed on the fluoroscopic image TI-2. Various graphs and the like are displayed in the area A2.

The area A3 includes a select window SW for accepting selection of a mode or the like, a first button B1 for instructing start or stop of imaging of the fluoroscopic image TI, and a second button for instructing a temporary stop of imaging of the fluoroscopic image TI. B2, a third button B3 for instructing the end of the treatment session, a control area CA set with a slide bar, a frame advance switch, etc. for retroactively checking the time-series DRR images or fluoroscopic images TI, and the preparation stage. A check box CB or the like for confirming completion is displayed. An operation on each part of the interface image IM is performed by a touch operation, a mouse click, a keyboard operation, or the like. For example, the first button B1 is operated by touch operation or mouse click.

The area A4 displays treatment stages according to the mode, and displays a fourth button B4, a fifth button B5, and a sixth button B6 for instructing to proceed to each stage. A graph of an external respiratory waveform based on the detection result of the sensor 15 and the like are displayed in the area A5. An image and text information indicating treatment plan information of the subject P and the like are displayed in the area A6. In the region A7, a CT image of the subject P is displayed, and the irradiation direction of the X-ray, the irradiation field, the irradiation direction of the treatment beam B, the outline of the target, the marker ROI, etc. are displayed superimposed.

<Flowchart (markerless tracking mode)>
Various functions of the interface image IM will be described below with reference to flowcharts. 3 and 4 are first and second flow charts showing an example of the flow of processing executed by the medical device 100. FIG. First, the overall control unit 110 refers to information input from the input operation acquisition unit 122, and determines whether or not markerless tracking has been selected in the select window SW (step S100). Selection of markerless tracking may be performed by a user's operation, or may be performed according to a signal from the treatment device 10 . The medical device 100 may make the selection based on the content of the treatment plan. Processing when a mode other than markerless tracking is selected will be described later. In the following description, when detecting that the medical device 100 has been operated, the overall control unit 110 makes a determination by referring to the information input from the input operation acquisition unit 122. is omitted.

When markerless tracking is selected in the selection window SW, the overall control unit 110 determines whether or not start of imaging is selected by operating the first button B1 (step S102). FIG. 5 is a diagram showing changes in display modes of the first button B1, the second button B2, and the third button B3. As shown in FIG. 5, in the initial state, the first button B1 is in a state in which shooting is "OFF", that is, the state in which shooting is not performed, and in addition to receiving an instruction to "start shooting". When the first button B1 is operated, the mode changes to indicate that photography is "ON", that is, that photography is being performed, and that the instruction "stop photography" is accepted. The first button B1 makes a state transition between these two modes.

In the initial state, the second button B2 accepts an instruction to "pause" the shooting when operated. When the second button B2 is operated, it changes to a mode of accepting an instruction to "resume photographing". Further, the third button B3 is in an initial state in a state of accepting an instruction to "close" the interface image IM, and when operated, the display of the interface image IM is stopped, and a series of processing ends.

When the start of imaging is selected by operating the first button B1, the integrated control unit 110 controls the output control unit 150 to instruct the treatment apparatus 10 to capture the fluoroscopic image TI used in the positioning stage and the preparation stage ( step S104). For example, the output control unit 150 instructs the therapeutic apparatus 10 to capture fluoroscopic images TI for k breaths. Note that the output control unit 150 may output an instruction to end imaging to the treatment apparatus 10 when the first button B1 is operated again. In this way, the output control unit 150 controls the imaging unit (radiation sources 12-1 and 12-2, detector 13-1, 13-2) is output. As a result, the operation of the treatment system 1 including the treatment apparatus 10 can be centrally managed by the medical apparatus 100, improving convenience.

The overall control unit 110 determines whether or not registration has been instructed by operating the fourth button B4 (step S106). FIG. 6 is a diagram showing a display example of the fourth button B4, fifth button B5, and sixth button B6 in the markerless tracking mode. In the markerless tracking mode, the fourth button B4 accepts an instruction for registration (learning the target position PT in the fluoroscopic image TI), the fifth button B5 accepts an instruction to create a reference image, and the sixth button B6 accepts a gate-on signal. receive confirmation instructions. In addition, the sixth button B6 can be used to select whether the output determination of the gate-on signal is performed at the two-dimensional position (2D) or the three-dimensional position (3D) of the target position.

When registration is instructed by operating the fourth button B4, the overall control unit 110 instructs the image processing unit 136 to acquire the target position in the fluoroscopic image TI from the target position PT in the DRR image. The overall control unit 110 instructs the display control unit 124 to superimpose the obtained target position PT on the perspective image TI and display it on the input/display unit 120 (step S108). As described above, the image processing unit 136 generates a DRR image with a known target position PT based on a DRR image created from a CT image captured in the planning stage and a fluoroscopic image TI captured after the planning stage. , a process of matching the characteristic part of the image with the fluoroscopic image TI, etc., to determine the target position PT in the fluoroscopic image TI. The relationship between the fluoroscopic image TI and the target position PT is provided to the reference image generator 132 .

An image in which the target position PT is superimposed on the fluoroscopic image TI is displayed, for example, in areas A1-1 and A1-2 of the interface image IM. The display control unit 124 causes the input/display unit 120 to display an image in which the target position PT is superimposed on the perspective image TI. Such images are displayed, for example, in areas A1-1 and A1-2 of the interface image IM. While this image is being displayed, the overall control unit 110 accepts the user's operation for adjusting the target position PT (step S110). Adjustment of the target position PT is performed, for example, by a drag-and-drop operation to the target position PT in the areas A1-1 and A1-2. When the target position PT is adjusted, the integrated control unit 110 provides the reference image creating unit 132 with the relationship between the adjusted fluoroscopic image TI and the target position PT.

The overall control unit 110 determines whether or not an instruction to create a reference image has been issued by operating the fifth button B5 (step S112). When the creation of a reference image is instructed by operating the fifth button B5, the overall control unit 110 instructs the reference image creation unit 132 to select the fluoroscopic image TI to be used as the reference image, and perform processing such as resizing. , to create a reference image (step S114). The reference image creation unit 132 creates a reference image (template) associated with the target position PT, and stores it in the storage unit 160 .

The target position specifying unit 140 specifies the target position PT in the fluoroscopic image TI using the created reference image. Based on the target position PT specified by the target position specifying unit 140, the image processing unit 136 superimposes the target position PT and the gating window on the perspective image TI. The input/display unit 120 displays a confirmation image including a fluoroscopic image TI on which the target position PT and the gating window are superimposed, and a DRR image on which the target position and the gating window are superimposed. The user determines whether or not to adjust the gating window based on the confirmation image. When the user determines that adjustment is necessary, the input operation acquisition unit 122 receives an instruction to adjust the gating window, and the gating window adjustment unit 152 adjusts the gating window according to the instruction (step S116). The adjusted gating window is superimposed on the fluoroscopic image TI together with the target position, and displayed on the input/display unit 120 as a confirmation image.

The gating window adjustment unit 152 may adjust not only the gating window projected onto the fluoroscopic image TI but also the three-dimensional shape of the gating window according to the acquired operation. By adjusting the gating window, it becomes possible to set the gating window according to the state of the subject P. In confirming the gating window, the input/display unit 120 may superimpose the gating window and the target position on the moving image in any slice indicated by the 4DCT image and display it. This moving image is displayed, for example, in area A7.

The adjustment of the gating window is performed by the user changing the area of the gating window GW superimposed on the DRR image or the fluoroscopic image TI displayed in the areas AI-1 and AI-2 shown in FIG. may be performed by For example, the position or margin amount of the gating window GW may be adjusted by a drag-and-drop operation on the boundary line of the gating window GW.

When the gating window is adjusted, the input/display unit 120 may display the margin added to the ROI and the diseased or characteristic area in the treatment plan in different manners. For example, the input/display unit 120 displays the margin added when defining the gating window and the diseased part or the region of the characteristic part in different colors or different saturations or brightnesses. The gating window adjustment unit 152 may accept only reduction of the margin portion as adjustment of the gating window.

When the gating window is adjusted, the input/display unit 120 may display the gating window before adjustment and the gating window after adjustment so as to be superimposed on the fluoroscopic image TI. By displaying the gating window before and after adjustment, the user can easily check the adjustment amount of the gating window. The input/display unit 120 displays the fluoroscopic image TI on which the gating window before adjustment is superimposed in the area A1-1 of the interface image IM, and displays the fluoroscopic image TI on which the gating window after adjustment is superimposed on the area A1-2. may be displayed in

The gating window adjusting section 152 may cause the storage section 160 to store information indicating the adjusted gating window. The gating window adjustment unit 152 may read the gating window after adjustment in the past treatment from the storage unit 160 and adjust the gating window using the read gating window. When a plurality of gating windows after adjustment are stored in the storage unit 160, the input/display unit 120 displays the gating windows after adjustment stored in the storage unit 160, and displays the gating windows after adjustment. You may acquire the operation of the user who selects. The gating window adjustment unit 152 selects one of the plurality of adjusted gating windows according to the acquired operation.

The gating window adjuster 152 may adjust the size of the gating window according to the amount of movement of the target position. For example, if the amount of movement of the target position on the fluoroscopic image TI is smaller than at the time of treatment planning and should be set smaller than the margin amount set in the treatment plan, the gating window adjustment unit 152 changes the value to a smaller value. be able to. Also, for example, when the target position changes significantly in a specific coordinate direction from the time of treatment planning, the margin amount in that direction can be adjusted within a range that does not hinder treatment. These are particularly effective in correcting errors due to therapeutic equipment errors and patient respiratory conditions.

The gating window adjustment unit 152 may compare the amount of movement of the target position in the DRR image and the amount of movement of the target position in the confirmation image, and determine the axial direction for changing the gating window based on the comparison result. For example, the gating window adjustment unit 152 may change the gating window according to the ratio of the amount of movement of the target position between the 4DCT image and the confirmation image. The gating window adjuster 152 may adjust the size of the gating window by changing the margin added when defining the gating window.

The overall control unit 110 determines whether confirmation of the gate-on signal has been instructed by the operation of the sixth button B6 (step S118). When the confirmation of the gate-on signal is instructed, the integrated control unit 110 determines the output of the gate-on signal according to the selection state of the two-dimensional position (2D) or the three-dimensional position (3D) of the sixth button B6. A selection is made between two-dimensional positions and three-dimensional positions (step S120). The output control unit 150 switches between the determination using the two-dimensional position and the determination using the three-dimensional position according to the selection of the integrated control unit 110 according to the selection state of the sixth button B6. The overall control unit 110 prohibits adjustment of the gating window and adjustment of the target position (step S122).

The overall control unit 110 instructs the display control unit 124 to change the check box CB to the check box CB, and causes the input/display unit 120 to display the output timing of the gate-on signal (step S124). . When the confirmation of the gate-on signal is instructed, the output timing of the gate-on signal is determined, and the determination result is displayed. However, when the check box CB is checked, the output timing of the gate-on signal is calculated and displayed, but the gate-on signal is not actually output to the therapeutic device 10 .

The overall control unit 110 determines whether or not the start of shooting has been selected by operating the first button B1 (step S126). When the start of imaging is selected by operating the first button B1, the integrated control unit 110 instructs the treatment apparatus 10 to capture the fluoroscopic image TI via the output control unit 150, and uses the captured fluoroscopic image TI. The input/display unit 120 instructs the display control unit 124 to display the target position and the gating window, and causes the input/display unit 120 to display the final confirmation image using the photographed fluoroscopic image TI (step S128).

The final confirmation image is displayed in areas AI-1 and AI-2. The final confirmation image is an image in which the target position PT and gating window GW are superimposed on the fluoroscopic image TI reproduced as a moving image (see FIG. 2). The output control unit 150 outputs a gate-on signal to the display control unit 124 when the target position PT is positioned within the gating window GW, and causes the area A2 to display that the gate-on signal is being output. By visually recognizing this final confirmation image, the user can determine whether or not the target position PT such as the affected area of the subject P is recognized as the correct position, and whether or not the timing at which the target position PT is positioned within the gating window GW is appropriate. Also, it is possible to confirm the output timing of the gate-on signal, the necessity of adjustment of the gating window, and the like. The final confirmation image is displayed until stop of photographing is selected by operating the first button B1 (step S130). Even after the stop of photographing is selected, the final confirmation image can be retroactively confirmed by operating the control area CA in which a slide bar, a frame advance switch, and the like are set.

Based on the final confirmation image displayed on the input/display unit 120, the user determines whether adjustment of the gating window is necessary. The overall control unit 110 accepts whether or not the gating window needs to be adjusted according to the user's operation input to the input/display unit 120 (step S132). If the gating window needs to be adjusted, the overall control unit 110 cancels the inhibition of gating window adjustment and target position adjustment, and returns the process to step S100. If the gating window need not be adjusted, the overall control unit 110 advances the process to step S134.

When the stop of photographing is selected by operating the first button B1, the overall control unit 110 determines whether or not the check box CB is unchecked (step S134). If the check box CB is not cleared, the integrated control unit 110 determines whether or not the start of shooting has been selected by operating the first button B1 (step S136). If shooting start is selected, the process returns to step S128, and if shooting start is not selected, the process returns to step S134. When the check box CB is unchecked, the central control unit 110 determines whether or not a start signal has been received from the therapeutic device 10 (step S138). This start signal is a signal output when a switch (not shown) of the treatment device 10 is operated so that the treatment can be started by the treatment device 10 . Upon receiving the start signal from the treatment apparatus 10, the integrated control unit 110 instructs the display control unit 124, the target position specifying unit 140, and the output control unit 150 to start treatment, and the output control unit 150 receives the fluoroscopic image TI. is instructed to the treatment apparatus 10 (step S140).

Further, when the check box is cleared in step S134, even if the start signal is not received from the treatment apparatus 10, the integrated control unit 110 determines whether or not imaging has started by operating the first button B1. good. When imaging is started and the target position PT specified by the target position specifying unit 140 is within the gating window, a gate-on signal may be output to the treatment apparatus 10 (not shown). If the check box is not cleared, beam B will not be output from the treatment device. Also, if the check box is not cleared in step S134 but is cleared after the start of imaging is selected, the gate-on signal may be output during imaging (not shown).

In this manner, the output control unit 150 outputs the gate-on signal to the therapeutic apparatus 10 on condition that the input operation acquiring unit 122 acquires an input operation to change the default state to the canceled state in the interface image IM. As a result, unintentional irradiation of the subject P with the treatment beam B can be suppressed, and the reliability of the treatment can be improved. Further, when the creation of the template is completed, the input operation acquisition unit 122 receives an instruction to start the treatment beam B irradiation stage without requesting an end operation of the preparation stage. Thereby, the operability of the medical device 100 can be improved.

When treatment is started, the target position specifying unit 140 performs template matching using a template on the fluoroscopic image TI to specify the target position. The output control unit 150 outputs a gate-on signal to the therapeutic device 10 when the target position is within the gating window GW. The output control unit 150 determines whether or not to output a gate-on signal according to the selection of the two-dimensional position (2D) or the three-dimensional position (3D) with the sixth button B6. The display control unit 124 causes the input/display unit 120 to display a treatment image in which the target position and the gating window GW are superimposed on the fluoroscopic image TI. Treatment images are displayed in areas A1-1 and A1-2.

The integrated control unit 110 integrates the output time of the gate-on signal to the therapeutic device 10 (step S142). The point at which the output time integration is started is either the point at which a start signal is received from the treatment apparatus 10 or the point at which imaging start is selected by operating the first button B1 and imaging is started. The integrated control unit 110 determines whether or not the ratio of the integrated time to the time that has elapsed since the start of treatment is equal to or less than a certain threshold (step S144). The integrated control unit 110 stops outputting the gate-on signal to the treatment apparatus 10 when the integrated time is equal to or less than the threshold (when the irradiation rate is decreased). In addition, the integrated control unit 110 stops the irradiation and imaging of the treatment beam B by the treatment apparatus 10, and terminates the treatment. If the accumulated time is not equal to or less than the threshold, overall control unit 110 advances the process to step S146.

The treatment continues until the end of imaging is selected by operating the first button B1, or until the dose of the irradiated treatment beam B reaches the dose defined by the treatment plan (step S146). The medical device 100 may end the treatment when receiving an irradiation completion signal from the treatment device 10 or when receiving a signal from the treatment device 10 indicating that the treatment device 10 has performed an operation to end irradiation. .

The display control unit 124 may change the color of the gating window when outputting the gate-on signal (when the output condition is met in the preparation stage) in the confirmation image, the final confirmation image, and the treatment image. For example, if the target position PT is within the gating window GW in both of the fluoroscopic images TI-1 and TI-2, the target will be the first color in only one of the fluoroscopic images TI-1 and TI-2. When the target position PT is within the gating window GW in both the second color and the fluoroscopic images TI-1 and TI-2 when the position PT is within the gating window GW (that is, the condition for outputting the gate-on signal is established), the frame line of the gating window GW may be displayed in a third color. Further, when the target position PT is not within the gating window GW in both the fluoroscopic images TI-1 and TI-2, the display control unit 124 may cause the input/display unit 120 to display an error icon. .

Further, the display control unit 124 may change the color or brightness of either the inner area or the outer area of the gating window GW when the condition for outputting the gate-on signal is satisfied. Furthermore, the medical device 100 may include a notification unit that notifies by sound or vibration when the condition for outputting the gate-on signal is satisfied.

The medical device 100 not only accepts mode switching among markerless tracking, marker tracking, and external respiratory gating in the process of step S100 in the above flowchart, but may accept switching at any timing from the preparation stage to the treatment stage. . In addition, redoing of processing is accepted as appropriate. For example, in the scene where the final confirmation image is being displayed, an operation for restarting from the shooting of the template is accepted. As a result, the user is not required to perform complicated operations, and convenience can be improved. In addition, when the mode is switched after the fluoroscopic image TI is captured, the already captured fluoroscopic image TI may be used as a template.

If the treatment is performed multiple times, the medical device 100 may use a template created from the previous treatment. FIG. 7 is a third flowchart showing an example of the flow of processing executed by the medical device 100. As shown in FIG. As illustrated, after markerless tracking is selected in the selection window SW, the overall control unit 110 determines whether or not "use the previous template" has been selected in any area of the interface image IM. (Step S101). If "use previous template" is selected, steps S102 to S114 are skipped and the process proceeds to step S116.

When the medical device 100 performs treatment in a plurality of times, the storage unit 160 stores DRR images created after the planning stage, and stores the DRR images from the storage unit 160 instead of generating the DRR images. May be read. When the mode is switched, the medical device 100 may read the DRR image from the storage unit 160 instead of generating the DRR image.

In the processing of the flowchart shown in FIG. 3, the medical device 100 identifies the target position by template matching, but the target position may be identified by machine learning. When specifying the target position by machine learning, the processing from steps S108 to S114 is replaced with processing for learning a classifier that derives the target position when a reference image is input.

Although the case where the reference image is created prior to treatment has been described, the medical device 100 may also concurrently add the fluoroscopic image TI taken during treatment to the reference image. When performing machine learning, the medical device 100 may perform machine learning in real time using the fluoroscopic image TI during treatment.

<Treatment flow (marker tracking mode)>
The marker tracking mode will be described below. Marker tracking mode uses markers to locate the lesion. A marker is embedded near the affected area, and the positional relationship between the marker and the affected area is learned in the planning stage. The marker is treated as a target position, and treatment beam B is delivered if the marker falls within the gating window. Moreover, the treatment beam B may be irradiated when the position of the affected part specified from the marker position falls within the gating window.

[Planning stage]
CT imaging of the subject P is performed in the planning stage of the marker tracking mode. As in the planning stage of the markerless tracking mode, in CT imaging, the subject P is imaged from various directions in various respiratory phases. A 4DCT image is generated based on the result of CT imaging, and the 4DCT image is stored in the storage unit 160 . The user defines the contour of the object for, for example, one CT image out of the n CT images, and inputs it to the medical apparatus 100 . In the marker tracking mode, the objects outlined by the user include markers implanted within the subject P's body. The image processing unit 136 sets the contour of the object in the CT image in which the contour of the object is not defined by the deformable registration. A treatment plan is then determined, similar to the markerless tracking mode.

As in the markerless tracking mode, a treatment plan is determined, and storage unit 160 stores the determined treatment plan information. When the contour of the tumor, the position of the marker, and the region containing the marker are defined as the ROI, the image processing unit 136 extracts the temporal change in the relative position of the tumor and the marker from the 4DCT image, and calculates the relative position. Information indicating the time series and the ROI may be stored in the storage unit 160 . In the marker tracking mode, the image processing unit 136 designates a region including the marker as a feature location and defines a gating window. In the marker tracking mode, similarly to the markerless tracking mode, the gating window is defined as an area obtained by adding a margin to the ROI of the marker.

[Positioning stage]
In the positioning stage, the bed position is adjusted. The positioning phase processing in marker tracking mode is similar to the positioning phase processing in markerless tracking mode. In addition, one or more markers are embedded in the vicinity of the affected area on the body of the subject P before CT imaging. The marker is made of a material (for example, gold or platinum) that does not easily transmit X-rays. Therefore, the marker appears black in the fluoroscopic image TI. Also, the marker has a shape such as a sphere or cylinder with a diameter of about 2 [mm], for example.

[Preparation stage]
In the preparation phase, the user selects at least one marker for tracking on the CT image of a certain respiratory phase, on the DRR image. Markers may be selected prior to the preparation stage, eg during the planning stage. When the user performs an operation to select a marker, the image processing unit 136 causes the input/display unit 120 to display the position of the selected marker superimposed on the CT image, the DRR image, or the fluoroscopic image TI. An image on which the positions of the markers are superimposed is displayed in areas A7, A1-1 and A1-2, for example. The user selects a marker on the CT image, the DRR image, or the fluoroscopic image TI, and adjusts the position of the marker and the position of the affected area as necessary. When adjusted, the adjustment amount for the position of the marker or the affected part is stored in the storage unit 160 as a correction amount. The target position in the marker tracking mode is the position of the selected marker, and the gating window may be adjusted so that the marker falls within the gating window when the tumor is within the permitted radiation range. Adjustment of the gating window in marker tracking mode is done in the same way as in markerless tracking mode.

FIG. 8 is a diagram showing an example of the interface image IM in the marker tracking mode displayed by the input/display unit 120 of the medical device 100. As shown in FIG. The interface image IM includes regions A1-1, A1-2, A2, A3, A4, A5, A6 and A7, as in markerless tracking mode. The marker-less tracking mode interface image IM is different from the marker-less tracking mode interface image IM in that the fluoroscopic images TI and CT images displayed in the areas A1-1, A1-2, and A7 include the marker MK and the epipolar line EL. different from The target position VPT and the gating window VGW in the regions A1-1 and A1-2 shown in FIG. 8 are the position of the affected area and the gating window for the affected area specified in the treatment plan. In the screen shown in FIG. 8, DRR images are displayed in areas A1-1 and A1-2, and a cross-sectional image based on a CT image is displayed in area A7. A perspective image TI may be displayed instead of the DRR image. The medical device 100 accepts designation of the marker MK by the following three methods. FIG. 8 shows an example in which one marker MK is displayed in each of the areas A1-1 and A1-2, but actually a plurality of markers are displayed in a selectable manner. Also, in the areas A1-1 and A1-2, it is preferable to display the gating area VGW of the affected area specified in the treatment plan and the target position VPT of the affected area in the case of the DRR image.

(1) The user designates a marker MK in area A7. Accordingly, an epipolar line EL is displayed on the fluoroscopic image TI. Then, the marker MK on the epipolar line EL can be designated. When the marker MK on the epipolar line EL is specified, the marker specification is completed. Note that the markers may be specified in advance in the treatment plan, and when the markers are selected, it is easier to use if they are adjustable on the position areas A1-1 and A1-2 of the markers MK.

(2) The user can also specify the marker MK on the DRR image. In this case, when the marker MK is specified on one DRR image (eg, the image of the area A1-1), the epipolar line EL is displayed on the other DRR image (eg, the image of the area A1-2). Then, the marker MK on the epipolar line EL on the other DRR image can be specified. When the marker MK on the epipolar line EL is specified, the specification of the marker MK is completed. At this time, the position of the designated marker MK is displayed on the CT image in the area A7.

(3) The user can also register marker positions as marker ROIs in the planning stage. In this case, marker positions are displayed on the DRR images of the areas A-1 and A1-2 and on the CT image of the area A7, and the user may designate the marker MK used for tracking.

In the preparation stage, the image processing unit 136 acquires the position of the selected marker in each CT image corresponding to another respiratory phase, and stores the acquired position in the storage unit 160 (each phase marker position calculation). When treatment is performed using 4DCT images used in the preparation stage, the image processing unit 136 may acquire from the storage unit 160 the positions of the markers used in the previous treatment in each CT image. Using the past marker positions eliminates the need to select a marker when the subject P is the same. When the phases and margins to be set in the gating window GW are specified, the output control section 150 sets an area in which the margins are added to the positions of the markers MK of each phase in the gating window GW. The gating window GW and the trajectory of the marker MK may be displayed on the DRR image. The setting of the gating window may be performed during the period after the treatment plan is created until the treatment is performed, and the timing of setting is not limited.

When a marker as a target is selected, the medical device 100 instructs the therapeutic device 10 to capture a fluoroscopic image TI. A fluoroscopic image TI is captured over a period of time equal to or longer than one respiration of the subject P. The target position specifying unit 140 detects the target position (marker position) in the fluoroscopic image TI based on the information of the marker MK designated as the feature location including the marker, and outputs the detected target position to the display control unit 124 . The display control unit 124 causes the input/display unit 120 to display images in which the target positions are superimposed on the fluoroscopic images TI-1 and TI-2. By superimposing the target position on the fluoroscopic image TI input by the medical device 100 in chronological order, the user can confirm the movement of the target position accompanying respiration of the subject P, and confirm the movement of the target position detected by the target position specifying unit 140. It is checked whether the target position matches the image of the marker on the fluoroscopic image TI. The medical device 100 may also superimpose and display the position of the affected area on the fluoroscopic image TI input in chronological order. The display control unit 124 may also cause the input/display unit 120 to display a gating window superimposed on the fluoroscopic image TI.

When the target position is confirmed by the user, the fluoroscopic image TI on which the target position (the position of the marker MK) and the gating window GW are superimposed, and the DRR on which the contour VPT of the affected area and the gating window VGW at the time of treatment planning are superimposed. A confirmation image including the image is displayed on the input/display unit 120 . A lesion contour VPT and a gating window VGW may be superimposed on the fluoroscopic image TI. Based on the confirmation image displayed on the input/display unit 120, the user confirms the target position, the gating window GW, and the position of the affected area, and determines whether or not to adjust the gating window GW. When the user determines that the gating window GW needs to be adjusted, the input operation acquisition unit 122 acquires an operation for adjusting the gating window GW from the input/display unit 120 . The gating window adjustment unit 152 adjusts the gating window GW according to the acquired operation.

The gating window adjustment unit 152 may adjust not only the gating window GW projected onto the fluoroscopic image TI but also the three-dimensional shape of the gating window according to the acquired operation. The adjusted gating window is stored in storage section 160 . By adjusting the gating window in the preparation stage, it becomes possible to set the gating window according to the condition of the subject P. In confirming the gating window, the input/display unit 120 may superimpose the gating window and the target position on the moving image in any slice indicated by the 4DCT image and display it. This moving image is displayed, for example, in area A7.

The output control section 150 determines whether or not the target position is within the gating window. In the treatment stage, if the target position is within the gating window, the output control section 150 outputs a gate-on signal to the display control section 124 and the treatment apparatus 10 . The display control unit 124 causes the input/display unit 120 to display whether or not the gate-on signal is output. For example, when the gate-on signal is output, the input/display section 120 changes the display color of the gating window. By changing the display color of the gating window, the user can confirm the output timing of the gate-on signal, and can confirm the relationship between the positions of the marker and the affected part and the output timing of the gate-on signal. As in the markerless tracking mode, the output control section 150 may switch between the two-dimensional mode and the three-dimensional mode to determine whether the target position is within the gating window.

[Treatment stage]
In the treatment stage, the output control unit 150 outputs a gate-on signal to the treatment device 10 when the target position is within the gating window. The treatment apparatus 10 irradiates the treatment beam B in response to the gate-on signal, and treatment is performed by irradiating the treatment beam B to the affected area.

<Flow chart (marker tracking mode)>
The processing of the medical device 100 to support treatment flow in marker tracking mode will now be described. Various functions of the interface image IM will be described with reference to flowcharts. 9 and 10 are fourth and fifth flowcharts showing an example of the flow of processing executed by the medical device 100. FIG.

The overall control unit 110 refers to the information input from the input operation acquiring unit 122 and determines whether or not marker tracking has been selected in the select window SW (step S200). If a mode other than marker tracking is selected, the process returns to step S100 in the flowchart shown in FIG.

When marker tracking is selected in select window SW, overall control unit 110 accepts selection and adjustment of the position of the marker (step S202). The processing from step S202 to step S206 may be performed before marker tracking is selected in the select window SW. In this case, the processing from step S202 to step S206 may be skipped manually or automatically.

The overall control unit 110 determines whether or not the calculation of each phase marker position has been instructed by the operation of the fourth button B4 (step S204). FIG. 11 is a diagram showing a display example of the fourth button B4, fifth button B5 and sixth button B6 in the marker tracking mode. In the marker tracking mode, the fourth button B4 accepts an instruction to calculate each phase marker position, the fifth button B5 accepts an instruction to detect a marker, and the sixth button B6 accepts an instruction to confirm a gate-on signal. With the fourth button B4, the user may specify the shape of the marker. With the sixth button B6, it is possible to select whether the output determination of the gate-on signal is performed at the two-dimensional position (2D) or the three-dimensional position (3D) of the target position.

When the calculation of each phase marker position is instructed by operating the fourth button B4, the overall control unit 110 instructs the image processing unit 136 to develop the target position (marker position) in the CT image of each respiratory phase. (Step S206). The display control unit 124 causes the input/display unit 120 to display the marker ROI indicating the marker position in the CT image in the area A7 or the like.

The overall control unit 110 determines whether or not the start of shooting has been selected by operating the first button B1 (step S208). When the start of imaging is selected, the integrated control unit 110 instructs the output control unit 150 to instruct the treatment apparatus 10 to image a fluoroscopic image TI as a first confirmation image (step S210). For example, the output control unit 150 instructs the therapeutic apparatus 10 to capture fluoroscopic images TI for k breaths. The output control unit 150 may output an instruction to end imaging to the treatment apparatus 10 when the first button B1 is operated again.

The overall control unit 110 determines whether or not the marker detection is instructed by the operation of the fifth button B5 (step S212). When the marker detection is instructed, the overall control unit 110 instructs the marker detection unit 134 to detect the target position (marker position) in each of the first confirmation images captured in step S210 (step S214). The target position detected by the marker detection unit 134 is superimposed on the first confirmation image displayed as a moving image in the areas A1-1 and A1-2, for example.

The image processing unit 136 superimposes the target position and the gating window on the fluoroscopic image TI based on the target position detected by the marker detection unit 134 . The input/display unit 120 displays a second confirmation image including a fluoroscopic image TI superimposed with the target position (position of the marker MK) and the gating window GW, and a DRR image superimposed with the target position and the gating window. The position VPT of the affected area corresponding to the target position (the position of the marker MK) and the gating window VGW set for the affected area may be superimposed on the fluoroscopic image TI. The user determines whether or not to adjust the gating window based on the second confirmation image. When the user determines that adjustment is necessary, the input operation acquisition unit 122 receives an instruction to adjust the gating window, and the gating window adjustment unit 152 adjusts the gating window according to the instruction (step S216). The adjusted gating window is displayed on the input/display unit 120 as a second confirmation image superimposed on the fluoroscopic image TI together with the target position. The gating window adjuster 152 adjusts the gating window as in the marker tracking mode. The input/display unit 120 may be set not to display the target position when the gating window VGW is displayed.

The gating window adjustment unit 152 may adjust not only the gating window projected onto the fluoroscopic image TI but also the three-dimensional shape of the gating window according to the acquired operation. By adjusting the gating window, it becomes possible to set the gating window according to the state of the subject P. In confirming the gating window, the input/display unit 120 may superimpose the gating window and the target position on the moving image in any slice indicated by the 4DCT image and display it. This moving image is displayed, for example, in area A7.

The gating window may be adjusted by the user using the pointing device to change the area of the gating window GW on the second confirmation image displayed in areas AI-1 and AI-2 on the interface image IM. (See Figure 8). The size of the gating window GW may be adjusted by a drag-and-drop operation on the boundary of the gating window GW. The gating window GW may be similarly reduced according to the amount of operation of the slide bar displayed in the control area CA of the area A3.

The gating window adjusting section 152 may adjust the size of the gating window according to the amount of movement between the target position and the affected part position in the second confirmation image. For example, the size of the gating window may be adjusted based on the ratio between the amount of movement of the target position and the amount of movement of the position of the affected part in the second confirmation image. When the margin used to define the contours of the affected area and the marker in the planning stage is 2 mm, and the movement amounts of the target position and the affected area position in the second confirmation image are 10 mm and 5 mm, respectively, the gating window adjustment unit 152 , the size of the gating window may be adjusted as follows: The gating window adjustment unit 152 calculates the ratio (5 mm/10 mm) of the movement amount (5 mm) of the target position to the movement amount (10 mm) of the position of the affected area, and multiplies the calculated ratio by the margin (2 mm) for the marker. Set the result (1 mm) to the new margin. The gating window adjuster 152 adjusts the gating window by changing the margin for the outline of the marker. The gating window adjustment unit 152 adjusts the gating window so that the ratio of the amount of movement of the target position to the amount of movement of the position of the affected area and the ratio of the margin to the outline of the marker to the margin to the outline of the affected area are matched. change the margin of The gating window adjuster 152 adjusts the size of the gating window by changing the margin. The amount of margin adjustment may be automatically calculated, and the amount of movement of the marker MK and the margin of the gating window may be displayed by the input/display unit 120 so that the amount of margin adjustment can be changed. Furthermore, it is easier to use if the user can manually change the adjustment of the size of the gating window.

The overall control unit 110 determines whether confirmation of the gate-on signal has been instructed by the operation of the sixth button B6 (step S218). When the confirmation of the gate-on signal is instructed, the integrated control unit 110 determines the output of the gate-on signal according to the selection state of the two-dimensional position (2D) or the three-dimensional position (3D) of the sixth button B6. Either the two-dimensional position or the three-dimensional position is selected (step S220). The output control unit 150 switches between the determination using the two-dimensional position and the determination using the three-dimensional position according to the selection of the integrated control unit 110 according to the selection state of the sixth button B6. The overall control unit 110 prohibits adjustment of the gating window and adjustment of the target position (step S222).

The overall control unit 110 instructs the display control unit 124 to change the check box CB to a check mark, and causes the input/display unit 120 to display the output timing of the gate-on signal (step S224). . When the confirmation of the gate-on signal is instructed, the output timing of the gate-on signal is determined, and the determination result is displayed. However, when the check box CB is checked, the output timing of the gate-on signal is calculated and displayed, but the gate-on signal is not actually output to the therapeutic device 10 .

The overall control unit 110 determines whether or not the start of shooting has been selected by operating the first button B1 (step S226). When the start of imaging is selected by operating the first button B<b>1 , the integrated control unit 110 instructs the treatment apparatus 10 via the output control unit 150 to perform imaging of the fluoroscopic image TI. The overall control unit 110 instructs the display control unit 124 to display the final second confirmation image using the photographed fluoroscopic image TI on the input/display unit 120 (step S228).

The final second confirmation image is displayed in areas AI-1 and AI-2. The final second confirmation image is an image in which the marker position (target position) and gating window GW are superimposed on the fluoroscopic image TI displayed as a moving image (see FIG. 8). By visually recognizing the final second confirmation image, the user can determine whether the marker MK is recognized as the target position, whether the timing at which the target position is positioned within the gating window GW is appropriate, and whether the output timing of the gate-on signal is correct. , and whether or not the gating window needs to be adjusted can be confirmed. The final second confirmation image is displayed until the stop of photographing is selected by operating the first button B1 (step S230). By operating the control area CA in which a slide bar, a frame advance switch, etc. are set, the final second confirmation image can be traced back and confirmed even after the photography stop is selected. Based on the final second confirmation image displayed on the input/display unit 120, the user determines whether adjustment of the gating window is necessary. The overall control unit 110 accepts whether or not the gating window needs to be adjusted according to the user's operation input to the input/display unit 120 (step S232). If the gating window needs to be adjusted, the overall control unit 110 cancels the inhibition of gating window adjustment and target position adjustment, and returns the process to step S100. If the gating window need not be adjusted, the overall control unit 110 advances the process to step S234.

When the stop of photographing is selected by operating the first button B1, the integrated control unit 110 determines whether or not the check box CB is unchecked (step S234). If the check box CB has not been cleared, the integrated control unit 110 determines whether or not start of shooting has been selected by operating the first button B1 (step S236). If shooting start is selected, the process returns to step S222, and if shooting start is not selected, the process returns to step S226. When the check box CB is unchecked, the central control unit 110 determines whether or not a start signal has been received from the therapeutic device 10 (step S238). This start signal is a signal output when a switch (not shown) of the treatment device 10 is operated so that the treatment can be started by the treatment device 10 . Upon receiving the start signal from the treatment apparatus 10, the overall control unit 110 instructs the display control unit 124, the marker detection unit 134, the target position specifying unit 140, and the output control unit 150 to start treatment. 150 instructs the treatment apparatus 10 to capture a fluoroscopic image TI (step S240).

Further, when the check box is cleared in step S234, even if the start signal is not received from the treatment apparatus 10, the integrated control unit 110 determines whether or not imaging has started by operating the first button B1. good. When imaging is started and the target position (the position of the marker MK) specified by the target position specifying unit 140 is within the gating window, the output control unit 150 may output a gate-on signal to the treatment apparatus 10 ( not shown). If the checkbox is not cleared, the treatment beam B will not be output from the treatment apparatus 10 . In addition, if the check box is not cleared in step S234, but the check box is cleared after the start of imaging is selected, the output control unit 150 may output the gate-on signal to the treatment apparatus 10 during imaging ( not shown).

When treatment is started, the target position identifying section 140 identifies the position of the marker detected by the marker detecting section 134 as the target position. The output control unit 150 outputs a gate-on signal to the therapeutic device 10 when the target position is within the gating window. The output control unit 150 determines whether or not to output a gate-on signal according to the selection of the two-dimensional position (2D) or the three-dimensional position (3D) with the sixth button B6. The display control unit 124 causes the input/display unit 120 to display a therapeutic image in which the target position and the gating window GW are superimposed on the fluoroscopic image TI. Treatment images are displayed in areas A1-1 and A1-2.

The overall control unit 110 integrates the output time of the gate-on signal to the therapeutic device 10 (step S242). The point at which the output time integration is started is either the point at which a start signal is received from the treatment apparatus 10 or the point at which imaging start is selected by operating the first button B1 and imaging is started. The integrated control unit 110 determines whether or not the ratio of the integrated time to the time that has elapsed since the start of treatment is equal to or less than a certain threshold (step S244). The integrated control unit 110 stops outputting the gate-on signal to the treatment apparatus 10 when the integrated time is equal to or less than the threshold (when the irradiation rate is decreased). In addition, the integrated control unit 110 stops the irradiation and imaging of the treatment beam B by the treatment apparatus 10, and terminates the treatment. If the integrated time is not equal to or less than the threshold, overall control unit 110 advances the process to step S246.

The treatment continues until the end of imaging is selected by operating the first button B1, or until the dose of the irradiated treatment beam B reaches the dose prescribed by the treatment plan (step S246).

The medical device 100 may end the treatment when receiving an irradiation completion signal from the treatment device 10 or when receiving a signal from the treatment device 10 indicating that the treatment device 10 has performed an operation to end irradiation. .

The display control unit 124 changes the color of the gating window when outputting the gate-on signal in the second confirmation image, the final second confirmation image, and the treatment image (when the condition for output is satisfied in the preparation stage). can be For example, when the target position (the position of the marker MK) does not fit within the gating window GW in both of the fluoroscopic images TI-1 and TI-2, the first color is used for the fluoroscopic images TI-1 and TI-2. If the target position is within the gating window GW in only one of the second colors, and if the target position is within the gating window GW in both fluoroscopic images TI-1 and TI-2 (i.e. The frame line of the gating window GW may be displayed in a third color (when the condition for outputting the gate-on signal is satisfied). Also, an error icon may be displayed when the target position does not fit within the gating window GW in either of the fluoroscopic images TI-1 and TI-2. Changing the display of the gating window VGW set for the affected area in accordance with the change of the gating window facilitates confirmation.

Further, the display control unit 124 may change the color or brightness of either the inner area or the outer area of the gating window GW when the condition for outputting the gate-on signal is satisfied. Furthermore, the medical device 100 may include a notification unit that notifies by sound or vibration when the condition for outputting the gate-on signal is satisfied.

The medical device 100 not only accepts mode switching among markerless tracking, marker tracking, and external respiratory gating in the process of step S200 in the above flowchart, but may accept switching at any timing from the preparation stage to the treatment stage. . In addition, redoing of processing is accepted as appropriate. For example, in a scene where the final second confirmation image is displayed, an operation for restarting from template shooting is accepted.

If the treatment is performed multiple times, the medical device 100 may use the positions of the markers used in the previous and previous treatments. FIG. 12 is a sixth flowchart showing an example of the flow of processing executed by the medical device 100. As shown in FIG. As shown in the figure, after the marker tracking is selected in the select window SW, the overall control unit 110 determines whether or not "use previous marker position" is selected in any area (step S300). ). If "use the previous marker position" is selected, steps S202 to S214 are skipped and the process proceeds to step S216.

In the marker tracking mode, as in the markerless tracking mode, the output control section 150 preferably uses the three-dimensional position relative to the target position (marker position) to determine whether to output the gate-on signal.

<External respiration gating mode>
The external respiratory gating mode (third mode) will be briefly described below.
[Planning stage]
Also in the planning stage of the external respiratory gating mode, the subject P is first subjected to CT imaging. In CT imaging, the subject P is imaged from various directions for each of various respiratory phases. Next, a 4DCT image is generated based on the CT imaging results. A 4DCT image is obtained by arranging n three-dimensional CT images in time series. The period obtained by multiplying this n by the time interval of the CT images in time series is set, for example, so as to cover the period during which the respiratory phase changes by one cycle. A 4DCT image is stored in the storage unit 160 .

Next, the user inputs a contour for, for example, one CT image out of the n CT images. This outline is the outline of a tumor that is an affected area, the outline of an organ to which the treatment beam B is not desired to be irradiated, or the like. Next, for example, the image processing unit 136 sets contours for each of the n CT images by deformable registration. A treatment plan is then determined. The treatment plan defines the location, direction, and amount of treatment beam B to be applied to the affected area based on the set contour information. It is determined according to the treatment method such as tracking irradiation method. A part or all of the processing in the planning stage may be executed by an external device. For example, the process of generating 4DCT images may be performed by a CT machine. Then, when the treatment beam B is irradiated from the direction determined in the treatment plan, a respiratory phase is obtained in which the treatment beam B impinges on the affected area.

[Positioning stage]
In the positioning stage, the bed position is adjusted. This is similar to the markerless tracking mode and the marker tracking mode.

[Treatment stage]
In the treatment stage, the therapeutic beam B is irradiated when the respiratory phase (external respiratory phase) grasped by the output control unit 150 based on the detection result of the sensor 15 enters the set irradiation range.

In the external respiration-gated mode, the medical device 100 can confirm the position of the affected area when the treatment beam B is irradiated by displaying the interface image IM. It will be possible to visually confirm whether the treatment is being performed at the right time, improving the accuracy of the treatment.

In the marker tracking mode and the markerless tracking mode, the medical device 100 of the embodiment described above determines whether or not to output the gate-on signal using the two-dimensional position of the target position, and also determines whether or not to output the gate-on signal using the three-dimensional position. It is possible to judge whether it is acceptable or not. When the three-dimensional shape of the gating window determined in the treatment plan has a complicated shape compared to the pillar and the rectangular parallelepiped, the three-dimensional region indicated by the gating window projected onto the fluoroscopic image TI is the gating window. It can be larger than the three-dimensional shape of the window. In such a case, the medical device 100 can instruct the treatment device 10 to irradiate the treatment beam B with higher accuracy by making a determination using the three-dimensional position. By irradiating the treatment beam B with high accuracy, the treatment time can be shortened, and the physical burden on the subject can be reduced.

The medical device 100 can adjust the gating window defined in the planning phase during the preparation phase or the treatment phase when the marker tracking mode and the markerless tracking mode are selected. In the preparation stage, when the user confirms the target position and the gating window on the fluoroscopic image TI, the gating window can be adjusted, so treatment can be performed without redefining the treatment plan. Since the treatment can be advanced according to the plan, it is possible to avoid delaying the treatment, and the treatment period can be shortened, so that the physical burden on the subject can be reduced.

<Others>
The medical device 100 of the above embodiment may have a daemon program that is always running. The medical device 100 receives the result of the treatment plan described above from another device. If the treatment plan is an internal respiratory gating plan or an external respiratory gating plan, the daemon program may automatically activate the function of each part of the medical device 100 in response to receiving the results of the treatment plan. good. In this case, the daemon program initiates preparatory processes for target position tracking such as deformable registration if the plan is internal respiratory gating, or displays the interface image IM if the plan is external respiratory gating. You can only go to

Further, each process of the flowcharts illustrated in FIGS. 3, 4, 7, 9, 10, 12, etc. may be interlocked so as not to proceed unless a positioning approval notification is received. The positioning approval notification may be performed by an input operation performed on the input/display unit 120, or may be received from another device. 3, 4, 7, 9, 10, 12, etc. may be controlled to return to the time when the positioning approval notice is received when the positioning approval cancellation notice is received. .

Further, when treatment is performed multiple times, the integrated control unit 110 stores various data (templates, tracking results, positioning approval history), etc. from previous treatments in the storage unit 160, and the display control unit 124 , the input/display unit 120 may display a comparison with the treatment status on that day.

While the final confirmation image is being displayed in step S128, the display control unit 124 causes the input/display unit 120 to display an image in which the determination result using the two-dimensional position and the determination result using the three-dimensional position are compared. You may let 13A and 13B are diagrams showing image examples for comparing determination results using two-dimensional positions and three-dimensional positions. In FIG. 13, the horizontal axis indicates time, and the vertical axis indicates whether or not the gate-on signal is output. The image shown in FIG. 13 is displayed, for example, in area A2 in interface image IM. The determination result (G2) using the two-dimensional position and the determination result (G3) using the three-dimensional position are shown on the same time axis. The display of the two determination results, that is, the display of the waveform diagrams of the gate-on signals G2 and G3 allows the user to confirm the difference between the two determination results. Based on the difference between the two determination results, the user can decide whether to use the 2D position or the 3D position for treatment. The two judgment results may be displayed based on the sequentially input fluoroscopic images TI-1 and TI-2, or based on the previously input fluoroscopic images TI-1 and TI-2. may

While the final confirmation image is being displayed in step S128, the display control unit 124 may cause the input/display unit 120 to display a graph showing the displacement of each of the three coordinates indicating the three-dimensional position of the target position. FIG. 14 is a diagram showing an example of a graph showing displacements of three coordinates indicating a three-dimensional position. In FIG. 14, the horizontal axis indicates time, and the vertical axis indicates displacement of each coordinate. By showing the displacement of the three-dimensional position of the target position in chronological order, the user can easily confirm the displacement of the target position due to respiration of the subject. The displacement of the three-dimensional position may be displayed based on the sequentially input fluoroscopic images TI-1 and TI-2, or based on the previously input fluoroscopic images TI-1 and TI-2. may be broken.

The displacement of the three coordinates indicating the three-dimensional position may be displayed so as to be able to compare with the waveform diagram of the gate-on signal using the three-dimensional position shown in FIG. That is, the waveform diagram of the gate-on signal and the displacement of the three-dimensional coordinates may be displayed on the same time axis. By displaying the displacement of the three-dimensional position and the gate-on signal so that they can be compared, the user can confirm the output timing of the gate-on signal in comparison with the displacement of the target position due to respiration. The displacement of the three-dimensional position and the gate-on signal may be compared based on the sequentially input fluoroscopic images TI-1 and TI-2, or on the previously input fluoroscopic images TI-1 and TI-2. may be done on the basis of

The display control unit 124 may display the graph with the largest displacement among the graphs showing the displacement of each of the three coordinates indicating the three-dimensional position of the target position, emphasizing it more than the other two graphs. For example, the display control unit 124 may display the line or dashed line indicating the graph with the largest displacement thicker than the other two graphs, may display the graph with higher luminance or saturation, or may display the graph with the highest displacement. Only graphs with large displacements may be displayed. Since the displacement of each of the three coordinates is synchronized with the respiratory phase of the subject P, the user can easily confirm the respiratory phase of the subject P by emphasizing and displaying the graph with the largest displacement.

The display control unit 124 displays the areas A1-1, A1-2, A2, and A3 in the interface image IM in the case where the determination is made using the two-dimensional position and the case where the determination is made using the three-dimensional position. , A4, A5, A6 and A7 may be changed in layout and size. For example, when determination is made using three-dimensional positions, the display control unit 124 changes the arrangement of the areas A1-1 and A1-2 and the area A2, arranges the area A2 on the upper side of the screen, and places the area A1- 1 and A1-2 may be placed at the bottom of the screen. By changing the layout or size of the interface image IM, the user can easily identify whether the determination is made using the two-dimensional position or the three-dimensional position.

After adjusting the gating window, the gating window adjustment unit 152 may return the position and size of the gating window to the position and size determined in the planning stage according to the user's operation. When the gating window is adjusted, the display control unit 124 may cause the input/display unit 120 to display an image comparing the waveform of the gate-on signal before adjustment and the waveform of the gate-on signal after adjustment. . This image may be displayed, for example, in the area A2 in the interface image IM similarly to the image shown in FIG. A user can easily confirm the influence of gating window adjustment on the gate-on signal by comparing the waveforms of the gate-on signal before and after the adjustment.

The display control unit 124 may cause the input/display unit 120 to display the gating window in different display modes depending on whether the gating window is adjusted or not. . For example, the display control unit 124 may change the display color of the gating window depending on whether the adjustment is performed or not. The display control unit 124 may always display the gating window when the adjustment is not performed, and blink the gating window when the adjustment is performed. The display control unit 124 may display an icon or a message indicating that the gating window has been adjusted when the gating window has been adjusted.

The gating window adjuster 152 may reduce the gating window when the movement speed of the target position changes during treatment. When the subject P is breathing heavily or the subject P is coughing, the moving speed of the target position becomes faster than when the subject is at rest. The integrated control unit 110 as a detection unit detects a predetermined threshold when the moving speed of the target position exceeds a certain value, or when the difference between the past average value of the moving speed of the target position and the current moving speed of the target position. If it exceeds, it may be determined that an abnormality has occurred in the subject P, and the gating window adjuster 152 may be instructed to reduce the gating window. The gating window adjuster 152 may, for example, reduce the gating window by reducing the margin included in the gating window, or may reduce the gating window by a predetermined reduction amount. The overall control unit 110 may instruct the gating window adjustment unit 152 to return the gating window to its original position and size when no abnormality is detected in the subject P. The integrated control unit 110 may use the detection result output from the sensor 15 to determine whether the subject P has an abnormality.

When determining that an abnormality has occurred in the subject P, the overall control unit 110 may notify the user to adjust the gating window. As a notification prompting the user to adjust the gating window, an icon or a message may be displayed on the input/display unit 120, or a sound or vibration may be generated by the notification unit. The medical device 100 adjusts and notifies the gating window, so that treatment corresponding to changes in the subject P can be performed.

When determining that an abnormality has occurred in the subject P, the overall control unit 110 may instruct the input/display unit 120 to change the display mode of the interface image IM. For example, the overall control unit 110 may stop displaying the gating window GW in the interface image IM. The overall control unit 110 may change the display of the interface image IM from color display to black-and-white display. The overall control unit 110 may display an icon or a message indicating an abnormality of the subject P. FIG. The overall control unit 110 can prompt the user to adjust the gating window by changing the display mode of the interface image IM. When the gating window is adjusted during treatment, the overall control unit 110 returns the process being executed to step S100 shown in FIG. 3 or step S200 shown in FIG.

After the position or size of the gating window is adjusted by the gating window adjustment unit 152, the overall control unit 110 controls the input/display unit 120 when the irradiation rate of the treatment beam B becomes smaller than a predetermined threshold value. may display an icon or message indicating that the irradiation rate has decreased. The irradiation rate of the therapeutic beam B is, for example, the ratio of the irradiation time of the therapeutic beam B to the elapsed time from the start of treatment. The overall control unit 110 can prompt the user to adjust the gating window or consider interrupting the treatment by causing the input/display unit 120 to display an icon or message indicating the decrease in the irradiation rate. The overall control unit 110 may cause the output control unit 150 to stop outputting the gate-on signal when the irradiation rate is smaller than the threshold.

The medical device 100 obtains learning results from only the DRR images, learning results from the DRR images and the fluoroscopic images TI taken during the treatment on the first day, learning results from the DRR images and the fluoroscopic images TI taken during the treatment on the second day, and the like. , and one of the stored learning results may be automatically or manually selected and used to identify the target position on the day of treatment.

In addition, the medical device 100 holds templates used for treatment on the first day, templates used for treatment on the second day, and the like, and automatically selects one of the templates on the day of treatment. Alternatively, it may be manually selected and used to identify the target location.

Further, when automatically selecting the learning result or the template, the medical device 100 may select the information of the day showing the trajectory closest to the trajectory of the tracking values on the day of treatment.

In the embodiment, the configuration in which the medical device 100 includes the marker detection unit 134 has been described. The medical device 100 that does not perform marker tracking and performs markerless tracking may not include the marker detection unit 134 .

According to at least one of the embodiments described above, when the two-dimensional position is within a predetermined two-dimensional gating window, a gate-on signal is output to instruct the treatment apparatus to irradiate the subject with the treatment beam. and a three-dimensional mode for outputting a gate-on signal to the treatment apparatus when the three-dimensional position is within a predetermined three-dimensional gating window. It is possible to switch between the irradiation of the treatment beam based on the determination used and the irradiation of the treatment beam based on the determination using the three-dimensional position. It is possible to irradiate the treatment beam with high accuracy by judging the irradiation timing according to the condition of the subject or the three-dimensional shape of the gating window. can be reduced.

While several embodiments of the invention have been described, these embodiments have been presented by way of example and are not intended to limit the scope of the invention. These 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 their modifications are included in the scope and spirit of the invention, as well as the scope of the invention described in the claims and equivalents thereof.

DESCRIPTION OF SYMBOLS 1... Treatment system, 10... Treatment apparatus, 11... Bed, 12... Radiation source, 13... Detector, 14... Irradiation gate, 15... Sensor, 20... Treatment apparatus side control part, 100... Medical apparatus, 110... Integrated control Unit 120 Input/display unit 122 Input operation acquisition unit 124 Display control unit 130 Acquisition unit 132 Reference image creation unit 134 Marker detection unit 136 Image processing unit 140 Target position Identification unit 150 Output control unit 152 Gating window adjustment unit 160 Storage unit

Claims (10)

an acquisition unit that acquires a plurality of fluoroscopic images of a subject;
a first specifying unit that specifies a two-dimensional position of a target position of the subject on the plurality of fluoroscopic images;
a second identifying unit that identifies a three-dimensional position of the target position based on the target position on the plurality of fluoroscopic images;
a two-dimensional mode for outputting an irradiation permission signal for instructing irradiation to a treatment apparatus that irradiates a treatment beam to the subject when the two-dimensional position is within a predetermined two-dimensional irradiation permission range; a control unit for switching between a three-dimensional mode and a three-dimensional mode for outputting the irradiation permission signal to the treatment apparatus when the position is within a predetermined three-dimensional irradiation permission range;
a display unit for displaying a screen including an image in which at least one of the two-dimensional irradiation permitted range or the three-dimensional irradiation permitted range and the target position are superimposed on the plurality of fluoroscopic images;
with
The display unit uses the determination result indicating whether or not the irradiation permission signal is output using the two-dimensional position and the three-dimensional position in the final confirmation stage before transitioning to the treatment stage after the preparation stage is completed. displaying an image in comparison with a determination result indicating whether or not the irradiation permission signal is output;
medical device. further comprising a setting unit that determines the three-dimensional irradiation permission range based on a CT image of the subject captured in a planning stage of treatment with the treatment beam;
A medical device according to claim 1 . The display unit changes the aspect of the screen in response to switching between the two-dimensional mode and the three-dimensional mode by the control unit.
3. A medical device according to claim 1 or claim 2. The display unit displays a graph showing the displacement of each coordinate included in the three-dimensional position when displaying the compared images .
4. A medical device according to any one of claims 1-3 . The display unit displays a graph of coordinates with the largest displacement among the coordinates included in the three-dimensional position, emphasizing it over other graphs.
5. A medical device according to claim 4. The display unit changes display colors of the two-dimensional irradiation permission range and the three-dimensional irradiation permission range at the timing when the irradiation permission signal is output.
6. A medical device according to any one of claims 1-5 . The display unit changes the color or brightness in an area inside or outside the two-dimensional irradiation permission range and the three-dimensional irradiation permission range at the timing when the irradiation permission signal is output.
7. A medical device according to any one of claims 1-6 . further comprising a notification unit that notifies the timing at which the irradiation permission signal is output by sound or vibration;
8. A medical device according to any one of claims 1-7. A control method performed by a medical device, comprising:
a first step of acquiring a plurality of fluoroscopic images of a subject;
a second step of identifying a two-dimensional position of a target position of the subject on the plurality of fluoroscopic images;
a third step of identifying a three-dimensional location of the target location based on the target location on the plurality of fluoroscopic images;
a two-dimensional mode for outputting an irradiation permission signal for instructing irradiation to a treatment apparatus that irradiates a treatment beam to the subject when the two-dimensional position is within a predetermined two-dimensional irradiation permission range; a fourth step of switching between a three-dimensional mode in which the irradiation permission signal is output to the treatment apparatus when the position is within a predetermined three-dimensional irradiation permission range;
a fifth step of displaying a screen including an image in which at least one of the two-dimensional irradiation permitted range or the three-dimensional irradiation permitted range and the target position are superimposed on the plurality of fluoroscopic images;
In the final confirmation stage after the preparation stage is completed and before the transition to the treatment stage, a determination result indicating whether or not the irradiation permission signal is output using the two-dimensional position, and the irradiation permission signal using the three-dimensional position. a sixth step of displaying an image in comparison with the determination result indicating the presence or absence of output;
A method of controlling a medical device comprising: The computer equipped with the medical device,
an acquisition unit that acquires a plurality of fluoroscopic images of a subject;
a first specifying unit that specifies a two-dimensional position of a target position of the subject on the plurality of fluoroscopic images;
a second identifying unit that identifies a three-dimensional position of the target position based on the target position on the plurality of fluoroscopic images;
a two-dimensional mode for outputting an irradiation permission signal for instructing irradiation to a treatment apparatus that irradiates a treatment beam to the subject when the two-dimensional position is within a predetermined two-dimensional irradiation permission range; a control unit for switching between a three-dimensional mode and a three-dimensional mode for outputting the irradiation permission signal to the treatment apparatus when the position is within a predetermined three-dimensional irradiation permission range;
a display unit for displaying a screen including an image in which at least one of the two-dimensional irradiation permitted range or the three-dimensional irradiation permitted range and the target position are superimposed on the plurality of fluoroscopic images;
A program for functioning as
The display unit uses the determination result indicating whether or not the irradiation permission signal is output using the two-dimensional position and the three-dimensional position in the final confirmation stage before transitioning to the treatment stage after the preparation stage is completed. displaying an image in comparison with a determination result indicating whether or not the irradiation permission signal is output;
program.

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