JP7179288B2 - CATHETER OPERATION ASSISTANCE DEVICE, OPERATION METHOD, PROGRAM, AND X-RAY MEDICAL SYSTEM - Google Patents

Description

TECHNICAL FIELD The present invention relates to a catheter operation assisting device for assisting an operator in catheter operation, an operation method thereof , a program, and an X-ray medical system.

2. Description of the Related Art Conventionally, an X-ray medical system has been proposed in which a catheter operation is performed while viewing an X-ray image obtained by X-ray imaging an affected area of a patient. For example, Patent Literature 1 describes a technique for improving the visibility of a catheter device in an image so as to enable efficient catheter manipulation.

In addition, in Patent Document 2, in catheter ablation for the purpose of treating arrhythmia, X-ray imaging is performed in a reference data acquisition mode with the tip of a cardiac potential measurement catheter positioned at the treatment target site. The positional information of the tip of the measurement catheter is collected, and then, in the support data generation mode, X-ray imaging is performed with the tip of the treatment catheter for cauterization of the treatment target site positioned near the treatment target site. By superimposing the positional information of the tip of the measurement catheter collected earlier on the X-ray image of the tip of the treatment catheter at this time, support data is generated, and the tip of the treatment catheter is positioned at the treatment target site. Techniques are described for precisely positioning the .

JP 2015-211914 A JP 2013-46750 A

However, the technique described in Patent Literature 1 does not provide feedback regarding the state of the catheter device in the patient's body to the operator who operates the catheter device, so that the operator can safely and accurately operate the catheter device. It was inadequate in terms of implementation.

In addition, the technique described in Patent Document 2 issues a warning when the distal end of the therapeutic catheter deviates from the target position, that is, the site to be treated, and notifies the degree of approach to the site to be treated. Therefore, it is insufficient from the viewpoint of safe and accurate catheter manipulation by the operator.

For example, in coil embolization, which is used as a therapeutic method for cerebral aneurysm, a delivery wire having a coil attached to its tip to be indwelled in the aneurysm, a microcatheter for guiding this, and these After inserting the guiding catheter to a certain position in the artery using a catheter device including a guiding catheter for guiding to a predetermined position in the artery, a microcatheter is inserted into the guiding catheter and its tip is inserted into the artery. A predetermined amount of coil is indwelled in the aneurysm by positioning it near the opening of the aneurysm and then inserting the delivery wire into the microcatheter to feed a predetermined amount. The amount of feeding of the guiding catheter, microcatheter, and delivery wire at this time is adjusted by using the X-ray opaque markers provided on each of the patient's X-ray images (X-ray moving images) displayed on the X-ray image monitor. ), the operator visually confirms the operation, but even if the technique of Patent Document 1 or 2 is applied to support such catheter operation, the degree of approach of the tip of the catheter to the aneurysm is sequentially notified. Therefore, it does not reduce the burden (fatigue) of the operator, and is extremely insufficient from the viewpoint of safety and certainty of catheter operation.

In addition, depending on the internal shape of the aneurysm and the direction in which the coil is inserted, the delivery wire, microcatheter, or guiding catheter may be misaligned due to the reaction force when the coil is pushed out, and the coil may not be placed inside the aneurysm normally. However, there has been a demand for a support system that properly feeds back operation information to the operator in such a situation and prompts the operator to immediately reinsert the coil.

In this way, performing surgery while watching the behavior of the catheter on the X-ray image monitor greatly depends on the experience and skill of the operator, and it causes great fatigue even for an experienced operator. For an operator who did not do this, it could lead to a serious situation of failure of the operation, but the conventional techniques have not been able to solve these problems.

The present invention has been made in view of such problems, and can reduce the burden on the operator when operating the catheter, and can operate the catheter without being greatly influenced by the experience and skill of the operator. The purpose is to provide a means that can improve the safety and accuracy of

A catheter operation assisting device of the present invention comprises an X-ray imaging device, a catheter having a first marker and a second marker located behind the first marker in the insertion direction, and an axial direction inside the catheter. a catheter operation assisting device for use with a catheter device comprising a movable wire having a third marker, the acquisition means acquiring X-ray image information of a predetermined region from the X-ray imaging device; and alert means for issuing an alert according to the positional relationship between the second marker of the catheter and the third marker of the wire using X-ray image information , wherein the alert means During the period until the tip of the third marker in the traveling direction reaches the target position of the second marker while the wire is operated to bring the third marker closer to the second marker A first mode for detecting the positional relationship between the tip and the target position, in which the center of the third marker in the traveling direction reaches the target position after the tip reaches the target position. a second mode for detecting the positional relationship between the center and the target position during the period until the center reaches the target position, and the rear end of the third marker in the traveling direction during the period after the center reaches the target position. and the target position .
According to a preferred embodiment of the present invention, the above-mentioned predetermined area is slightly larger than the second marker of the catheter and the third marker of the wire according to the respective sizes in the X-ray image. Each is set in a larger area.

Another catheter operation assistance device of the present invention is a catheter operation assistance device used with an X-ray imaging device and a catheter device including a catheter having a marker formed with a predetermined length in the advancing direction thereof, Acquiring means for acquiring X-ray image information of a predetermined region from the X-ray imaging apparatus; and detection means for detecting the positional relationship of the marker with respect to a target position using the X-ray image information; The detection means detects the positional relationship between the tip of the marker and the target position until the tip of the marker in the traveling direction reaches the target position, and detects the positional relationship between the tip and the target position. The positional relationship between the center and the target position is detected until the center of the marker in the traveling direction reaches the target position by using the A positional relationship between the rear end in the traveling direction and the target position is detected.
According to a preferred embodiment of the present invention, the predetermined area is set to be slightly larger than the size of the marker in the X-ray image.

Alerts are alerts by sounds such as beeps or sounds such as voice announcements, or blinking marks on the monitor (display) screen of the X-ray imaging device, or colors such as red or yellow on part or the entire screen. An alert with a visual indication, such as a change to , is preferred.
The present invention also includes a catheter operation support method, a program for executing the same, and an X-ray medical system having the above catheter operation support device, X-ray imaging device, and catheter device.
In particular, the catheter operation support device of the present invention can be configured as an optional unit that can be appropriately attached to an X-ray imaging apparatus, and an existing X-ray imaging apparatus can be easily upgraded to a highly safe X-ray medical system. It becomes possible to let

According to the present invention, it is possible to improve the safety and accuracy of catheter manipulation by the operator.

1 is a schematic diagram showing a schematic configuration of an example of an X-ray medical system incorporating a catheter operation support device according to an embodiment of the present invention; FIG. FIG. 2 is a schematic diagram showing the configuration of members included in the example of the catheter device shown in FIG. 1; 2 is a schematic diagram showing an example of an X-ray image displayed by a display unit of the display device shown in FIG. 1; FIG. FIG. 2 is a schematic diagram showing the configuration of Example 1 of the catheter operation support device shown in FIG. 1; FIG. 5 is a flow chart for explaining the second marker recognition/tracking operation of the catheter operation support device shown in FIG. 4 ; FIG. 5 is a flowchart for explaining alignment marker recognition/tracking operations of the catheter operation support device shown in FIG. 4 ; FIG. 3 is a schematic diagram showing an example of the positional relationship between the microcatheter and the coil delivery wire shown in FIG. 2; FIG. 8 is a schematic diagram for explaining the positional relationship between the second marker of the microcatheter and the alignment marker of the coil delivery wire shown in FIG. 7 and the relationship between the alert level. FIG. 5 is a diagram showing an example of a display screen displayed by an image display unit of the catheter operation support device shown in FIG. 4; FIG. FIG. 2 is a schematic diagram showing the configuration of Example 2 of the catheter operation support device shown in FIG. 1; FIG. 11 is a flowchart for explaining the operation of the catheter operation support device shown in FIG. 10;

EMBODIMENT OF THE INVENTION Below, the form (embodiment) for implementing this invention is demonstrated, referring drawings.

As shown in FIG. 1, the X-ray medical system 100 includes a catheter device 110, an X-ray imaging device 120, a display device 130, a control device 140, an input device 150, and a catheter operation support device 160. there is

The catheter device 110 is a device used for catheter treatment, which is inserted by an operator 210 targeting an affected area of a patient 220 . Here, in this embodiment, an example in which a cerebral aneurysm is selected as an affected part of the patient 220 and coil embolization is performed thereon will be described.

As shown in FIG. 2, the catheter device 110 includes a guiding catheter 111 shown in FIG. 2(a), a microcatheter 112 shown in FIG. 2(b), a coil mechanism 113 shown in FIG. d) includes a guide wire 114 shown in FIG. Although the members shown in FIGS. 2(a)-(d) are used in combination, they are not pre-assembled. Here, the assembly of members shown in FIGS. In FIG. 2, the direction from left to right on the paper surface is the advancing direction when each member of the catheter device 110 is inserted.

In FIG. 2(a), the guiding catheter 111 is a catheter provided with a tip marker 111b made of an X-ray opaque material at the tip 111a in the traveling direction.

In FIG. 2B, the microcatheter 112 is a catheter having an outer diameter smaller than the inner diameter of the guiding catheter 111 shown in FIG. direction). This microcatheter 112 is provided with a first marker 112b made of an X-ray opaque material at a distal end portion 112a in the advancing direction, and an inner edge (advancing direction A second marker 112c made of a radiopaque material having a rear end 112d is provided. In this embodiment, the distance from the distal end portion 112a of the microcatheter 112 to the center of the second marker 112c in the advancing direction is, for example, 3 cm.

In FIG. 2C, the coil mechanism 113 is a coil delivery wire having an outer diameter smaller than the inner diameter of the microcatheter 112 shown in FIG. direction). The coil mechanism 113 includes a delivery wire 113a, a coil 113b, and a coil disconnection mechanism (not shown). The delivery wire 113a is provided with an alignment marker 113d made of an X-ray opaque material at a position a predetermined distance behind the distal end 113c in the traveling direction. In the example shown here, the alignment marker 113d has a predetermined length (2 mm in this embodiment, for example) in the direction of travel, and is wider in the direction of travel than the second marker 112c of the microcatheter 112. there is FIG. 2(c) also shows a front end 113f of the alignment marker 113d in the traveling direction and a rear end 113e of the alignment marker 113d in the traveling direction. In this embodiment, the distance from the distal end 113c of the delivery wire 113a to the rear end 113e of the alignment marker 113d is, for example, 4 cm. The coil 113b is a soft coil detachably attached to the distal end portion 113c of the delivery wire 113a, and is left in the aneurysm.

In FIG. 2(d), the guide wire 114 is a catheter having a distal end portion 114a and an outer diameter smaller than the inner diameter of the guiding catheter 111 shown in FIG. 2(a). It is movable in both directions (forward direction and reverse direction).

Next, coil embolization for an aneurysm using this catheter device 110 will be described with reference to FIG.

FIGS. 3(a) to 3(e) schematically show X-ray images in each scene when the operator 210 performs coil embolization using the catheter device 110. FIG. These images are captured by the image capture unit 11 of the display device 130 shown in FIG. An image of a scene.

FIG. 3A shows a scene in which the operator 210 inserts and indwells the guiding catheter 111 into the carotid artery of the patient 220 . Here, in the X-ray image, the blood vessel of the patient 220 appears whitish, and the tip marker 111b of the guiding catheter 111 appears black because it is made of an X-ray opaque material. The guiding catheter 111 is guided by the guide wire 114 and is inserted up to this position and left at this position.

Next, in FIG. 3(b), in preparation for an emergency, the operator 210 passes the guide wire 114 and its tip 114a through the position of the aneurysm 301 to reach a predetermined position in the cerebral blood vessel 300. It shows a scene in which the guide wire 114 is indwelled in the cerebral blood vessel 300. FIG. Here, since the guide wire 114 is made of metal, it appears blackish in the X-ray image.

Subsequently, in FIG. 3(c), the operator 210 inserts the microcatheter 112 into the guiding catheter 111, and the fast marker 112b is positioned near the opening of the aneurysm 301 to facilitate delivery of the coil 113b (aneurysm 301 shows a scene in which the needle is fed from the top of the opening 301 until it reaches a position slightly inside the aneurysm. Here, since the first marker 112b and the second marker 112c of the microcatheter 112 are made of an X-ray opaque material, they appear dark in the X-ray image. The microcatheter 112 is guided by a second guide wire (not shown) and is inserted up to this position and left there.

Next, FIG. 3D shows a scene where the operator 210 is inserting the delivery wire 113a into the microcatheter 112 after removing the second guide wire that guided the microcatheter 112 . In the scene of FIG. 3(d), the delivery wire 113a is inserted only to a position where the distal end portion 113c thereof reaches the second marker 112c of the microcatheter 112. At this time, the alignment marker 113d of the microcatheter 112 It is positioned much before the second marker 112c. By this operation, part of the coil 113b provided at the distal end portion 113c of the delivery wire 113a is inserted into the aneurysm 301 from the distal end portion 112a of the microcatheter 112, that is, the position of the first marker 112b. Here, in the X-ray image, the patient's 220 blood vessel (including the aneurysm 301) appears whitish, the alignment marker 113d of the delivery wire 113a is made of an X-ray opaque material, and the coil 113b is made of metal. Because it is formed with, it appears blackish.

Subsequently, FIG. 3(e) shows a scene in which the operator 210 further feeds the delivery wire 113a. During this operation, the operator 210 moves the delivery wire 113a until the rear end 113e of the alignment marker 113d of the delivery wire 113a overlaps with the center of the second marker 112c of the microcatheter 112 (detailed later). Send in. As a result, the interior of the aneurysm 301 is filled with a predetermined amount of coil 113b. After that, the operator 210 disconnects the coil 113b from the delivery wire 113a and indwells the coil 113b inside the aneurysm 301 . Then, the delivery wire 113a, the microcatheter 112, the guide wire 114, and the guiding catheter 111 are removed to complete the treatment.

Returning to FIG. 1, the X-ray imaging apparatus 120 is an apparatus for imaging an area including an affected part of a patient 220 using X-rays 122a. It is composed of a section 122 , an X-ray detection section 123 and a C-arm 124 .

The top plate 121 is a member for placing the patient 220, and is made of a material that transmits X-rays 122a.

The X-ray generator 122 irradiates a region including the diseased part of the patient 220 with X-rays 122 a under the control of the control device 140 .

The X-ray detection unit 123 detects the X-rays 122a conically emitted from the X-ray generation unit 122 and transmitted through the patient 220 under the control of the control device 140, and generates a signal corresponding to the distribution pattern of the X-rays 122a. Generate. Here, in the present embodiment, the X-ray detection unit 123 is, for example, a radiographic camera including a fluorescent screen and a CCD camera for receiving the X-rays 122a that have passed through the subject. An output signal representing an X-ray moving image, which is a sequence of images at a time interval (frame rate) of . In this embodiment, the X-ray moving image generated by the X-ray detection unit 123 corresponds to an example of "X-ray image information" of the present invention.

The C-arm 124 has an X-ray generation unit 122 fixed to one end and an X-ray detection unit 123 fixed to the other end. It is a support member for arranging to face each other. The C-arm 124 is configured to be movable under the control of the control device 140, for example.

The display device 130 includes an image acquisition unit 11 that acquires the output signal of the X-ray detection unit 123,
an image processing unit 12 that generates a digital image signal by performing processing such as edge enhancement, grayscale correction, and digitization on the output signal of the X-ray detection unit 123 captured by the image capturing unit 11; It includes an information addition unit 13 for adding additional information input through the control device 140 to the output signal, and a display unit 14 for displaying the output of the information addition unit 13 and the output of the catheter operation support device 160 . Further, the display device 130 includes a storage unit 15 for storing the output of the image processing unit 12, and a display unit for switching the information displayed by the display unit 14 between the output of the information addition unit 13 and the output of the storage unit 15. It is configured including the switching unit 16 , and all of these are controlled by the control device 140 . Also, the display unit 14 is, for example, an image display device such as a flat panel.

In this display device 130 , the X-ray image captured by the X-ray imaging device 120 can be displayed by the display section 14 while adding additional information appropriately input through the control device 140 by the information addition section 13 . In addition, the X-ray image at a certain point in time stored in the storage unit 15 can be displayed by switching with the switching unit 16 .

The information input to the information addition unit 13 through the control device 140 includes various information useful to the operator 210, such as biometric information of the patient 220, personal information such as age and sex, designation of a region including a lesion site to be treated, and the like. is.

(Example 1)
The configuration of the first embodiment of the catheter operation support device 160 shown in FIG. 1 is, for example, the configuration shown in FIG. In the catheter operation support device 160-1 shown in FIG. 4, the search area specifying unit 21 allows the operator to select the second marker detection unit 23 for detecting the second marker 112c of the microcatheter 112 and the alignment marker 113d of the delivery wire 113a. This is for setting a marker search area for the alignment marker detection unit 26 for detection. The image receiving section 22 receives the digital image signal from the image processing section 12 of FIG. In this embodiment, the search area specifying unit 21 and the image receiving unit 22 are configured to correspond to an example of the "acquisition unit" of the present invention.

The template storage unit 30 stores template data corresponding to the X-ray digital image of the second marker 112c of the microcatheter 112. FIG. The second marker detection unit 23 extracts a signal portion corresponding to the template data stored in the template storage unit 30 from the output signal of the image reception unit 22 corresponding to the search area specified through the search area specification unit 21. is detected, and as a result an image corresponding to the second marker 112c in the search area is detected along with its position. The image data output from the second marker detection unit 23 is stored in the second marker storage unit 24 together with information on the coordinate position of the center of the image of the second marker 112c. In this embodiment, the template storage section 30 and the second marker detection section 23 constitute second marker detection means.

The alignment marker detection unit 26 detects an image corresponding to the alignment marker 113d of the delivery wire 113a along with its position based on the output signal of the image reception unit 22 and the output of the image data storage unit 28 supplied through the image processing unit 29. do. The alignment marker 113d has a characteristic shape of a rectangle in a two-dimensional image. Therefore, the alignment marker detector 26 does not use the template data as the second marker detector 23 does, and compares the current output signal of the image receiver 22 with the image signal previously stored in the image data storage 28. By doing so, when the unique shape is detected, it is detected as the alignment marker 113d. The image data storage unit 28 sequentially stores the moving image output from the image receiving unit 22 . The image data output from the alignment marker detection unit 26 is stored in the alignment marker storage unit 27 as the coordinate position of the leading edge, center, or trailing edge of the image of the alignment marker 113d (or the center point, length, or angle of the image). good). In this embodiment, the alignment marker detection section 26, the image data storage section 28, and the image processing section 29 constitute alignment marker detection means.

The second marker extraction unit 25 sequentially monitors the image data of the second marker 112c stored in the second marker storage unit 24, and the reliability of the image data (with respect to the template data) stored in the second marker storage unit 24 has decreased. Then, the second marker storage unit 24 is instructed to newly store the output of the second marker detection unit 23 again.

Based on the output of the second marker storage unit 24 and the output of the alignment marker storage unit 27, the distance determination unit 31 determines the distance between the center of the second marker 112c and the tip, center, or rear end of the alignment marker 113d in two-dimensional coordinates. is calculated and compared with preset distance data (a plurality of data with different pluses and minuses) stored therein to determine the distance between the two markers 112c and 113d. In this embodiment, the distance determination unit 31 constitutes detection means for detecting the positional relationship of the alignment marker 113d with respect to the center of the second marker 112c, which is the target position.

Here, the distance determination section 31 operates in three modes as follows.
(First mode) A period until the tip 113f of the alignment marker 113d reaches the center of the second marker 112c, which is the target position stored in the second marker storage unit 24: the center of the tip 113f and the second marker 112c Detect the positional relationship with
(Second mode) A period after the tip 113f reaches the center of the second marker 112c and until the center of the alignment marker 113d in the traveling direction reaches the center of the second marker 112c, which is the target position: A positional relationship between the center of the alignment marker 113d and the center of the second marker 112c is detected.
(Third Mode) Period after the center of the alignment marker 113d reaches the center of the second marker 112c: The positional relationship between the rear end 113e of the alignment marker 113d and the center of the second marker 112c is detected.

The output of the distance determination section 31 is supplied to the alert signal generation section 32 . The alert signal generation unit 32 outputs an alert visual display signal and an alert audio signal to the image display unit 33 in order to alert the operator 210 according to the output of the distance determination unit 31 . In this case, in this embodiment, the image display unit 33 may have a visual display function based on the alert visual display signal and an audio output function based on the alert audio signal. Then, when the alert visual display signal and the alert audio signal are output from the alert signal generating unit 32, the image display unit 33 performs visual display processing based on the alert visual display signal and audio output processing based on the alert audio signal. . In this embodiment, the distance determination section 31, the alert signal generation section 32, and the image display section 33 are configured to correspond to an example of the "alert means" of the present invention.
Also, the alert visual display signal and the alert audio signal output to the image display unit 33 are supplied to the display unit 14 of the display device 130 in FIG. In this case, in this embodiment, the display unit 14 may have a visual display function based on the alert visual display signal and an audio output function based on the alert audio signal. Then, when the alert visual display signal and the alert audio signal are output from the image display unit 33, the display unit 14 performs visual display processing based on the alert visual display signal and audio output processing based on the alert audio signal. can be picked

Next, the operation of the catheter operation support device 160-1 shown in FIG. 4 will be described with reference to FIGS. 5 and 6. FIG. First, the recognition/tracking operation of the second marker 112c will be described with reference to FIG. As shown in FIG. 3(c), the operator 210 feeds the microcatheter 112 to recognize and track the second marker 112c, the first marker 112b, and the coil 113b near the opening of the aneurysm 301. It is started in a position where it is easily accessible (a position slightly inside the aneurysm 301 from the top of the opening of the aneurysm 301).

First, in step S101 of FIG. 5, the operator 210 designates a small search area including the second marker 112c through the search area designating section 21. FIG. The search area specified through the search area specifying unit 21 at this time defines the "predetermined area" of the present invention.
Next, in step S102, the second marker detection unit 23 performs template matching using the initial template data (image data) T0 stored in the template storage unit 30 for the image signal of the search area specified in step S101. detect. In template matching detection, a matching value is calculated for each small region image T having the same size as the template image T0 for all similar images in the search region. At this time, in the second marker storage unit 24, the data of the image T having the higher matching value with respect to the template image T0 is stored together with the information of its center. , is updated.
Next, in step S103, the second marker extraction unit 25 extracts the image T of the small region having the maximum matching value in step S102, which is stored in the second marker storage unit 24 at this time, as the image of the second marker 112c. recognize that there is
Next, in step S104, the second marker extraction unit 25 calculates the template matching value of the image T having the maximum matching value determined in step S103. A value obtained by multiplying this template matching value by a constant β (0.95<β<1.0) is used as a matching determination threshold. This is because the conformity determination threshold value itself is not a fixed value, but is a conformity criterion that takes into account the initial detection result of the actual image. This match determination threshold is used in step S107, which will be described later.
Positional tracking of the second marker 112c is performed each time an image is read. Note that if the result of the suitability determination in the previous step S107 (described later) is Lost, the process starts from the next step S106 instead of the next step S105.

Next, in step S105, the second marker detection unit 23 sets a square area within a certain range from the center position of the marker image T as a search area.
Next, in step S106, the second marker detection unit 23 performs template matching detection for a small region corresponding to the image T of the second marker 112c in the entire search region. The data of the image T having the higher matching value is stored in the marker storage unit 24 together with its center information. In this way, the center of the small area image T having the maximum matching value is used as a second marker center position candidate.
Next, in step S107, the second marker extraction unit 25 compares the conformity determination reference value obtained in step S105 with the maximum conformity value obtained in step S106. If the maximum matching value is smaller, the marker is considered lost, and this round of processing ends. In this case, the next process starts from step S106. Otherwise, the process of step S108 is continued.
In step S108, the second marker storage unit 24 updates the center of the image T of the second marker 112c to the center position candidate obtained in step S106.
The above steps S101 to S108 are controlled by a program incorporated in the control section 34. FIG.

Next, the recognition/tracking operation of the alignment marker 113d will be described with reference to FIG. As shown in FIG. 3(d), the operator 210 feeds the delivery wire 113a, and the alignment marker 113d moves to a position slightly past the tip marker 111b of the guiding catheter 111. is started when the
First, in step S201 of FIG. 6, the operator 210 designates an initial search area through the search area designating section 21. Here, the alignment marker 113d is a small small rectangle with a low pixel value in the digital image. At this time, the initial search area specified through the search area specifying unit 21 defines the "predetermined area" of the present invention.
Therefore, in step S202, the alignment marker detection unit 26 extracts edges from the image, and then selects all connected components whose diameter is equal to or less than a certain value as conformity determination targets in the next step S203.
In step S203, the alignment marker detection unit 26 detects a rectangle (with any orientation) surrounding the connected components to be determined. At this time, the alignment marker detection unit 26 excludes those pixels in which the average value of the pixel values in the rectangle is equal to or greater than a predetermined value, and regards the rectangle as lost when all the connected components are excluded. Then, the alignment marker detection unit 26 recognizes and detects the image of the alignment marker 113d that is closest to the previous position among the connected components that have not been eliminated. At this time, the image data output from the alignment marker detection unit 26 is stored in the alignment marker storage unit 27 together with positional information on the coordinates of the leading edge, center, and trailing edge of the image data. The alignment marker image is updated each time.

Next, in step S204, the feature of the rectangle (found in step S203) surrounding the connected component detected as the image of the alignment marker 113d in step S203 is regarded as a rectangle simulating the alignment marker 113d, and its tip , the center, and the rear end are the alignment marker positions. Data of a rectangular image simulating the alignment marker 113d and position data of its leading end, center, and trailing end are left in the alignment marker storage unit 27. FIG.
Next, in step S205, the alignment marker detection unit 26 makes the next search area for tracking larger than that of the second marker 112c, because the movement of the alignment marker 113d may be fast (large). In addition, the alignment marker detection unit 26 also expands in the long side direction of the rectangle as the next search area.
By the above operation, the feature data of the image of the alignment marker 113 d and the position data of the leading end, the center and the trailing end are stored in the alignment marker storage unit 27 .

Here, the alignment marker 113d is an X-ray opaque portion provided at a portion approximately 4 cm away from the distal end portion 113c of the delivery wire 113a as described above. The alignment marker 113d moves along the route.
Therefore, when detecting the alignment marker 113d, the difference between the accumulated image of the past several frames and the current image is taken to extract the portion with motion (step S211 in FIG. 6), and the opening process is performed to extract the portion other than the main portion with motion. is eliminated, expansion processing is performed to extract the coil passage path in the current frame (step S212 in FIG. 6), and the image of step S211 is accumulated to extract the entire coil passage path image M (step S212 in FIG. 6). S213), by using this M as an image processing mask in the previous step S202, only the vicinity of the path along which the tip portion 113c of the delivery wire 113a passed can be targeted for search.
The above steps S201 to S205 and S211 to S213 are controlled by a program incorporated in the control section 34. FIG.

Next, operations of the distance determination section 31, the alert signal generation section 32, and the image display section 33 in FIG. 4 will be described with reference to FIGS. 7, 8, and 9. FIG.
In FIG. 7 , the direction from left to right on the paper surface is the advancing direction when inserting the catheter device 110 .

First, in the scene shown in FIG. 7A, the tip 113f of the alignment marker 113d of the delivery wire 113a is in front of the second marker 112c of the microcatheter 112, and the coil 113b is still inserted into the aneurysm 301 at this time. missing or only partially inserted.

In the scene shown in FIG. 7(b), the tip 113f of the alignment marker 113d has reached the center of the second marker 112c. no.
Here, until the state of FIG. A positional relationship with the center of the second marker 112c is detected. This state of FIG. 7(b) is referred to as stage "T".

In the scene shown in FIG. 7(c), the center of the alignment marker 113d is substantially aligned with the center of the second marker 112c. not in a state
Here, after reaching the state shown in FIG. 7B until reaching the state shown in FIG. , the positional relationship with the center of the second marker 112c stored in the second marker storage unit 24 is detected. This state of FIG. 7(c) is called a stage "Cross".

The scene shown in FIG. 7D shows a state in which the rear end 113e of the alignment marker 113d has reached the center of the second marker 112c. At this time, the coil 113b is inserted into the aneurysm 301 by a predetermined amount. Therefore, the operator must stop further feeding of the delivery wire 113a in the state shown in FIG. 7(d) and cut off the coil 113b at the distal end 113c of the delivery wire 113a.
Here, after reaching the state shown in FIG. 7C until reaching the state shown in FIG. Based on the output of the storage unit 27, the positional relationship between the rear end 113e of the alignment marker 113d and the center of the second marker 112c stored in the second marker storage unit 24 is detected. This state of FIG. 7(d) is referred to as stage "inverted T".
7(d), a so-called overshoot (OS) state occurs, and there is a risk that the distal end portion 113c of the delivery wire 113a or the excessively fed coil 113b may damage the aneurysm 301 or the like of the patient 220. become dangerous.

During the operation of the microcatheter 112 and the delivery wire 113a by the operator, the distance determination unit 31 in FIG. The distance between the tip, the center, or the rear end of the marker 113d is determined, and a determination signal capable of distinguishing each of FIGS. 7(a) to (d) is output.

This will be described with reference to FIG.
FIG. 8 shows an example of the positional relationship between the center 112c1 of the second marker 112c and the leading edge 113f, center 113d1, and trailing edge 113e of the alignment marker 113d for each of alert levels 1 to 8 and OS. Specifically, in FIG. 8, alert levels 1 to 8 and OS are shown in the alert level display area 810, and the center 112c1 of the second marker 112c and the alignment marker 113d in each of the alert levels 1 to 8 and OS are shown in the positional relationship display area 820. 113f, the center 113d1, and the rear end 113e. In FIG. 8, alert level 3 corresponds to stage "T" where tip 113f of alignment marker 113d reaches center 112c1 of second marker 112c, and alert level 5 corresponds to center 112c1 of second marker 112c and alignment marker 113d. corresponds to the stage "Cross" in which the center 113d1 of the center 113d1 of the second marker 112c substantially coincides with the stage "Cross", and the alert level 8 is the stage "reverse T Equivalent to Note that the alert level OS corresponds to an overshoot state in which the rear end 113e of the alignment marker 113d passes the center 112c1 of the second marker 112c in the traveling direction.

In FIG. 8, in a first mode 811, which is a period until the tip 113f of the alignment marker 113d reaches the center 112c1 of the second marker 112c, which is the target position, the distance determination unit 31 determines the tip of the alignment marker 113d. The positional relationship between 113f and the center 112c1 of the second marker 112c is detected. Further, the distance determination unit 31 determines a second distance, which is a period after the tip 113f of the alignment marker 113d reaches the center 112c1 of the second marker 112c and until the center 113d1 of the alignment marker 113d reaches the center 112c1. In mode 812, the positional relationship between the center 113d1 of the alignment marker 113d and the center 112c1 of the second marker 112c is detected. In the third mode 813, which is a period after the center 113d1 of the alignment marker 113d reaches the center 112c1 of the second marker 112c, the distance determination unit 31 determines that the rear end 113e of the alignment marker 113d and the center of the second marker 112c 112c1 is detected.
In the first mode 811, the distance determination unit 31 detects the positional relationship between the center 112c1 of the second marker 112c, which is the target position, and the tip 113f of the alignment marker 113d. The positional relationship with the center 113d1 of the marker 113d is detected, and in the third mode 813, the positional relationship with the rear end 113e of the alignment marker 113d is detected. This conforms to the positional relationship to be observed when operating the delivery wire 113a to bring the alignment marker 113d closer to the center 112c1 of 112c. Therefore, the above-described detection processing by the distance determination unit 31 is a technique that can further improve the safety and accuracy of catheter manipulation.

The second marker storage unit 24 stores coordinate position information of the center of the second marker 112c (112c1 in FIG. 8). (113d1 in FIG. 8) and the positional information on the coordinates of the rear end 113e are stored. Then, as described above, based on the information stored in the second marker storage unit 24 and the alignment marker storage unit 27, the distance determination unit 31 selects the above-described three modes 811 according to the positional relationship between the two markers. 813, that is, with respect to the center 112c1 of the second marker 112c, which is the target position, in the first mode 811 until the stage "T" is reached, the position or distance of the tip 113f of the alignment marker 113d is measured to reach the stage "T". In a second mode 812 later and before reaching the stage "Cross", the position or distance of the center 113d1 is determined, and in a third mode 813 after reaching the stage "Cross", the position or distance of the rear end 113e is determined. , a determination signal corresponding to the determination position or separation distance is output to the alert signal generation unit 32 .

7 and 8, for example, the scene shown in FIG. 7(a) is at alert level 2 shown in FIG. 8, and the scene shown in FIG. 7(b) is at alert level 3 shown in FIG. , the scene shown in FIG. 7(c) corresponds to alert level 5 shown in FIG. 8, and the scene shown in FIG. 7(d) corresponds to alert level 8 shown in FIG.

The distance determination unit 31 discriminates between alert levels 1 to 8 and OS shown in FIG. It judges and outputs a judgment signal related to the judged alert level to the alert signal generator 32 .

Based on the output of the distance determination unit 31, the alert signal generation unit 32 outputs to the image display unit 33 an alert signal consisting of different alert visual display signals and different alert audio signals for each of alert levels 1 to 8 and OS. do.

Based on the alert signal from the alert signal generating section 32, the image display section 33 performs display as shown in FIG. 9, for example. In FIG. 9 , an X-ray image 410 indicates an X-ray image output from the image data storage unit 28 . An alert display object 420 is displayed superimposed on this X-ray image 410 . In this alert display object 420, an enlarged image 421 obtained by enlarging the image area 411 of the X-ray image 410, and the second marker 112c of the microcatheter 112 in the enlarged image 421 are expressed as a circular index 441. An index setting display portion 422 expressing the alignment marker 113d of the delivery wire 113a as a rectangular index 442, an alert level information display portion 423 indicating alert level information based on the positional relationship between the second marker 112c and the alignment marker 113d, and an alert level. It has a background display section 424 with colors and hatching based on the alert level information shown in the information display section 423 .

In the display screen shown in FIG. 9, in the display area 450 on the right side of the X-ray image 410, an alert level display section having display segments 431 to 438 corresponding to alert levels 1 to 8 and OS shown in FIG. 430 is provided. Then, on the left side of the alert level display portion 430 in the display area 450, an index 441 indicating the second marker 112c of the microcatheter 112 in the enlarged image 421, which is shown in the index setting display portion 422, and An index 442 indicating the alignment marker 113d of the delivery wire 113a is also shown so that the positional relationship between the second marker 112c and the alignment marker 113d can be understood at a glance. At this time, the alert level display unit 430 sets the traveling direction of the delivery wire 113a and the like from bottom to top. 442 will move in the direction from bottom to top. Here, in this embodiment, the position of the second marker 112c of the microcatheter 112 and the alignment marker 113d of the delivery wire 113a is determined by the position of the upper end of the index 442 indicating the alignment marker 113d with respect to the display segments 431-438. configured to recognize relationships. In this embodiment, the length L of the display segments 431 to 437 in the marker advancing direction is set to L431 in order to issue a more detailed alert as the indicator 442, that is, the alignment marker 113d approaches the indicator 441, that is, the second marker 112c. =L432=L441.times.1/2, L433=L434=L441.times.1/4, and L435=L436=L437=L441.times.1/6. L438 is appropriate. In this case, the image display unit 33 is configured so that the positional relationship between the upper end of the index 442 indicating the alignment marker 113d and each of the display segments 431 to 438 corresponds to each of the alert levels 1 to 8 and OS. Note that the image display unit 33 outputs a signal for always positioning the index 441 indicating the second marker 112 c at the boundary position between the display segments 432 and 433 .

In the state shown in FIG. 9, the upper end of the index 442 indicating the alignment marker 113d of the delivery wire 113a is positioned at the display segment 436 (alert level 6 in FIG. 8). , "6" indicating alert level 6 is displayed, and the background display portion 424 displays a pattern similar to the pattern assigned to the display segment 436. FIG. In addition, in the alert level display section 430 shown in FIG. 9, for convenience of illustration, the display segments 431 to 438 are displayed in different colors by attaching different patterns. is of course possible. Furthermore, in this embodiment, in addition to the alert display shown in FIG. In addition, a form of outputting different alert sounds can be adopted. The output of the image display unit 33 is supplied to the display unit 14 of the display device 130 shown in FIG. 1, and the display unit 14 performs the alert display similar to that shown in FIG. can be

The operation of each part of the apparatus described above is controlled by the control part 34, and in particular, a program is built to control each step of marker detection. The control unit 34 cooperates with the control device 140 in FIG. 1 to control the catheter operation support device 160-1.

As described above, according to the catheter operation assisting device 160-1 of the present embodiment, when filling the coil 113b into the aneurysm 301, the distal end portion 113c of the delivery wire 113a is positioned with respect to the aneurysm 301 and the coil 113b is placed. At this time, an alert display that appeals to the operator's 210 vision and an alert sound that appeals to his or her hearing are output.

Further, in the catheter operation support device 160-1 of this embodiment, a plurality of different alerts are issued for levels 1 to 8 in FIG. Specifically, in the case of levels 1 to 8 in FIG. 8, a plurality of different alerts are given by display segments 431 to 438 shown in the alert level display section 430 in FIG.
More specifically, in this embodiment, the alert means comprising the distance determination section 31, the alert signal generation section 32 and the image display section 33 includes display segments 431 and 432 as shown in FIGS. Different alerts are provided in three modes: a first mode 811, a second mode 812 including display segments 433 and 434, and a third mode 813 including display segments 435-438. With such a configuration, it is possible to inform the operator 210 of the mode of the treatment currently being performed.
In addition, the alert means are different like display segments 431 and 432 depending on the distance between the tip 113f of the alignment marker 113d and the center 112c1 of the second marker 112c, which is the target position, in the case of the first mode 811. I try to do multiple alerts. Also, in the case of the second mode 812, the alert means are different like the display segments 433 and 434 depending on the distance between the center 113d1 of the alignment marker 113d and the center 112c1 of the second marker 112c which is the target position. I try to do multiple alerts. In addition, in the case of the third mode 813, the alert means displays the display segments 435 to 438 according to the distance between the rear end 113e of the alignment marker 113d and the center 112c1 of the second marker 112c, which is the target position. I'm trying to do multiple different alerts. According to such a configuration, it is possible to inform the operator 210 of a more detailed situation in each of the three modes 811 to 813 for each mode.

That is, in this embodiment, the amount of insertion of the coil 113b is determined by the relative positional relationship between the alignment marker 113d of the delivery wire 113a and the second marker 112c of the microcatheter 112. FIG. This is based on the assumption that if the setting position of the microcatheter 112 is appropriate, the setting position and cutting position of the coil 113b will also be as intended. Therefore, the key point is how to set alert level 8 in FIG. As an approach for coil insertion, the operator takes it from around alert level 1 to alert level 3 while paying attention to it in FIG. The journey beyond alert level 5 to alert level 8 should be more cautious. Based on this idea, as described above, the length L of the display segments 431 to 437 in FIG. is 1/6 of L441.

In the catheter operation support device 160-1 of the present embodiment, level 8 in FIG. 8 is determined when the center 112c1 of the second marker 112c and the rear end 113e of the alignment marker 113d are aligned. However, point-to-point matching is unstable, and it may be more realistic to provide a certain tolerance. As an example, in FIG. 9, an allowable area 437a having a constant width is provided at the boundary between the display segment 437 and the display segment 438, and while the upper end of the indicator 442 indicating the alignment marker 113d is within this allowable area 437a, the second marker The center 112c1 of the alignment marker 112c and the rear end 113e of the alignment marker 113d may substantially coincide in position. According to such a configuration, it is possible to improve the stability of the coil placement procedure for the operator 210 .
As a further modification of the display segments 431-438, display segments 431 and 432 are combined into a display segment for the first mode 811, and display segments 433 and 434 are combined, in line with modes 1-3 described above. is used as the display segment for the second mode 812, and as the display segment for the third mode 813, the display segments 435 to 437 are combined to indicate that the coil attention is about to be completed, and the completion of coil placement is notified. and a display segment 438 for warning of overshoot.

In the catheter operation support device 160-1 of this embodiment, the second marker 112c of the microcatheter 112 located 3 cm from the tip 112b and the alignment marker of the delivery wire 113 similarly located 4 cm from the tip 113c 113d is monitored. For example, when the distal end portion 112b of the microcatheter 112 or the distal end portion 113c of the delivery wire 113 is targeted for monitoring, part of the coil 113b is fed into the aneurysm 301. overlaps the first marker 112b and the tip portion 113c, making it difficult to track the first marker 112b and the tip portion 113c.

(Example 2)
Next, Example 2 will be described.
The configuration of the second embodiment of the catheter operation support device 160 shown in FIG. 1 is, for example, the configuration shown in FIG.

In the catheter operation support device 160-2 shown in FIG. 10, for example, when filling the coil 113b inside the aneurysm 301 (scenes of FIGS. 3(c) to 3(e)), the first marker 112b of the microcatheter 112 , an alert such as an alert display is performed based on the change in the position of the first marker 112b during the coil filling operation.

That is, depending on the internal shape of the aneurysm 301 and the direction in which the coil 113b is inserted, the delivery wire 113a, the microcatheter 112, or the guiding catheter 111 is pushed back by the reaction force when the coil 113b is pushed out, and the coil 113b is normally inserted into the aneurysm. There may be situations where it is not possible to detain Therefore, the catheter operation assisting device 160-2 according to the present embodiment is configured to perform an alert such as an alert display when the first marker 112b of the microcatheter 112 is displaced from the intended arrival position by a certain amount or more.

In FIG. 10, the same reference numerals as those shown in FIG. 4 are assigned to components having equivalent or similar functions to those in FIG. The template storage unit 30 stores template data corresponding to the shape and features of the fast marker 112b in the X-ray image in order to specify the fast marker 112b of the microcatheter 112 here. Also in the second embodiment, the search area specifying unit 21 and the image receiving unit 22 are configured to correspond to an example of the "acquisition unit" of the present invention, and these configurations are the same as those of the above-described first embodiment. Therefore, detailed description thereof is omitted.

Based on the template data from the template storage unit 30, the marker detection unit 231 performs template matching detection on the output of the image reception unit 22 for the entire search area designated by the operator 210 through the search area designation unit 21. , the first marker 112b is detected. The marker detection unit 231 outputs positional information on the two-dimensional coordinates of the center of the image corresponding to the first marker 112b. Also in the second embodiment, the search area specified through the search area specifying unit 21 defines the "predetermined area" of the present invention.

The marker storage unit 241 stores the position information of the center of the image corresponding to the first marker 112b, which is the output of the marker detection unit 231, on two-dimensional coordinates. In this embodiment, the marker storage unit 241 has a configuration corresponding to an example of the "storage means" of the present invention.

The distance determination unit 311 compares the output of the marker storage unit 241 with the subsequent output of the marker detection unit 231 to determine whether or not the center of the image corresponding to the first marker 112b after position storage has been displaced. Determine the distance of At this time, the distance determination unit 311 compares the distance with a previously stored allowable distance range, and outputs a determination signal for an alert when the distance exceeds the allowable range.
Based on the output of the distance determination unit 311, the alert signal generation unit 321 determines the position from the stored specific arrival position after the first marker 112b reaches a specific position in the body of the patient 220. An alert visual display signal and an alert audio signal are output to the image display unit 331 assuming that the deviation exceeds a predetermined allowable range.
The image display unit 331 can take a form having an alert sound output function based on the alert audio signal in addition to the alert visual display function based on the alert visual display signal. Then, when the alert visual display signal and the alert audio signal are output from the alert signal generating unit 321, the image display unit 331 performs alert visual display processing based on the alert visual display signal and alert sound output processing based on the alert audio signal. I do.
In this embodiment, the distance determination unit 311, the alert signal generation unit 321, and the image display unit 331 constitute an example of the "alert means" of the present invention.

Also, the alert visual display signal and the alert audio signal output to the image display unit 331 are supplied to the display unit 14 of the display device 130 in FIG. In this case, in this embodiment, the display unit 14 may have an alert sound output function based on the alert audio signal in addition to the alert visual display function based on the alert visual display signal. Then, when the alert visual display signal and the alert audio signal are output from the image display unit 331, the display unit 14 performs alert visual display processing based on the alert visual display signal and alert sound output processing based on the alert audio signal. can take any form.
Also, the control unit 341 cooperates with the control device 140 in FIG. 1 to control the catheter operation support device 160-2.

Next, the operation of the catheter operation support device 160-2 according to this embodiment will be described with reference to FIGS. 3 and 11. FIG.

While observing the display unit 14 of the display device 130, the operator 210 advances a series of operations starting from the insertion of the guiding catheter 111 into the carotid artery in FIG. 3(a).

Then, when the first marker 112b of the microcatheter 112 reaches the entrance of the aneurysm 301 as shown in FIG. , to set the search area based on the user's operation instructions.
Next, in this state, when the operation unit 242 is operated in step S302, in step S303, the marker storage unit 241 stores the image corresponding to the first marker 112b output from the marker detection unit 231 at this time. Stores center position information.

Thereafter, the operator 210 operates the delivery wire 113a to start sending the coil 113b attached to the distal end thereof into the aneurysm 301 (FIG. 3(d)). At this time, in step S<b>304 , the distance determination unit 311 detects the output from the marker detection unit 231 every moment (for example, frame rate), that is, the position information of the first marker 112 b and the first marker 112 b stored in the marker storage unit 241 . The difference between the two, that is, the amount of positional deviation is detected based on the positional information of .
Next, in step S305, the distance determination unit 311 determines whether or not the positional deviation amount detected in step S304 has exceeded the allowable value δ related to the predetermined allowable range. As a result of this determination, if the amount of positional deviation detected in step S304 does not exceed the allowable value δ (S305/NO), the process returns to step S304 to continue the detection of the amount of positional deviation in step S304.

On the other hand, as a result of the determination in step S305, if the amount of positional deviation detected in step S304 exceeds the allowable value δ (S305/YES), the process proceeds to step S306. For example, the microcatheter 112 is pushed back due to reaction force applied to the delivery wire 113a due to an increase in the feeding amount of the coil 113b, or if the coil 113b is caught, and as a result, the positional deviation amount detected in step S304 exceeds the allowable value δ. case is conceivable.
In step S<b>306 , the alert signal generation unit 321 outputs an alert visual display signal and an alert audio signal to the image display unit 331 to alert the operator 210 . Thereafter, when the alert visual display signal and the alert audio signal are output from the alert signal generating unit 321, the image display unit 331 performs alert visual display processing based on the alert visual display signal and alert sound output processing based on the alert audio signal. I do.

The alert visual display signal and the alert audio signal output to the image display unit 331 are also supplied to the display unit 14 of the display device 130 in FIG. Then, when the alert visual display signal and the alert audio signal are output from the image display unit 331, the display unit 14 performs alert visual display processing based on the alert visual display signal and alert sound output processing based on the alert audio signal. can take any form. For example, visual and auditory alerts are provided by means of the appearance of an alert mark, blinking, blinking of the entire screen, coloring, or the like.

When an alert is issued, the operator 210 changes the state of the coil 113b by, for example, stopping the pushing of the delivery wire 113a and pulling it back a little as needed, and then pushes the microcatheter 112 again to achieve the fast Marker 112b is caused to return to the storage position of step S303.
When the center position of the image corresponding to the first marker 112b is returned to the memory position of step S303, the positional deviation amount becomes equal to or less than the allowable value δ, and the alert disappears, so the pressing of the coil 113b is resumed.

After that, if the above-described alert is not issued before the operator 210 finishes sending all the coils 113b into the aneurysm 301, it means that the placement of the coils 113b has been completed safely. 113b, the coil 113b is cut off from the delivery wire 113a, the catheter operation support device 160-2 is turned off, and the delivery wire 113a, microcatheter 112, guide wire 114, and guiding catheter 111 are all pulled out of the patient's blood vessel. Remove from and finish the procedure.

As described above, in this embodiment, when the coil 113b is inserted into the aneurysm 301, if the position of the microcatheter 112 changes for some reason and there is a risk that the coil 113b cannot be inserted correctly, an alert is generated. will be issued. As a result, the operator 210 can perform safer coil embolization by inserting the coil 113b while making corrections.
Note that steps S301 to S306 in FIG. 11 are controlled by a program incorporated in the control unit 341. FIG.

In this embodiment, the movement of the fast marker 112b of the microcatheter 112 is monitored, but the present invention is not limited to this aspect. For example, as shown in FIG. 3(e), as the coil 113b is fed into the aneurysm 301, part of the coil 113b may overlap the fast marker 112b, making it difficult to track the fast marker 112b. If there is such a concern, the second marker 112c should be subject to movement monitoring instead of the first marker 112b.

As another aspect of this embodiment, both the first marker 112b and the second marker 112c of the microcatheter 112 may be subject to movement monitoring. In this case, a set of the marker detection unit 231, the marker storage unit 241, and the distance determination unit 311 shown in FIG. 10 is provided corresponding to each of the markers 112b and 112c.

In addition, as a further aspect of this embodiment, the first marker 112b and the second marker 112c of the microcatheter 112, which is the target of movement monitoring, are formed using a light-emitting member sensitive to X-rays 122a instead of an X-ray opaque member. You can make it work. For example, as a mechanoluminescent material, strontium aluminate (SrAl ₂ O ₄ :Eu) doped with europium that emits green light to control its structure is known to have the highest luminance, and is also produced industrially. . Other colors include zinc sulfide doped with transition metals and rare earths (ZnS:Mn), barium calcium titanate ((Ba, Ca) _TiO3 :Pr), calcium aluminate yttrium ( _CaYAl3O7 : _Ce ) also emit yellow-orange, red, and blue, respectively. By using these colored light emitters, it can be expected that the signal level of the object to be monitored moving in the monochrome X-ray image will be increased, leading to an improvement in detection accuracy.

In addition, as a further aspect of this embodiment, the moving monitoring target may be a part of the guiding catheter 111 in FIG. 2(a) or the guide wire 114 in FIG. . Specifically, the tips 111a and 114a, or other appropriate positions are coated with X-ray opaque or the above-described light-emitting member to form markers for detection. Displacement of the microcatheter 112 and coil mechanism 113 may be detected and alerted by monitoring markers on the guidewire 114 .
Further, for example, as still another aspect of the present embodiment, the alert signal generating unit 321 and the image display unit 331 are attached to each catheter (111, 112, 113, 114 shown in FIG. 2) included in the catheter device 110. The above-described alert can be provided for two or more cases in which the amount of positional deviation of each marker exceeds the allowable value δ set for each. According to such a configuration, for example, even if a situation occurs in which the safety and accuracy of catheter manipulation are impaired in an area other than the area that the operator 210 is gazing, it is possible to alert the operator 210 to that effect. Therefore, it is possible to further improve the safety and accuracy of catheter manipulation by the operator 210 .

In the above-described embodiment of the present invention, a form applied to the cerebral blood vessel 300 as the affected part of the patient 220 has been explained, but the present invention is not limited to such a form. In the present invention, a site other than the cerebral blood vessel 300 can be applied as long as it is a site of the patient 220 where catheter treatment can be performed. For example, sites other than the cerebral blood vessels 300 include cardiovascular vessels, lymph vessels, portal veins, ureters, and the like. The present invention is also applicable when the catheter device 110 is used for diagnostic purposes as well as for therapeutic purposes.

In addition, the present invention supplies a program that implements one or more functions of the above-described embodiments to a system or device via a network or a storage medium, and one or more processors in the computer of the system or device execute the program. It can also be realized by a process of reading and executing. This program is included in the present invention.

It should be noted that the above-described embodiments of the present invention are merely examples of specific implementations of the present invention, and the technical scope of the present invention should not be construed to be limited by these. is. That is, the present invention can be embodied in various forms without departing from its technical concept or main features.

100: X-ray medical system, 110: Catheter device, 111: Guiding catheter, 112: Microcatheter, 112b: First marker, 112c: Second marker, 113: Coil mechanism, 113a: Delivery wire, 113b: Coil, 113d: Alignment Marker 120: X-ray imaging device 130: Display device 160: Catheter operation support device 14: Display unit 23, 26, 231: Marker detection unit 24, 27, 241: Marker storage unit 31, 311: Distance determination unit 32, 321: Alert signal generation unit 33, 331: Image display unit 140: Control device 150: Input device 210: Operator 220: Patient

Claims (12)

An X-ray imaging device, a catheter having a first marker and a second marker located behind the first marker in the insertion direction, and a third marker axially movable inside the catheter and having a third marker A catheter manipulation assistance device for use with a catheter device comprising a wire having
Acquisition means for acquiring X-ray image information of a predetermined region from the X-ray imaging apparatus;
alert means for alerting according to the positional relationship between the second marker of the catheter and the third marker of the wire using the X-ray image information;
havedeath,
While operating the wire to bring the third marker closer to the second marker, the alert means is configured such that the tip of the third marker in the direction of travel is located with respect to the target position of the second marker. A first mode for detecting the positional relationship between the tip and the target position during a period until the tip reaches the target position, and after the tip reaches the target position, the third marker is moved to the target position. A second mode for detecting the positional relationship between the center and the target position during the period until the center in the traveling direction reaches the target position, and a period after the center reaches the target position for the third marker. Different alerts are given in three modes in the third mode for detecting the positional relationship between the rear end in the traveling direction and the target position. A catheter operation support device characterized by: 2. The catheter operation assistance according to claim 1 , wherein said alert means, in said first mode, issues a plurality of different alerts according to the distance between said tip and said target position. Device. 3. The catheter according to claim 1 or 2 , wherein said alert means, in said second mode, provides a plurality of different alerts according to the distance between said center and said target position. Operation support device. 4. The alert means according to any one of claims 1 to 3 , wherein in the third mode, the alert means issues a plurality of different alerts according to the distance between the rear end and the target position. 2. The device for assisting catheter operation according to item 1. A catheter operation support device for use with an X-ray imaging device and a catheter device including a wire having a marker formed with a predetermined length in the advancing direction thereof,
Acquisition means for acquiring X-ray image information of a predetermined region from the X-ray imaging apparatus;
detection means for detecting the positional relationship of the marker with respect to the target position using the X-ray image information;
has
The detection means is
detecting a positional relationship between the tip and the target position until the tip of the marker in the traveling direction reaches the target position;
detecting the positional relationship between the center and the target position after the tip reaches the target position and until the center of the marker in the traveling direction reaches the target position;
After the center reaches the target position, the catheter operation assisting device detects a positional relationship between a rear end of the marker in the advancing direction and the target position. The catheter operation support device according to any one of claims 1 to 5 , wherein the alert means outputs an alert visual display signal as the alert. The catheter operation support device according to any one of claims 1 to 6 , wherein the alert means outputs an alert audio signal as the alert. a catheter operation support device according to any one of claims 1 to 7 ;
the X-ray imaging device;
the catheter device;
An X-ray medical system comprising: An X-ray imaging device, a catheter having a first marker and a second marker located behind the first marker in the insertion direction, and a third marker axially movable inside the catheter and having a third marker A method of operating a catheter manipulation assistance device for use with a catheter device comprising a wire having
an acquisition step in which the catheter operation support device acquires X-ray image information of a predetermined region from the X-ray imaging device;
an alert step in which the catheter operation support device uses the X-ray image information to issue an alert according to the positional relationship between the second marker of the catheter and the third marker of the wire;
has
In the alert step, while the wire is operated to bring the third marker closer to the second marker, the tip of the third marker in the direction of travel is positioned with respect to the target position of the second marker. A first mode for detecting the positional relationship between the tip and the target position during a period until the tip reaches the target position, and after the tip reaches the target position, the third marker is moved to the target position. A second mode for detecting the positional relationship between the center and the target position during the period until the center in the traveling direction reaches the target position, and a period after the center reaches the target position for the third marker. A method for operating a catheter operation support device, wherein different alerts are issued in three modes in a third mode for detecting the positional relationship between the rear end and the target position in the traveling direction. A method of operating a catheter operation support device used with an X-ray imaging device and a catheter device including a wire having a marker formed with a predetermined length in the advancing direction thereof, comprising:
an acquisition step in which the catheter operation support device acquires X-ray image information of a predetermined region from the X-ray imaging device;
a detection step in which the catheter operation support device uses the X-ray image information to detect the positional relationship of the marker with respect to the target position;
has
The detection step includes:
detecting a positional relationship between the tip and the target position until the tip of the marker in the traveling direction reaches the target position;
detecting the positional relationship between the center and the target position after the tip reaches the target position and until the center of the marker in the traveling direction reaches the target position;
After the center reaches the target position, the operation method of the catheter operation assisting device, wherein the positional relationship between the rear end of the marker in the traveling direction and the target position is detected. An X-ray imaging device, a catheter having a first marker and a second marker located behind the first marker in the insertion direction, and a third marker axially movable inside the catheter and having a third marker for the use of a catheter device comprising a wire having
an acquisition function for acquiring X-ray image information of a predetermined region from the X-ray imaging device;
an alert function that uses the X-ray image information to issue an alert according to the positional relationship between the second marker of the catheter and the third marker of the wire;
be realized by a computer,
The alert function is such that, while the wire is operated to bring the third marker closer to the second marker, the tip of the third marker in the direction of travel is positioned relative to the target position of the second marker. A first mode for detecting the positional relationship between the tip and the target position during a period until the tip reaches the target position, and after the tip reaches the target position, the third marker is moved to the target position. A second mode for detecting the positional relationship between the center and the target position during the period until the center in the traveling direction reaches the target position, and a period after the center reaches the target position for the third marker. Different alerts are given in three modes in a third mode for detecting the positional relationship between the rear end in the traveling direction and the target position. program. For the use of an X-ray imaging device and a catheter device comprising a wire having a marker formed of a predetermined length in its direction of travel,
an acquisition function for acquiring X-ray image information of a predetermined region from the X-ray imaging device;
a detection function that detects the positional relationship of the marker with respect to the target position using the X-ray image information;
is realized on a computer,
The detection function is
detecting a positional relationship between the tip and the target position until the tip of the marker in the traveling direction reaches the target position;
detecting the positional relationship between the center and the target position after the tip reaches the target position and until the center of the marker in the traveling direction reaches the target position;
A program for detecting a positional relationship between a rear end of the marker in the advancing direction and the target position after the center reaches the target position.

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