JP7271126B2 - Ultrasound diagnostic equipment and medical image processing equipment - Google Patents

Description

An embodiment of the present invention relates to an ultrasonic diagnostic apparatus and a medical image processing apparatus.

Conventionally, Cardiac Resynchronization Therapy (CRT) is known as one of heart failure treatment methods. CRT is a therapy that paces the left and right ventricles to improve the pumping function of the heart. In addition, CRT is a therapeutic method that restores near-normal pump function by correcting the timing deviation of contraction in the heart using a pacemaker or the like.

In recent years, large-scale studies in Europe and the United States have confirmed the therapeutic effect of CRT, and CRT is becoming established as one of the therapeutic methods for heart failure. In Japan as well, CRT became insurance coverage in 2004. In addition, CRT is being established as a therapeutic method for improving the QOL (Quality Of Life) of patients suffering from severe heart failure, and the number of treatments using CRT is increasing year by year. Like pacemakers and implantable cardioverter defibrillators (ICDs), CRTs require surgery to implant the body and leads (electrodes). In CRT, leads are placed on the outer surface of the left ventricle while inserted into the coronary veins to provide pacing that compensates for contraction timing deviations in the right atrium and right ventricle, as well as the left ventricle and right ventricle of the heart. detained.

Japanese Unexamined Patent Application Publication No. 2004-454 WO2011/093193 JP 2014-61093 A Japanese Patent Application Laid-Open No. 2008-302220 JP 2007-296362 A

The problem to be solved by the present invention is to provide an ultrasonic diagnostic apparatus and medical image processing capable of allowing an operator to easily determine the position of a lead placed on the outer surface of the left ventricle while being inserted into the coronary vein. to provide the equipment.

An ultrasonic diagnostic apparatus according to an embodiment includes a first generator, a second generator, and a display controller. The first generating unit generates a myocardial image of the left ventricle of the heart based on a plurality of time-series first three-dimensional medical image data generated by three-dimensionally scanning the heart of the subject with ultrasound. Generate stimulus propagation image data indicative of stimulus propagation information. The second generation unit extracts the coronary veins from the second three-dimensional medical image data in which the coronary veins of the heart of the subject are rendered in a distinguishable manner, and generates the second three-dimensional medical image data and the stimulus propagation image data. are aligned to generate composite image data showing a composite image in which the coronary vein and the stimulation propagation image shown by the stimulation propagation image are synthesized. The display control unit causes the display unit to display the composite image indicated by the composite image data, and displays a mark at the position of the slowest stimulus propagation image in the stimulus propagation image included in the composite image displayed on the display unit. .

FIG. 1 is a diagram showing a configuration example of an image processing system according to the first embodiment. FIG. 2 is a block diagram showing a configuration example of the ultrasonic diagnostic apparatus according to the first embodiment. FIG. 3 is a diagram showing an example of a stimulus propagation image according to the first embodiment. FIG. 4 is a diagram showing an example of coronary veins according to the first embodiment. FIG. 5 is a diagram for explaining an example of processing executed by the control circuit according to the first embodiment; FIG. 6 is a diagram showing an example of an electrocardiographic waveform according to the first embodiment and graphs of time change curves of average motion information (average rate of change in area) for each segment of the left ventricular surface. 7 is a diagram for explaining an example of a process executed by a control circuit according to the first embodiment; FIG. FIG. 8 is a flowchart showing an example of the placement position determination process performed by the ultrasonic diagnostic apparatus according to the first embodiment. FIG. 9 is a diagram for explaining an example of processing executed by the ultrasonic diagnostic apparatus according to the first modification. FIG. 10 is a diagram for explaining an example of the principle of candidate mark display processing in the second modification. FIG. 11 is a diagram for explaining an example of the principle of candidate mark display processing in the second modification. FIG. 12 is a diagram for explaining an example of the principle of candidate mark display processing in the second modification. FIG. 13 is a diagram for explaining an example of processing executed by the ultrasonic diagnostic apparatus according to the second modification. FIG. 14 is a diagram for explaining an example of processing executed by an ultrasonic diagnostic apparatus according to the second modification. FIG. 15 is a diagram for explaining an example of processing executed by the ultrasonic diagnostic apparatus according to the second modification. FIG. 16 is a diagram for explaining an example of processing executed by a filter processing circuit according to the sixth modification of the first embodiment; FIG. 17 is a diagram illustrating an example of the configuration of a medical image processing apparatus according to the second embodiment; FIG. 18 is a diagram showing a display example of the X-ray diagnostic apparatus according to the second embodiment. FIG. 19 is a diagram illustrating an example of the configuration of a medical image processing apparatus according to the third embodiment;

Hereinafter, an ultrasonic diagnostic apparatus and a medical image processing apparatus according to embodiments will be described with reference to the drawings. Note that the contents described in one embodiment or modified example may be similarly applied to other embodiments or other modified examples.

(First embodiment)
First, a configuration example of an image processing system according to the first embodiment will be described. FIG. 1 is a diagram showing a configuration example of an image processing system according to the first embodiment.

As shown in FIG. 1, the image processing system according to the first embodiment includes an ultrasonic diagnostic apparatus 1, an X-ray CT (Computed Tomography) apparatus 2, and an image storage apparatus 3. Each device illustrated in FIG. 1 can directly or indirectly communicate with each other through, for example, an in-hospital LAN (Local Area Network) 4 installed in the hospital. For example, when a PACS (Picture Archiving and Communication System) is introduced into the image processing system, each device mutually transmits and receives medical image data and the like according to the DICOM (Digital Imaging and Communications in Medicine) standard.

Each device illustrated in FIG. 1 can read and display data received from other devices by transmitting and receiving DICOM standard data. In this embodiment, as long as the data received from another device can be processed by the own device, the data may be transmitted and received according to any standard.

The ultrasonic diagnostic apparatus 1 generates ultrasonic image data of an arbitrary cross section by an operator adjusting the position of an ultrasonic probe that performs two-dimensional ultrasonic scanning. The ultrasonic diagnostic apparatus 1 also uses a mechanical 4D probe or a 2D array probe to perform three-dimensional scanning with ultrasonic waves and generate three-dimensional ultrasonic image data. The ultrasonic diagnostic apparatus 1 then transmits various types of ultrasonic image data to the image storage apparatus 3 .

The X-ray CT apparatus 2 has a rotatable rotating frame supporting an X-ray tube that emits X-rays and an X-ray detector that detects X-rays that have passed through a subject at opposing positions. The X-ray CT apparatus 2 rotates a rotating frame while irradiating X-rays from an X-ray tube, thereby collecting data of X-rays that have been transmitted, absorbed, and attenuated in all directions. Reconstruct line CT image data. The X-ray CT image data is a tomographic image on the plane of rotation (axial plane) between the X-ray tube and the X-ray detector. Here, in the X-ray detector, multiple rows of detection element arrays, which are multiple X-ray detection elements arranged in the channel direction, are arranged along the body axis direction of the subject. For example, the X-ray CT apparatus 2 having an X-ray detector with 16 arrays of detection element arrays obtains a plurality of images along the body axis direction of the subject from the projection data acquired by one rotation of the rotating frame. (for example, 16) X-ray CT image data are reconstructed.

In addition, the X-ray CT apparatus 2 rotates the rotating frame and performs a helical scan in which a table on which the subject is placed is moved. It can be reconstructed as CT image data. Alternatively, for example, in the X-ray CT apparatus 2 having an X-ray detector with 320 arrays of detection element arrays, a three-dimensional X-ray CT image covering the entire heart can be obtained simply by performing a conventional scan in which the rotation frame is rotated once. Data can be reconstructed. In addition, the X-ray CT apparatus 2 can capture three-dimensional X-ray CT image data in chronological order by continuously performing helical scanning and conventional scanning.

In addition, in the present embodiment, the X-ray CT apparatus 2 performs the above-described method of reconstructing the three-dimensional X-ray CT image data for the subject into which the contrast medium is injected, thereby obtaining a three-dimensional contrast-enhanced image. CT image data can be reconstructed. For example, the X-ray CT apparatus 2 reconstructs three-dimensional contrast-enhanced CT image data including the heart of the subject by performing imaging at the timing when a contrast agent injected into the subject flows through the coronary veins of the heart. Coronary veins are clearly depicted in such contrast-enhanced CT image data. More specifically, in such contrast-enhanced CT image data, the coronary veins of the subject P's heart are rendered in a distinguishable manner. The X-ray CT device 2 then transmits various CT image data to the image storage device 3 .

In the first embodiment, the ultrasonic diagnostic apparatus 1 aligns three-dimensional ultrasonic image data generated by the ultrasonic diagnostic apparatus 1 and three-dimensional contrast-enhanced CT image data captured by the X-ray CT apparatus 2. do This alignment will be described later.

The image storage device 3 is a database that stores medical image data. For example, the image storage device 3 stores medical image data such as ultrasonic image data and CT image data transmitted from each of the ultrasonic diagnostic device 1 and the X-ray CT device 2 in a storage circuit, and stores the medical image data. do. The storage circuit referred to here is implemented by, for example, a RAM (Random Access Memory), a semiconductor memory device such as a flash memory, a hard disk, or an optical disk. The medical image data stored in the image storage device 3 includes, for example, a subject ID (identifier) of a subject, an examination ID that is an ID of an examination performed on the subject, and It is stored in association with incidental information such as the device ID, which is the ID of the device used.

Next, a configuration example of the ultrasonic diagnostic apparatus 1 shown in FIG. 1 will be described with reference to FIG. FIG. 2 is a block diagram showing a configuration example of the ultrasonic diagnostic apparatus according to the first embodiment. As illustrated in FIG. 1, the ultrasonic diagnostic apparatus 1 according to the first embodiment has an apparatus main body 100, an ultrasonic probe 101, an input device 102, a display 103, and an electrocardiograph 104.

The ultrasonic probe 101 has, for example, a plurality of elements such as piezoelectric transducers. These multiple elements generate ultrasonic waves based on drive signals supplied from a transmission circuit 110 of the apparatus main body 100, which will be described later. Also, the ultrasonic probe 101 receives reflected waves from the subject P and converts them into electric signals. Further, the ultrasonic probe 101 has, for example, a matching layer provided on the piezoelectric transducers, and a backing material or the like for preventing the ultrasonic waves from propagating backward from the piezoelectric transducers. Note that the ultrasonic probe 101 is detachably connected to the device main body 100 .

When ultrasonic waves are transmitted from the ultrasonic probe 101 to the subject P, the transmitted ultrasonic waves are successively reflected by discontinuous surfaces of acoustic impedance in the body tissue of the subject P, and are reflected by the ultrasonic probe 101 as reflected waves. is received by a plurality of elements possessed by . The amplitude of the received reflected wave depends on the difference in acoustic impedance at the discontinuity from which the ultrasonic waves are reflected. In addition, when the transmitted ultrasonic pulse is reflected by the moving blood flow or the surface of the heart wall, the reflected wave depends on the velocity component of the moving object in the ultrasonic transmission direction due to the Doppler effect. , undergoes a frequency shift.

The ultrasonic probe 101 is provided detachably from the device main body 100 . When scanning a two-dimensional region within the subject P (two-dimensional scanning), the operator connects, for example, a 1D array probe in which a plurality of piezoelectric transducers are arranged in a row as the ultrasonic probe 101 to the apparatus main body 100. do. A 1D array probe is a linear ultrasonic probe, a convex ultrasonic probe, a sector ultrasonic probe, or the like. Further, when scanning a three-dimensional region within the subject P (three-dimensional scanning), the operator connects, for example, a mechanical 4D probe or a 2D array probe as the ultrasonic probe 101 to the apparatus main body 100 . A mechanical 4D probe is capable of two-dimensional scanning using multiple piezoelectric transducers arranged in a row like a 1D array probe, and the multiple piezoelectric transducers are oscillated at a predetermined angle (oscillation angle). Three-dimensional scanning is possible by In addition, the 2D array probe is capable of three-dimensional scanning by means of a plurality of piezoelectric transducers arranged in a matrix, and is also capable of two-dimensional scanning by focusing and transmitting ultrasonic waves.

The input device 102 is implemented by input means such as a mouse, keyboard, button, panel switch, touch command screen, foot switch, trackball, joystick, or the like. The input device 102 receives various setting requests from the operator of the ultrasonic diagnostic apparatus 1 and transfers the received various setting requests to the apparatus main body 100 .

The display 103 displays, for example, a GUI (Graphical User Interface) for the operator of the ultrasonic diagnostic apparatus 1 to input various setting requests using the input device 102, and displays an ultrasonic image generated in the apparatus main body 100. An ultrasound image or the like indicated by the data is displayed. The display 103 is realized by a liquid crystal monitor, a CRT (Cathode Ray Tube) monitor, or the like. The display 103 is an example of a display unit.

The electrocardiograph 14 acquires an electrocardiogram (ECG) of the subject P as a biological signal of the subject P subjected to ultrasonic scanning. The electrocardiograph 14 transmits the acquired electrocardiographic waveform to the apparatus main body 100 .

The apparatus main body 100 generates ultrasonic image data based on reflected wave signals transmitted from the ultrasonic probe 101 . The device main body 100 can generate two-dimensional ultrasonic image data based on reflected wave signals corresponding to a two-dimensional region of the subject P transmitted by the ultrasonic probe 101 . Further, the apparatus main body 100 can generate three-dimensional ultrasonic image data based on the reflected wave signal corresponding to the three-dimensional region of the subject P transmitted by the ultrasonic probe 101 .

As shown in FIG. 2, the apparatus main body 100 includes a transmission circuit 110, a reception circuit 120, a B-mode processing circuit 130, a Doppler processing circuit 140, an image generation circuit 150, an image memory 160, and a storage circuit 170. , a control circuit 180 and a data processing circuit 190 .

The transmission circuit 110 is controlled by the control circuit 180 to transmit ultrasonic waves from the ultrasonic probe 101 . The transmission circuit 110 has a rate pulser generation circuit, a transmission delay circuit, and a transmission pulser, and supplies drive signals to the ultrasonic probe 101 . When scanning a two-dimensional region within the subject P, the transmission circuit 110 causes the ultrasonic probe 101 to transmit an ultrasonic beam for scanning the two-dimensional region. Further, when scanning a three-dimensional region within the subject P, the transmission circuit 110 causes the ultrasonic probe 101 to transmit an ultrasonic beam for scanning the three-dimensional region.

A rate pulse generator circuit repeatedly generates a rate pulse for forming a transmission ultrasonic wave (transmission beam) at a predetermined rate frequency (PRF: Pulse Repetition Frequency). By passing the rate pulse through the transmission delay circuit, a voltage is applied to the transmission pulser with different transmission delay times. For example, the transmission delay circuit generates a transmission delay time for each piezoelectric transducer necessary for focusing the ultrasonic waves generated from the ultrasonic probe 101 into a beam and determining the transmission directivity. given for each rate pulse. The transmission pulser applies a driving signal (driving pulse) to the ultrasonic probe 101 at a timing based on the rate pulse. The transmission delay circuit arbitrarily adjusts the transmission direction of the ultrasonic wave from the piezoelectric transducer surface by changing the transmission delay time given to each rate pulse.

The drive pulse is transmitted from the transmission pulser through the cable to the piezoelectric transducer in the ultrasonic probe 101, and then converted from an electric signal to mechanical vibration in the piezoelectric transducer. Ultrasonic waves generated by this mechanical vibration are transmitted into the living body. Here, ultrasonic waves having different transmission delay times for each piezoelectric transducer are focused and propagate in a predetermined direction.

Note that the transmission circuit 110 has a function capable of instantaneously changing the transmission frequency, the transmission drive voltage, etc., in order to execute a predetermined scan sequence under the control of the control circuit 180 . In particular, the change of the transmission drive voltage is realized by a linear amplifier type oscillator circuit capable of instantaneously switching the value, or by a mechanism for electrically switching a plurality of power supply units.

A reflected wave of the ultrasonic wave transmitted by the ultrasonic probe 101 reaches the piezoelectric vibrator inside the ultrasonic probe 101, and then is converted from mechanical vibration to an electrical signal (reflected wave signal) in the piezoelectric vibrator, It is input to the receiving circuit 120 . Under the control of the control circuit 180, the receiving circuit 120 performs various processes on the reflected wave signal transmitted from the ultrasonic probe 101 to generate reflected wave data, and sends the generated reflected wave data to the B-mode processing circuit. 130 and Doppler processing circuit 140 . The receiving circuit 120 generates two-dimensional reflected wave data from the two-dimensional reflected wave signal transmitted from the ultrasonic probe 101 . The receiving circuit 120 also generates three-dimensional reflected wave data from the three-dimensional reflected wave signal transmitted from the ultrasonic probe 101 .

The receiving circuit 120 has a preamplifier, an A/D (Analog to Digital) converter, a quadrature detection circuit, and the like. The preamplifier amplifies the reflected wave signal for each channel to perform gain adjustment (gain correction). The A/D converter converts the gain-corrected reflected wave signal into a digital signal by A/D-converting the gain-corrected reflected wave signal. The quadrature detection circuit converts the digital signal into a baseband in-phase signal (I signal, I: In-phase) and a quadrature signal (Q signal, Q: Quadrature-phase). The quadrature detection circuit then outputs the I signal and Q signal (IQ signal) as reflected wave data to the B-mode processing circuit 130 and the Doppler processing circuit 140 .

B-mode processing circuit 130, under the control of control circuit 180, performs logarithmic amplification, envelope detection processing, logarithmic compression, etc. on the reflected wave data output from receiving circuit 120 to obtain a signal for each sample point. Data (B-mode data) in which the intensity (amplitude intensity) is represented by the brightness of luminance is generated. The B-mode processing circuit 130 outputs the generated B-mode data to the image generation circuit 150 . The B-mode processing circuit 130 is realized by, for example, a processor.

Under the control of the control circuit 180, the Doppler processing circuit 140 analyzes the frequency of the reflected wave data output from the receiving circuit 120, thereby detecting moving objects (blood flow, tissue, contrast agent echo components, etc.) based on the Doppler effect. is extracted, and data (Doppler data) representing the extracted motion information is generated. For example, the Doppler processing circuit 140 extracts average velocity, variance, power, and the like from multiple points as motion information of the moving object, and generates Doppler data representing the extracted motion information of the moving object. The Doppler processing circuit 140 outputs the generated Doppler data to the image generation circuit 150 . The Doppler processing circuit 140 is implemented by, for example, a processor.

The B-mode processing circuit 130 and the Doppler processing circuit 140 can process both two-dimensional reflected wave data and three-dimensional reflected wave data.

The image generation circuit 150 is controlled by the control circuit 180 to generate ultrasound image data from the data output by the B-mode processing circuit 130 and the Doppler processing circuit 140 . The image generation circuit 150 is implemented by a processor. Here, the image generating circuit 150 converts (scan converts) the scanning line signal train of the ultrasonic scanning into the scanning line signal train of the video format typified by television, etc., and generates ultrasonic image data for display. . For example, the image generating circuit 150 generates ultrasonic image data for display by performing coordinate conversion according to the scanning mode of ultrasonic waves by the ultrasonic probe 101 . In addition, the image generation circuit 150 performs various image processing other than scan conversion, such as image processing (smoothing processing) for regenerating an average brightness image using a plurality of image frames after scan conversion, Image processing (edge enhancement processing) or the like using a differential filter is performed within the image. The image generating circuit 150 also synthesizes character information of various parameters, scales, body marks, etc. with the ultrasonic image data.

The image generation circuit 150 also performs coordinate transformation on the three-dimensional B-mode data generated by the B-mode processing circuit 130 to generate three-dimensional B-mode image data. The image generation circuit 150 also performs coordinate transformation on the three-dimensional Doppler data generated by the Doppler processing circuit 140 to generate three-dimensional Doppler image data. That is, the image generating circuit 150 generates "three-dimensional B-mode image data and three-dimensional Doppler image data" as "three-dimensional ultrasound image data (volume data)". The image generation circuit 150 then performs various rendering processes on the volume data in order to generate various types of two-dimensional image data for displaying the volume data on the display 103 .

Further, the image generating circuit 150 according to this embodiment has an alignment function 150a. The alignment function 150a performs various alignments. For example, the three-dimensional ultrasonic image data generated by the ultrasonic diagnostic apparatus 1 and the three-dimensional contrast-enhanced CT image data captured by the X-ray CT apparatus 2 are aligned. Alignment function 150a will be described later.

The B-mode data and Doppler data are ultrasound image data before scan conversion processing, and the data generated by the image generation circuit 150 are ultrasound image data for display after scan conversion processing. B-mode data and Doppler data are also called raw data.

The image memory 160 is a memory that stores various image data generated by the image generation circuit 150 . Image memory 160 also stores data generated by B-mode processing circuit 130 and Doppler processing circuit 140 . The B-mode data and Doppler data stored in the image memory 160 can be called up by the operator after diagnosis, for example, and become ultrasonic image data for display via the image generation circuit 150 . For example, the image memory 160 is implemented by a RAM, a semiconductor memory device such as a flash memory, a hard disk, or an optical disk.

The storage circuit 170 stores control programs for transmitting and receiving ultrasonic waves, image processing, and display processing, diagnostic information (for example, patient ID, doctor's findings, etc.), various data such as diagnostic protocols and various body marks. . The storage circuit 170 is also used for storing data stored in the image memory 160 as required. For example, the storage circuit 170 is implemented by a semiconductor memory device such as flash memory, a hard disk, or an optical disk.

A control circuit 180 controls the entire processing of the ultrasonic diagnostic apparatus. Specifically, the control circuit 180 controls the transmission circuit 110 and the reception circuit 120 based on various setting requests input by the operator via the input device 102 and various control programs and various data read from the storage circuit 170 . , B-mode processing circuit 130 , Doppler processing circuit 140 , image generation circuit 150 and data processing circuit 190 . The control circuit 180 also controls the display 103 to display the ultrasonic image indicated by the display ultrasonic image data stored in the image memory 160 . The control circuit 180 is implemented by, for example, a processor.

The data processing circuit 190 is controlled by the control circuit 180 and performs various types of processing on various types of ultrasound image data generated by the image generation circuit 150 . The data processing circuit 190 has an exercise information generation function 190a. The motion information generation function 190a generates various types of motion information about the heart. The exercise information generation function 190a will be described later. The data processing circuit 190 is implemented by, for example, a processor.

Here, for example, each processing function of the image generating circuit 150 and the data processing circuit 190 described above is stored in the storage circuit 170 in the form of a computer-executable program. The image generation circuit 150 reads a program corresponding to the alignment function 150a from the storage circuit 170 and executes the read program to implement the alignment function 150a. The data processing circuit 190 reads a program corresponding to the motion information generating function 190a from the storage circuit 170 and executes the read program to realize the motion information generating function 190a. In other words, the image generation circuit 150 in a state where the program corresponding to the alignment function 150a is read has the alignment function 150a shown in FIG. Further, the data processing circuit 190 in a state where the program corresponding to the motion information generating function 190a is read has the motion information generating function 190a shown in FIG.

The term "processor" used in the above description is, for example, a CPU (Central Processing Unit), a GPU (Graphics Processing Unit), an application specific integrated circuit (ASIC), or a programmable logic device (e.g., Circuits such as Simple Programmable Logic Device (SPLD), Complex Programmable Logic Device (CPLD), or Field Programmable Gate Array (FPGA). The processor implements its functions by reading and executing programs stored in the storage circuit 170 . Note that instead of storing the program in the memory circuit 170, the program may be configured to be directly installed in the circuit of the processor. In this case, the processor implements its functions by reading and executing the program embedded in the circuit. Note that each processor of the present embodiment is not limited to being configured as a single circuit for each processor, and may be configured as one processor by combining a plurality of independent circuits to realize its function. good. Furthermore, a plurality of components in FIG. 1 may be integrated into one processor to realize its functions.

The overall configuration of the ultrasonic diagnostic apparatus 1 according to the first embodiment has been described above. Here, a case where an operator who performs CRT using the ultrasonic diagnostic apparatus 1 places a lead on the outer surface of the left ventricle while being inserted into the coronary vein of the heart of the subject P will be described. In this case, since the position where the lead is placed depends on the characteristics of the heart of the subject P, it is difficult for the operator to place the lead in a suitable position. Also, there is the task of performing a test each time the lead is placed to ensure that the heart's signals are being properly sensed. Therefore, if the work is repeatedly performed until the lead is placed in an appropriate position, the subject P is burdened. Therefore, the ultrasonic diagnostic apparatus 1 according to the present embodiment is designed so that the operator can easily determine the position of the lead placed on the outer surface of the left ventricle while being inserted into the coronary vein. Executes various processes described in .

For example, the image generating circuit 150 converts a plurality of three-dimensional B-mode data from a plurality of three-dimensional B-mode data obtained by capturing images of the left ventricle of the heart of the subject P in time series over a period of one heartbeat or more. Generate B-mode image data. In this way, a plurality of time-series three-dimensional B-mode image data are generated by three-dimensionally scanning the heart of the subject P with ultrasound. Note that the three-dimensional B-mode image data is an example of the first three-dimensional medical image data.

FIG. 3 is a diagram showing an example of a stimulus propagation image according to the first embodiment. Then, as shown in FIG. 3, the motion information generation function 190a generates a stimulus in which stimulation propagation information of the myocardium is superimposed on a surface rendering image of the left ventricular surface, based on a plurality of three-dimensional B-mode image data. Stimulus propagated image data indicative of propagated image 12 is generated. For example, the motion information generation function 190a generates stimulus propagation image data using the technique described in Japanese Patent Application Laid-Open No. 2012-187383. The stimulus propagation image 12 is also referred to as a "temporal preserving superimposed image".

For example, as shown in the stimulus propagation image 12, the left ventricle endocardial surface is divided into 16 segments recommended by the American Society of Echocardiography and the like. However, the motion information generation function 190a sets a mesh composed of a plurality of rectangles smaller than 16 fractions on the left ventricular endocardial surface. Then, the motion information generating function 190a calculates the rate of change (unit: %) of the area of each rectangle for each cardiac phase. Then, the motion information generation function 190a assigns a color corresponding to the cardiac phase in which the rate of change in area exceeds the threshold for the first time in a certain cardiac phase to the rectangle, thereby showing the mode of propagation of the stimulus. generates stimulus propagation image data showing a stimulus propagation image 12 that is easy for the operator to understand. Thus, the motion information generating function 190a generates stimulation propagation image data representing stimulation propagation information of the myocardium of the left ventricle of the subject P's heart based on a plurality of three-dimensional B-mode image data. Note that the exercise information generation function 190a is an example of a first generation unit.

Then, the registration function 150a extracts at least one of various long axes and various short axes of the left ventricle of the heart of the subject P from the stimulus propagation image data. For example, the long axis includes a horizontal long axis (HLA).

The alignment function 150a acquires three-dimensional contrast-enhanced CT image data including the heart of the subject P from the image storage device 3 via an interface (not shown).

FIG. 4 is a diagram showing an example of coronary veins according to the first embodiment. Then, as shown in FIG. 4, the registration function 150a extracts the coronary veins 11 of the subject P's heart from the three-dimensional contrast-enhanced CT image data. For example, the registration function 150a extracts the coronary veins 11 using voxel value thresholding, region growing, or other segmentation processing on the three-dimensional contrast-enhanced CT image data. Specifically, the registration function 150a extracts CT image data showing the coronary veins 11 from the three-dimensional contrast-enhanced CT image data. In this way, the positioning function 150a extracts the coronary veins 11 from the three-dimensional contrast-enhanced CT image data in which the coronary veins of the heart of the subject P are drawn in a distinguishable manner. The three-dimensional contrast-enhanced CT image data is an example of the second three-dimensional medical image data. Also, the alignment function 150a is an example of a second generator.

In this embodiment, the stimulus-propagated image data indicating the stimulus-propagated image 12 and the contrast-enhanced CT image data indicating the coronary veins 11 are to be aligned.

Then, the registration function 150a extracts from the three-dimensional contrast-enhanced CT image data the axes of the same type as the axes extracted from the previous stimulus propagation image data.

Then, the registration function 150a aligns the axes extracted from the stimulation propagation image data with the axes extracted from the three-dimensional contrast-enhanced CT image data, so that the CT image data showing the coronary veins 11 and the stimulation propagation image 12 are aligned. Alignment with stimulus propagation image data shown is performed. CT image data showing the coronary vein 11 is an example of medical image data.

FIG. 5 is a diagram for explaining an example of processing executed by the alignment function according to the first embodiment; As shown in FIG. 5, the registration function 150a provides superimposed image data (composite image data) showing a superimposed image (composite image) 10 in which the coronary veins 11 are superimposed on the stimulus propagation image 12 after the registration has been performed. ). That is, the registration function 150a generates composite image data representing the composite image 10 in which the coronary vein 11 and the stimulus propagation image 12 are composited. Alignment function 150a is an example of a second generator.

Then, the control circuit 180 causes the display 103 to display the superimposed image 10 indicated by the superimposed image data.

Then, as shown in FIG. 5, the operator viewing the superimposed image 10 displayed on the display 103, for example, on the stimulus propagation image 12, a region of interest (ROI: Region Of Interest) at a site where the stimulus is slow to propagate. 12a is input through the input device 102. FIG. When the lead placed in the coronary vein 11 is close to such a region where the propagation of stimulation is slow, pacing that corrects the difference in contraction timing between the left ventricle and the right ventricle in CRT is considered to be performed effectively. because it will be

Then, when receiving the setting instruction, the control circuit 180 sets the region of interest 12a based on the setting instruction. Then, the control circuit 180 displays a mark (first mark) 11a indicating a candidate position where the lead is placed on the coronary vein 11 closest to the region of interest 12a. This allows the operator to know that the lead placement position for effectively stimulating the region of interest 12a is the position of the mark 11a.

In this way, control circuit 180 accepts setting of region of interest 12 a in stimulus propagation image 12 included in synthesized image 10 displayed on display 103 . Then, the control circuit 180 sets the received region of interest 12 a on the stimulus propagation image 12 . For example, the control circuit 180 causes the display 103 to display a mark indicating the range of the region of interest 12a superimposed on the stimulus propagation image 12 . Then, the control circuit 180 displays the mark 11a at the position on the coronary vein 11 included in the composite image 10 displayed on the display 103, which is closest to the region of interest 12a. The control circuit 180 is an example of a display control section.

FIG. 6 is a diagram showing an example of an electrocardiographic waveform according to the first embodiment and graphs of time change curves of average motion information (average rate of change in area) for each segment of the left ventricular surface. Here, the control circuit 180 displays the superimposed image 10 shown in FIG. 5 together with the electrocardiogram waveform shown in FIG. It may be displayed on the display 103 . In addition, in FIG. 6, the time change curve of the average area change rate for each section is indicated by a solid line.

A graph of the time change curve of the average area change rate is generated by the exercise information generation function 190a. For example, the motion information generating function 190a calculates all rectangles in each segment in each set of a reference cardiac phase (reference cardiac phase) and each of a plurality of other cardiac phases. By dividing the sum of the calculated area change rates by the number of rectangles, the mean area change, which is the average value of the area change rates for each segment in each pair of the reference cardiac phase and each of the other multiple cardiac phases, is obtained. Calculate the rate. Then, the motion information generation function 190a plots the average area change rate calculated for each group of the reference cardiac phase and each of the plurality of cardiac phases other than the reference cardiac phase, thereby obtaining Calculate the graph of the time change curve of the average area change rate of .

Furthermore, the control circuit 180 according to the present embodiment may cause the display 103 to display a graph of the time change curve of the average area change rate of the region of interest 12a, as shown in FIG. In addition, in FIG. 6, the time change curve of the average area change rate of the region of interest 12a is indicated by a broken line. Such a time change curve of the average area change rate of the region of interest 12a is also generated by the motion information generation function 190a. For example, the motion information generation function 190a calculates the sum of the area change rates calculated for all rectangles in the region of interest 12a in each pair of the reference cardiac phase and each of the plurality of other cardiac phases as the number of rectangles. By dividing by , an average area change rate, which is an average value of area change rates of the region of interest 12a in each pair of the reference cardiac phase and each of the plurality of other cardiac phases, is calculated. Then, the motion information generation function 190a plots the average area change rate calculated for each pair of the reference cardiac phase and each of the plurality of cardiac phases other than the reference cardiac phase, thereby obtaining the average of the region of interest 12a. A graph of the time change curve of the area change rate is calculated. That is, the motion information generating function 190a generates the average area change rate of the part within the region of interest 12a. Then, the control circuit 180 causes the display 103 to display the average area change rate of the part within the region of interest 12a.

By displaying such a graph of the time change curve of the average area change rate of the region of interest 12a, the operator can grasp in detail the aspect of the propagation of the stimulus of the site where the region of interest 12a set by him/herself is set. can do.

Here, each of the 16 segments recommended by the American Society of Echocardiography and the like on the left ventricle endocardial surface is a segmented region by segmentation in cardiac clinical practice. For example, the region of interest 12a is smaller than such a divided region. Therefore, the time change curve of the average area change rate of the region of interest 12a is a time change curve for a subdivided region rather than the time change curve of the average area change rate for each divided region (section).

Also, in this embodiment, the input device 102 has a button called a best position button. 7 is a diagram for explaining an example of a process executed by a control circuit according to the first embodiment; FIG. When the best position button is pressed by the operator, the control circuit 180 places a mark (second mark) 12b on the position of the slowest stimulus propagation image 12 on the stimulus propagation image 12, as shown in FIG. display. As a result, the operator can grasp the position on the coronary vein 11 closest to the position of the mark 12b as the lead placement position where the above-described pacing can be effectively performed. Therefore, according to this embodiment, the operator can easily determine the position of the lead placed on the outer surface of the left ventricle while being inserted into the coronary vein.

That is, the control circuit 180 causes the display 103 to display the synthesized image 10 indicated by the above-described synthesized image data. In addition, the control circuit 180 displays the mark 12b at the position of the slowest stimulus propagation image 12 included in the composite image 10 displayed on the display 103 .

Then, the operator sets the region of interest 12a many times while shifting the position of the region of interest 12a, for example. Here, the operator checks the graph of the time change curve of the average area change rate of the region of interest 12a displayed on the display 103 each time the region of interest 12a is set. This allows the operator to grasp the site where the stimulus is thought to propagate the slowest. Then, the operator determines, for example, the position on the coronary vein 11 closest to the site where the propagation of the stimulus is considered to be the slowest as the placement position for the lead. Then, the operator inputs designation of the determined placement position via the input device 102 . In this way, the operator determines the position of the lead placed on the outer surface of the left ventricle while being inserted into the coronary vein by checking the graph of the time change curve of the average area change rate of the region of interest 12a. do. Therefore, according to this embodiment, the operator can easily determine the position of the lead.

When the designation of the placement position is input, the control circuit 180 stores the position information indicating the specified placement position in the storage circuit 170 as the position information indicating the position where the leads are actually placed on the CRT.

FIG. 8 is a flowchart showing an example of the placement position determination process performed by the ultrasonic diagnostic apparatus according to the first embodiment. The placement position determination process shown in FIG. 8 is executed, for example, when the ultrasonic diagnostic apparatus 1 receives an instruction for executing the placement position determination process from the operator via the input device 102 .

As shown in FIG. 8, the motion information generating function 190a generates stimulus propagation image data representing the stimulus propagation image 12 based on a plurality of three-dimensional B-mode image data (step S101). Then, the registration function 150a extracts at least one of various long axes and various short axes of the left ventricle of the heart of the subject P from the stimulus propagation image data (step S102).

Then, the alignment function 150a acquires three-dimensional contrast-enhanced CT image data including the heart of the subject P from the image storage device 3 via an interface (not shown) (step S103). The registration function 150a extracts the coronary veins 11 of the subject P's heart from the three-dimensional contrast-enhanced CT image data (step S104).

Then, the alignment function 150a extracts from the three-dimensional contrast-enhanced CT image data the same type of axes as the previously extracted from the stimulus propagation image data (step S105). Then, the registration function 150a aligns the axis extracted from the stimulation propagation image data with the axis extracted from the three-dimensional contrast-enhanced CT image data, thereby providing the stimulation propagation image data showing the stimulation propagation image 12 and the coronary veins. 11 is aligned with the CT image data (step S106).

Then, the registration function 150a generates superimposed image data representing the superimposed image 10 in which the coronary veins 11 are superimposed on the stimulus propagation image 12 (step S107).

Then, the control circuit 180 causes the display 103 to display the superimposed image 10 indicated by the superimposed image data (step S108).

Then, the control circuit 180 determines whether or not an instruction (setting instruction) for setting the region of interest 12a has been received from the operator via the input device 102 (step S109). If no setting instruction has been received (step S109: No), the control circuit 180 proceeds to step S112.

On the other hand, if a setting instruction has been received (step S109: Yes), the control circuit 180 sets the region of interest 12a based on the setting instruction (step S110). Then, the control circuit 180 displays a first mark 11a indicating a lead placement candidate at a position on the coronary vein 11 closest to the region of interest 12a (step S111).

Control circuit 180 determines whether or not the best position button has been pressed (step S112). If the best position button has not been pressed (step S112: No), the control circuit 180 proceeds to step S114.

On the other hand, if the best position button is pressed (step S112: Yes), the control circuit 180 causes the second mark 12b to be displayed on the stimulus propagation image 12 at the position of the slowest stimulus propagation (step S113). ).

The control circuit 180 determines whether or not designation of the placement position has been received from the operator via the input device 102 (step S104). If the designation of the placement position has not been received (step S104: No), the control circuit 180 returns to step S109 and executes the processes after step S109 again.

On the other hand, if the designation of the placement position has been accepted (step S104: Yes), the control circuit 180 stores the position information indicating the specified placement position as the position information indicating the position where the lead is placed on the actual CRT. 170 (step S115). Then, the control circuit 180 ends the placement position determination process.

Step S101 shown in FIG. 8 is a step corresponding to the exercise information generating function 190a. Step S101 is a step in which the data processing circuit 190 calls and executes a program corresponding to the exercise information generation function 190a from the storage circuit 170, thereby realizing the exercise information generation function 190a.

Steps S102 to S107 are steps corresponding to the alignment function 150a. Steps S102 to S107 are steps in which the image generation circuit 150 calls and executes a program corresponding to the alignment function 150a from the storage circuit 170, thereby realizing the alignment function 150a.

The ultrasonic diagnostic apparatus 1 according to the first embodiment has been described above. According to the ultrasonic diagnostic apparatus 1 according to the first embodiment, as described above, the operator can easily determine the position of the lead placed on the outer surface of the left ventricle while being inserted into the coronary vein. be able to.

(First Modification of First Embodiment)
In the above-described first embodiment, the motion information generation function 190a generates stimulation propagation image data representing the stimulation propagation image 12 in which the stimulation propagation information of the myocardium is mapped onto the surface rendering image of the left ventricular surface. explained the case. However, the motion information generating function 190a generates stimulus propagation image data representing the stimulus propagation image 12 as well as stimulus propagation image data showing the stimulus propagation image in which the myocardial stimulus propagation information is mapped to the polar-map of 16 segments. may Therefore, such a modified example will be described as a first modified example of the first embodiment. In the following description, differences between the ultrasonic diagnostic apparatus 1 according to the first modification and the ultrasonic diagnostic apparatus 1 according to the first embodiment will be described.

FIG. 9 is a diagram for explaining an example of processing executed by the ultrasonic diagnostic apparatus according to the first modification. As shown on the left side of FIG. 9, in the first modified example, the alignment function 150a uses a superimposed image (composite image) 10 in which the coronary veins 11 are superimposed on the stimulus propagation image 12, as in the first embodiment. to generate superimposed image data (composite image data). That is, the registration function 150a generates composite image data representing the composite image 10 in which the coronary vein 11 and the stimulus propagation image 12 are composited. Note that a mark 12b is arranged on the stimulus propagation image 12. FIG.

Then, as shown on the right side of FIG. 9, in the first modified example, the registration function 150a generates a stimulation propagation image 20a in which stimulation propagation information of the myocardium is mapped on a 16-segment polar-map. Generate data. Then, the registration function 150a generates superimposed image data (composite image data) representing a superimposed image (composite image) 20 in which the coronary veins 11 are superimposed on the stimulus propagation image 20a. That is, the registration function 150a generates composite image data representing a composite image 20 in which the coronary vein 11 and the stimulus propagation image 20a are composited. Note that the position corresponding to the mark 12b is indicated by two arrows 20b and 20c on the stimulus propagation image 20a. Specifically, the position between the two arrows 20b and 20c is the position corresponding to the mark 12b.

Then, the control circuit 180 causes the display 103 to display the synthesized image 10 and the synthesized image 20 side by side.

The ultrasonic diagnostic apparatus 1 according to the first modification of the first embodiment has been described above. According to the ultrasonic diagnostic apparatus 1 according to the first modification, as in the first embodiment, the operator is instructed to indicate the position of the lead to be placed on the outer surface of the left ventricle while being inserted into the coronary vein. can be easily determined.

(Second Modification of First Embodiment)
Next, a second modification of the first embodiment will be described. Unlike the ultrasonic diagnostic apparatus 1 according to the first embodiment, the ultrasonic diagnostic apparatus 1 according to the second modification has a mark (a mark 11a in the first embodiment) indicating a candidate position where the lead is placed. ) (candidate mark display process) is different. Therefore, an example of candidate mark display processing executed by the ultrasonic diagnostic apparatus 1 according to the second modification will be described with reference to FIGS. 10 to 15. FIG.

First, an example of the principle of candidate mark display processing in the second modification will be described with reference to FIGS. 10 to 12 are diagrams for explaining an example of the principle of candidate mark display processing in the second modification.

For example, when a region of interest is set on the stimulus propagation image, assume that there are four positions on the coronary vein where the distance from the region of interest is less than a predetermined threshold, as shown in FIG. . However, in FIG. 10, the coronary veins are not shown, and each of the four tissues of the subject's left ventricular wall (myocardium) 30 closest to each of the four points on the coronary vein is labeled "30a". is indicated.

Here, for example, if there is scar tissue on the heart wall 30 near where the lead is placed, even if the above-described pacing is performed, it is considered that the effect is limited. Therefore, as shown in FIG. 11, the control circuit 180 identifies the scar tissue 30b of the heart wall 30. As shown in FIG. For example, the control circuit 180 identifies the scar tissue 30b of the heart wall 30 from the longitudinal strain (Longitudinal Strain) calculated for each rectangle by the motion information generating function 190a. More specifically, control circuit 180 identifies scar tissue 30b as scar tissue 30b, which corresponds to a substantially unchanged rectangle whose longitudinal strain is less than a predetermined threshold. In the example of FIG. 11, control circuit 180 identifies four scar tissue 30b.

Then, the control circuit 180 identifies two tissues 30a, excluding the scar tissue 30b shown in the example of FIG. 11, out of the four tissues 30a shown in FIG. Then, as shown in FIG. 12, the control circuit 180 causes the mark 30c to be displayed at the position on the coronary vein closest to each of the two tissues 30a. The principle has been described above with reference to FIGS.

Next, a specific example will be described with reference to FIGS. 13 to 15. FIG. 13 to 15 are diagrams for explaining an example of processing executed by the ultrasonic diagnostic apparatus according to the second modification.

The control circuit 180 first identifies a range on the coronary vein such that the distance from the region of interest (not shown) set on the stimulus propagation image of the composite image 20 shown in FIG. 13 is less than a predetermined threshold. do. However, in FIG. 13, the coronary veins are not shown, and the range of tissue 30a on the left ventricular surface corresponding to the specified range on the coronary veins is shown.

FIG. 14 shows a motion information image 21 in which distortion information indicating distortion in the long-axis direction of the myocardium is superimposed on a surface rendering image of the left ventricle lining. The motion information image data representing the motion information image 21 is generated by the motion information generating function 190a. For example, the motion information generation function 190a sets a mesh made up of a plurality of rectangles on the left ventricular surface. Then, the motion information generating function 190a calculates the distortion in the longitudinal direction for each rectangle. Note that the strain in the longitudinal direction is an example of motion information. Then, the motion information generation function 190a assigns a color corresponding to the distortion in the long axis direction to each rectangle, and the motion information image 21 showing the distortion in the long axis direction for each local area is easy for the operator to understand. Generate data. In this manner, the motion information generating function 190a generates motion information image data representing the longitudinal distortion of the myocardium of the left ventricle of the subject P's heart based on a plurality of three-dimensional B-mode image data.

Then, as shown in FIG. 14, the control circuit 180 specifies the range of the scar tissue 30b as the range of the scar tissue 30b, where the strain in the longitudinal direction is less than a predetermined threshold, and the region remains almost unchanged.

Then, the control circuit 180 specifies a range excluding the range of the scar tissue 30b shown in the example of FIG. 14 from the range of the tissue 30a shown in FIG. Then, as shown in FIG. 15, the control circuit 180 displays a mark 30c at a position on the coronary vein (not shown) corresponding to the specified range. Thus, control circuit 180 identifies myocardial scar tissue based on longitudinal strain and causes mark 30c to be displayed to avoid the identified scar tissue.

According to a second variant, marks 30c are set to indicate potential lead placement positions so as to avoid scar tissue. Therefore, according to the second modification, the operator can easily determine a more appropriate position of the lead that is placed on the outer surface of the left ventricle while being inserted into the coronary vein.

(Second embodiment)
Here, the subject P on whom the CRT is to be performed undergoes various examinations before the CRT is performed. Various examinations include, for example, electrophysiological examination using an electric catheter, echocardiography, MRI examination using an MRI (Magnetic Resonance Imaging) device, coronary vein CT examination, and X-ray diagnostic equipment. inspection, etc. Therefore, by displaying various medical images indicated by various types of medical image data obtained by these examinations in a common coordinate system, the contents obtained by each examination are displayed in an integrated manner. will be described as an embodiment.

In the description of the second embodiment, the same reference numerals may be given to the same configurations as those of the above-described embodiment and modifications, and the description thereof may be omitted. The ultrasonic diagnostic apparatus 1 according to the second embodiment executes processing similar to that of the ultrasonic diagnostic apparatus 1 according to the first embodiment or any of the modifications. In addition to this, the ultrasonic diagnostic apparatus 1 according to the second embodiment executes processing described below.

The image processing system according to the second embodiment has an MRI apparatus, an X-ray diagnostic apparatus, etc. in addition to the ultrasonic diagnostic apparatus 1, X-ray CT apparatus 2, and image storage apparatus 3 shown in FIG. Each device is in a state of being able to directly or indirectly communicate with each other via the hospital LAN 4 .

For example, in each examination performed using each of the ultrasonic diagnostic apparatus 1, the X-ray CT apparatus 2, the image storage apparatus 3, the MRI apparatus, and the X-ray diagnostic apparatus, a common mark is placed on the subject P. By setting to the same position, a common coordinate system can be constructed for a plurality of examinations.

FIG. 16 is a block diagram showing a configuration example of an ultrasonic diagnostic apparatus according to the second embodiment. The ultrasonic diagnostic apparatus 1 according to the second embodiment differs from the ultrasonic diagnostic apparatus 1 according to the first embodiment in that an attachment device 105 is attached to the subject P. FIG.

For example, the attachment device 105 is attached to a set position on the body surface of the subject P, for example. This setting position can be changed arbitrarily. The attachment device 105 includes an "omniTRAX (trademark) bracket" (manufactured by Sibuco). For example, in each examination performed using each of the ultrasonic diagnostic apparatus 1, the X-ray CT apparatus 2, the image storage apparatus 3, the MRI apparatus, and the X-ray diagnostic apparatus, the attachment device 105 is attached to the same subject P. By setting the positions, a common coordinate system can be constructed for each inspection. For example, a common coordinate system is constructed by generating medical image data for each examination so as to include the attachment device 105 and performing alignment by matching the position of the attachment device 105 included in each of the plurality of pieces of medical image data. can. By displaying each diagnostic image in a common coordinate system, for example, it is possible to know how scar tissue is displayed in each diagnostic image, and the positional relationship becomes clearer.

Since a common coordinate system can be constructed in this way, the ultrasonic diagnostic apparatus 1 according to the second embodiment can display various images on the display 103 as shown in FIG. FIG. 17 is a diagram showing a display example of the display according to the second embodiment. In the present embodiment, the control circuit 180 controls delayed contrast enhancement image data obtained from an MRI apparatus, electrophysiological examination map data obtained by an electric catheter in an electrophysiological examination, and an X-ray image obtained from an X-ray diagnostic apparatus. Various medical image data such as data are stored in the storage circuit 170 . Then, the control circuit 180 acquires various types of medical image data stored in the storage circuit 170, and uses the acquired various types of medical image data to execute the processing described below.

As shown in FIG. 17, the control circuit 180 causes the display 103 to display the synthesized image 10 and the synthesized image 20 arranged vertically on the left edge. The composite image 10 includes a cut plane 10a.

Further, the control circuit 180 causes the display 103 to display the delayed contrast-enhanced image 41 indicated by the delayed contrast-enhanced image data obtained from the MRI apparatus. The delayed contrast-enhanced image 41 shows, for example, a cut plane of the subject P cut by the cut plane 10a. The delayed contrast-enhanced image data is, for example, medical image data obtained by imaging the subject P into which a gadolinium-based contrast agent has been introduced by an MRI apparatus. Scar tissue can be easily identified by using the delayed contrast-enhanced image data. The delayed contrast-enhanced image 41 includes two arrows 41a and 41b. The two arrows 41a, 41b are marks indicating scar tissue.

Further, the control circuit 180 causes the display 103 to display an electrocardiographic waveform and graph similar to the electrocardiographic waveform and graph shown in FIG.

Further, the control circuit 180 causes the display 103 to display the electrophysiological test map 42 indicated by the electrophysiological test map data. The electrophysiological examination map 42 includes a mark 42a indicating the position of the lead placed in the right atrium of the subject P and a mark 42b indicating the position of the lead placed in the right ventricle.

Here, the lead placed on the outer surface of the left ventricle while inserted into the coronary vein should be moderately distant from the lead placed in the right atrium and the lead placed in the right ventricle in the left ventricular overview. The therapeutic effect of CRT is high. Therefore, the control circuit 180 according to the present embodiment controls the position of the lead placed in the right atrium of the subject P, and the position of the lead placed in the right ventricle of the subject P by a predetermined distance, which is the position of the stimulus propagation. Marks 12c and 20d indicating a certain range are placed at positions on the images 12 and 20a. This allows the operator to determine the optimum site for placing the lead among the sites where stimulation propagation is slow.

Further, the control circuit 180 causes the display 103 to display the X-ray image 43 indicated by the X-ray image data acquired from the X-ray diagnostic apparatus. The X-ray image 43 shows, for example, a cut plane of the subject P cut by the cut plane 10a. The X-ray image 43 includes the subject P's coronary veins.

In this way, the control circuit 180 according to the second embodiment uses the common coordinate system to display the medical image indicated by the medical image data acquired from another medical image diagnostic apparatus on the display 103 .

Next, the case where the operator performs CRT on the subject P using the X-ray diagnostic apparatus will be described. FIG. 18 is a diagram showing a display example of the X-ray diagnostic apparatus according to the second embodiment. As shown in FIG. 18, the X-ray diagnostic apparatus can similarly display the stimulation propagation image 12 superimposed on the X-ray image 50 using a common coordinate system.

Here, the control circuit 180 of the ultrasonic diagnostic apparatus 1 acquires the position information indicating the placement position from the storage circuit 170, and obtains the stimulus propagation image 12 in which the mark 12c is placed at the placement position indicated by the position information. Send data to X-ray diagnostic equipment. As a result, the X-ray diagnostic apparatus displays the stimulation propagation image 12 on which the mark 12c is superimposed, as shown in FIG. Since the operator can adjust the position of the lead using the mark 12c as the target position, the operator can easily place the lead in an appropriate position.

The ultrasonic diagnostic apparatus 1 according to the second embodiment has been described above. According to the ultrasonic diagnostic apparatus 1 according to the second embodiment, it is possible to integrally display the contents obtained in each examination. Further, according to the ultrasonic diagnostic apparatus 1 according to the second embodiment, as in the first embodiment, the operator is instructed to insert the lead inserted into the coronary vein and placed on the outer surface of the left ventricle. The position can be determined easily.

(Third embodiment)
Next, a third embodiment will be described. FIG. 19 is a diagram illustrating an example of the configuration of a medical image processing apparatus according to the third embodiment; As shown in FIG. 19, the medical image processing apparatus 5 is connected to an ultrasonic diagnostic apparatus 1, an X-ray CT apparatus 2, and an image storage apparatus 3 via an in-hospital LAN 4. FIG. The configuration shown in FIG. 19 is merely an example. In addition to the ultrasonic diagnostic apparatus 1, X-ray CT apparatus 2, and image storage apparatus 3 shown in the figure, various devices such as terminal devices may be connected to the hospital LAN 4. good.

An ultrasonic diagnostic apparatus 1 stores a plurality of time-series 3D B-mode image data generated by three-dimensionally scanning the heart of a subject P with an image storage device 3 and a medical image processing device 5 . Send to

The X-ray CT apparatus 2 transmits three-dimensional contrast-enhanced CT image data to the image storage apparatus 3 and the medical image processing apparatus 5 .

The image storage device 3 stores a plurality of three-dimensional B-mode image data transmitted from the ultrasonic diagnostic apparatus 1 . The image storage device 3 also stores the three-dimensional contrast-enhanced CT image data transmitted from the X-ray CT device 2 . For example, the image storage device 3 is realized by computer equipment such as a server device. The image storage device 3 acquires a plurality of three-dimensional B-mode image data from the ultrasonic diagnostic apparatus 1 via the hospital LAN 4, and stores the acquired plurality of three-dimensional B-mode image data inside or outside the device. stored in a memory such as a hard disk or an optical disk. The image storage device 3 also acquires 3D contrast-enhanced CT image data from the X-ray CT apparatus 2 via the hospital LAN 4 and stores the acquired 3D contrast-enhanced CT image data in a memory such as a hard disk or an optical disk. In addition, the image storage device 3 transmits a plurality of 3D B-mode image data and 3D contrast-enhanced CT image data stored in the memory to the medical image processing device 5 in response to a request from the medical image processing device 5. do.

The medical image processing apparatus 5 acquires a plurality of three-dimensional B-mode image data and three-dimensional contrast-enhanced CT image data from the ultrasonic diagnostic apparatus 1, the X-ray CT apparatus 2, and the image storage apparatus 3 via the hospital LAN 4. FIG. The medical image processing apparatus 5 then processes a plurality of three-dimensional B-mode image data and three-dimensional contrast-enhanced CT image data. For example, the medical image processing apparatus 5 stores a plurality of acquired 3D B-mode image data and 3D contrast-enhanced CT image data in a memory 5b to be described later, and stores the plurality of 3D B-mode image data stored in the memory 5b. Various types of processing are performed on the image data and the three-dimensional contrast-enhanced CT image data. Then, the medical image processing apparatus 5 causes the display 5d, which will be described later, to display the processed image and the like.

As shown in FIG. 1, the medical image processing apparatus 5 has a communication interface 5a, a memory 5b, an input interface 5c, a display 5d, and a processing circuit 5e.

The communication interface 5a is connected to the processing circuit 5e and controls transmission of various data between the ultrasonic diagnostic apparatus 1, the X-ray CT apparatus 2 and the image storage apparatus 3 which are connected via the hospital LAN 4. FIG. Also, the communication interface 5 a controls communication between the ultrasonic diagnostic apparatus 1 , the X-ray CT apparatus 2 and the image storage apparatus 3 . For example, the communication interface 5a is implemented by a network card, network adapter, NIC (Network Interface Controller), or the like. For example, the communication interface 5 a receives a plurality of 3D B-mode image data and 3D contrast-enhanced CT image data from the ultrasonic diagnostic apparatus 1 , the X-ray CT apparatus 2 and the image storage apparatus 3 . The communication interface 5a outputs the received plurality of three-dimensional B-mode image data and three-dimensional contrast-enhanced CT image data to the processing circuit 5e.

The memory 5b is connected to the processing circuit 5e and stores various data. For example, the memory 5b is implemented by a RAM, a semiconductor memory device such as a flash memory, a hard disk, or an optical disk. In this embodiment, the memory 5b stores a plurality of 3D B-mode image data and 3D contrast-enhanced CT image data received from the ultrasonic diagnostic apparatus 1, the X-ray CT apparatus 2, and the image storage apparatus 3. FIG.

In addition, the memory 5b stores various information used in processing by the processing circuit 5e, processing results by the processing circuit 5e, and the like. For example, the memory 5b stores image data for display generated by the processing circuit 5e. The memory 5b is an example of a storage unit.

The input interface 5c is connected to the processing circuit 5e, converts an input operation received from an operator into an electric signal, and outputs the electric signal to the processing circuit 5e. For example, the input interface 5c includes a trackball, a switch button, a mouse, a keyboard, a touch pad for performing input operations by touching the operation surface, and a touch panel in which the display screen and the touch pad are integrated. It is realized by a screen, a non-contact input device using an optical sensor, or a voice input device.

The display 5d is connected to the processing circuit 5e and displays various information and various images output from the processing circuit 5e. For example, the display 5d is realized by a liquid crystal monitor, a CRT monitor, or the like. For example, the display 5d displays a GUI for receiving instructions from the operator, various display images, and various processing results by the processing circuit 5e. The display 5d is an example of a display section.

The processing circuit 5e controls each component of the medical image processing apparatus 5 according to an input operation received from an operator via the input interface 5c. For example, the processing circuit 5e is implemented by a processor. In this embodiment, the processing circuit 5e causes the memory 5b to store a plurality of three-dimensional B-mode image data and three-dimensional contrast-enhanced CT image data output from the communication interface 5a. The processing circuit 5e also controls the display 5d to display the image indicated by the image data.

As shown in FIG. 19, the processing circuit 5e has an acquisition function 5f, an image generation function 5g, a data processing function 5h, and a control function 5i. Here, for example, each processing function of the acquisition function 5f, the image generation function 5g, the data processing function 5h, and the control function 5i, which are components of the processing circuit 5e shown in FIG. 5b. The processing circuit 5e reads each program from the memory 5b and executes each read program to implement the function corresponding to each program. In other words, the processing circuit 5e from which each program has been read has each function shown in the processing circuit 5e of FIG.

All the processing functions of the acquisition function 5f, the image generation function 5g, the data processing function 5h and the control function 5i may be stored in the memory 5b in the form of one program that can be executed by a computer. For example, such programs are also referred to as medical image processing programs. In this case, the processing circuit 5e reads the medical image processing program from the memory 5b, and executes the read medical image processing program to obtain the acquisition function 5f, the image generation function 5g, the data processing function 5h, and the data processing function 5h corresponding to the medical image processing program. It implements the control function 5i.

The acquisition function 5f acquires a plurality of three-dimensional B-mode image data and three-dimensional contrast-enhanced CT image data from the memory 5b. A plurality of three-dimensional B-mode image data and three-dimensional contrast-enhanced CT image data acquired by the acquisition function 5f are used for various processes by the image generation function 5g, the data processing function 5h, and the control function 5i.

The image generation function 5g corresponds to the function of the image generation circuit 150 described above (for example, the alignment function 150b). The image generation function 5g uses the data acquired by the acquisition function 5f to perform various processes similar to the various processes executed by the image generation circuit 150. FIG. The image generation function 5g is an example of a second generation unit.

The data processing function 5h corresponds to the function of the data processing circuit 190 described above (for example, the motion information generating function 190a). The data processing function 5h uses the data acquired by the acquisition function 5f to perform various processes similar to the various processes executed by the data processing circuit 190. FIG. The data processing function 5h is an example of a first generator.

Control function 5i corresponds to the function of control circuit 180 described above. The control function 5i uses the data acquired by the acquisition function 5f to perform various processes similar to the various processes executed by the control circuit 180. FIG. The control function 5i is an example of a display control section.

The medical image processing apparatus 5 according to the third embodiment has been described above. According to the medical image processing apparatus 5 according to the third embodiment, similarly to the ultrasonic diagnostic apparatus 1 described above, the operator is instructed to insert the lead inserted into the coronary vein and placed on the outer surface of the left ventricle. The position can be determined easily.

According to at least one embodiment or modification described above, the operator can easily determine the position of the lead that is placed on the outer surface of the left ventricle while being inserted into the coronary vein.

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.

1 Ultrasound Diagnostic Apparatus 150a Alignment Function 180 Control Circuit 190a Motion Information Generation Function

Claims (9)

Stimulation indicating stimulation propagation information of the myocardium of the left ventricle of the heart based on a plurality of time-series first three-dimensional medical image data generated by three-dimensionally scanning the heart of the subject with ultrasound. a first generator that generates propagation image data;
extracting the coronary veins from the second three-dimensional medical image data in which the coronary veins of the heart of the subject are rendered in a distinguishable manner, and aligning the medical image data showing the coronary veins with the stimulus propagation image data; a second generator for generating composite image data representing a composite image in which the coronary vein and the stimulus propagation image represented by the stimulus propagation image data are combined;
Display control for displaying a composite image represented by the composite image data on a display unit, and displaying a mark at a position of a site where the stimulus propagates the slowest in the stimulus propagation image included in the composite image displayed on the display unit. Department and
with
The display control unit receives setting of a region of interest in the stimulus propagation image included in the composite image displayed on the display unit, sets the received region of interest on the stimulus propagation image, An ultrasonic diagnostic apparatus , wherein a mark is displayed at a position on the coronary vein included in the composite image displayed on the display unit, which is near the display unit. The first generation unit generates motion information of a part within the region of interest,
The display control unit causes the display unit to display the exercise information.
The ultrasonic diagnostic apparatus according to claim 1 . The first generation unit generates the motion information of a site within the region of interest, which is smaller than the segmented region by segmentation in cardiac clinical practice.
The ultrasonic diagnostic apparatus according to claim 2 . The first generating unit generates motion information of the myocardium of the left ventricle of the heart based on the first three-dimensional medical image data,
The display control unit identifies the scar tissue of the myocardium based on the exercise information, and displays the mark so as to avoid the identified scar tissue.
The ultrasonic diagnostic apparatus according to claim 1 . The display control unit causes the display unit to display a medical image indicated by medical image data acquired from another medical image diagnostic apparatus using a common coordinate system.
The ultrasonic diagnostic apparatus according to any one of claims 1-4 . The display control unit causes the display unit to display an electrophysiological test map indicated by the electrophysiological test map data,
The electrophysiology map includes a mark indicating the position of the lead placed in the right atrium of the subject and a mark indicating the position of the lead placed in the right ventricle,
The ultrasonic diagnostic apparatus according to claim 5 . The display control unit displays a position on the stimulus propagation image at a position a predetermined distance from the position of the lead placed in the right atrium and the position of the lead placed in the right ventricle, Placing a mark indicating a certain range,
The ultrasonic diagnostic apparatus according to claim 6 . The display control unit causes the display unit to display a delayed contrast-enhanced image indicated by delayed contrast-enhanced image data acquired from an MRI (Magnetic Resonance Imaging) device,
the delayed contrast image includes marks indicative of scar tissue;
The ultrasonic diagnostic apparatus according to any one of claims 5-7 . A plurality of time-series first three-dimensional medical image data generated by three-dimensionally scanning the heart of a subject with ultrasound, and the coronary veins of the heart of the subject are depicted in a distinguishable manner. an acquisition unit that acquires second three-dimensional medical image data;
a first generation unit that generates stimulation propagation image data indicating stimulation propagation information of the myocardium of the left ventricle of the heart based on the plurality of first three-dimensional medical image data;
The coronary veins are extracted from the second three-dimensional medical image data, and the medical image data showing the coronary veins and the stimulus propagation image data are aligned so that the coronary veins and the stimulus propagation image data show the coronary veins. a second generation unit that generates composite image data representing a composite image combined with the stimulus propagation image;
Display control for displaying a composite image represented by the composite image data on a display unit, and displaying a mark at a position of a site where the stimulus propagates the slowest in the stimulus propagation image included in the composite image displayed on the display unit. Department and
with
The display control unit receives setting of a region of interest in the stimulus propagation image included in the composite image displayed on the display unit, sets the received region of interest on the stimulus propagation image, A medical image processing apparatus for displaying a mark at a near position on the coronary vein included in the synthesized image displayed on the display unit.

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