JP7438731B2 - Medical image processing device, operating method of the medical image processing device, and medical image processing program - Google Patents

Description

Embodiments disclosed in this specification and the like relate to an operating method of a medical image processing apparatus , a medical image processing method, and a medical image processing program.

In recent years, a treatment method using radio ablation under CT guidance has become popular as one of cancer treatments. This ablation is a treatment method in which, for example, a cautery needle (electrode needle, puncture needle) is inserted into cancer cells and high frequency is applied to cauterize the cancer cells with radio waves to cause necrosis.

Conventionally, when performing ablation treatment, thermography or a needle equipped with a thermometer is inserted into the cancer cells to be ablated and monitored to see if the target temperature has been reached. .

However, thermography measures the body surface temperature of a subject. Therefore, during ablation treatment, it is difficult to know the current temperature of the ablation target within the subject, whether the ablation target has reached the target temperature (e.g. 70°C) for necrosis of cancer cells, etc. Can not. For this reason, it is difficult for the surgeon to judge in real time when to stop the procedure and how far the influence of heat has spread.

In addition, in the case of a method that measures the temperature inside the subject by puncturing a needle with a thermometer attached, measuring the temperature using this method during treatment requires a lot of effort for the surgeon and increases the number of puncture points. Therefore, it becomes a burden on the examinee.

Special table 2018-524124 publication

One of the problems that the embodiments disclosed in this specification etc. are intended to solve is that during treatment such as ablation, the operator makes appropriate decisions based on information regarding the temperature of the treatment target area inside the subject. The aim is to provide information for

A medical image processing apparatus according to an embodiment includes an information generation section and an output control section. The information generation unit includes a first image obtained by capturing at least one observation area before treatment, and at least one second image obtained by capturing at least one observation area during treatment. is used to generate temperature-related information, and alert information is generated based on the temperature-related information. The output control section causes the output section to output the alert information.

FIG. 1 is a diagram showing the configuration of a treatment system S in which a medical image processing apparatus according to an embodiment is used. FIG. 2 is a block diagram showing a configuration example of an X-ray CT apparatus according to an embodiment. FIG. 3 is a diagram showing an example of a graph showing the correspondence between CT value changes and temperature changes. FIG. 4 is a diagram showing an example of a temperature change map. FIG. 5 is a diagram showing an example of a display form of a temperature change map. FIG. 6 is a diagram showing an example of a temperature change graph. FIG. 7 is a diagram showing another example of the temperature change graph. FIG. 8 is a flowchart showing the operation flow of the medical image processing device in treatment using the ablation device. FIG. 9 is a diagram for explaining a modification of the medical image processing apparatus according to the embodiment.

DESCRIPTION OF THE PREFERRED EMBODIMENTS A medical image processing apparatus, a medical image processing method, and a medical image processing program according to embodiments will be described in detail below with reference to the accompanying drawings.

FIG. 1 is a diagram showing the configuration of a treatment system S in which a medical image processing apparatus 100 according to an embodiment is used. As shown in FIG. 1, the treatment system S includes an X-ray computed tomography imaging device 1 (hereinafter referred to as “X-ray CT device 1”) and a treatment device 2. Note that in this embodiment, the X-ray CT apparatus 1 and the treatment apparatus 2 are capable of communicating with each other, but they may not be able to communicate with each other.

The treatment device 2 punctures the tissue of the subject with a needle, and supplies heat, energy, waves, etc. from the needle to perform ablation using radio waves, ablation using microwaves, freezing using CRYO, etc. , a treatment device that causes necrosis of cancer cells.

In this embodiment, in order to make the description more specific, it is assumed that the treatment device 2 is an ablation device that performs ablation using radio waves (hereinafter, the treatment device 2 will also be referred to as "ablation device 2"). In the present embodiment, the tumor region to be ablated by the ablation device 2 within the subject, and the region added as a margin around the tumor region to be ablated (hereinafter referred to as "ablation additional region"). ) are referred to as "cautery target regions", and regions located around the ablation target region (such as blood vessels) that must be avoided from ablation are referred to as "cautery avoidance regions". A plurality of cauterization addition areas and ablation avoidance areas may be set. In addition, areas that the operator must monitor during ablation treatment, such as the ablation addition area and the ablation avoidance area, are referred to as "observation areas."

The X-ray CT apparatus 1 is a medical image diagnostic apparatus for acquiring in real time CT images used for monitoring the position of the ablation needle within the subject and the observation area during treatment using the ablation apparatus 2 . That is, in treatment using the ablation device 2, the X-ray CT apparatus 1 acquires volume data regarding the subject through CT fluoroscopic imaging in response to instructions from the operator. Note that the acquisition of CT image data by CT fluoroscopic imaging may be either volume imaging or helical imaging.

Furthermore, the X-ray CT apparatus 1 includes a medical image processing apparatus 100. In treatment using the ablation device 2, the medical image processing device 100 uses CT image data acquired by the X-ray CT device 1 to generate and display information regarding the temperature of an observation region existing inside the subject. . The configuration of this medical image processing apparatus 100 will be explained in detail later.

Next, an outline of the configuration of the X-ray CT apparatus 1 will be explained. FIG. 2 is a block diagram showing a configuration example of the X-ray CT apparatus 1 according to the embodiment. As shown in FIG. 2, the X-ray CT apparatus 1 according to the embodiment includes a gantry device 10, a bed device 30, and a console device 40.

In this embodiment, the rotation axis of the rotation frame 13 in a non-tilted state or the longitudinal direction of the top plate 33 of the bed device 30 is defined as the Z-axis direction, an axis perpendicular to the Z-axis direction and horizontal to the floor surface. The direction is defined as the X-axis direction, the axial direction perpendicular to the Z-axis direction and perpendicular to the floor surface as the Y-axis direction.

The gantry device 10 has an imaging system for capturing medical images used for diagnosis. That is, the gantry device 10 is a device having an imaging system that irradiates the subject P with X-rays and collects projection data from the detection data of the X-rays that have passed through the subject P, and includes an X-ray tube 11 and a wedge 16. , a collimator 17 , an X-ray detector 12 , an X-ray high voltage device 14 , a DAS (Data Acquisition System) 18 , a rotating frame 13 , a control device 15 , and a bed device 30 .

The X-ray tube 11 is a vacuum tube that irradiates thermoelectrons from a cathode (filament) toward an anode (target) by applying a high voltage from an X-ray high voltage device 14 .

The wedge 16 is a filter for adjusting the amount of X-rays emitted from the X-ray tube 11. Specifically, the wedge 16 transmits and attenuates the X-rays emitted from the X-ray tube 11 so that the X-rays emitted from the X-ray tube 11 to the subject P have a predetermined distribution. This is a filter that

The wedge 16 is, for example, a wedge filter or a bow-tie filter, and is a filter made of aluminum processed to have a predetermined target angle and a predetermined thickness.

The collimator 17 is a lead plate or the like for narrowing down the irradiation range of the X-rays that have passed through the wedge 16, and forms a slit by combining a plurality of lead plates or the like.

The X-ray detector 12 detects the X-rays emitted from the X-ray tube 11 and passed through the subject P, and outputs an electrical signal corresponding to the amount of X-rays to the data acquisition device (DAS 18). The X-ray detector 12 has, for example, a plurality of X-ray detection element rows in which a plurality of X-ray detection elements are arranged in the channel direction along one circular arc centered on the focal point of the X-ray tube 11. The X-ray detector 12 has, for example, a plurality of X-ray detection element rows in which a plurality of X-ray detection elements are arranged in the channel direction along one circular arc centered on the focal point of the X-ray tube. The X-ray detector 12 has, for example, a structure in which a plurality of X-ray detection element rows in which a plurality of X-ray detection elements are arranged in a channel direction are arranged in a slice direction (also called a body axis direction or column direction).

Further, the X-ray detector 12 is, for example, an indirect conversion type detector having a grid, a scintillator array, and a photosensor array. The scintillator array includes a plurality of scintillators, and each scintillator includes a scintillator crystal that outputs light in an amount of photons corresponding to the amount of incident X-rays. The grid is disposed on the X-ray incident side of the scintillator array and has an X-ray shielding plate that has the function of absorbing scattered X-rays. The optical sensor array has a function of converting the amount of light from the scintillator into an electrical signal, and includes optical sensors such as photomultiplier tubes (PMTs). Note that the X-ray detector 12 may be a direct conversion type detector having a semiconductor element that converts incident X-rays into electrical signals.

The X-ray high-voltage device 14 includes an electric circuit such as a transformer and a rectifier, and includes a high-voltage generator that has a function of generating a high voltage to be applied to the X-ray tube 11, and a high-voltage generator that has the function of generating a high voltage to be applied to the and an X-ray control device that controls the output voltage according to the X-rays. The high voltage generator may be of a transformer type or an inverter type. Note that the X-ray high voltage device 14 may be provided on the rotating frame 13 or may be provided on the fixed frame (not shown) side of the gantry device 10. Note that the fixed frame is a frame that rotatably supports the rotating frame 13.

The DAS 18 includes an amplifier that performs amplification processing on the electrical signal output from each X-ray detection element of the X-ray detector 12, and an A/D converter that converts the electrical signal into a digital signal. generate. The detection data generated by the DAS 18 is transferred to the console device 40.

The rotating frame 13 is an annular frame that supports the X-ray tube 11 and the X-ray detector 12 facing each other, and allows the X-ray tube 11 and the X-ray detector 12 to be rotated by the control device 15. Note that the rotating frame 13 may further support an X-ray high voltage device 14 and a DAS 18 in addition to the X-ray tube 11 and the X-ray detector 12. Note that the detection data generated by the DAS 18 is transmitted, for example, by optical communication from a transmitter having a light emitting diode provided on the rotating frame 13 to a photodiode provided on a non-rotating portion of the gantry device 10 such as a fixed frame. and is transferred to the console device 40. Note that the method for transmitting the detection data from the rotating frame 13 to the non-rotating portion of the gantry device 10 is not limited to optical communication, and may be performed using other non-contact data transmission methods.

The control device 15 includes a processing circuit including a CPU and the like, and a drive mechanism such as a motor and an actuator. The control device 15 has a function of receiving input signals from an input interface 43 attached to the console device 40 or an input interface attached to the gantry device 10 and controlling the operations of the gantry device 10 and the bed device 30. Further, the control device 15 receives an input signal and performs control to rotate the rotating frame 13 and control to operate the gantry device 10 and the bed device 30.

For example, the control device 15 rotates the rotating frame 13 about an axis parallel to the X-axis direction based on inclination angle (tilt angle) information input by an input interface attached to the gantry device 10 By doing so, the gantry device 10 is tilted. Note that the control function 150a of the control device 15 or the processing circuit 150 is an example of a control section.

The bed device 30 is a device on which a subject P to be scanned is placed and moved, and includes a base 31, a bed driving device 32, a top plate 33, and a support frame 34. The base 31 is a casing that supports the support frame 34 movably in the vertical direction. The bed driving device 32 is a motor or an actuator that moves the top plate 33 on which the subject P is placed in its longitudinal direction (Z-axis direction in FIG. 2). The top plate 33 provided on the upper surface of the support frame 34 is a plate on which the subject P is placed. In addition to the top plate 33, the bed driving device 32 may move the support frame 34 in the longitudinal direction of the top plate 33.

The bed driving device 32 moves the base 31 in the vertical direction according to a control signal from the control device 15. The bed driving device 32 moves the top plate 33 in the longitudinal direction according to a control signal from the control device 15.

The console device 40 is a device that receives user operations on the X-ray CT device 1 and reconstructs X-ray CT image data from the X-ray detection data collected by the gantry device 10. The console device 40 includes a memory 41, a display 42, an input interface 43, and a processing circuit 150.

Here, the medical image processing apparatus 100 according to this embodiment is realized by, for example, a memory 41, a display 42, an input interface 43, and a processing circuit 150.

The memory 41 is realized by, for example, a RAM (Random Access Memory), a semiconductor memory element such as a flash memory, a hard disk, an optical disk, or the like. The memory 41 stores, for example, projection data and reconstructed image data. The memory 41 is an example of a storage section.

The memory 41 also stores dedicated programs for realizing a control function 150a, a preprocessing function 150b, a reconfiguration processing function 150c, an information generation function 150d, and an output control function 150e, which will be described later. Furthermore, the memory 41 stores information (graph) showing the correspondence between the amount of change in CT value (or the amount of change in pixel value associated with the CT value) and the amount of temperature change, as shown in FIG. It stores information (table) regarding temperature sensitivity of , information regarding temperature generated by processing described later, and the like.

Returning to FIG. 2, the display 42 is a monitor that the user refers to, and displays various information. For example, the display 42 outputs a medical image (CT image) generated by the processing circuit 150, a GUI (Graphical User Interface) for accepting various operations from the user, and the like. For example, the display 42 is a liquid crystal display or a CRT (Cathode Ray Tube) display. The display 42 is an example of a display section.

The input interface 43 receives various input operations from the user, converts the received input operations into electrical signals, and outputs the electrical signals to the processing circuit 150. For example, the input interface 43 receives, from the user, acquisition conditions when acquiring projection data, reconstruction conditions when reconstructing a CT image, image processing conditions when generating a post-processed image from a CT image, and the like. Further, the input interface 43 receives inputs related to area designations such as a tumor area, an ablation target area, an ablation avoidance area, and the like. Further, the input interface 43 receives, for example, an instruction to select information to be included in alert information, which will be described later. For example, the input interface 43 is realized by a mouse, keyboard, trackball, switch, button, joystick, or the like. The input interface 43 is an example of an input section.

The processing circuit 150 controls the overall operation of the X-ray CT apparatus 1 . The processing circuit 150 has, for example, a control function 150a, a preprocessing function 150b, a reconstruction processing function 150c, an information generation function 150d, and an output control function 150e. In the embodiment, each processing function performed by the component control function 150a, preprocessing function 150b, reconstruction processing function 150c, information generation function 150d, and output control function 150e is in the form of a program executable by a computer. It is stored in the memory 41. The processing circuit 150 is a processor that reads programs from the memory 41 and executes them to implement functions corresponding to each program. In other words, the processing circuit 150 in a state where each program is read has each function shown in the processing circuit 150 of FIG.

In addition, in FIG. 2, a single processing circuit 150 realizes the processing functions performed by a control function 150a, a preprocessing function 150b, a reconstruction processing function 150c, an information generation function 150d, and an output control function 150e. However, the processing circuit 150 may be configured by combining a plurality of independent processors, and functions may be realized by each processor executing a program.

In other words, each of the above-mentioned functions may be configured as a program and one processing circuit executes each program, or a specific function may be implemented in a dedicated independent program execution circuit. It's okay.

The term "processor" used in the above description refers to, for example, a CPU (Central Processing Unit), a GPU (Graphical Processing Unit), or an Application Specific Integrated Circuit. it: ASIC), programmable logic devices (e.g. simple Simple Programmable Logic Device (SPLD), Complex Programmable Logic Device (CPLD), and Field Programmable Gate Array ray: means a circuit such as FPGA). The processor realizes functions by reading and executing programs stored in the memory 41. Note that instead of storing the program in the memory 41, the program may be directly incorporated into the circuit of the processor. In this case, the processor realizes its functions by reading and executing a program built into the circuit.

The processing circuit 150 controls various functions of the processing circuit 150 using the control function 150a based on input operations received from the user via the input interface 43. The processing circuit 150 uses a preprocessing function 150b to generate data that is subjected to preprocessing such as logarithmic conversion processing, offset processing, sensitivity correction processing between channels, and beam hardening correction on the detection data output from the DAS 18. . Note that the data before preprocessing (detection data) and the data after preprocessing may be collectively referred to as projection data. The processing circuit 150 uses a reconstruction processing function 150c to perform reconstruction processing using a filtered back projection method, a successive approximation reconstruction method, etc. on the projection data generated by the preprocessing function 150b to obtain CT image data. generate. Furthermore, the processing circuit 150 uses the reconstruction processing function 150c to convert the reconstructed CT image data into tomographic image data of an arbitrary cross section or the like based on the input operation received from the user via the input interface 43. Convert to 3D image data.

The processing circuit 150 uses the information generation function 150d to generate information regarding the temperature of the observation region inside the subject using CT image data acquired by the X-ray CT device 1 during treatment using the ablation device 2. generate. That is, the processing circuit 150 uses the information generation function 150d to generate a CT image (first image) acquired by imaging the observation area before the ablation procedure using the X-ray CT apparatus 1, and an X-ray image of the observation area during the ablation procedure. Information regarding temperature is generated using at least one CT image (second image) captured and acquired by the CT apparatus 1.

Here, "information regarding temperature" is information including at least one of a temperature change map, an attained temperature map, a calorie accumulation map, and a temperature change graph, for example. Further, "information regarding temperature" includes information generated based on a temperature change map, an attained temperature map, a heat amount accumulation map, a temperature change graph, and the like.

Each of the temperature change map, attained temperature map, heat amount accumulation map, and temperature change graph will be explained below.

The temperature change map is information indicating the spatial distribution of the current temperature (or the amount of temperature change from the reference temperature) for each position in the observation area.

FIG. 4 is a diagram showing an example of a temperature change map. Note that in the example of FIG. 4, the observation area is set as the entire image. In Figure 4, the upper right shows a temperature change map based on a coronal cross section including the ablation needle N, the lower right shows a temperature change map based on a sagittal cross section including the ablation needle N, and the upper left shows a temperature change map based on an axial cross section perpendicular to the ablation needle N. , the lower left shows volume rendering images as three-dimensional images, respectively. Each temperature change map is a color map, and differences in temperature are expressed by different colors.

Note that FIG. 4 illustrates a temperature change map as a color map. On the other hand, for example, a temperature change map may be created and displayed as a contour line display in which differences in temperature are expressed by contour lines. When displaying contour lines for each temperature change, the target temperature for causing necrosis of cancer cells can be set using a scale (memory).

FIG. 5 is a diagram showing another example of the display form of the temperature change map. In the left column of FIG. 5, the lower row shows a CT image with an axial section, the interrupted CT image with a coronal section, and the upper row shows a CT image with a sagittal section. In addition, in the right column of FIG. 5, a temperature change map that extracts only the region where the temperature is higher than a certain temperature (for example, 10 degrees lower than the target temperature) is shown for each CT image in the left column for the ablation needle N or Each is shown superimposed in real time with the tumor region R as a reference.

By observing the temperature change map shown in the right column of Figure 5, the surgeon can determine whether the target temperature has reached the target temperature and what the current temperature of the target region is. Where is the target temperature not reached? How much time will it take for the area to be ablated to reach the target temperature? Is the temperature in the area to be ablated exceeded the allowable value? What is the current temperature around the area to be ablated? It is possible to visually and quickly grasp, for example, how many degrees it is.

Note that the temperature change map can be generated, for example, as follows. That is, first, the observation area before the ablation procedure is imaged by the X-ray CT apparatus 1 to obtain a reference CT image. The CT value of each tissue in this pre-ablation CT image corresponds to a temperature approximately equal to body temperature (approximately 36° C. to 40° C.). Next, the observation area during the ablation procedure is imaged by the X-ray CT apparatus 1 to obtain a CT image during the ablation procedure. A difference image between the CT image during ablation and the CT image before ablation is generated, and the difference value of each pixel, a graph showing the correspondence between CT value change and temperature change, and information regarding the temperature sensitivity of each tissue are generated. By using , it is possible to generate a temperature change map that shows how much the temperature at each position in the observation area has changed from the body temperature. Note that the temperature change map is updated in real time every time a CT image is captured during ablation.

The achieved temperature map is information indicating the spatial distribution of the maximum temperature (or the maximum temperature change from the reference temperature) among multiple time phases during the ablation procedure for each position in the observation region. The calorific value integration map is information indicating the spatial distribution of integrated values of temperature changes for each position in the observation area.

The reached temperature map stores the temperature changes between each time phase of CT fluoroscopic imaging during ablation, maps them in time series, and displays the distribution of time phases with larger temperature changes from the standard (maximum temperature change). It can be generated by Further, the heat amount integration map can be generated by integrating temperature changes for each pixel in the observation area.

The temperature change graph is information including at least one of temperature change graphs showing temperature changes over time for a ROI (Region Of Interest) set within the observation region.

6 and 7 are diagrams showing examples of temperature change maps. As shown in FIG. 6, the temperature change graph is a graph in which representative values (for example, average value, median value, maximum value, minimum value, etc.) of temperature change within the set ROI are plotted in time series. Additionally, as shown in Figure 7, the maximum temperature change H within the ROI can be determined by the difference between the maximum and minimum values of the temperature change graph, and the integrated amount of heat within the ROI can be determined by the area under the temperature change graph. .

Note that the ROI used in generating the temperature change graph may include multiple pixels or may include only one pixel. Moreover, the ROI setting may be automatic or manual. Further, when automatically setting the ROI, for example, an area within a predetermined radius from the vicinity of the heat generation source of the cautery needle can be set as the ROI. Further, the predetermined radius at this time can be freely specified by the user.

Additionally, in general, the CT value decreases as the tissue temperature increases. However, in the examples of FIGS. 6 and 7, a temperature change graph is generated in which the CT value is plotted so that as the tissue temperature increases, the CT value also increases, taking into account the user's intuitive understanding.

Further, the processing circuit 150 uses the information generation function 150d to determine whether or not the ablation target area has reached the target temperature, based on the temperature change map, the reached temperature map, the heat amount integration map, and the temperature change graph. It is determined whether the temperature is higher than the value. This determination, for example, extracts whether there are pixels in the ablation target area that have reached the target temperature, or whether there are pixels that have reached a temperature above an allowable value in the ablation avoidance area, in the temperature change map or the reached temperature map. This can be achieved by

In addition, the processing circuit 150 uses the information generation function 150d to calculate the ablation target area from the correlation equation based on the temperature change graph regarding the region of interest in the treatment using the ablation device 2, assuming that the temperature change and time are correlated. The predicted time until the area reaches the specified target temperature and the predicted time until the ablation avoidance area reaches a temperature equal to or higher than the allowable value are calculated.

Furthermore, the processing circuit 150 uses the information generation function 150d to generate alert information based on information regarding temperature. Here, the alert information is support information that urges the surgeon's attention and allows the surgeon to make appropriate decisions in ablation treatment. The alert information is, for example, information to notify that the ablation target area included in the observation area has reached the target temperature (first information), or information to notify that the ablation target area will reach the target temperature after a certain period of time has passed. information (second information), information to notify that the cauterization avoidance region included in the observation area has reached the permissible temperature (third information), information that the cauterization avoidance region has reached the permissible temperature after a certain period of time has elapsed. (fourth information), information (fifth information) to notify that the operation of the ablation device should be controlled (for example, stop or change the ablation intensity, etc.) based on information regarding temperature; Information (sixth information) informing that the imaging operation of the X-ray CT apparatus 1 should be controlled (for example, stopping or changing imaging conditions) based on the information, and prediction until the target temperature of the ablation target area reaches the target temperature. It includes at least one of the time (first predicted time) and the predicted time until the ablation avoidance region reaches the allowable temperature (second predicted time).

Note that the alert information is typically image information. The alert information is, for example, an image in a temperature change map, reached temperature map, calorific value accumulation map, temperature change graph, etc. that highlights the area where the target temperature or permissible temperature has been reached by different colors, blinking, or the like. In addition, the alert information may be, for example, ``In the area to be ablated, there are places where the target temperature has already been reached (or has exceeded the target temperature). Please stop the ablation and imaging immediately.'', ``Ablation There are areas in the avoidance area that have already reached (or exceeded) the allowable temperature. Please stop ablation and imaging immediately.", "The area to be ablated will reach the target temperature in 30 seconds. The images include messages and sounds such as "The temperature will be reached." and "The ablation avoidance area will reach the permissible temperature in 30 seconds."

Note that the information to be included in the alert information can be selected, for example, by a selection instruction from the input interface 43. The processing circuit 150 uses the information generation function 150d to generate alert information including the selected information based on the information regarding temperature.

Further, the processing circuit 150 uses the information generation function 150d to control the operation of the ablation device 2 (for example, stop it, change the ablation intensity, etc.) based on the information regarding the temperature in conjunction with the generation of alert information. A control signal (first control signal) and a control signal (second control signal) for controlling the imaging operation of the X-ray CT apparatus 1 (for example, stopping, changing imaging conditions, etc.) are generated. Note that instead of both the first control signal and the second control signal, at least one may be generated. Furthermore, a priority is set as to whether the generation of the first control signal and the second control signal is linked to the generation of alert information about the ablation target area or the generation of alert information about the ablation avoidance area. I can do it.

The processing circuit 150 causes the display 42 to display information regarding the temperature of the observation area inside the subject in real time during treatment using the ablation device 2 using the output control function 150e. In addition, the processing circuit 150 uses the output control function 150e to simultaneously output a temperature change map, an attained temperature map, a heat amount integration map, and a CT image (for example, an MPR image of three orthogonal cross sections) with the ablation needle or tumor region as a reference (for example, , superimposed, or in parallel) on the display 42 in real time.

The processing circuit 150 uses the output control function 150e to control the temperature when the ablation target region reaches the therapeutically effective temperature (or a certain period of time before reaching it), and when the ablation avoidance region reaches a temperature equal to or higher than the allowable value (or a certain period of time before reaching the temperature). At set timings such as (before), temperature-related information including information for notifying the operator of these details is displayed on the display 42.

For example, the processing circuit 150 uses the output control function 150e to display a temperature change map or the like in a different color on the display 42 as an alert function to notify the operator. Further, the processing circuit 150 uses the output control function 150e to display the ablation target region and the ablation avoidance region in a highlighted manner on the display 42 so that they can be distinguished from other parts.

In addition, the processing circuit 150 uses the output control function 150e to predict the time it will take for the ablation target area to reach the specified target temperature and for the ablation avoidance area to reach the specified allowable temperature in treatment using the ablation device 2. The predicted time until the end is displayed on a display 42 in real time.

Further, the processing circuit 150 uses the output control function 150e to highlight the ablation avoidance area by coloring, outline, etc. in order to distinguish it from the ablation target area and other areas.

In addition, the processing circuit 150 uses the output control function 150e to control when the ablation needle has already been ablated, when newly inserting the ablation needle into a different position during an ablation procedure, or when ablating a different position in a treatment using the ablation device 2. Information regarding the temperature in which the area that has been ablated (target temperature reached area) and the area that has not yet been ablated (target temperature not reached area) are distinguished is displayed on the display 42 in real time in order to navigate to the next ablation position. let

Further, the processing circuit 150 causes the output control function 150e to display alert information on the display 42 in real time, together with or alone regarding the temperature information, during treatment using the ablation device 2. Further, the processing circuit 150 outputs a first control signal for controlling the operation of the ablation device 2 to the ablation device 2 during treatment using the ablation device 2, using the output control function 150e. Furthermore, the processing circuit 150 outputs a second control signal for controlling the imaging operation of the X-ray CT apparatus 1 to the X-ray CT apparatus 1 in treatment using the ablation apparatus 2 using the output control function 150e. .

Note that the timing for outputting the first control signal and the second control signal includes, for example, the timing when it is determined that the ablation target area included in the observation area has reached the target temperature, and the timing when it is determined that the ablation target area included in the observation area has reached the target temperature. the timing at which it is determined that the area has reached the allowable temperature, the elapse of the first predicted time until the ablation target area reaches the target temperature, and the elapse of the second predicted time until the ablation avoidance area reaches the allowable temperature. You can set the following.

Next, the flow of the operation of the medical image processing apparatus 100 in treatment using the ablation device 2 will be explained.

FIG. 8 is a flowchart showing the operation flow of the medical image processing apparatus 100 in treatment using the ablation device 2. As shown in FIG. Note that before or during treatment using the ablation device 2, the X-ray CT device 1 acquires volume data about the ablation target region and the ablation avoidance region at any time by CT fluoroscopic imaging according to the operator's instructions, and creates a medical image. It is assumed that the processing device 100 receives CT images acquired by the X-ray CT device 1 in real time. Further, the X-ray CT apparatus 1 is assumed to acquire volume data of at least a temporal phase or more for the observation region before ablation by CT fluoroscopic imaging during steps S1 to S5 in FIG. 8, for example.

As shown in FIG. 8, first, the processing circuit 150 uses a three-dimensional image (volume rendering image) acquired by CT fluoroscopic imaging by the X-ray CT device 1 and an MPR image based on three orthogonal sections using the information generation function 150d. Then, designation and detection of the tumor region is executed (step S1). Note that the tumor region may be specified by the user manually based on drawing on the displayed image, or may be automatically detected by segmentation processing. Furthermore, the user may manually fine-tune the area automatically detected by the segmentation process.

Next, the processing circuit 150 uses the information generation function 150d to detect an additional area for ablation around the specified or detected tumor area, and performs mask processing for the area to be ablated including the tumor area and the additional area for ablation (step S2). As with the detection of the tumor region, this additional ablation region may be detected manually by the user, automatically detected by segmentation processing, or a combination thereof. Furthermore, the ablation target region is set as the ROI by masking the ablation target region.

Next, the processing circuit 150 uses the information generation function 150d to detect an ablation avoidance area around the ablation target area, and performs mask processing for the ablation avoidance area (step S3). For this ablation avoidance region, as well as the detection of tumor regions and additional ablation regions, any of manual detection by the user, automatic detection through segmentation processing, or a combination thereof can be employed. Further, by masking the ablation avoidance region, the ablation avoidance region is set as the ROI.

Next, when the puncturing of the ablation needle is started (step A1), the processing circuit 150 uses the information generation function 150d to detect and track the ablation needle (step S4).

Next, the processing circuit 150 uses the information generation function 150d to create MPR images of three orthogonal cross sections with the ablation needle as a reference. The processing circuit 150 uses the output control function 150e to display the created MPR images of the three orthogonal cross sections on the display 42 (step S5).

Next, the processing circuit 150 uses the information generation function 150d to detect the arrival of the ablation needle to the ablation target area (step A2, step S6). Furthermore, ablation is initiated at an arbitrary timing after this detection (step A2).

Next, the processing circuit 150 uses the information generation function 150d to determine the position between each volume data over time (volume data during ablation) received from the X-ray CT apparatus 1 after the start of ablation and the volume data before ablation. The alignment is executed (step S7). The positioning is performed based on the position of the ablation needle and the position of the tumor region within the volume data. Note that alignment does not necessarily have to be performed.

Next, the processing circuit 150 uses the information generation function 150d to generate difference data between the volume data during ablation and the volume data before ablation, and uses the difference data to measure the change in CT value in each ROI. (Step S8).

Next, the processing circuit 150 uses the information generation function 150d to use the change in CT value in each observation region, the graph showing the correspondence between the change in CT value and the change in temperature, and the information regarding the temperature sensitivity of each tissue. Then, the CT value change amount is converted into a temperature change amount (step S9), and information regarding the temperature for each observation area is generated.

Next, the processing circuit 150 uses the information generation function 150d to determine whether the target temperature for ablation has reached the target temperature based on the information regarding the temperature (step S10). If the information generation function 150d determines that the ablation target region has reached the target temperature (Yes in step S10), the processing circuit 150 generates alert information, a first control signal, and a second control signal. (Step S12). on the other hand. If the information generation function 150d determines that the target temperature has not been reached in the region to be ablated (No in step S10), the processing circuit 150 repeatedly executes the processes from step S6 to step S10.

Next, the processing circuit 150 uses the information generation function 150d to determine whether the ablation avoidance region has reached the permissible temperature based on the information regarding the temperature (step S11). When the information generation function 150d determines that the cauterization avoidance region has reached the allowable temperature (Yes in step S11), the processing circuit 150 generates alert information, a first control signal, and a second control signal. (Step S12). on the other hand. When the information generation function 150d determines that the target temperature has not been reached in the region to be ablated (No in step S11), the processing circuit 150 repeatedly executes the processes from step S6 to step S11.

Next, the processing circuit 150 causes the output control function 150e to display (output) the alert information on the display 42 together with or alone with information regarding the temperature for each observation area (step S13).

At this time, for example, the processing circuit 150 uses the output control function 150e to highlight the alert information and the area where the target temperature or permissible temperature has been reached by using a different color, blinking, or the like.

Note that during ablation, each time the X-ray CT apparatus 1 performs imaging, the processes from step S6 to step S13 are repeatedly performed. Further, when the ablation is completed, the information regarding the last generated temperature is stored in the memory 41 as procedure performance information and managed for each patient.

The area that can be cauterized in one ablation is limited to a radius of several centimeters. Therefore, depending on the size and shape of the region to be ablated, the ablation needle is re-inserted at different positions and ablation is performed multiple times to burn out the region to be ablated. Furthermore, even when multiple ablation target areas are set, the ablation needle is re-inserted at different positions and ablation is performed multiple times. In each ablation, the processes from step S6 to step S13 are repeatedly executed.

As described above, the medical image processing apparatus according to the embodiment includes the information generation function 150d as an information generation section and the output control function 150e as an output control section. The information generation function 150d uses a CT image obtained by capturing at least one observation region before ablation and at least one CT image obtained by capturing at least one observation region during ablation, Information regarding temperature is generated, and alert information is generated based on the information regarding temperature. The output control function 150e outputs alert information to the display 42 serving as an output unit.

The alert information includes information to notify that the ablation target area included in the observation area has reached the target temperature (first information), and information to notify that the ablation target area will reach the target temperature after a certain period of time. information (second information), information to notify that the ablation avoidance region included in the observation area has reached the permissible temperature (third information), information to inform that the ablation avoidance region has reached the permissible temperature after a certain period of time has elapsed; information to notify (fourth information), information to notify that the operation of the ablation device 2 should be controlled based on information regarding temperature (fifth information), and imaging by X-ray CT device 1 based on information regarding temperature. At least one of the information (sixth information) notifying that the operation should be controlled can be included.

Based on the displayed alert information, the operator can, during ablation treatment, stop ablation by the ablation device 2, stop imaging by the X-ray CT device 1, move the ablation needle to a position away from the ablation avoidance area, etc. decisions can be made quickly and appropriately. As a result, unnecessary cauterization and radiation exposure can be reduced.

Furthermore, the information generation function 150d generates at least one of a first control signal that controls the operation of the ablation device 2 and a second control signal that controls the imaging operation of the X-ray CT device 1. The output control function 150e transmits a first control signal to the ablation device 2. Further, the output control function 150e transmits a second control signal to the X-ray CT apparatus 1.

Therefore, at least one of the ablation device 2 and the X-ray CT device 1 can be automatically stopped in conjunction with the display of alert information. As a result, the ablation device 2 and the X-ray CT device 1 can be stopped quickly, reducing the operator's workload and reducing unnecessary cauterization and radiation exposure.

(Modification 1)
In the above embodiment, the case where the X-ray CT apparatus 1 has the function of the medical image processing apparatus 100 has been exemplified. On the other hand, the medical image processing apparatus 100 may be realized by a medical workstation, a personal computer, or the like. The medical image processing apparatus 100 according to Modification 1 can be applied, for example, to a case where a puncture robot is operated remotely.

FIG. 9 is a diagram for explaining the medical image processing apparatus 100 according to the first modification. As shown in FIG. 9, the medical image processing apparatus 100 can communicate with at least the X-ray CT apparatus 1. The medical image processing apparatus 100 receives CT images captured by the X-ray CT apparatus 1 in real time, and uses the CT images to generate the above-mentioned temperature information, generate alert information based on the temperature information, and generate the first control signal. generation, and generation of the second control signal. The alert information is transmitted to the X-ray CT apparatus 1 and displayed in real time. Further, the first control signal is transmitted from the medical image processing device 100 to the ablation device 2 in conjunction with the transmission of alert information. The second control signal is transmitted from the medical image processing apparatus 100 to the X-ray CT apparatus 1 in conjunction with the transmission of alert information.

Therefore, even if, for example, the medical image processing device 100 is installed in a different location from the ablation device 2 and the X-ray CT device 1, the same effects as in the embodiment can be achieved.

(Modification 2)
In the embodiment described above, the case where the medical image processing apparatus 100 is used in ablation under CT guidance using the X-ray CT apparatus 1 has been exemplified. On the other hand, the medical image processing apparatus 100 can also be used in guided ablation using a medical image diagnostic apparatus such as a magnetic resonance imaging apparatus, an X-ray diagnostic apparatus, or an ultrasound diagnostic apparatus.

(Modification 3)
In the above embodiment, the case where alert information is generated and displayed as image information has been exemplified. On the other hand, alert information as audio information may be generated and output from the audio output unit (speaker).

Examples of audio information include, ``In the area to be ablated, there are places where the target temperature has already reached (or exceeded) the target temperature. Please stop ablation and imaging immediately.'' and ``Avoid ablation.'' The ablation device 2 or It is possible to employ the output of a sound to urge the line CT apparatus 1 to stop. Further, alert information as image information and alert information as audio information may be used together.

According to at least one embodiment described above, during treatment such as ablation, it is possible to provide information for the operator to make an appropriate judgment based on information regarding the temperature of the treatment target area inside the subject. can.

Further, although some embodiments of the present invention have been described, these embodiments are presented as examples and are not intended to limit the scope of the invention. These embodiments can be implemented in various other forms, and various omissions, substitutions, and changes can be made without departing from the gist of the invention. These embodiments and their modifications are included within the scope and gist of the invention as well as within the scope of the invention described in the claims and its equivalents.

1 X-ray CT device 10 Frame device 11 X-ray tube 12 X-ray detector 13 Rotating frame 14 X-ray high voltage device 15 Control device 16 Wedge 17 Collimator 18 DAS (Data Acquisition System)
30 Bed device 31 Base 32 Bed driving device 33 Top plate 34 Support frame 40 Console device 41 Memory 42 Display 43 Input interface 150 Processing circuit 150a Control function 150b Pre-processing function 150c Reconfiguration processing function 150d Information generation function 150e Output control function

Claims (11)

Using a first image obtained by capturing at least one observation area before treatment and at least one second image obtained by capturing at least one observation area during treatment, the temperature is determined. and generate information regarding the temperature, and generate first alert information regarding the treatment target area detected in the observation area and second alert information regarding the treatment avoidance area detected in the observation area based on the information regarding the temperature. an information generation unit that generates;
an output control unit that causes an output unit to output the treatment target area, the treatment avoidance area, the first alert information, and the second alert information together with the information regarding the temperature;
A medical image processing device equipped with The information generation unit includes:
The first alert information includes first information for notifying that the treatment target area included in at least one of the observation areas has reached the target temperature, and the treatment target area has reached the target temperature for a certain period of time. generating information including at least one of second information for notifying that the second information will arrive after the elapsed time;
The second alert information includes third information for notifying that the treatment avoidance area included in at least one of the observation areas has reached the permissible temperature, and the treatment avoidance area has reached the permissible temperature after a certain period of time. generating information including at least one of fourth information for informing that the
As the first alert information or the second alert information, fifth information informing that the operation of the treatment device used for the treatment should be controlled based on the information regarding the temperature, based on the information regarding the temperature. generating information including at least one of sixth information informing that the imaging operation of the imaging device used to capture the first image and the second image should be controlled;
The medical image processing device according to claim 1. The information generation unit further generates a first control signal that controls the operation of the treatment device based on the information regarding the temperature,
The output control unit outputs the first control signal,
The medical image processing device according to claim 2. The information generating unit generates information including a first predicted time until the treatment target area reaches the target temperature as the first alert information , and generates information including a first predicted time until the treatment target area reaches the target temperature as the second alert information. generating information including a second predicted time for the treatment avoidance region to reach an acceptable temperature;
The output control unit outputs the first control signal after the first predicted time or the second predicted time has elapsed.
The medical image processing device according to claim 3. The information generation unit further generates a second control signal that controls the operation of the imaging device based on the information regarding the temperature,
the output control unit outputs the second control signal;
The medical image processing device according to claim 2. The information generating unit generates information including a first predicted time until the treatment target area reaches the target temperature as the first alert information , and generates information including a first predicted time until the treatment target area reaches the target temperature as the second alert information. generating information including a second predicted time for the treatment avoidance region to reach an acceptable temperature;
The output control unit outputs the second control signal after the first predicted time or the second predicted time has elapsed.
The medical image processing device according to claim 5. further comprising a selection unit that selects the first information to the sixth information,
The information generation unit generates the first information, the second information, the third information, the fourth information, and the fifth information as the first alert information or the second alert information. The medical image processing apparatus according to any one of claims 2 to 6, wherein the medical image processing apparatus generates information including information selected by the selection unit from among the sixth information. The information generation unit generates image information as the first alert information or the second alert information,
The medical image according to any one of claims 1 to 7, wherein the output control unit displays at least one of the first alert information and the second alert information on a display unit as the output unit. Processing equipment. The information generation unit generates audio information as the first alert information or the second alert information,
The medical device according to any one of claims 1 to 7, wherein the output control unit outputs at least one of the first alert information and the second alert information to an audio output unit as the output unit. Image processing device. In the method for operating a medical image processing device, the medical image processing device includes:
Using a first image obtained by capturing at least one observation area before treatment and at least one second image obtained by capturing at least one observation area during treatment, the temperature is determined. generate information about;
Generating first alert information regarding the treatment target area detected in the observation area and second alert information regarding the treatment avoidance area detected in the observation area based on the information regarding the temperature;
Outputting the treatment target area, the treatment avoidance area, the first alert information, and the second alert information together with the information regarding the temperature;
A method with to the computer,
Using a first image obtained by capturing at least one observation area before treatment and at least one second image obtained by capturing at least one observation area during treatment, the temperature is determined. and generate information regarding the temperature, and generate first alert information regarding the treatment target area set in the observation area and second alert information regarding the treatment avoidance area set in the observation area based on the information regarding the temperature. An information generation function to generate,
an output control function that causes an output unit to output the treatment target area, the treatment avoidance area, the first alert information, and the second alert information together with the information regarding the temperature;
A medical image processing program that realizes this.

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