JPH03133429A - 血管内のカテーテルのリアルタイム表示方法 - Google Patents

血管内のカテーテルのリアルタイム表示方法

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Publication number
JPH03133429A
JPH03133429A JP2258790A JP25879090A JPH03133429A JP H03133429 A JPH03133429 A JP H03133429A JP 2258790 A JP2258790 A JP 2258790A JP 25879090 A JP25879090 A JP 25879090A JP H03133429 A JPH03133429 A JP H03133429A
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catheter
image
antenna
tip
blood vessel
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JP2947908B2 (ja
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Manfred Pfeiler
マンフレート、プフアイラー
Helmut Ermert
ヘルムート、エルメルト
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Siemens AG
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Siemens AG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A61B2090/3929—Active markers

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Abstract

(57)【要約】本公報は電子出願前の出願データであるた
め要約のデータは記録されません。

Description

【発明の詳細な説明】 〔産業上の利用分野〕 本発明は、血管内のカテーテルのリアルタイム表示方法
およびこの方法を実施するためのカテーテルに関する。
〔従来の技術〕
血管造影法による診察および特に処置技術においては、
Ｘ線透視を適用していわゆる“バスファインダ表示”が
非常に頻繁に行われる。その際、先ず造影剤技術によっ
て観察対象の血管範囲（血管構造）の精密なトポロジー
を検出するために樹枝状血管のＸ線像が撮影されて記憶
される。その後カテーテルを適用する際、かかるカテー
テルは樹枝状血管を見ることの出来ない透視像内に表示
される。カテーテルの位置、方位および移動を再生する
連続透視像はその場合血管構造を含む造影剤像と常時組
合わせられる（重畳される）０合成された連続全体像は
それゆえ血管構造内のカテーテルを示し、医者によるカ
テーテルのコントロールされた移動を可能にする。
このような技術は樹枝状血管の記憶像を作成するための
造影側注入の際ならびにその後行われるカテーテル適用
の際にＸ線透視装置の適用を必要とする。このことは患
者ならびに特に医者に対して、樹枝状血管の記す、α像
を作成するために必要であるＸ線露光よりも強いＸ線露
光が行われることを意味する。
血管構造を撮影して記憶する技術としては、通常カテー
テルを介して行われる造影剤適用を伴ったＸ線技術以外
には他に適当な技術が存在しない。
Ｘ線撮影はカテーテルを適用する前に１回行われる。撮
影は患者および医者に対して僅少なＸ線露光が行われる
ことを意味する。
〔発明が解決しようとする課題〕 本発明は、カテーテルの永続的な表示を行うために治療
中はＸ線透視を、非イオン化線、波または場を利用しか
つ中よされるＸ線露光の利点を有する他の方法によって
置き換えることを課題とする。
〔課題を解決するための手段］ このような課題は、本発明によれば、受信器によって検
出されて電気的画像信号に変換される電磁波または音響
波を放射するための送信器を備え、送信器または受信器
はカテーテルに付設され、カテーテルの画像をＸ線血管
像に重畳させることを特徴とする血管内のカテーテルの
リアルタイム表示方法によって解決される。
この方法を実施するためのカテーテルは、本発明によれ
ば、その先端で送信アンテナまたは受信アンテナを担持
することを特徴とする。
〔発明の効果］ ところで、米国特許第４６９７５９５号明細書および刊
行物「メディカル・アンド・バイオロジカル・エンジニ
アリング・アンド・コンピュートゥング（Ｍｅｄｉｃａ
ｌ　　ａｎｄ　　Ｂｉｏｌｏｇｉｃａｌ　　Ｅｎｇｉｎ
ｅｅｒｉｇ　　ａｎｄ　　Ｃ。
ｍｐｕｔｕｎｇ）Ｊ　　（１９８４年、第２６８頁〜第
２７１頁）によれば、カテーテルに超音波送信器が付設
され、その超音波を検出することによって患者内のカテ
ーテルの位置測定を行うことが公知である。しかしなが
ら、このようにして作成されたカテーテルの画像を他の
画像、例えばＸ線血管像に重畳させることはこの従来技
術からは想起し得ないものである。
原理的な相違について以下で説明する。
（１）　　カテーテルは通用された線（Ｘ線）との相互
作用に関してその周囲（生物学的組織）とはコントラス
トが大きく異なるので、公知の技術においてはカテーテ
ルの表示が技術的に簡単である。非イオン化線を利用す
るか、または超音波、マイクロ波を使用した場合には非
イオン化線を使用した場合と同程度に良いかまたはもっ
と良好であるコントラスト比が呈される模写方法および
相応するリアルタイム模写装置を用いて、カテーテルを
表示する非Ｘ線像が適宜の方法にて造影剤像と組合わせ
られることによって、バスファインダ技術が原理的に同
じように適用され得る。従って上述した問題は取除かれ
る。何れにしても適用性および分解能に関して模写装置
への要求は可成り満たされる。
（２）他の点は位置測定方法の適用にある。位置測定方
法は以下で説明するように模写方法とは異なっている。
つまり、模写方法は所定の制限枠内で画像の内部におけ
る多数の対象物または対象物点をトポロジツク的に正確
に表示または分解することができる。レーダー技術にお
いて多目的能力があることを表すこの特性は位置測定方
法を有していない０位置測定方法は即ち対象物だけが表
示される、つまり位置測定される場合にだけ精密かつ明
確に動作する。カテーテルは本来単一の目的のために用
いられるのではなく、その全模写は同様に適宜の多目的
形模写方法を必要とする。パスファインダ技術において
はしかしながら血管構造のトポグラフィツク的表示を行
うことができることによりカテーテルの予め定められた
移動方向を知ることができる。
今、単一かつ適当な対象物点、例えばカテーテル先端を
永続的に位置測定すること、連続的な位置を記憶するこ
と、従ってこの点の移動を追跡することに成功した場合
、下に置かれた造影剤傷内にカテーテルを再現しかつ像
表示するために必要である全ての情報が自由に入手可能
になる。模写方法に対する位置測定方法の利点は、周囲
媒体（組１ａ）の周波数および位相速度によりその都度
決定される使用波長が比較的大きくしかも位置測定精度
のオーダ内に入っている必要のない渡場を用いて動作し
得るという点にある。非イオン化波（電磁波、音響波）
においては、波到達距離は周波数が大きくなる程強く減
少することが知られている。それゆえ、位置測定方法の
適用の際比較的大きな波長、従って比較的小さな周波数
を使用することができるという利点が奏される。さらに
、位置測定方法における信号帯域幅およびアパーチュア
ーでの無駄、特にそのスベクトラル（信号）もしくは空
間的（アパーチュアー）利用密度に関する信号帯域幅お
よびアパーチュアーでの無駄は、模写方法における無駄
よりも非常に僅かである９位置測定すべき対象物点を僅
かな個別周波数（例えば３〜５）の際にも少ない体外ア
パーチュアー支持点（例えば３〜５個の送信器／受信器
）と相互作用させることは十分可能である。このような
相互作用を用いて位相または走行時間を測定することに
より対象物位置と種々のアパーチュアー支持点との間の
距離または距離差が決定され、それらの組合わせにより
対象物点の明白かつ精密な位置決定（位置測定）が可能
になる。
対象物点つまりカテーテル先端は何れにしても適宜の方
法でマーキングされなければならない。
さらに、従来のパスファインダ技術と同じように、カテ
ーテル像と血管像とが空間的に正確な配置にて相互に組
合わせられそして血管構造が治療中にずれたりまたは変
形したりしないと言う条件が適用される。
（３）上記（２）で述べた原理は同様に身体の他の中空
構造体、例えば胆管にも適用され、また特有のコントラ
スト挙動（例えば骨）により方位構造を示す構造体を有
するｚＩ域に対しても適用され得る０診察技術に応じて
その場合にはカテーテルの代わりに先端を位置測定され
る針が同様に用いられ得る。
次に技術的実現性について考察する。
ａ）［磁渡場による位置測定 カテーテル先端のマーキングはリード線がカテーテル内
またはカテーテルに沿って案内されるアンテナを装備す
ることによって有利に行われる。アンテナとしては電気
式アンテナ（ダイポール）または磁気式アンテナ（ルー
プ）が使用され得る。これらの型のアンテナの利点はカ
テーテル先端の位置測定および方位決定を可能にする偏
波特性にある。アンテナは送信アンテナとしてまたは受
信アンテナとして運転され、その場合必要ならば適宜の
形状にて生物学的組織の皮膚表面に整合させられる体外
アンテナが同様に受信アンテナまたは送信アンテナとし
て作動する。カテーテル先端と外部アンテナとの間の多
重通路伝播においては、適宜の多重周波数技術または広
帯域技術によって関与しているアンテナ間の直通路つま
り最短路が決定され得る。生物学的組織の誘電不均一性
が比較的大きいためにくこの方法による絶対的位置測定
は非常に精密にはならない、しかしながら、１つの時点
または同様に複数の時点に対するカテーテル先端の現在
位置が短時間に例えばＸ線透視によって自由に得られる
場合には、それに続く時間または時間的合間に位置の相
対的変化を電磁的位置測定方法により大きな精度でもっ
て決定することができる。
ｂ）　音響波による位置測定 同様にして音響波によっても位置測定が可能である。生
物学的組織のコントラストに関する問題は音響波の場合
には電磁波の場合よりも著しく僅かである。多重通路伝
播に関する問題はしかしながら音響波の場合には僅かな
ダンピングのために電磁波の場合よりも大きい。しかし
ながら、両問題はケースａ）において説明したのと同じ
ようにして解決可能である。カテーテル先端の方位の決
定は音響波には偏波特性がないために電磁波の場合のよ
うには与えられない。
何れにしても音響アンテナのはっきりした方向性はアン
テナ担持体としてのカテーテル先端の方位決定のために
原理的に利用可能である。多数に分割されたアンテナ要
素をカテーテル先端に装備することは方位決定の他のや
り方を堤供する。技術的にはカテーテルにおけるアンテ
ナとしてはセラミックまたはポリマー圧電要素が考慮さ
れる。送信信号振幅が高いので音響的位置測定の場合に
は受信アンテナとしてカテーテルアンテナを運転するの
が有利である。伝送路が互いに逆の関係になるので、伝
送方向を逆にしても位置測定結果は同じ値となる。
〔実施例〕
次に、本発明の実施例を図面に基づいて詳細に説明する
。
第１図にはカテーテル２が挿入されている血管１が示さ
れている。カテーテル２はその先端でアンテナ３、例え
ばグイポールを担持しており、このアンテナは送信器４
からエネルギーを供給される。
アンテナ３を担持するカテーテル先端の位置を測定する
ために受信器５が設けられており、この受信器５は身体
表面７上の受信アンテナ８ａ、８ｂ、８ｃによってアン
テナ３から放射された電磁波を受信する。デイスプレィ
装置６は例えばＸ線像に重畳させることによって上述し
た方法でカテーテル先端の位置を像表示するために使わ
れる。
上述したように、カテーテル先端には、外部のカテーテ
ル端部に配置された受信器に接続された受信アンテナが
取付けられる。身体表面７の外には受信器の代わりに送
信器が設けられる。
使用すべき波は上述したように同様に超音波でも良い。
受信信号を処理するために信号処理ユニット９が使われ
る。この信号処理ユニット９には他の入力端１０を介し
て血管構造に関する画像情報が供給される。カテーテル
先端に付設された送信アンテナは同様に受信アンテナま
たはセンサによって置き換えられ得る。このような運転
様式においては、４は受信器であり、５は送信器であり
、８ａ、８ｂ、８ｃは送信アンテナとなる。
上述した装置においては、カテーテル先端の合成画像ま
たは描き続けた画像が作成され、この画像においては時
間経過に応じて位置測定された位置がカテーテル先端の
進行経路を示す、先端領域には個々に位置測定可能なセ
グメントを設けることでき、その場合多重周波数法また
はマルチプレクズ法によってカテーテル先端の位置およ
び方向が測定可能である。
【図面の簡単な説明】
第１図は本発明を実施するための実施例を示す概略図で
ある。 １・・・血管 ２・・・カテーテル ３・・・アンテナ ４・・・送信器 ５・・・受信器 ６・・・デイスプレィ装置 ７・・・身体表面 ８ａ、８ｂ、８ｃ・・・受信アンテナ

Claims (1)

  1. 【特許請求の範囲】 １）受信器（５）によって検出されて電気的画像信号に
    変換される電磁波または音響波を放射するための送信器
    （４）を備え、前記送信器（４）または受信器（５）は
    カテーテル（２）に付設され、前記カテーテル（２）の
    画像をＸ線血管像に重畳させることを特徴とする血管（
    １）内のカテーテルのリアルタイム表示方法。 ２）カテーテル先端の画像が作成されることを特徴とす
    る請求項１記載の方法。 ３）合成画像または描き続けた画像が作成され、時間経
    過に応じて位置測定された位置がカテーテル先端の進行
    経路を示すことを特徴とする請求項２記載の方法。 ４）カテーテルはその先端で送信アンテナまたは受信ア
    ンテナ（３）を担持することを特徴とする請求項１ない
    し３の１つに記載の方法を実施するためのカテーテル。 ５）前記カテーテル（２）の先端領域には個々に位置測
    定可能なセグメント（３）が設けられ、その場合多重周
    波数法またはマルチプレクス法によってカテーテル先端
    の位置および方向が測定可能であることを特徴とする請
    求項４記載のカテーテル。
JP2258790A 1989-09-29 1990-09-27 血管内のカテーテルのリアルタイム表示方法 Expired - Lifetime JP2947908B2 (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
EP89118096.0 1989-09-29
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