JPH06261907A - Ultrasonic therapeutic device - Google Patents

Abstract

PURPOSE:To make setting of the shape and position of impact waves in the optimum irradiating conditions by analyzing the physical state of the area near an object to be treated on the basis of the reflected waves of measuring ultrasonic waves received, and changing the properties of the therapeutical ultrasonic waves to be transmitted. CONSTITUTION:Ultrasonic waves radiated in a body are reflected, received by a piezo element group 1, passed through a reception delay circuit 18, and amplified by an amplifier 9, and then only the signals from a focused region are taken out by a gate circuit 10. The separated signal is sent to a peak value sensing circuit 11 for sensing of the max. amplitude value, and a calculus judging circuit 12 judges whether the peak value is greater than the predetermined threshold, and the result is sent to a control circuit 8. It is also sent to a spectrum analyzer 13, and the frequency analyzed data is forwarded to a crush degree measuring circuit 14, and the data of the frequency components is normalized with the output from a peak value sensing circuit 11. Among the data normalized, the ratio of the strength of a certain frequency to the set value is determined, and with this ratio the size of crushed pieces is measured, and the data acquired is fed to the control circuit 8.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic calculus breaking device for treating calculi in a living body by using strong ultrasonic waves.

[0002]

2. Description of the Related Art In recent years, in the treatment of calculi mainly in the urinary tract, Extracorporeal Shock Wave Lithotripsy (ESWL) has been used to irradiate shock waves from outside the body to crush the calculi. Similarly, a method for treating a tumor inside the body by focusing a shock wave from outside the body is also being studied.

By the way, there are roughly three types of shock wave sources used for the ESWL. The first method is called an underwater discharge method, in which a pair of electrodes are placed at the first focal point of a reflecting mirror forming a part of a spheroid to cause electric discharge. The spherical shock wave generated by this underwater discharge concentrates on the second focal point, which is reflected and focused by the reflecting mirror, and crushes the stones placed there.

The second method is an electromagnetic induction method, which generates a shock wave by a principle very similar to that of a speaker. When a large pulse current is suddenly applied to the flat coil, a large repulsive force due to the back electromotive force is generated in the conductive plate placed on the front surface, which becomes a flat shock wave. This plane shock wave is focused by an acoustic lens to form a focal point.

The third method is the piezo method. When a large voltage pulse is applied to a piezo element that forms part of a spherical shell, powerful ultrasonic waves are emitted. This ultrasonic wave gradually transforms into a shock wave due to the nonlinearity of the medium, and becomes a strong shock wave at the focal point, which is the center of the spherical shell.

Each of these three types of shock wave sources has merits and demerits, and at present, it cannot be said that which is the optimum shock wave source. For example, the underwater discharge method generally has a large energy, but a large focal size and a large crushing force, but the size of the crushed piece also becomes large, and it may be difficult to discharge it to the outside of the body. On the contrary, the epizo method generally has a small energy and a sharp focus, and therefore has an advantage that the broken pieces are fine, but has a problem that the crushing force is slightly inferior. And the electromagnetic induction method is said to be in between. It has been considered that the physical properties at these focal points are almost determined by the shock wave source method and cannot be controlled arbitrarily. "However, recently, as shown in Japanese Patent Application No. 4-2535353, a method has been proposed in which the focus size is controlled by changing the drive phase of a plurality of piezo elements. According to this, at the start of treatment, the focus is increased and the crushing proceeds faster, and if the crushing progresses to a certain extent, then the focus is made smaller and the crushed pieces are made finer. It is possible to control by irradiating with power and reducing the power when crushing progresses to a certain extent or more.

In addition to the type of shock wave source and the size of the focal point, factors that determine the crushing status of calculi have been clarified (6th Autumn Meeting of the ME Society of Japan p38). More specifically, the crushing force of the calculus differs depending on the positional relationship between the shock wave focus and the calculus, and is also affected by the type of calculus. For example, in the case of a very hard but fragile stone such as a model stone made of activated alumina, the relative position of the focal point does not change significantly, and rather the crushing force is maximum when the focal point is aligned with the rear surface of the stone. . In addition, stones that are relatively soft like gallstones and have a low acoustic impedance and are considered not to be so brittle have the largest crushing force when they are focused near the surface. The power is decreasing. Therefore, with gallstones, it is desired to bring the focus position to the surface, but it is actually difficult.

That is, as shown in Japanese Patent Application No. 3-324781, when the gallbladder gallstone is irradiated from below, the gallstone surface is often in contact with the anterior wall of the gallbladder, but if the focus is on the stone surface. The gall bladder wall is exposed to high pressure, and damage (mostly inflammatory thickening) is likely to occur. For this reason, the focus is on the back of the calculus, taking into account the reduction of the crushing power. However, when the gallbladder gallstones are irradiated from above, the situation becomes very different. This is because the stone will sink to the bottom of the gallbladder due to gravity. At this time, bile is present above the gallstone, that is, on the shock wave source side. Therefore, even if the focus is on the surface of the stone, the strength of the shock wave at the anterior wall of the gallbladder is weak, so treatment can be performed without causing much damage.

In addition to this, in order to accurately align the focal position of the shock wave with the irradiation target, ultrasonic waves and radiation for image drawing are used. In the case of using ultrasonic waves for image visualization, there are problems that the irradiation target becomes unclear or cannot be rendered if obstacles such as ribs exist on the ultrasonic wave propagation path. Therefore, Japanese Patent Laid-Open No. 3-280942
As shown in Japanese Patent Publication, the probe (inner probe) for imaging the ultrasonic image inside the therapeutic applicator moves.
There is known a method of rotating so as to avoid a propagation path of ultrasonic waves for image visualization from an obstacle. However, the conventional apparatus provided with only the ultrasonic imaging means has a problem that it cannot be applied to an irradiation target that is difficult to be visualized by ultrasonic waves.

Also, when only radiation is used for alignment, the amount of radiation exposure becomes a problem, and long-term real-time monitoring during treatment cannot be performed. Therefore, recently, as shown in FIG. 8, both the radiation imaging tube and the ultrasonic probe for image visualization are provided in the therapeutic applicator, or the radiation imaging tube is detachable as shown in FIG. A designed ultrasonic therapy device has been proposed,
In all of them, the axis of the ultrasonic image rendering probe was fixed to the applicator, and it was difficult to visualize the irradiation target by the ultrasonic image when there were obstacles. Further, in a device in which the radiation image pickup tube is always present in the shock wave propagation path, a part of the energy of the shock wave is scattered by the image pickup tube, and there is a drawback that the energy utilization efficiency is poor. Further, in the apparatus for attaching and detaching the irradiation ray imaging tube, the radiation imaging tube must be removed and attached for each treatment / diagnosis, which is complicated.

Further, when the focal position of the shock wave is adjusted to the irradiation target, generally, the irradiation target is first drawn by an external hand probe, and the inclination angle, azimuth and position of the external hand probe at that time are used to determine the therapeutic applicator. Determine tilt, azimuth and position. At this time, the position of the external hand probe is clarified by marking on the body surface of the patient, but the angle and rotation angle depended solely on the memory of the operator. Therefore, an external hand probe that can be easily operated manually can easily draw the irradiation target, but the irradiation target can be drawn by the inner probe in the therapeutic applicator that requires mechanical operation, that is, the focal position of the shock wave and the irradiation target can be displayed. It wasn't easy to match.

[0012]

As described above, there has been proposed a method of controlling the shape and position of the shock wave focus depending on the state and type of the calculus, but the operator treats before or during treatment. It was necessary to continuously observe the target stones and control the shock wave source, which made the operation complicated and difficult to implement.

The present invention provides an extracorporeal shock wave calculus breaking device capable of measuring the condition, type, etc. of calculi by ultrasonic waves for measurement during treatment with shock waves and setting the shape and position of shock waves to the optimum irradiation conditions. It is provided.

In addition, it is difficult to clearly delineate the irradiation purpose when there are obstacles such as ribs with a conventional therapeutic ultrasonic applicator having a built-in radiation imaging tube and ultrasonic image depiction probe. However, there is a drawback in that it takes time to align the therapeutic ultrasonic energy for irradiation purposes. Further, when the radiation imaging tube is in the propagation path of the therapeutic ultrasonic wave, the radiation imaging tube scatters the energy of the therapeutic ultrasonic wave and the utilization efficiency of the ultrasonic energy deteriorates, or There is a problem in that a device that needs to be attached or detached is troublesome.

Further, since the operation of the ultrasonic probe in the therapeutic applicator is a mechanical operation, it is very different from the operation feeling by hand typified by the ultrasonic hand probe, and it is not easy to depict the purpose of irradiation. It was

The present invention eliminates the drawbacks associated with imaging as described above, makes effective use of the energy of therapeutic ultrasonic waves, and enables quick and easy extracorporeal shock wave calculi to align the irradiation objective and confirm the therapeutic effect. It is intended to provide a crushing device.

[0017]

In order to solve the above-mentioned conventional problems, the present invention is directed to irradiating an object such as a stone in a patient's body with acoustic energy from an acoustic energy generating means in the first invention. In the ultrasonic treatment apparatus for crushing and treating by crushing, the acoustic energy generating means is capable of transmitting the measurement acoustic energy to the vicinity of the object and receiving the reflected wave corresponding to the measurement acoustic energy. Then, an ultrasonic treatment apparatus is constituted by means for analyzing a physical state in the vicinity of the object based on the received reflected wave and means for changing the property of acoustic energy based on this means.

According to the second aspect of the invention, in an ultrasonic therapy apparatus for irradiating an object such as a stone in the patient's body with acoustic energy from the acoustic energy generating means for crush treatment, the patient's body can be imaged with radiation. Radiation image pickup means, ultrasonic image pickup means capable of picking up an ultrasonic image of a focal position of the acoustic energy generating means, and the radiation image pickup means or the ultrasonic image pickup means or a movement for movably holding these means. An ultrasonic treatment device is configured from the means.

[0019]

According to the first invention of the present application, in the shock wave source using the piezo element, a weak ultrasonic wave is transmitted and received from the same piezo element that emits a strong shock wave, and the reflected wave from the area including the calculus is transmitted. If the size of the calculus fragments in the focal area is obtained by frequency analysis and it is determined that "the calculus has not been crushed" based on the measured value, the irradiation continues under the maximum conditions for the focal size and energy, and If the size of the focal spot or the energy is reduced, it is possible to control the focus size or the energy to be smaller.

Further, similarly to the above, the shock wave generating piezo element collects the reflected signal of the area including the calculus, detects a strong reflected wave of a predetermined value or more, and measures the reflected wave intensity of the predetermined area in front of it. . If the reflection intensity is equal to or higher than a predetermined value, it is determined that the tissue is in contact with the front of the calculus, and the focal position is changed to set the calculus surface having the maximum reflection intensity to the back. On the contrary, when the reflection intensity is low and it is determined that the front is a liquid,
The focus can be made to coincide with the stone surface where the reflection intensity is maximum, and the treatment can be advanced under the optimum irradiation conditions.

On the other hand, according to the second aspect of the present invention, since the central axis of the radiation imaging tube and the central axis of the movable ultrasonic image drawing probe are always on the focal point of the therapeutic acoustic energy, the If the irradiation purpose cannot be clearly displayed on the ultrasonic image, the irradiation purpose can be clearly displayed on the ultrasonic image without moving the therapeutic applicator and radiation imaging tube by moving the ultrasonic image drawing probe. It is possible. As a result, the horizontal plane can be aligned with the radiation image and the vertical plane can be reliably aligned with the ultrasonic image with respect to the input direction of the therapeutic acoustic energy. And it can be done quickly. Also, since only the ultrasonic probe can be moved and adjusted so that the ultrasonic image becomes clear, it is possible to take the radiation image at the same angle before and after the treatment without moving the therapeutic applicator. Will be easier.

Further, by disposing the radiation imaging tube outside the propagation path of the acoustic energy for treatment, scattering of the acoustic energy by the radiation imaging tube is avoided, and the expandable container is arranged on the propagation path of the radiation. When the image is taken, the container is expanded and the radiation propagation medium is introduced inside, and when the acoustic energy is radiated, the container is contracted to improve the energy use efficiency both during radiation imaging and during acoustic energy irradiation. To do.

Furthermore, the external ultrasonic hand probe and the therapeutic applicator are fitted with their tilt and azimuth detectors, preferably a small fiber optic gyro,
By displaying the above angle to the operator, the operator can easily make the inclination angle and azimuth angle of the therapeutic applicator the same as those of the hand probe, and the axis of the therapeutic applicator can be adjusted by laser light. By clearly indicating the position of the body surface to which the guide applicator for treatment is brought into contact,
It is easy to visualize and align the irradiation purpose. Further, by automatically controlling the operation range of the operator described above, after the irradiation purpose is drawn by the hand probe, the tilt angle and azimuth angle of the therapeutic applicator are automatically controlled, and the treatment can be surely and quickly performed. .

[0024]

Embodiments of the first and second inventions will be described below with reference to the drawings. FIG. 1 is a diagram showing a configuration diagram of an ultrasonic therapeutic apparatus according to an embodiment of the first invention. The piezo element group 1 which is a shock wave source is coupled to the patient 3 by a water bag 2. Each piezo element group 1 is connected to a drive circuit group 4. The drive circuit group 4 is initially supplied with a low voltage from the high-voltage power supply 7 via the attenuator 5, and is driven at a timing of a pulse given an appropriate delay by the transmission delay circuit group 17, and does not become a shock wave. Irradiate a weak ultrasonic pulse. Here, the delay value is set so that the operator can focus on the stones drawn by an image device such as an ultrasonic diagnostic device (not shown). The ultrasonic waves emitted into the body are reflected by the portions having different acoustic impedances. This reflected wave is received by the same piezo element group 1 used for transmission. This received RF signal wave is usually a reception delay circuit group 1 having the same delay value as the transmission delay circuit group 17.
After being delayed by 8, the signal is amplified by the amplifier 5, and the gate circuit 10 extracts only the signal from the focal region. This can be easily realized by taking in the driving timing of the driving circuit 4 and providing a sampling gate after the round trip time of the distance to the focus. The separated signal is sent to the peak value detection circuit 11 to detect the maximum amplitude value, and the value is sent to the calculus determination circuit 12. The calculus determination circuit 12 determines the magnitude relationship between this peak value and a preset threshold value, and sends it to the control circuit 8. This peak value is C
Displayed on RT16.

On the other hand, the signal separated by the gate circuit 10 is also sent to the spectrum analyzer 13 and its frequency-analyzed data is sent to the crushing degree measuring circuit 14. The crushing degree measuring circuit 14 first normalizes the data of the frequency component by the output from the peak value detecting circuit 11. The ratio between the intensity of a certain frequency (for example, 150 KHz) and the set value is obtained from the normalized data. This set value may be data stored in advance or one of the measurement data whose sampling timing is determined by the external switch 15. The fragment size is measured according to the ratio thus obtained, and the data is sent to the control circuit 8.
Further, this ratio is displayed on the CRT 16.

Next, when the control circuit 8 sends a signal "greater than a threshold value" from the calculus determination circuit 13 and a signal "stone is sufficiently large" from the crushing degree measuring circuit 14, the focus It is determined that there is a calculus that has not been crushed, the attenuator 5 is controlled, and the drive circuit group 4 is driven under the condition that the drive voltage is maximum. Further, at this time, the delay value of the transmission delay circuit group 17 is set to a value for expanding the focus.

When the treatment progresses in this state and the calculus is crushed to some extent, the signal from the calculus crushing degree measuring circuit 14 changes to "the calculus is insufficient but small". Based on this data, the control circuit 8 controls the attenuator 5 and narrows the output, and at the same time, it also controls the transmission delay circuit 17 to form a sharp focus. This makes the crushed pieces even finer,
It becomes sandy. Finally, since the signal from the calculus crushing degree measuring circuit 14 becomes "the calculus is sufficiently small", the irradiation of the shock wave is stopped.

Here, of the properties of the shock wave, both the focus size and the shock wave energy were controlled at the same time, but either one may be used. Further, in order to measure the degree of crushing, a peak value of a single frequency of 150 KHz normalized by the peak value of reflected wave was used, but in addition to this, JP-A-4-11123.
Other characteristic values representing the degree of crushing as shown in 6 may be used.

FIG. 2 is a diagram showing the configuration of an ultrasonic therapeutic apparatus according to another embodiment of the first invention. In the figure, components having the same functions as those in the above embodiment have the same names and
It is indicated by a number.

Each piezo element group 1 is coupled to a drive circuit group 4, and the drive circuit group 4 is initially coupled to a low voltage power source 22 via a changeover switch 21.
The drive circuit 4 is driven at the timing of the pulse given an appropriate delay by the transmission delay circuit group 17, and emits a weak ultrasonic wave pulse that does not become a shock wave. Here, the delay value is set so that the operator can focus on the stones drawn by an image device such as an ultrasonic diagnostic device (not shown). The reflected wave from the inside of the body is received by the same piezo element group 1 used for transmission. The received RF signal is usually delayed by the reception delay circuit group 18 having the same delay value as that of the transmission delay circuit group 17, and then amplified by the amplifier 5, and only the signal from the focal region is amplified by the gate circuit 10. Taken out. The classified signal is guided to the signal analysis circuit 24. Here, the operation of the signal analysis circuit 24 will be described. FIG. 3 is a diagram showing an RF signal cut out by the gate circuit 10. First, the signal analysis circuit 24 finds the time of the point 31 showing the maximum reflection amplitude which is considered to be the reflection from the surface of the calculus. Further, the integral value of the energy of the signal within a predetermined width τ before this maximum amplitude point 31, that is, here about 2 μsec (about 3 mm as a distance) is obtained. If the soft tissue is immediately in contact with the calculus, the energy integral value is relatively large because it integrates an infinite number of reflected waves. On the contrary, when there is no tissue in front of the calculus and there is liquid such as bile, the energy integral value becomes extremely small because there is almost no reflector. Next, the signal analysis circuit 24 sends the maximum amplitude time and the energy integrated value obtained as described above to the control circuit 8 '. When it is determined that "the front of the stone is liquid", the control circuit 8'controls the transmission delay circuit 17 so that the shock wave focus coincides with the maximum amplitude point. On the contrary, when it is judged that “the tissue before the stone is tissue”, the transmission delay circuit 1 is set so that the shock wave focus is located at the back of the maximum amplitude point.
Control 7 As a result, it is possible to crush stones with maximum efficiency while minimizing tissue damage near the stones.

In the first embodiment, the shock wave is controlled by determining the crushing degree of the calculus from the reflection signal from the calculus, but the reflection signal also includes information on the type of calculus. Therefore, the type of stone is read by analyzing the signal, and the shock wave focus size that realizes the most efficient destruction according to the type,
It is also possible to control the position and the like.

In another embodiment, the means for measuring the condition of the calculus and its surroundings uses a method of transmitting and receiving a weak ultrasonic wave from the same piezo element as the shock wave source and analyzing the received signal. The invention is not limited to this.
For example, a method of determining the crushing condition of the calculus from ultrasonic or X-ray image analysis for obtaining the position of the calculus is known, but the same effect can be obtained by using the characteristic values of data quantifying the crushing condition. Is obtained. The shock wave may be controlled by determining the presence of the liquid in front of the calculus and the characteristics of the calculus from the image analysis. [Second Invention] FIG. 4 is a diagram showing a configuration of an ultrasonic therapeutic apparatus according to an embodiment of the second invention. Here, an applicator for extracorporeal shock wave calculus breaking using a piezo element will be described.

The piezo element group 1 for generating a strong ultrasonic wave is constructed so as to form a part of a sphere centered on the focal point F. The ultrasonic imaging probe 41 has a central axis C ₁
Is fixed to the holder 42 so as to pass through the focal point F and form a predetermined angle with the central axis C ₂ of the piezo element group 1, and can rotate about the central axis C ₁ and can move back and forth. The holder 42 can be rotated about the central axis C ₂ of the piezo element group 1. Further, the central axis C ₂ and the central axes of the radiation image receiving device 43 and the radiation generating device 43 ′ coincide with each other. The expandable container 44 is, for example, a film made of an organic material, and is expanded by the expandable container control unit 45 at the time of capturing a radiographic image and comes into contact with the patient 3. At this time, the applicator 46 is filled with water as a shock wave propagation medium,
The inside of the expandable container 44 is filled with air whose radiation attenuation constant is smaller than that of water. The volume of water due to the expansion of the telescopic container 44 is absorbed by the water tank T via the pressure valve B so that excess pressure is not applied to the patient 3. When the radiography is completed, the expandable container 44 contracts and the inside of the applicator 46 is completely filled with water so that the shock wave can efficiently propagate. At this time, the volume of water of the expandable container 44 flows from the tank T to the pressure valve B.
Is supplied via.

Next, an actual stone crushing treatment procedure will be described as an example. Understand which part of the body the calculus exists from the previously examined data. Then, the radiation devices 43, 4 are drawn so that the expected site is depicted.
A radiographic image is taken by 3 '. At this time, the expandable container 44 is filled with air, and the radiation reaches the living body without being attenuated by water. After shooting, the container 44 is the control unit 4
5, the applicator 46 is filled with the shock wave propagating medium water. The captured image is displayed by the radiographic image display unit 47, and the operator can immediately read in which direction and how much the treatment target deviates from the central axis of the applicator 46. The operator inputs 4
When the deviation is input via 8, the controller 49 sends a control signal to the applicator moving means 50, and the applicator 46 is parallel to the plane of the radiographic image until the treatment target coincides with the axis 5 of the applicator 46. Move to. After that, the operator observes the in-vivo image by the ultrasonic probe 3 with the ultrasonic image display device 47 and applicator 4
If 6 is moved in parallel with the axis C ₂ , the treatment target is drawn on the ultrasonic image display device 47 ′ when the shock wave focus and the treatment target overlap. At this time, the holder 42 or the ultrasonic probe 41 can be rotated and adjusted so that the ultrasonic image becomes clear.

By the above operation, it is possible to perform a three-dimensional simple and quick alignment using radiation and ultrasonic waves. Next, FIG. 5 shows a detailed structure of the above-described ultrasonic probe for image drawing.

The ultrasonic image drawing probe 41 is a motor 5
It is connected to 1a and can rotate. Further, the ultrasonic probe 41 and the motor 51 are attached to a support column 52, and the support column 52 is movable by a rack and pinion 53.
Move up and down. In addition, the movable table 54 includes the motor 5
The holder 42 is moved by the 1b and the belt 55.
Since the holder 42 has the same curvature as that of the piezo element group 1, the central axis C ₁ of the ultrasonic probe 41 is always the therapeutic ultrasonic energy generated from the piezo element group 1 even after the movable table 54 is moved. It coincides with the focal point F.

Next, the expandable container 44 will be described.
The expandable container 44 has a bag shape made of, for example, an organic material, and its expansion and contraction are controlled by the control unit 45.
When the container 44 is expanded, air is introduced into the container 44 from the pump P by the control unit 45 through the flexible tube 56, and when contracted, the air in the container 44 is discharged.

Next, another embodiment will be described with reference to FIG. 6 is structurally similar to the device shown in FIG. 4 except for the radiation image receiving device 43, the radiation generating device 43 ′, the expandable container 44, the flexible tube 56, the radiation device holder 61 and the arm 62. The other components are omitted since they are the same. The container 44 is mounted on the radiation image receiving device 43. The radiation receiving device 43, the container 44, and the tube 56 are attached to the axis C _{2 of the} applicator 46 by the holder 61.
It is possible to rotate around. The axis C _{3 of the} radiation device is always on the focus F of the therapeutic ultrasound and the axis C ₃ of the applicator 46 is
It is inclined at a predetermined angle with respect to ₂ . Piezo element group 1
, The axis C ₃ shown in FIG. 3 (b) is a hole in the circumferential direction as indicated by oblique lines, the radiation image receiving device 43 and the generator 43 'move circumferentially along the center of the hole It is like this. Further, when the radiation is imaged, the container 44 is inflated by the control unit 45 through the tube 56 and swells as shown in FIG. 3B, and the air inside the container 44 is discharged during the irradiation of therapeutic ultrasonic waves. Deflate. By arranging the radiation device outside the applicator in this way,
It is possible to avoid scattering of therapeutic ultrasonic waves by the radiation image receiving device (or the generating device). Further, since the axis C _{3 of the} radiation apparatus can be rotated around the axis C ₂ of the applicator 46 while keeping the focal point F of the therapeutic ultrasonic wave at the center F, it is possible to perform 3 in 2 direction imaging
Dimensional position can be determined. Further, when the treatment target cannot be drawn well due to obstacles such as ribs, the axis C _{3 of the} radiation apparatus can be rotated to avoid the obstacle, and the treatment target can always be drawn.

The actual alignment procedure is as follows. Applicator 4 for the treatment target shown in the radiographic image
6, the amount of movement of the applicator 46 required to match on the axis of 6 is calculated by the electronic calculator 63, and the movement mechanism 64 until the axis C ₂ of the applicator 46 matches the treatment target according to the calculated value. After moving 46, it moves parallel to the axis 5 to bring the focus position to match the treatment target.

The ultrasonic image drawing probe 41 can also be moved while being aligned with the focal point of the therapeutic ultrasonic wave as described in the first embodiment. FIG. 7 is an example in which a radiographic image and an ultrasonic image are displayed. By arranging the radiographic image and the ultrasonic image in parallel, the position of the calculus in the body can be easily grasped. FIG. 7b shows a case where the propagation path of the therapeutic ultrasonic wave has an angle with respect to the ultrasonic image as indicated by a dotted line on the screen.
In this way, by showing the shock wave propagation path by the dotted line, the relative positional relationship between the ultrasonic image and the shock wave propagation path can be immediately understood.

In each of the second inventions, the ultrasonic probe 41 is arranged in the shock wave propagation path, but the ultrasonic probe 41 is not limited to this and may be located at any position where the treatment target can be confirmed.

[0042]

According to the first aspect of the present invention, the operator can perform treatment with optimal shock wave properties according to the condition of stones without the need for continuous and complicated control, and the treatment efficiency and safety. The property is improved.

According to the second aspect of the invention, the movable ultrasonic image drawing is characterized by having an axis that makes a predetermined angle with the axis of the therapeutic applicator and that coincides with the focus of the therapeutic applicator. By moving the ultrasonic probe or the radiation device inside the applicator without moving the applicator, a clear ultrasonic image can be obtained without being affected by obstacles such as ribs. Since the image can be drawn with certainty, it is possible to perform quick and easy alignment in three dimensions.

Further, even if the treatment target is delicately moved due to the irradiation of the acoustic energy for treatment and the treatment target cannot be clearly displayed, the treatment target is made clear in real time by moving only the treatment ultrasonic probe. Can be depicted. As a result, since the treatment applicator is not moved during the treatment, it is possible to capture the radiation image at the same position and the same angle before and after the treatment, and thus it is easy to compare the treatment effects.

Further, by expanding and contracting the container on the axis of the radiation device and inside the propagating portion of the therapeutic acoustic energy, and disposing the radiation device outside the propagating portion, the radiation generating device (or the image receiving device) is attached and detached. Even if it is not performed, the therapeutic acoustic energy is not scattered, so that the operability of the device and the utilization efficiency of the therapeutic acoustic energy can be improved.

[Brief description of drawings]

FIG. 1 is a diagram showing the configuration of an ultrasonic therapeutic apparatus according to an embodiment of the first invention.

FIG. 2 is a diagram showing a configuration of an ultrasonic therapeutic apparatus according to another embodiment of the first invention.

FIG. 3 is a diagram showing a received waveform of reflected ultrasonic waves in FIG.

FIG. 4 is a diagram showing the configuration of an ultrasonic therapeutic apparatus according to an embodiment of the second invention.

5 is a diagram showing details of the ultrasonic probe for image drawing in FIG.

FIG. 6 is a diagram showing a configuration of an ultrasonic therapy apparatus according to another embodiment of the second invention.

FIG. 7 is a diagram showing a display example of a radiation image and an ultrasonic image in the second invention.

FIG. 8 is a diagram showing a conventional treatment apparatus.

FIG. 9 is a diagram showing a conventional treatment apparatus.

[Explanation of symbols]

 1 ... Piezo element group 2 ... Water bag 4 ... Drive circuit group 5 ... Attenuator 7, 23 ... High voltage power supply 8 ... Control circuit 10 ... Gate circuit 11 ... Peak value detection circuit 12 ... Stone determination circuit 13 ... Spectrum analyzer 14 ... Fragility measuring circuit 21 ... Changeover switch 22 ... Low voltage power supply 24 ... Signal analysis circuit 41 ... Ultrasonic imaging probe 42 ... Holding tool 43 ... Radiation imager 43 '... Radiation generator 44 ... Expansion container 45 ... Expansion container control unit 46 ... Applicator 47 ... Radiation image display section 47 '... Ultrasonic image display section 48 ... Input section 49 ... Controller 50 ... Applicator moving means 51a, 51b ... Motor 51 ... Strut 53 ... Rack and pinion 54 ... Movable stand 55 ... Belt 56 ... Tube 61 ... Radiation device holder 62 ... Arm 63 ... Computer 64 ... Moving mechanism

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Yoshiharu Ishibashi 1 Komukai Toshiba-cho, Kouki-ku, Kawasaki-shi, Kanagawa Incorporated Toshiba Research and Development Center

Claims (9)

[Claims] 1. An ultrasonic therapy apparatus for irradiating and crushing an object in a patient with acoustic energy from the acoustic energy generating means, wherein the acoustic energy generating means includes a measuring sound near the object. Means for transmitting a physical energy and capable of receiving a reflected wave corresponding to the acoustic energy for measurement, and analyzing a physical state in the vicinity of the object based on the received reflected wave, and And a means for changing the property of acoustic energy based on the means. 2. The ultrasonic therapeutic apparatus according to claim 1, wherein the means for analyzing the physical state near the object is a means for measuring the diameter of the object. 3. The means for analyzing a physical state in the vicinity of the target object is a means for determining the presence of a living tissue on the front side of the target object in the traveling direction of the shock wave. 1. The ultrasonic therapy device according to 1. 4. The ultrasonic therapeutic apparatus according to claim 1, wherein the means for analyzing the physical state near the target object is a means for determining the type of the target object. 5. The ultrasonic therapeutic apparatus according to claim 1, wherein the means for changing the property of the acoustic energy is at least one of a focus size, an acoustic energy amount or a focus position. 6. An ultrasonic therapy apparatus for irradiating an object such as a stone in a patient's body with acoustic energy from the acoustic energy generating means for fragmentation treatment, and a radiation imaging means capable of radiographically imaging the inside of the patient's body. It is characterized by comprising an ultrasonic image pickup means capable of picking up an ultrasonic image of a focal position of the acoustic energy generating means, and the radiation image pickup means or the ultrasonic image pickup means or a moving means for movably holding these means. Ultrasonic therapy device. 7. The ultrasonic therapeutic apparatus according to claim 6, wherein the ultrasonic imaging unit is provided in a propagation path of the acoustic energy. 8. The ultrasonic therapeutic apparatus according to claim 6, wherein the radiation imaging unit is provided in a propagation path of the acoustic energy. 9. The radiation imaging means is provided outside the propagation path of the acoustic energy, and spatially separates the propagation path of the acoustic energy and the propagation path of radiation from the radiation imaging means. The ultrasonic treatment apparatus according to claim 6, which has.