JPH0747079A - Ultrasonic therapeutic system - Google Patents

Abstract

PURPOSE:To make accurate and safe therapy in the irradiation position and/or on irradiating path by reproducing simulatively the part near the lesion on the basis of three-dimensional information continued on the time axis, determining the conditions pertaining to ultrasonic irradiation, and performing ultrasonic irradiation of the lesion on the basis of the determined conditions. CONSTITUTION:The lesion of an examinee 3 and the situation around the lesion are sensed, and the corresponding image is stored in a memory 328. The data of physical properties of the structure of organ, bone, etc., is entered to this image from a console 14 so that a three-dimensional pseudo model of vital organism is prepared which includes changes along the time axis, and the prepared model is displayed on a display 15. Then the position where irradiation can be made with the least risk of being of being obstructed by any bone, organ, etc., is sought from the image, and the region which accepts therapy is identified through calculation. For each of such regions, the irradiating path of ultrasonic waves from an ultrasonic wave applicator 16 is simulated, when that of the vibrators which generates the wave colliding with the obstacle should be stopped. The therapeutic protocol including the region to be treated, the sequence, etc., are decided from the three-dimensional still image, and necessary treatments take place.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic therapeutic apparatus for irradiating ultrasonic waves from outside a subject for treatment.

[0002]

2. Description of the Related Art Recently, MIT (Minimally Invasive Tre)
The flow of minimally invasive treatment called “atment” is attracting attention in various fields of medicine, and the development of a minimally invasive treatment method (device) in consideration of QOL (Quality of Life) is desired.

Regarding the treatment of calculus in the urological field, it has been put to practical use with a calculus crushing device that non-invasively crushes calculi by irradiating strong ultrasonic waves (shock waves) from the outside of the body and is drawing attention. There are underwater discharge method, electromagnetic induction method, micro explosive method and piezo method as shock wave source, but the method of using a piezo element as a powerful ultrasonic source is a small focus, no consumables, strong ultrasonic intensity It has excellent advantages such as controllability and control of the focus position by phase control of drive waveforms applied to a plurality of piezo elements (JP-A-60-145131, USP 4,52).
6,168). Further, the shape of the focus can be changed by controlling the phase of the drive waveform (Japanese Patent Laid-Open No. 62-42773).

On the other hand, regarding the treatment of tumors, various treatment methods such as surgical, endoscopic, radiation and hyperthermia are used, but all have problems and a definitive treatment method is still established. It has not been. The most reliable method is a surgical operation, but it has a problem that the laparotomy places a heavy burden on the patient. The endoscopic method is effective for superficial tumors of luminal organs, but for infiltrative tumors, it is insufficiently monitored and cannot be adequately treated. Other radiation,
There is a problem with hyperthermia in that a reliable and sufficient therapeutic effect cannot be obtained.

As one of the treatment techniques for tumors having a low degree of invasiveness, a hyperthermia treatment method has attracted attention. This is a therapeutic method that selectively kills cancer cells only by heating and maintaining the affected area at 42.5 ° C. or higher by utilizing the difference in heat sensitivity between tumor tissue and normal tissue. As a heating method, a method using an electromagnetic wave such as a microwave has been preceded. However, it is difficult to selectively heat a deep tumor due to the electrical characteristics of the living body, and the treatment result is good. Examples are limited to superficial (within 5 cm depth) tumors. Therefore, a method using acoustic energy such as ultrasonic waves has been considered for the treatment of deep tumors. This utilizes the characteristics of ultrasonic focusing and high depth of penetration. Regarding these techniques, as disclosed in Japanese Patent Laid-Open No. 61-13955, ultrasonic waves generated outside the body are focused on a treatment site inside the body, and cancer is hyperthermically treated by heat generated by absorption of ultrasonic energy of tissues. A device that does this is being developed.

[0006] Further, there is also reported a treatment method in which the above-mentioned warming treatment method is advanced to heat the tumor portion to 80 ° C or higher to denature the tumor tissue. In addition, instead of heat generated by ultrasonic waves, a therapeutic method of irradiating cancer with powerful pulsed ultrasonic waves that break stones and necrosis of cells by its mechanical force is also being studied. (Hoshi, S. et al.:
J. Urology, Vol.146 (1991) pp439) These treatments do not require laparotomy, so the burden on the patient can be reduced, but since the affected area cannot be seen directly, it is necessary for treatment inside the body. Means for obtaining information and the position of the treatment target are required.

In the tumor treatment apparatus, an ultrasonic tomographic image is used when the focus is positioned, but the tumor to be treated often has a three-dimensionally complicated shape, and the two-dimensional image shows the entire tumor. It is very difficult to treat everywhere. Therefore, as disclosed in Japanese Patent Application Laid-Open No. 61-209643, a combination with a three-dimensional image using ultrasonic waves has been proposed. However, ultrasonic waves show the back of aerated organs such as bones and lungs. No accurate three-dimensional image could be obtained based on ultrasonic information. Further, in the conventional example, the relative position between the focus and the treatment site is simply confirmed, there is no means for determining the effect of the treatment, and it is impossible to determine whether to continue or terminate the treatment until after several weeks to several months. Therefore, a method of combining the ultrasonic treatment apparatus with an MRI or X-ray CT that collects three-dimensional information in the living body and displays an image inside the body can be considered. Japanese Unexamined Patent Publication No. 02-161434 describes an apparatus that performs treatment such as puncture based on an MRI image.

In addition, in a tumor treatment method using high-intensity ultrasonic waves, ultrasonic waves of extremely high intensity are applied to a localized area near the focal point, so that the area where a tumor exists is focused unlike conventional hyperthermia. It is necessary to uniformly irradiate while scanning. Especially when irradiating with a powerful ultrasonic wave of several thousand W / cm ² , it is considered that the change in the acoustic characteristics due to the thermal denaturation of the affected area and the cavitation caused by the irradiation becomes a serious problem, and sometimes causes the side effect. Although there is a possibility, we have already proposed a powerful ultrasonic irradiation method to solve this problem.

By the way, a drawback of the above-mentioned treatment methods is that the energy is concentrated in a very localized area, so that the affected part is displaced due to, for example, respiratory movements or body movements, and normal tissue is focused. The point is that normal tissues will be damaged as they are. Therefore, it is considered that a high-resolution and real-time treatment monitor is essential for the actual treatment. Also, due to the movement of the affected area due to respiratory movement, etc., the temperature at the focus does not rise sufficiently,
The cancer may recur as a result of insufficient necrosis of the tumor cells.

On the other hand, in the case of lithotripsy treatment, as described in detail in Japanese Patent Application Laid-Open No. 62-049843, a piezo element is used as a strong ultrasonic wave generation source so as not to damage the living body. The ultrasonic wave is emitted from the piezo element toward the focal point, the matching state between the focal point and the stone portion is judged from the intensity of the reflected wave, and the strong ultrasonic wave is emitted only when the focal point and the stone portion match. The technology is known.

As described above, the high-intensity ultrasonic waves are widely applied in the field of medicine, but when a high therapeutic effect is desired in a short time, it is possible to deal with it by simply increasing the applied energy, and the therapeutic efficiency with respect to the applied energy. Improvement was not considered. In other words, the focal pressure, the size, the total energy contained in the focal region, etc. were not adjusted with respect to the input energy. For example, the focus size of high-intensity ultrasound is fixed, and the focus size is unnecessarily small for a wide range of affected areas, resulting in poor treatment efficiency, or conversely, the focus size is too large for a narrow range of affected areas. There was a defect that even the surrounding normal tissue was damaged.
For the above problems, in the ultrasonic therapy device using a spherical shell-shaped applicator, spherical accuracy is reduced equivalently by adjusting the drive timing of each therapeutic ultrasonic wave generation element, and A technique of irradiating an affected area with strong ultrasonic waves having a focal size corresponding to the size is known.

[0012]

As described above, in the treatment apparatus utilizing high intensity ultrasonic waves, it is important to irradiate only the affected area and not affect the normal area. However, if tissues with different acoustic impedances exist in the ultrasonic wave irradiation path, refraction and reflection occur there, causing the focal point to deviate from the theoretically planned position, and the acoustic impedances such as bones, lungs, and voids (intestinal gas) remarkably differ. When a substance is present, ultrasonic waves do not propagate behind it due to reflection, and heating due to absorption of energy on that surface occurs,
There was a risk of unplanned degeneration.

Further, since there are more blood vessels inside the tumor than in normal tissue, if such a portion is irradiated with intense energy instantaneously and heated, the tissue will fall off and cause major bleeding. I was afraid.

Furthermore, changes in the acoustic characteristics of tissues that have been heat-denatured by the irradiation of intense ultrasonic waves have not been taken into consideration in the conventional ultrasonic therapeutic apparatus. That is, from the results of the basic experiments conducted by us, the ultrasonic attenuation of the site thermally denatured by the irradiation of strong ultrasonic waves is larger than that of the surrounding normal tissue, and the degenerated site on the ultrasonic image is Since it can be confirmed as a high echo, it was also clarified that the difference in the acoustic impedance with respect to the surrounding tissue becomes large and the reflection of ultrasonic waves becomes large. For this reason, it is possible to cause sufficient thermal denaturation at almost the focal position by irradiation for a short time to a site that has not undergone thermal denaturation, but a site that has already undergone thermal denaturation in front of the site to be irradiated. In such a case, ultrasonic waves are scattered at the degenerated site and sufficient energy does not reach the targeted site, and at the same time, there is a possibility that a large amount of heat is generated in front of the degenerated site. Furthermore, when the same region is irradiated for a long time, the tissue in the focal region is thermally denatured, and then strong ultrasonic wave scattering / attenuation occurs in front of the thermally denatured region, causing the thermal denatured region to widen toward the front side of the focus. A phenomenon was observed. Therefore, if such a phenomenon occurs during the treatment, there is a risk that the normal tissue will be seriously damaged and serious side effects will be caused.

Further, when an affected part which is not a high-reflector of ultrasonic waves, that is, a tumor or the like moves due to movement such as respiration,
The erroneous irradiation prevention function devised in Japanese Patent Laid-Open No. 62-049843 cannot be applied, and it has been difficult to reliably and effectively treat the targeted site. Moreover, there was a possibility that sufficient necrosis of the tumor cells could not be obtained due to the focus shift.

Therefore, the present invention has been made to solve the above-mentioned problems, and an object thereof is to provide an ultrasonic treatment apparatus for performing safe and efficient treatment. Further, during treatment, when the patient feels intense pain, heat, or the like due to the irradiation of intense ultrasonic waves, or when the patient moves abruptly for some other reason, there is also a problem that the intense ultrasonic wave focus deviates from a predetermined position.

Although the relationship between the ultrasonic wave irradiation path and the focal point and the living tissue has been described above, the ultrasonic wave treatment apparatus also has a problem of focus characteristics. That is, in the focus size control method as described above, the size of the focus size is controlled by considering only the size of the treatment target. However,
Focusing on the therapeutic effect, for example, in the case of lithotripsy treatment,
B. Report by Granz et al. (What makes a shock wave eff
icient in lithotripsy.J.stone disease, 4 (1992) p
As shown in p123), it is known that the amount of calculus fracture depends more strongly on the total energy contained in the focal region than on the focal pressure. However, there is a threshold of the focal peak pressure at which crushing starts, and below that pressure, the calculus is not crushed. On the other hand, M. Report of Ioritani et al. (Renal tis
sue damigeindused by focused shock waves. Proc. 18
th Inter.sympo. Shock waves and shock tubes, 1990)
It is also known that the biological damage is more intense as the heating pressure is higher, as shown in. Therefore, it is important to irradiate the calculus with a necessary amount of energy at a pressure value that can crush the calculus and at a pressure that is as low as possible so as to suppress living body damage as much as possible. Similar effects can be considered not only for the treatment of lithotripsy but also for treatment of ultrasonic high-temperature cancer. Without taking these into consideration, simply increasing the input energy only increases the peak pressure while keeping the pressure distribution of the focus approximately similar, and the therapeutic area is limited to the vicinity of the focus center. Not only not
Since the peak pressure is large, there is a problem that side effects increase. In addition, if the focus size control is made to correspond only to the size of the treatment target, the peak pressure will be reduced by the amount of enlargement of the focus size, so if the input energy is small, it will not exceed the pressure threshold required for treatment. There was a problem.

[0018]

In order to solve the above-mentioned problems, in the present invention, means for collecting three-dimensional information in the vicinity of a treatment region of a subject that is temporally continuous, and means for collecting the three-dimensional information based on the three-dimensional information. Means for simulated reproduction of the vicinity of the treatment site of the specimen, ultrasonic irradiation condition setting means for obtaining conditions regarding ultrasonic irradiation by using the information regarding the vicinity of the treatment site and ultrasonic irradiation reproduced by this means, It is characterized in that it is provided with an ultrasonic wave irradiation means for performing ultrasonic wave irradiation to the treatment site of the subject based on the obtained conditions concerning the ultrasonic wave irradiation.

Specifically, it is provided with a means for acquiring a blood vessel image of the affected area and a means for treating the affected area, and controls the means for treating based on the image and blood vessel image obtained by the means. .

Means for collecting temporally consecutive three-dimensional information in the vicinity of the treatment region in the subject, and means for dividing the treatment region of the subject in the vicinity of a plurality of regions based on the three-dimensional information,
A means for setting a priority for a plurality of the divided areas, an ultrasonic wave generating means for focusing the ultrasonic waves at an arbitrary focus, and an ultrasonic wave generating means for dividing each area into the divided areas according to the priority. It is characterized by further comprising control means for controlling so that the focal points of the ultrasonic waves are sequentially focused.

Further, in an ultrasonic treatment apparatus for focusing an ultrasonic wave to treat a tumor in a body, an ultrasonic wave source for generating an ultrasonic wave and focusing it on a predetermined site in the body, and driving the ultrasonic source. Ultrasonic transducer driving means, an image diagnostic apparatus for obtaining a tomographic image or a three-dimensional image of a diseased part, input power / driving frequency / electroacoustic conversion efficiency of the ultrasonic transducer, and a body surface calculated from the image diagnostic apparatus Means for calculating the ultrasonic intensity at the focal position from the focal depth from the ultrasonic attenuation factor of the biological tissue, and means for controlling the ultrasonic irradiation time or the irradiation position to the affected area according to the calculated focal ultrasonic intensity Have.

Further, in an ultrasonic treatment apparatus for focusing ultrasonic waves to treat a tumor in the body, an ultrasonic source for generating ultrasonic waves and focusing the ultrasonic waves at a predetermined site in the body, and an ultrasonic focus by the ultrasonic source. Means for moving the body, a first CT device for collecting two-dimensional or three-dimensional information in the living body and displaying an image inside the body, and a first CT device for collecting and displaying two-dimensional or three-dimensional temperature-dependent parameters in the living body It is characterized by having two CT devices and means for displaying information by the above two CT devices in an overlapping manner on a three-dimensional image.

Further, the absolute coordinates and temperature of the maximum temperature rising point are calculated from the distribution of the two-dimensional or three-dimensional temperature-dependent parameters collected by the second CT apparatus, and the strong ultrasonic focus always coincides with the coordinates. It is characterized in that the focus is controlled so as to move.

[0024]

In the first aspect of the invention, the three-dimensional structure in the vicinity of the affected area and its temporal change are obtained in advance by the image diagnostic apparatus, and the acoustic parameters, heating characteristics and the like peculiar to each tissue are input. By doing so, a biological model can be created. By calculating the refraction and reflection by various tissues contained in the path that passes when the ultrasonic wave is applied from the ultrasonic applicator to the tumor, the ultrasonic wave with which intensity is applied at which position and how much is degenerated Can predict what will happen.
For those that do not transmit ultrasonic waves, the vibrator irradiating this path can be stopped to prevent unnecessary heating.

Further, in the treatment of a tumor by high-intensity ultrasound, the dropout of the blood vessel is prevented by controlling the irradiation power at the running position of the blood vessel, avoiding the treatment, etc. based on the information on the existing position of the blood vessel. By lowering the power and extending the irradiation time, it is possible to prevent fibrosis and to prevent the loss of blood vessels while killing tumor cells around blood vessels.

Furthermore, after measuring the three-dimensional shape of the tumor, by irradiating the treatment target site with strong ultrasonic waves from a position deeper than the body surface, sufficient heat can be obtained at the targeted focal position, and It is possible to suppress heat generation in unnecessary parts. At the same time, by making use of the fact that ultrasonic waves are very difficult to reach the back of the heat-denatured site, the entire back of the tumor mass is treated first, and the irradiation to the back of the tumor makes it extremely Can be treated without worrying about the influence of sound waves.

The powerful ultrasonic wave irradiation time is controlled by the values of input power, driving frequency, focal ultrasonic wave intensity, etc., and it is possible to treat only a limited area near the irradiation, and a safe ultrasonic wave with less influence on the front of the focal point. A treatment device can be provided.

Not only the treatment can be performed while confirming the real-time temperature distribution in the living body, but also the intense ultrasonic focus is always made to coincide with the maximum exothermic point, so that the heating can be performed more quickly and effectively. Furthermore, it becomes possible to follow the movement of the affected part due to breathing movements or body movements in real time.

[0029]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will be described below with reference to the drawings. FIG. 1 shows a block diagram of this embodiment. In this example, a magnetic resonance imaging apparatus (MRI), which is an example, was used as an image diagnostic apparatus.

In FIG. 1, the static magnetic field magnet 1 is excited by the excitation power source 2 and applies a uniform static magnetic field in the z direction to the subject 3. The gradient magnetic field coil 4 is arranged in a static magnetic field magnet, and is driven by a gradient magnetic field power source 6 of the gradient magnetic field coil 4 controlled by a sequence controller 5, and the bed 7
X, y, z orthogonal to the subject 3 which is the upper patient
Gradient magnetic fields Gx, Gy, and Gz whose magnetic field strength changes linearly in the three directions are applied. The high frequency coil 8 is a transmission / reception coil and is arranged in the gradient magnetic field coil 4. Under the control of the sequence controller 5, the high frequency signal from the transmitter 9 is applied to the high frequency coil 8 via the duplexer 10, and the high frequency magnetic field generated thereby is applied to the subject 3 in the high frequency coil 8 on the bed 7. Is applied. The high-frequency coil 8 is capable of generating a uniform high-frequency magnetic field in the region of the subject 3 to be imaged. For example, a saddle type coil,
A distributed constant type coil or a quadrature transmission coil configured by using these is used. However, when the treatment target is limited and a higher S / N ratio is desired,
A surface coil may be used for transmission / reception or reception.
When a surface coil is used for reception, a uniform coil is used for transmission.

The high frequency coil 8 receives the magnetic resonance signal from the subject 3, and the received signal is sent to the receiving unit 11 via the duplexer 10. The duplexer 10 is used for switching the high frequency coil 8 between transmission and reception, and transmits the high frequency signal from the transmission unit 9 to the high frequency coil 8 during transmission, and receives the reception signal from the high frequency coil 8 during reception. It works to lead to the section 11. The received signal is detected and band-limited by the low-pass filter,
It is sent to the data collection unit 12 under the control of the sequence controller 5. The data collection unit 12 collects the received signals, performs A / D conversion of the received signals, and sends the signals to the control circuit 13 as image reconstruction data.

The control circuit 13 is controlled by the console 14 and performs an image reconstruction process including a two-dimensional Fourier transform on the image reconstruction data input from the reception unit 11. It also controls the sequence controller 5. The image data obtained by the control circuit 13 is supplied to the image display 15 and an image is displayed.

On the other hand, the ultrasonic applicator 16 is provided with an ultrasonic transducer group consisting of a piezoelectric element group capable of generating focused ultrasonic waves, and is attached to the subject 3 with a flexible water bag. An independent drive circuit group 17 and a phase control circuit group 18 are coupled to each element. The strength of the drive circuit group 17 is determined by the power supply 19, and a voltage pulse is applied to each piezo element in response to a trigger from the phase control circuit group 18. The power supply 19 and the phase control circuit group 18 are controlled by the control circuit 13. With an ultrasonic transducer,
It is well known that the focal position can be electronically moved three-dimensionally by controlling the phase of each element when transmitting an ultrasonic wave (USP 4,526,168). reference). This makes it possible to sequentially treat the treatment areas without moving the applicator by generating a delayed pulse so that the focus is on the treatment area.

Although the focus movement is electronically controlled here, it may be mechanically moved. Next, the treatment including the simulation will be described. First, as a preliminary inspection,
The position of the affected part tumor of the subject 3 and the situation around the affected part is detected. For example, as shown in FIG.
MRI and X are used to determine the shape / property and temporal changes in the surrounding conditions of the other internal organs 22, bone 21, blood vessels, nerves, etc. (showing images that change with time from FIG. 2 (a) to (c)). −
A three-dimensional, high-speed image is taken using an image diagnostic apparatus such as CT, each tissue is discriminated, each is extracted, and the image is stored in the memory 328 of FIG. Especially for periodical movements such as respiratory movements, images of one cycle or more are acquired. The spatial resolution at that time needs to be such that tumors and other tissues can be distinguished, and the temporal resolution needs to be sufficiently fine (for example, 1 second or less) with respect to the respiratory cycle.

Next, data of physical characteristic values of tissues such as organs and bones (for example, temperature rising characteristic with respect to heating, acoustic impedance, etc.) is input from the console 14 to the MRI image and the X-CT image, and the time is input. A three-dimensional pseudo biological model including changes is created. When displaying this, each organization can be displayed independently, and these can also be displayed in an overlapping manner. These selections can be made by entering from the console. The display means may project three dimensions into two dimensions and display it on a flat display, but in this case, its direction and size can be freely set from the console. Alternatively, stereoscopic display using holography, or 3D display using a spatial scanning type stereoscopic display
You may display by dimension.

Next, on the other hand, the ultrasonic applicator 1
The mounting position of the water bag 20 containing the cup rig liquid 24, which is one of the configurations of No. 6, is determined. For example, if the tumor area (affected area 23) is periodically moved by breathing as shown by the shaded area in FIG. 3, the obstacles such as bones 21 and organs 22 are most affected by the affected area 23 at each time. It suffices to search the image for a position that can be irradiated so that there is no light.

Then, the area that can be treated in this condition is calculated. The refraction and reflection caused by the difference in acoustic impedance between tissues are calculated, and the irradiation path of ultrasonic waves from the ultrasonic applicator is simulated for each position of the tumor area. When ultrasonic obstacles such as lung fields are present in the path, the transducer that generates ultrasonic waves that hit the obstacle stops driving, prevents unnecessary heating on the reflective surface, and prevents the other transducers. The driving condition is determined so that the power source is controlled and the driving power is controlled so as to drive and apply constant energy in the focal region. For example, when the affected part 23, the ultrasonic applicator 16 and the obstacle 25 are present as shown in FIG. 4, the path is calculated as shown by the arrow, and only the diagonally shaded part of the ultrasonic applicator is driven, so that the obstacle is blocked. To prevent the irradiation of light. Since there is a limit to the power on the power supply side and the high focus power area of focus movement by phase control is limited to some extent around the geometric focus of the applicator, treatment is performed from this condition and the selection result of the oscillator. The possible area can be determined.

Next, at the time of actual treatment, the operator (doctor) first determines a treatment protocol such as a treatment area and a treatment order from the obtained three-dimensional still image. At this time, it is determined to satisfy the condition for the treatment order from the device side, for example, the condition that the treatment is performed from a region far from the applicator (the ultrasonic wave does not reach the depth of the degeneration region).
Next, according to this protocol, treatment is performed while moving the focus in order. At that time, the positional relationship between the treatment target and its periphery is determined from the image obtained immediately before irradiation in which phase of respiratory movement, and irradiation is performed under the irradiation conditions of this phase. Alternatively, if a breathing monitor is used and the image and the output of the breathing monitor are associated with each other in advance, the phase of respiration can be determined by observing the output of the breathing monitor during treatment.

The flow chart at this time will be described separately for the case where the respiration monitor shown in FIG. 5 is used and the case where phase detection is performed from the MRI image shown in FIG. Further, by using such a pseudo biological model, it is possible to simulate the deviation of the pseudo focus due to phase control due to refraction between tissues, reflection and the like. If the deviation is large, the phase of each phase control circuit is finely adjusted to control the focus so that it matches the set focus. When the focal pressure is reduced due to the shift, the power of the power supply is controlled so that a sufficient therapeutic effect can be obtained.

In the above, the irradiation path viewed from the applicator was evaluated by simulation, but the optimum irradiation condition for each focus may be sequentially determined based on the preset treatment sequence (setting of the focus position). In this case, since a series of treatment operations can be simulated sequentially in time, it is possible to virtually execute the treatment by displaying it in animation, it is possible to reconfirm the safety of the treatment procedure and predict the treatment effect. Since the flow of treatment can be grasped at a glance, this can be indicated to the patient and informed consent can be obtained, which is effective.

As a concrete procedure, simply speaking, the treatment order is first determined, and the irradiation condition in each phase of respiration is calculated for each focus set at that time in the same manner as described above ( In this case, the treatment target is not the whole affected area but one point). Among them, the optimum phase (as many oscillators as possible can be used, or obstacles in the path or a dangerous area when irradiated is not included as much as possible) is determined.

This work is performed for each focus. Then, during the treatment, the focus is set in a determined order, and the irradiation is performed when the optimum phase comes. As a detailed procedure, as shown in FIG. 5, a plurality of three-dimensional temporally continuous images are picked up using MRI, MRA or the like (step 700). The captured image is input to the simulation process and the treatment planning process. In the simulation process, first, these images extract each organ and tissue (step 701). And, based on these information, bones,
Create blood vessel, nerve, and organ models (step 70)
2). These values are input in order to fit the biological characteristic values to these models (step 703). Then, the position of the applicator is determined (step 704), and the treatable area of each phase of breathing is calculated (step 70).
5), this result is output to the respiratory monitor processing.

On the other hand, for the treatment plan, N focus points are set to determine the treatment protocol (step 707). First, in the treatment, the first information of the N focal points is set (step 708). Then, the phase is detected as a respiration monitor (step 706), and the first focus is set with reference to the simulation image (step 709). Next, focus adjustment is performed so as to match the first focus (step 710). Then, ultrasonic waves are applied to this focus (step 711). Next, the first information is sequentially set up (step 712), and ultrasonic waves are continuously emitted until the Nth focal point is reached, thus ending the treatment.

FIG. 6 is a flow chart when the phase is detected by the MRI image. 5 differs from FIG. 5 only in that the MRI continuous image (step 714) is included in FIG. 6, whereas the respiratory monitor is used for phase detection in FIG.

Also, after all treatment procedures have been decided,
The treatment is virtually executed according to the treatment order, and the treatment effect (degeneration region) is synthesized. You can then check for treatment leaks, erroneous irradiation, and unnecessary heating.

Here, it is assumed that the irradiation time of one treatment energy is sufficiently short with respect to the respiratory cycle. However, when the irradiation time is set to be long by lowering the power, it is always the same during irradiation to the set focus inside the tumor. Since it is possible to efficiently irradiate the points, it is set based on the time-varying image of the pseudo biological model so that the phase is changed in accordance with the respiratory movement in order to move the focus in accordance with the respiratory movement. The irradiation route at that time is also set so as to avoid obstacles as described above.

Up to this point, obstacles that have been obtained by a prior examination have been targeted, but in reality, intestinal gas such as gas during treatment may suddenly appear during treatment. For such a thing, an image is acquired before starting treatment or immediately before irradiation, and the area is reset so as to avoid such a path.

When the image is retaken again before the treatment, the retaken image may be used to perform the simulation again, or only the change may be added to the previously performed simulation.

When an image is obtained immediately before irradiation during the actual treatment, a pseudo biological model is recreated from the image and the planned irradiation path is recalculated. Then, the deviation from the focus set at the time of the simulation in advance is corrected, and the transducer is selected again so that ultrasonic waves are not applied to obstacles such as intestinal gas newly included in the path.

In order to perform such a correction, it is necessary to make correspondence between the three-dimensional image of the pseudo biological model obtained during the treatment simulation in advance and the image obtained immediately before.
For that purpose, an image is acquired before starting the treatment, and the position of the subject, the body position, the position of the applicator, the angle, etc. are adjusted so that this image matches the image of the simulation. By fixing the subject in the best matching condition, the deviation from it can be reduced.

Even so, there is a possibility that some displacement may occur due to body movement during treatment, so always compare the image obtained immediately before with the simulation image in the breathing phase,
Calculate the residual. For example, when the sum of the values is more than a certain value, the treatment is stopped, the image on the simulation side is subjected to coordinate transformation so as to minimize the deviation, and the irradiation path from the applicator at that time is calculated again. Alternatively, readjust the positions of the subject and the applicator.

As such means for adjusting the position of the subject, by using means for adjusting the position and angle of the bed from the outside, it is necessary to take out the subject from the gantry each time and adjust by the movement itself. It can be reduced.

A procedure embodying the above method is shown in FIG. First, a three-dimensional temporal continuous image is captured by MRI and MRA (step 800). These captured images are output to the pseudo biological model characteristic processing step and the treatment planning step. In the step of the pseudo biological model creation processing, each organ and tissue are extracted (step 8).
01). Next, bone, blood vessel, nerve, and organ models are created based on this information (step 802). Then, the biological characteristic value is input to this model (step 803).
The position of the applicator is determined based on this information (step 804). This determined information is sent to the treatment planning step and the treatment step. Information to the steps of the treatment plan is to adjust the position of the subject and the applicator even if the subject shifts during treatment,
Used to stop treatment. On the other hand, in the step of the treatment plan, first, N focal points are set to determine the treatment protocol (step 805). Next, n is set to 1 (step 806). Then, first, the first focus is set (step 807), and the treatable path of each phase of respiration for determining the drive voltage, the drive oscillator, etc. is calculated and obtained (step 808). Next, n is set up to 1 (step 809), a treatable path to the n-th focus is calculated (step 810), and when this is completed, the process proceeds to the treatment step. In the step of treatment, in response to the step of creating a pseudo biological model, continuous images of MRI are captured and phase detection is performed (step 811),
Output to the nth focus setting step. On the other hand, in response to the treatment planning step, n is first set to 1 (step 812). Then, first, the first focus is set (step 813). With this first focus setting, the focus is adjusted (step 814). When this adjustment is completed, ultrasonic waves are emitted (step 815). Then, n is set up to 1 (step 816) and ultrasonic waves are sequentially irradiated to the nth focus (step 81).
7).

Here, the biological model is a computer graphic, but it may be a substance such as water or agar whose physical characteristics are close to those of the biological tissue, and may be actually produced.

Although the tumor treatment using ultrasonic waves has been described here, the same can be applied to a calculus breaking device using ultrasonic waves. For example, the lung field is often included in the path of ultrasonic waves, and excessive heating in the lung field can be prevented by selecting a vibrator so as not to include these fields.

Further, here, the image monitor is provided with MRI, X-.
Although a gantry type such as CT is mainly used, an inner type ultrasonic probe may be used or used in combination as in a conventional calculus breaking device. It is also possible to use a normal X-ray image instead of CT. In such a case, if there is an obstacle such as a bone in the path of the ultrasonic waves for imaging or the X-ray, the area behind it cannot be imaged. Therefore, by simulating these paths similarly to the case of the therapeutic ultrasonic waves, it is possible to arrange the ultrasonic probe or to irradiate the X-rays in a place that is not affected by the obstacle or is less susceptible to the obstacle.

Next, the second invention will be described. Second
The configuration of the device in the invention of 1 is the same as that in FIG. MR angiography (MRA) is used as the blood vessel image acquisition means. Time of Flight, Phase Cont
There are some that use rast, MTC, etc., and any one can be used.

At the time of treatment, in order to make a treatment plan,
A magnetic resonance image and a magnetic resonance blood vessel image are captured in the same imaging region, a treatment target is extracted from this image, and an image of the blood vessel contained therein is acquired. For example, as shown in FIG. 8, a three-dimensional imaged area 221 is displayed, and the affected area 23,
The blood vessel portion 223 is overlaid and displayed. Then, as shown in FIG. 9, the position of the focal point 224 of the focused ultrasound for treatment is set so that the affected area 23 can be treated evenly, and if the treatment area (hatched portion) overlaps the blood vessel for each set focal point, Lower the irradiation power to prevent the dropout of
The tumor cells surrounding the blood vessel are irradiated so as to cause fibrosis. For example, as shown in FIG. 10, irradiation positions A, B,
When C and D are set, the power is increased to increase the therapeutic effect on the non-vascular part when it is distant from the blood vessel part 223 like A, and fibrosis is caused near the blood vessel part 223. Then, as a whole, sufficient treatment beyond fibrosis can be performed, and the power of each focus is adjusted so as to prevent dropout in the blood vessel.

As a concrete treatment procedure, there is a flow as shown in FIG. First, when deciding the irradiation condition, the temperature distribution based on the irradiation condition is theoretically calculated, or the temperature distribution for the irradiation condition obtained experimentally is stored in the memory and it is stored according to the irradiation condition. By calling, the temperature of the blood vessel tissue in the vicinity thereof is obtained, and the condition is determined so as to increase the irradiation power within a range in which the blood vessel is not dropped. Then, the irradiation conditions for each set focus are determined so that all tumor tissues are treated. At this time, both the focus position and the irradiation power may be changed to optimize so that a large amount of power is not applied to the blood vessel. Then, the experimental treatment is carried out according to the plan thus decided.
In MRI, non-invasive body temperature distribution measurement can be performed by using temperature dependence of parameters such as diffusion and proton chemical shift (JP-A-59-196431 and JP-A-62-81538, JP-A-62-81538). As disclosed in Japanese Patent Laid-Open No. 61-8040), this can be prevented in real time by performing this in real time during treatment, measuring the temperature distribution during heating, and monitoring the blood vessel so that it is not overheated. .

First, an MRI image near the treatment target is acquired (step 900). A tumor is extracted from this MRI image (step 901). Next, blood vessels in the tumor are extracted by MRA (step 902). The irradiation position is set based on these pieces of information (step 903), and when the treatment plan is completed, the process moves to the treatment step. When the planning is not completed, it is judged whether or not the treatment area includes blood vessels (step 905). If there are blood vessels, the irradiation time is lengthened to lower the power level (step 906). If the blood vessel is not included, the irradiation time is shortened and the power level is increased (step 907). When the plan is completed, the irradiation position is set (step 908) and irradiation is performed (step 90).
9).

Alternatively, when such a temperature measurement procedure by MRI is used, as shown in FIG. 12, a detailed treatment plan up to the irradiation condition is not established, the irradiation site is set in the tumor part, and irradiation is started. While obtaining the temperature distribution in real time, increase the power within the range where the temperature of the blood vessel part within it does not exceed the set threshold value, and when the threshold value is exceeded, the irradiation of the irradiation site is terminated. Alternatively, the focus may be adjusted to another irradiation site, the treatment may be repeated in the same manner, and the planned treatment range may be treated.

The procedure of FIG. 12 will be described below. First, an MRI image near the treatment target is acquired (step 910).
Next, a tumor is extracted from the acquired MRI image (step 911). Next, intratumoral blood vessels are extracted by MRA (step 912). The irradiation position is set based on these pieces of information (step 913), and it is determined whether or not to continue the treatment (step 914).
Ultrasonic waves are emitted (step 915) and temperature measurement is performed using MRI (step 916). As a result of the measurement, the temperature of the blood vessel is compared with a predetermined threshold value (step 917). If the threshold value is higher than the temperature of the blood vessel portion, the power is increased (step 919), and if the threshold value is the opposite, irradiation is terminated (step 918).

In particular, it may be set so as to avoid irradiation for a major thick blood vessel during treatment planning. During the actual treatment, ordinary magnetic resonance images are continuously acquired, and the blood vessel image obtained by angiography can be superimposed on the continuously imaged images if the relative positional relationship with the magnetic resonance image is acquired at the time of treatment planning. By displaying it as, it is possible to correct the positional deviation due to movement or the like. However, if the magnetic resonance blood vessel image can be taken in real time, it is possible to irradiate the therapeutic energy while sequentially confirming the blood vessels in the treatment area before the treatment.

Further, since the blood flow in the capillaries can be imaged by obtaining an image of perfusion (perfusion) using Gd-DTPA, similarly, the irradiation power is lowered particularly in the place where the capillaries are gathered. You can avoid major bleeding by controlling so.

Also in the current tumor treatment, there is a treatment method in which the supply of nutrients to the tumor is stopped by embolizing the feeding blood vessels, and the tumor site is necrotic. In terms of preventing major bleeding from blood vessels, the safety can be further enhanced by performing embolization of feeding blood vessels to the tumor site before treatment and performing heat treatment while preventing bleeding.

In the above description, the angiography can be performed by X-ray angiography as long as the blood vessel position can be grasped three-dimensionally.
It may be ultrasonic waves. An image diagnostic apparatus for treatment planning and monitoring may be X-ray CT, ultrasound, or a combination of these and MRI. Further, the treatment means may be any treatment device capable of intensively supplying energy to the treatment part in the body, and may be radiation treatment or laser heating treatment of puncture in the optical fiber tissue.

Next, an embodiment relating to the third invention will be described with reference to the drawings. FIG. 13 is a block diagram showing the configuration of an embodiment of the present invention. One or a plurality of piezo element groups 35 for irradiating therapeutic ultrasonic waves are provided through the water bag 20 to the patient 3
Is coupled to. The piezo element group 35 is driven by the drive circuit group 17, and a focal point 224 of strong ultrasonic waves is generated in the affected part 23 in the patient's body via the coupling liquid 24 in the water bag.
To form.

The state during treatment and the positional relationship between the piezo element and the patient are determined by the signal from the ultrasonic probe 36 fixed to the applicator so that a tomographic image of the plane passing through the geometrical focus of the piezo element can be obtained. The ultrasonic diagnostic device 37 monitors the image by displaying it on the image display 15.

Next, the CT unit for positioning / treatment planning will be described. In this embodiment, MRI is used. The patient 3 is set in a supine position on the electric table 310 and is sent into an imaging gantry in which the static magnetic field magnet 1, the gradient magnetic field coil 4 and the high frequency coil 8 are built. The table moving device 311 moves the electric table 310 under the control of the control circuit 13. Next, the control circuit 13 activates the gradient magnetic field power supply 6 and the transmission / reception circuit 316 by a predetermined sequence (for example, T2 weighted imaging method) instructed from the console 14, and stores image information of the multi-plane inside the patient 3 in the memory. . This three-dimensional information is the control circuit 1
3 is displayed on the image display 15 in a pseudo three-dimensional manner, and the operator inputs a treatment plan from the console 14 while viewing the image of the inside of the body including the affected area 23. here,
The treatment plan is the irradiation intensity, irradiation time, interval, etc. of ultrasonic waves at the focus 224. When the console 14 gives an instruction to start treatment, the control circuit 13 controls the mechanical arm 318 to move the treatment head to the treatment position. At this time, the position of the focal point 224 of the strong ultrasonic wave is determined by a signal from an applicator position detection device 319 including a potentiometer attached to each position of the mechanical arm 318, the MRI device and the mechanical force measured in advance. The control circuit 13 calculates from the attachment position information with the arm 318, and the MRI of the image display 15 is calculated.
Display on the image. This display is not limited to the focus, but it is also possible to display an expected heat generation area (for example, a heat generation area of 70 ° C. or higher calculated by frequency, input power, depth of ultrasonic focus, etc.).

Here, details of the ultrasonic irradiation control method for tumor tissue in the present invention will be described. FIG. 14 is an example of the irradiation procedure (irradiation order on the screen) of this irradiation control method.
We have already confirmed experimentally that the heat-denatured site of ultrasonic heating has greater attenuation and scattering of ultrasonic waves than normal tissue. For this reason, if a heat-denatured site already exists, heat-treating tumor cells at a position deeper than that site is (1) sufficiently shielded by ultrasonic waves at the heat-denatured site. Energy does not reach (2) The ultrasonic attenuation at the existing heat degeneration site is large, causing heat generation and heat degeneration in the tissue in front of it,
It is not clinically preferable because it may lead to unexpected side effects. To prevent such a phenomenon from occurring, it is better to measure the spatial distribution of the tumor on the image in advance and then proceed with the treatment from the deepest position to the shallower position in the ultrasonic wave incident direction. it is conceivable that. In this figure, the affected area is sliced in a direction perpendicular to the central axis of the piezo element group 35, and the treatment is advanced from the deep slice side in the figure in the direction of the arrow (= body surface direction). , The phase control circuit group 1 by the control circuit 13
8 is controlled to delay drive the drive circuit group 17. Regarding the irradiation order within the same slice, Japanese Patent Laid-Open No. 04-0436
In order to reduce the influence of cavitation as described in Japanese Patent Publication No. 03, it is possible to adopt a method of sequentially irradiating from voxels 323 that are distant from each other.

FIG. 15 shows another example of the irradiation procedure of this irradiation control method. (A) is an example on a CT image, and (b) is an example on an ultrasonic image. In this example, the voxels 323 located on the opposite side of the ultrasonic wave incident direction of the tumor are sequentially irradiated first to realize safe and reliable treatment. Furthermore, by realizing heat denaturation from the back of the tumor in a shell shape, it becomes difficult for ultrasound to reach the normal tissue in the back of the tumor, and side effects on the normal tissue can be suppressed. is there.

Such a treatment method can be used in the ultrasonic B mode or the like.
It is also possible on a three-dimensional screen. In the above embodiment, M
The initial mounting position information of the RI device and the mechanical arm was measured in advance, and the positional relationship between the image and the intense ultrasonic focus was calculated based on that information. However, the piezo element group 35 was also included in the three-dimensional image at the same time. By acquiring, the geometrical position information of the piezo element group 35 is calculated from the image, and the focal position is calculated from this value and the time delay value given to each element, and the focal position is displayed on the three-dimensional image. It is also possible to do so. At this time, by attaching the applicator base point marker 322 to a position serving as a base point (reference) of the delay given to the piezo element group 35, the direction of the applicator can be easily discriminated from the image,
The focus position can be easily calculated. In this case, the applicator position detection device 319 is not necessary, and it is sufficient to hold the treatment head (= piezo element group 35 + water bag 20 + ultrasonic probe 36) for the mechanical arm as well, so more free operation is possible. become.

In the above embodiment, the display and the indication of the treatment point were performed by inputting from the console on the pseudo three-dimensional image. However, by inputting with a 3D mouse or the like in a virtual three-dimensional space using virtual reality. It is also possible to do so. Furthermore, the contour of the tumor tissue can be extracted from the difference in signal intensity between the normal tissue portion and the tumor tissue portion to automatically divide the treatment region.

Next, FIG. 16 is a block diagram showing the configuration of an embodiment according to the fourth invention. Embodiments of the present invention will be described below with reference to the drawings. Irradiate therapeutic ultrasonic waves 1
One or a plurality of piezo element groups 35 are coupled to the surface of the three patients through the water bag 20. The piezo element group 35 is driven by the drive circuit group 17, and the focal point 2 of the intense ultrasonic waves is generated in the affected part 23 in the patient's body through the coupling liquid in the water bag.
24 is formed.

In the present embodiment, the state during treatment and the positional relationship between the piezo element and the patient are the ultrasonic probe fixed to the applicator so that a tomographic image of the plane passing through the geometrical focus of the piezo element can be obtained. The ultrasonic diagnostic device 3 receives the signal from 36.
The image is displayed on the image display 15 by the monitor 7. Further, the ultrasonic focus, the ultrasonic passage path, the marker, etc. are displayed on the image by being superimposed through the DSC 326.

Next, a method of controlling the intensity of focused ultrasonic waves will be described. The ultrasonic waves propagating through the medium are reduced in pressure and strength due to the attenuation of the medium. It is generally known that the attenuation is proportional to the frequency of the ultrasonic wave and the propagation distance of the ultrasonic wave in the medium. The attenuation in water can be almost ignored, but the attenuation in the living body cannot be ignored. Therefore, the deeper the affected area 23 is and the higher the frequency of the ultrasonic wave generated by the piezo element is, the larger the attenuation becomes. The strength decreases. Furthermore, when the drive timing of the piezo element group 35 is controlled to electronically scan the focus position, the strength of the ultrasonic wave changes depending on the focus position when the drive voltage is constant.

In this example, an auxiliary input device such as a light pen 329 is used on the image display 15 to mark the body surface position and the affected area 23, and the distance between them is controlled by the control circuit from the correspondence with the number of dots in the memory 328. Calculated in 13. Further, when controlling the focus position via the phase control circuit group 18, the delay value given to each element by the control circuit 13 is used to calculate the attenuation due to the propagation distance. Since the attenuation differs depending on the treatment site, an appropriate value according to the site is stored in the memory 328 as a table in advance. The selection is performed, for example, by displaying a treatment site selection switch on the screen and selecting with a light pen 329 or the like (see FIG. 1).
7). Based on these values and the driving frequency, the control circuit 13 calculates a focus intensity curve with respect to the input power of the power source 19, stores this value in the memory 328, and accordingly, the ultrasonic intensity at the focus is always the set value. Control.

In the above embodiment, the driving voltage was controlled to keep the ultrasonic intensity at the focus constant, but the time-temperature rise curve at the focal point for ultrasonic intensity, frequency, attenuation, and heat conduction was calculated. It is also possible to control the temperature rise by calculating and controlling the driving time.

However, this temperature increase is previously stored in the memory 328.
It is also possible to use the value stored in. In addition, in our experiment, we observed a phenomenon in which the heat-generating region expands in front of the focus and the heat-denatured region expands with long-time irradiation, but in order to respond to this, the maximum irradiation time for the focus intensity (safe irradiation (Time = irradiation time that can modify only the focal region at a certain ultrasonic intensity) is stored in the memory, and the drive time of the drive trigger pulse generator 325 is controlled by the control circuit 13 according to this value to ensure safe treatment. Secure.

Further, depending on the driving power, there may be a case where the temperature rise of, for example, 50 ° C. cannot be obtained within a certain reference time, and in such a case, the maximum number of times is increased within a predetermined irradiation time. A process such as displaying on the image display 15 whether the temperature rise can be obtained, issuing a warning such as insufficient focus intensity (display, ringing, etc.), and disabling the generation of a trigger pulse by the control circuit 13 so that irradiation cannot be performed. I do.

In the above embodiment, the surface of the body, the affected area, etc. are indicated by the light pen or the like to determine the depth. It is also possible to extract the high echo part of the body surface on the image memory and automatically calculate the depth to the focus.

Next, an embodiment relating to the fifth invention will be described with reference to FIG.
It will be described based on. On the other hand, conventionally, in fields such as hyperthermia, it has been strongly desired to develop a method for non-invasively measuring the temperature distribution inside a living body, such as ultrasonic waves, microwaves, and X-rays.
A method for measuring the temperature of a deep part of a living body using a line has been reported.

In recent years, in the field of MRI as well, attempts have been made to measure temperature distribution using temperature-dependent parameters of NMR signals. Of these, attention has been paid to the fact that the chemical shift of hydrogen-bonded OH groups has temperature dependence, and a method for measuring the temperature distribution in a living body at high speed and with high accuracy has also been reported. Hereinafter, a method for automatically tracking the focus on the affected area using the temperature distribution measurement in the living body will be described (here, the temperature distribution measurement by MRI will be described as an example).

The details of the control method of the automatic focus tracking are shown in FIG. First, in order to extract a tumor with high definition and high contrast, the gradient magnetic field power source 6 and the transmission / reception circuit 316 are activated in the sequence S1 for acquiring a T2-weighted image, and the three-dimensional information D0 in the patient's body is stored in the memory 328. , At the same time, display on the image display 15. Then, the internal temperature distribution measurement sequence S2 is activated to perform 3 before the intense ultrasonic wave irradiation.
The dimensional temperature distribution D1 is measured and similarly stored in the memory. Here, each sequence is activated by the sequence controller 5 reading out the sequence data S1, S2, S3 ... Stored in the memory 328. Next, the control circuit 1
The drive circuit 17 is driven at a low output by the signal from 3,
The patient's body is warmed with an acoustic output that does not affect the living body by short-time irradiation of 45 ° C or less, and the three-dimensional temperature distribution D2
To get. Then, by taking the difference between D2 and D1 and displaying it on D0, it is possible to accurately know the position where the temperature has risen, that is, the position on the three-dimensional image D0 at which the focus position matches (the focus position. Matching mode). This makes it possible to accurately focus on the tumor portion and perform safe treatment.

By measuring the temperature rising point in this way, it is possible to know the current ultrasonic irradiation point, and by tracking the temperature rising point in real time during strong ultrasonic irradiation, it is possible to obtain strong ultrasonic waves. It becomes possible to make the focus follow the affected area. This focal point tracking sequence is shown in FIG.
Shown in. First, FIG. 19A is a sequence according to the short burst irradiation method. After focusing on the affected area 23 according to the above-described focus position adjusting mode, burst irradiation of intense ultrasonic waves is started. The temperature rise distribution D3 is acquired again immediately before one short burst irradiation ends and the next short burst irradiation starts. The coordinates of the maximum temperature rise point are calculated from the data of D3. Alternatively, the center of gravity of the temperature rise distribution may be used as the focus coordinates. And
From the first coordinate of the focus position obtained from D2, the deviation of the coordinate obtained from D3 (= the position to which the next short burst is applied) is calculated, and the drive phase for driving the piezo element group 35 is calculated by the control circuit 13, The phase information is sent to the phase control circuit group 18. The drive circuit 13 drives the piezo element group 35 according to the phase information sent from the phase control circuit group 18.
Similarly, immediately before each irradiation, the temperature rise distributions D4, D5,
By obtaining D6 ... and controlling the strong ultrasonic focus to always match the maximum temperature rise position according to these values, it is possible to always keep the focus consistent with the affected area that moves due to respiratory movement or the like. . As a result, it is possible to avoid that a sufficient temperature rise cannot be obtained due to defocusing, or that an unintended part is injured.

In the above-mentioned embodiment, the focus position is made to coincide with the affected area while performing the short burst irradiation. However, as shown in FIG. 19B, the focus movement / following control during continuous irradiation is also possible. Further, at this time, the maximum point of temperature rise is measured from the temperature rise distributions D2, D3, D4 ... Acquired at each set time interval, and the focus is controlled so as to always match the maximum point calculated from the image data.

Although the focus movement control is discrete in the above method, for example, from the two values of D2 and D3, D3 to D
It is also possible to interpolate the values between 4 and perform continuous focus movement control, or use the values of 3 points to more accurately predict and interpolate the focus movement path to the next point for follow-up control. It is possible.

In the above-mentioned embodiment, only the measurement of the temperature rise distribution is described, but more accurate treatment can be performed by simultaneously acquiring and displaying the image data. Further, although the NMR parameter is used for measuring the temperature distribution, the present invention is not limited to this, and it is also possible to use, for example, a change in sound velocity on an ultrasonic image or a temperature change in a tissue CT value on an X-ray CT image. .

The above treatment process is displayed on the image display 15 together with the image data and the temperature rise data as shown in FIG. 20, and the temperature change at the maximum temperature rise point is also monitored at the same time. And, for example, the peak temperature rise is 7
When the temperature reaches 0 ° C. or higher, the irradiation of intense ultrasonic waves is stopped and the irradiation of the next irradiation point is started.

In the above embodiment, the focus is made to follow the actually measured temperature distribution, but it is also possible to calculate the temperature increase distribution by simulation and display it on the actual image.

Next, the sixth invention will be described with reference to FIG. FIG. 21 shows the third and fourth inventions and the configuration of the apparatus except that there is no MRI apparatus and that a pressure sensor 513 for measuring the internal pressure of the coupling liquid 24 in the ultrasonic applicator 16 is added. Is the same.

During the treatment, when the patient 3 feels intense pain, heat, etc., or moves suddenly for some other reason, the strong ultrasonic focus 224 is deviated from the predetermined position, and normal tissue is erroneously irradiated. There is danger. Therefore, when a rapid pressure change occurs in the coupling liquid 24 in the water bag 20 due to the movement of the patient 3, the pressure sensor 513 detects the pressure and sends the information to the control circuit 13. The control circuit 13 directly sends a command to the drive circuit group 17 to immediately stop the intense ultrasonic wave irradiation.

Further, in the case of high-intensity ultrasonic irradiation,
Patient 3 may feel pain. The coupling liquid 24 due to the'reflexive movement 'caused by the pain of the patient 3 at this time
Pressure change is transmitted to the control circuit 13 by the pressure sensor 513,
The control circuit 13 instructs the drive circuit 17 to decrease the irradiation intensity at the next irradiation by one step or several steps.

As the patient 3 becomes accustomed to intense ultrasonic irradiation,
No pain even with high intensity irradiation. Therefore, the control circuit 13 performs irradiation with low intensity a predetermined number of times,
The drive circuit group 17 is instructed to increase the irradiation intensity by one step or several steps. Here, when the pressure sensor 513 again senses the "reflexive movement" of the patient, the irradiation intensity is lowered by one step.

These settings can be input from the console 14 in advance. Here, by measuring the pressure change in the coupling liquid using a pressure sensor, the patient 3
However, the control circuit 13 may detect a large change in the image on the image display 15 during the treatment. At this time, before treatment, a real-time ultrasonic image of the inside of the body is displayed on the image display 15, and the control circuit 13
The position of the treatment site and the periodic movement (for example, respiratory movement of the organ) shown on the ultrasonic image at this time are stored as a'basic form '. During the treatment, when the ultrasonic image exceeds the predetermined allowable range and is different from the stored state due to the rapid movement of the patient, the control circuit 13 causes the drive circuit group 17 to stop the irradiation in the same manner as described above. In addition, the reflexive movement due to the pain of the patient 3 is detected from the difference between the basic shape of the ultrasonic image and the real-time image, and the irradiation intensity is controlled in the same manner as above.

Further, shock generated in a patient due to pain or heat may be detected by an electroencephalogram (not shown), an electrocardiogram, an internal current, or the like to stop the irradiation of intense ultrasonic waves and control the irradiation intensity.

Further, in order to avoid the risk that the operator's pain, heat sensation, danger to the human body due to failure of the treatment device, etc. are not perceived by the operator, means (not shown) for calling the operator to the patient, Alternatively, the treatment device may be provided with a means for making an emergency stop.

Although the treatment of the tumor has been described in the present embodiment, the same can be applied to the device for crushing and treating the calculi in the body with high-intensity ultrasonic waves. Next, the seventh invention will be described with reference to FIG.

In the figure, the ultrasonic applicator 16
Is a piezoelectric element group 35 arranged on a spherical surface as a whole so that the wavefront of the generated ultrasonic wave in a normal operation (without giving a delay time) is concave, and an imaging element inserted and arranged at the center of this piezoelectric element group. Ultrasonic probe 36 and water bag 2
It is composed of 0s. This ultrasonic applicator 1
6 is brought into contact with the patient 3 via the water bag 20 and a therapeutic ultrasonic wave is emitted toward the treatment target.

The piezoelectric element groups 35 are connected to separate drive circuit groups 17 and can be independently driven. The drive circuit group 17 is connected to a power source 19 and a phase control circuit group 18, is supplied with predetermined power energy from the power source 19, and generates a power pulse at a timing determined by a signal from the phase control circuit group 18.
The calculus size measuring means 612 is Japanese Patent Application No. 3-199695.
As described in the issue, it monitors the progress of calculus fragmentation treatment, measures the size of the calculus before treatment and the size and spread of calculus fragments after treatment, and controls the result. Output to the circuit 13. The control circuit 13 determines the output of the power supply 19 and the delay value of the phase control circuit group 18 while referring to the memory 328 based on the data from the stone size measuring means 612 and the information input from the console 14, and The size of the focus mark displayed on the ultrasonic diagnostic imaging apparatus 37 is changed. These controls can be done in real time during treatment. The memory 328 stores in advance information on the values of the focus pressure, the focus size, and the focus energy when the drive energy and the drive timing of the piezoelectric element group 35 are changed.

Next, the operation of this embodiment will be described by taking calculus breaking treatment as an example. Stone 23 in patient 3
Suppose that crush treatment is performed by irradiating the patient with intense ultrasonic waves for treatment. Generally, it is common practice to irradiate the patient with low-energy ultrasonic waves and gradually increase the ultrasonic energy until the patient becomes accustomed to the pain and no longer feels the pain. Follow the instructions below.

When the ultrasonic wave output is increased, the peak pressure of the focal point is unnecessarily increased and the energy does not contribute effectively to the crushing by merely linearly increasing the driving energy of the vibrator. This is shown in FIG. In the figure, the dotted line is the threshold value of the pressure required for crushing, and indicates that crushing occurs above this pressure. (A) is a case where the input energy is small, and the crushable area is only within the range shown in (a). Now, when the drive voltage is increased, the focus pressure distribution increases while maintaining an approximately similar shape, and as shown in FIG. 24 (B), the effective pressure region for crushing is in the range shown in (b). Usually, the size of the calculus is between a few mm and a dozen and a few mm, and (b) is about 2 to 3 mm, so the crushing does not effectively occur with respect to the input energy despite the large focal pressure. . As described in the section of the problem to be solved by the invention, it is known that the minimum pressure for crushing calculi exists (broken line in FIG. 24) and the crushing amount depends on energy. Therefore, by increasing the focus size by increasing the focus size or lengthening the waveform temporally while keeping the pressure at or above the threshold value, it becomes possible to efficiently perform fragmentation with respect to the input energy. In this embodiment, the control circuit 13 automatically performs the above control.
That is, each time the drive energy of the irradiation ultrasonic wave is set, the focus size does not exceed the calculus size based on the information from the calculus size measuring device 612 or the ultrasonic image diagnostic device 37, and the memory 328 of the memory 328 is selected. With reference to the contents, the output of the power supply 19 and the delay value of the phase control circuit group 18 are controlled to adjust the focus energy and the focus peak pressure. At this time, the size of the focus mark displayed on the ultrasonic diagnostic screen is also changed according to the focus size. Instead of referring to the contents of the memory 328, the control circuit 13 may perform calculation or information may be input from the console 14.

As the control method of the focal pressure and the size,
A method of electronically lowering the spherical surface accuracy and lowering the zero-cross frequency of the waveform as described in Japanese Patent Application No. 4-2535353 may be used.

If this embodiment is applied, for example, even if the therapeutic ultrasonic wave output is set high immediately after the start of treatment,
The ultrasonic energy immediately after irradiation is lowered, the ultrasonic energy is increased as the number of times of irradiation increases, and the drive timing of each ultrasonic transducer is controlled to automatically enlarge the focus size and increase the focus pressure. You can build a system that keeps it constant.

Next, a second embodiment of the seventh invention will be described. The system configuration of the second embodiment is shown in FIG.
Same as No. 3, but a variable focus position applicator using a phased array is used as a therapeutic ultrasonic wave generation source.

It is known that when the focal position is electronically moved from the geometrical center point using a phased array or the like, the peak pressure and the focal size at the focal point after the movement change. Especially when the focus position is moved from the internal center point to the applicator side, the focus pressure increases,
There are focal positions where the focal spot size becomes narrow. In this case, it is possible that the pressure becomes large enough to affect the biological damage.

In the present embodiment, information on the focal pressure and the focal size with respect to the focal position and the input energy is recorded in advance in the memory 328 or the like, and the control circuit 13 optimizes it for each focal position based on the information. And outputs drive energy information and delay information. The power supply 19 and the phase control circuit group 18 output optimized drive energy and delay pulse according to the signal from the control circuit 13. On the ultrasonic diagnostic screen, focus marks of positions and sizes corresponding to the focus position and the focus size are displayed. Note that information such as the focus position information, the drive voltage, and the delay value may be calculated by calculation instead of reading them from the memory. The information can be changed from the console at any time.

Since all of the above are performed electronically, focus energy and focus pressure can be controlled in real time during treatment. Further, even when the coincidence (mismatch) between the treatment target and the focus is detected by using the erroneous irradiation prevention function described in JP-A-62-49843, by using the present invention, which focus A stable reflection signal can be obtained by making the pressure or size constant at the position, and the erroneous irradiation prevention function can be stably used even when the focus is moved.

[0109]

As described above in detail, according to the present invention, in the image guided ultrasonic treatment apparatus, the irradiation position can be determined in advance by the simulation using the image obtained in advance and the biological characteristic value. Displacement and irradiation route can be evaluated, and accurate and safe treatment can be performed.

Further, in a tumor treatment apparatus for performing treatment monitoring by images, by controlling the conditions of treatment energy irradiation according to the blood vessel image, it is possible to prevent erroneous irradiation of blood vessels and perform safe and reliable treatment. Can be provided.

Next, since strong ultrasonic waves can be emitted based on the three-dimensional shape of the tumor and the treated heat-denatured region,
Sufficient heat generation can be obtained at the aimed focus position, and heat generation at unnecessary portions can be suppressed. Further, it is possible to provide a safe ultrasonic treatment apparatus capable of treating only a localized area near the focus and suppressing the influence on the front of the focus.

[Brief description of drawings]

FIG. 1 is a configuration diagram of an embodiment of the first and second inventions.

FIG. 2 is a schematic diagram showing a time change of a three-dimensional image in the vicinity of an affected area in the first invention.

FIG. 3 is a schematic view showing an arrangement example of an ultrasonic applicator for an affected area in the first invention.

FIG. 4 is a schematic diagram showing an ultrasonic applicator driving method and an ultrasonic path set by calculation in the first invention.

FIG. 5 is a flowchart of a treatment simulation based on calculation of a treatable area from an applicator (when a respiratory monitor is used) according to the first invention.

FIG. 6 is a flow chart of treatment simulation based on calculation of a treatable area from an applicator (when detecting a respiratory phase from a real-time image of MRI) according to the first invention.

FIG. 7 is a flow chart of treatment simulation in the case of sequentially determining the optimum irradiation condition of each focus according to the first invention.

FIG. 8 is a display example for a treatment plan in which a treatment target and a blood vessel image inside the treatment target are overlapped and displayed according to the second invention.

FIG. 9 is a schematic diagram showing a treatment target and a planned ultrasonic irradiation position in the second invention.

FIG. 10 is a diagram showing a temperature distribution and an ultrasonic wave irradiation position in the second invention.

FIG. 11 is a flowchart of a treatment procedure in which a treatment plan is performed and then treatment is performed in the second invention.

FIG. 12 is a flow chart of an example of a treatment procedure using temperature distribution measurement by MRI according to the second invention.

FIG. 13 is a configuration diagram of an embodiment relating to third and fifth inventions.

FIG. 14 is a diagram showing a procedure for irradiating an intense ultrasonic wave on a CT image according to the third invention.

FIG. 15 is a diagram showing another irradiation procedure on the CT image and the ultrasonic image in the third invention.

FIG. 16 is a configuration diagram of an embodiment according to the fourth invention.

FIG. 17 relates to the fourth aspect of the present invention, showing a configuration diagram on a tomographic image and setting of a body surface position.

FIG. 18 is a detailed view of focus movement control according to the fourth invention.

FIG. 19 is an example of a treatment sequence according to the fourth invention.

FIG. 20 is an example of CRT display during treatment according to the fourth invention.

FIG. 21 is a configuration diagram of an embodiment according to the sixth invention.

FIG. 22 is a schematic view of an ultrasonic applicator according to a sixth aspect of the invention.

FIG. 23 is a block diagram of an embodiment according to the seventh invention.

FIG. 24 is a relation between the magnitude of the focal pressure and the threshold value at which the therapeutic effect appears in the seventh invention.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Static magnetic field magnet 2 ... Excitation power supply 3 ... Patient (subject) 4 ... Gradient magnetic field coil 5 ... Sequence controller 6 ... Gradient magnetic field power supply 7 ... Bed 8 ... High frequency coil 9 ... Transmitter 10 ... Duplexer 11 ... Receiver 12 Data collection unit 13 Control circuit 14 Console 15 Image display 16 Ultrasonic applicator 17 Drive circuit group 18 Phase control circuit group 19 Power supply (for pulse generation) 20 Water bag 21 Bone 22 Organ 23 ... Affected part 24 ... Coupling liquid 25 ... Obstacle 35 ... Piezo element group 36 ... Ultrasonic probe 37 ... Ultrasonic diagnostic device 221 ... Imaging area 223 ... Blood vessel 224 ... Focus 310 ... Electric cable 311 ... Table moving device 316 ... Transmission circuit 318 ... Mechanical arm 319 ... Applicator position detection device 322 ... Applicator origin marker 323 ... Powerful ultrasonic irradiation voxel 325 ... Drive trigger pulse generator 326 ... Digital scan converter (DSC) 328 ... Image memory 329 ... Light pen 330 ... Treatment site selection switch 513 ... Pressure sensor 612 ... Stone size measuring means 616 ... Super Sound wave output setting switching means

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Yoshiharu Ishibashi 1 Komukai Toshiba-cho, Sachi-ku, Kawasaki-shi, Kanagawa Toshiba Research & Development Center (72) Inventor Mariko Shibata Toshiba, Komukai-shi, Kawasaki-shi, Kanagawa Town No. 1 Incorporated company Toshiba Research and Development Center (72) Inventor Shiro Saito Komukai Toshiba Town No. 1, Komukai-ku, Kawasaki City, Kanagawa Prefecture Incorporated Toshiba Research and Development Center (72) Inventor Mori Izumi Kawasaki, Kanagawa Prefecture Komukai-Toshiba-cho 1-ku, Toshiba Research & Development Center

Claims (4)

[Claims] 1. A means for collecting three-dimensional information in the vicinity of a treatment site of a subject that is temporally continuous, and a means for simulating the vicinity of the treatment site of the subject based on the three-dimensional information. Using the information related to the ultrasonic irradiation and the vicinity of the treatment site reproduced by means, based on the ultrasonic irradiation condition setting means for obtaining the conditions for the ultrasonic irradiation, and the obtained conditions for the ultrasonic irradiation, An ultrasonic treatment apparatus comprising an ultrasonic wave irradiation means for performing the ultrasonic wave irradiation to a treatment site of the subject. 2. The ultrasonic wave irradiation condition setting means uses the information concerning the blood vessel and the information concerning the ultrasonic wave irradiation obtained from the three-dimensional information in the vicinity of the treated region of the subject, and the condition for the ultrasonic wave irradiation. The ultrasonic therapy device according to claim 1, wherein 3. The ultrasonic treatment apparatus according to claim 1, wherein the ultrasonic wave irradiation condition setting means obtains an ultrasonic wave irradiation position and irradiation time as the ultrasonic wave irradiation conditions. 4. A means for collecting temporally continuous three-dimensional information in the vicinity of a treatment site in a subject, and a means for dividing the vicinity of the treatment site in the subject into a plurality of regions based on the three-dimensional information. , Means for setting priorities for the plurality of divided regions, ultrasonic wave generating means for focusing the ultrasonic waves to an arbitrary focus, and the ultrasonic wave generating means for dividing the ultrasonic waves according to the priority. An ultrasonic treatment apparatus comprising control means for controlling the focal point of the ultrasonic wave to sequentially focus on each area.