WO2010020730A1 - Dispositif de traitement therapeutique - Google Patents
Dispositif de traitement therapeutique Download PDFInfo
- Publication number
- WO2010020730A1 WO2010020730A1 PCT/FR2009/051593 FR2009051593W WO2010020730A1 WO 2010020730 A1 WO2010020730 A1 WO 2010020730A1 FR 2009051593 W FR2009051593 W FR 2009051593W WO 2010020730 A1 WO2010020730 A1 WO 2010020730A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- images
- interference
- power waves
- probe
- transducer
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N7/00—Ultrasound therapy
- A61N7/02—Localised ultrasound hyperthermia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
Definitions
- the present invention applies to the field of the treatment of living beings by ultrasonic therapy devices.
- the present invention relates to a therapeutic treatment device, as well as a method for controlling and optimizing this device.
- an ultrasound transducer emits concentrated power waves into a tissue target. These waves are absorbed by the tissue, which causes a rise in temperature of the tissue in the focal zone and coagulation of the target.
- the treatment is generally performed under ultrasound control, with an ultrasound probe mechanically linked to the transducer, for example as described in FR 2 886 534.
- An ultrasonic in-line imaging system is thus obtained.
- Obtaining coagulation of the tissue depends on several factors, for example:
- the transducer may be in direct contact with the tissue, but generally there is a balloon filled with a gel or a liquid capable of transmitting ultrasound.
- the balloon thanks to its flexibility, conforms to the fabric and facilitates the acoustic contact between the transducer and the tissue.
- the coupling liquid is refrigerated, which thermally protects the fabric at its interface with the device.
- the liquid circulates, allowing then maintain the interface temperature constant and evacuate any bubbles.
- a first problem of the ultrasonic treatment of tissues is the immediate control of the effectiveness of the treatment of tissues exposed to ultrasound, at the level of the target, but also at the level of the tissues that must be left intact, such as the interface between the device and tissue (the skin in the case of extracorporeal treatment) or other internal anatomical structures.
- tissue changes induced by power ultrasound are not visible with conventional ultrasound.
- the temperature rise of the target depends on several factors:
- the transmission of the beam towards the target and in particular the coupling between the transducer and the tissue via, for example, the skin,
- hyperechoic spots are probably created by gases created in the home by power ultrasound, either because of cavitation induced by the acoustic field, or by the gas released by the fabric when it is heated to high temperature. This phenomenon is referred to as boiling.
- the observation of the hyperechoic spots in the focus allows to a certain extent to control the treatment: in the absence of hyperechoic spot, we will apply a higher acoustic energy, while we will reduce the energy if we observe a visible hyperechoic spot .
- the power beam causes strong interference or disturbances on the ultrasound image of the target.
- This interference curtain is superimposed on the image of rest (i.e., obtained in the absence of HIFU firing) of the tissue, thereby forming an interference image.
- the structure of this interference image is random and changes during shooting. In practice therefore, we do not see or miss the target during firing and the observation of hyperechoic spots is possible only after interruption of the power beam (shot) on the image of rest.
- shots and observations on the idle images are alternative, as in documents US20080051656, US20060264748 and US20030028111.
- this method requires the interruption of the treatment to be able to observe the images of rest, and in particular the hyperechoic spots.
- the present invention proposes a solution to the aforementioned problems by defining a processing device and a method of therapy control that is non-invasive, simple, inexpensive, and does not require interruption of the power beam during measurement.
- the present invention provides a therapeutic treatment device comprising an acoustic transducer able to emit power waves towards a target to process it, the power waves having a focal point, an imaging probe, such as a ultrasound probe, able to emit waves to provide a pictorial representation of the target and its environment, before, during and after remission of the power waves from the transducer, the probe and the transducer being integral with each other, and, a display device able to display the images taken by the probe, namely rest images taken before and / or after transmission of the power waves and interference images, taken during the transmission of the power waves.
- the focal point of the power waves being located in the image taken by the probe, characterized in that it further comprises detection means for detecting a change.
- the present invention overcomes a prejudice of the prior art that considers interference images as disturbed or parasitic images that are useless or impossible to analyze.
- the present invention goes against the common practice of observing the resting images to infer the effectiveness of the shots.
- shots are often interrupted, not because they have effectively reached their targets, but to observe on the images of rest if they have been effective enough or not.
- the sequence of successive shots is not determined by the effectiveness of the shots, but by the search for their effectiveness on the images of rest, for which it is necessary to cut the shot.
- the effect and / or the effectiveness of the shot is controlled in real time directly from the interference images by detecting a structure change representative of the effectiveness of the shots.
- the invention consists in control the effects of acoustic energy in tissues caused by power ultrasound by observing the interference of the ultrasound control image.
- the detection means may comprise means for measuring the brightness of the interference images.
- the structure of the interference images is analyzed on the basis of their brightness or brightness, and a change of structure of the interference images will be detected from a change in brightness of these images.
- the measuring means determine a measurement zone that is common to several interference images, and measure the average brightness in this measurement zone for each interference image.
- This measurement zone can be chosen as forming all or part of the interference image.
- the measurement zone forms a very small part of the interference image, and it is positioned to contain the anatomical site to be observed, such as the target or a vital organ in the vicinity of the target, but do not damage it.
- the measurement of the average brightness in this measurement zone for each of the interference images makes it possible to assign a characteristic value to each interference image, and a characteristic change in these average values of brightness will be observed which is indicative the effectiveness of the power waves of the shot.
- the interference images are images composed of gray levels ranging from white to black
- the measurement means measuring the average of the gray levels in the measurement zone for each interference image. This is particularly the case when using an ultrasound probe that delivers black and white images consisting of gray levels.
- the detection means may comprise warning means able to trigger an alert signal when the measuring means measure a sudden enhancement of the brightness between interference images. successive.
- This sudden enhancement of brightness is a characteristic structure change of the interference images which is indicative of the efficiency of the power waves. It has been observed empirically that this sudden enhancement of brightness corresponds with the appearance of a hyperechoic spot, observable on the images of rest.
- the invention also defines a method for controlling and optimizing a therapeutic treatment device comprising an acoustic transducer able to emit power waves towards a target to process it, an imaging probe such as an ultrasound probe, capable of transmitting waves to provide a pictorial representation of the target and its environment, before, during and after the transmission of power waves from the transducer, and a display device able to display the images taken by the probe, that is, idle images, taken before and / or after transmission of the power waves and interference images, taken during transmission of the power waves, the method being characterized in that it comprises detecting a change of structure of interference images that is indicative of the effectiveness of power waves.
- the method comprises the following steps: determining, for a group of successive interference images in time, a measurement zone that is common to the interference images of the group, and measuring the brightness of each of the images of interference of the group in this area of measurement.
- the measuring step may comprise measuring the average brightness in the measurement zone for each of the interference images of the group.
- the interference images are images composed of gray levels ranging from white to black, the measurement step comprising measuring the average of the gray levels in the measurement zone for each interference image.
- the method further comprises another step of detecting a sudden enhancement of the measured brightness between successive interference images over time.
- the spirit of the present invention is to use the interference images, and not images of rest, to determine in real time the effectiveness of the power waves of the shot.
- the measurement of the brightness, especially average, in a given area of the interference images allows, through a comparative analysis, to detect any characteristic change in structure and indicative of the effectiveness of the shot.
- the paradox of the present invention resides in the fact that disturbed or parasitized images are analyzed, while clear images are available which are free of disturbances or parasites.
- FIG. 1 is a very schematic view of a therapeutic treatment device according to the invention
- FIG. 2 is a schematic view illustrating the acoustic transducer and the imaging probe during the treatment of the thyroid of a patient
- FIGS. 3a and 3b are schematic negative representations of two images of rest, taken just after a shooting sequence
- FIGS. 4a and 4b are schematic negative views of interference images taken respectively just before FIGS. 3a and 3b;
- FIG. 5 is a graph representing the average brightness of consecutive interference images
- FIG. 6 is another graph representing the linear relationship that exists between the enhancement of the brightness of the interference images and the appearance of hyperechoic marks on the images of rest.
- the device firstly comprises an acoustic emission source
- the transducer 1 which may advantageously be an ultrasonic transducer adapted to produce an ultrasound beam Fu.
- the ultrasound transducer is of the HIFU focused type for producing a focused ultrasound beam at a precise focal point.
- the transducer 1 may comprise a chamber filled with a coupling fluid through which the ultrasonic beams propagate.
- the chamber may for example be delimited by a flexible balloon intended to come into intimate contact with an outer surface S of an area of a body where there is a target to be treated T.
- the outer surface S is the skin of the patient.
- circulation means 12 are generally provided which make it possible to regulate the flow rate and the temperature of the coupling fluid inside the chamber 11.
- the transducer Naturally, in order to operate, it is necessary to have a power supply 13 as well as a displacement control 14 which makes it possible to precisely move and locate the transducer relative to the patient. To do this, the transducer 1 is preferably mounted on an articulated arm 16. Finally, the transducer is coupled to a computer 15 which makes it possible to manage all the parameters of the transducer, such as its power, its frequency, its pulse duration, etc.
- the treatment device of the invention also comprises imaging means which may for example be in the form of an ultrasound probe 2 coupled to an ultrasound system 21 and a display screen 22 which displays views or images in section of the anatomical site traveled by the probe 2.
- imaging means may for example be in the form of an ultrasound probe 2 coupled to an ultrasound system 21 and a display screen 22 which displays views or images in section of the anatomical site traveled by the probe 2.
- the probe 2 may be of the type with bars.
- the ultrasound system 21 can be coupled to the computer 15 of the transducer as one This can be seen in Figure 1.
- the ultrasound image is acquired by the computer via the electronic link from 21 to 151.
- the ultrasound system 21 produces on the display screen 22 successive images in time of the zone surrounding the focal point of the ultrasonic beams Fu. These images are composed of pixels with gray levels ranging from black to white. White pixels are representative of a very strongly echogenic element, while black pixels are representative of very little or no echogenic elements at all. This is well known for ultrasound images.
- the display screen 22 provides images before the transmission of the power waves Fu, during the transmission of the power waves, and after remission of the power waves. In other words, ultrasound images are available before, during and after firing. The images taken before and after the shots are relatively clear and show the target to be treated and its anatomical environment. These images are referred to here as "resting images", that is, in the absence of shots.
- FIGS. 3 and 3b Such idle images are shown schematically in negative in FIGS. 3 and 3b. This is in fact negative images, since the white areas in these figures actually appear in black on the display screen 22, and the black areas appear in white on the display screen.
- the lower part of FIGS. 3a and 3b represents the tissue anatomical site incorporating the target T represented in dashed lines.
- the skin S of the patient can be clearly identified.
- Figure 3b clearly shows a hyperechoic mark H.
- the display screen also produces images corresponding to the shooting phases. Due to the power provided by the power waves Fu, considerable interference is generated which disturbs or parasitizes the image, so that the representation of the anatomical site as visible in FIGS. 3a and 3b is no longer or only very weakly noticeable.
- interference images Such images are shown schematically in negative in Figures 4a and 4b.
- FIG. 4a was taken just before the idle image 3a.
- the interference image of FIG. 4b it has for example been taken just before the idle image of FIG. 3b. It is very difficult to discern in Figure 4a the contour of the skin S.
- the interference in the form of diverging beams upward almost completely mask the representation of the anatomical site, as visible in Figures 3a and 3b.
- FIG. 4b shows how it is possible to detect a brightness enhancement of the interference image in a zone of predefined measurement of the image, which is designated Zm.
- the brightness of the image ie the gray level, is measured in the zone Zm.
- this zone Zm encompasses the focus of the shooting transducer.
- the zone is determined so as to preferentially take into account the part of the image which enhances itself the most during a shot that causes a hyperechoic mark. It avoids taking into account the entire interference image, because sometimes there are enhancements in the lateral parts of the image, which are not indicative of effective treatment.
- the measurement zone is elongate in shape towards the transducer, is centered laterally on the focal point, encompasses the latter, but is shifted towards the transducer so as to encompass part of the pre-focal zone.
- a zone Zm that does not include the focal zone for example including an anatomical structure that one wants to protect acoustic waves.
- a structure adjacent to the target can become hyperechoic during treatment, indicating that it is modified by ultrasound. This may be the case of the skin or subcutaneous tissues, such as the carotid C visible in Figure 2. This effect should generally be avoided and this is possible thanks to the invention.
- a measurement zone Zm will be placed around the image to protect the anatomical zone to be protected and the possible enhancement of the interference image in this zone will be monitored.
- the average brightness of the gray levels in the Zm zone taken during the shot can be calculated: this value makes it possible first of all to detect the presence of an interference image and thus to control the effective emission of the power shots. .
- the calculated value can also detect any increase in gray levels during an effective shot. This enhancement occurs especially if the interference is concentrated in the zone Zm.
- this enhancement of the gloss which is found to be related to the presence of a hyperechoic mark, reveals a change in the structure of the interference image which is characteristic or indicative of the effect and / or the shooting efficiency.
- Several methods are possible to detect the effectiveness of the HIFU shot. In a first mode, we make the average pixel by pixel in the zone Zm of each image taken during the shooting. Each of the averages obtained on an image are then averaged over time during the duration of the shot. If the figure obtained is greater than an experimentally fixed threshold, the shooting
- HIFU is considered effective.
- the pixel pixel is also averaged in the zone Zm of the image at a time t of the shot, at which the average pixel to pixel is subtracted from the zone Zm of the image at a previous instant t - dt. If the figure obtained is greater than an experimentally fixed threshold, the shooting
- HIFU is considered effective. This second mode makes it possible to interrupt the firing when the efficiency threshold is reached.
- the pixel-to-pixel difference is made in the zone Zm of an image taken after the shooting with an image taken before the shot. The maximum of this difference is then calculated. This maximum can be used as an indicator of absence or presence of a hyperechoic mark.
- Figure 5 shows the evolution of the average gray level in the zone Zm as the progress of a shot, according to the second mode. It can be noted that the curve has an abrupt stall up which corresponds to a sudden enhancement of brightness, indicative of the presence of a hyperechoic spot, and therefore of an effective treatment.
- Figure 6 shows results, obtained in 11 patients, carrying a thyroid nodule and treated with HIFU.
- Post-recorded ultrasound images were videotaped during firing. The presence or absence of a hyperechoic mark was detected after each shot, and during each shot the eventual enhancement of the interference image.
- These detections were made with the image analysis methods specified above. We see that there is a very good correlation between the two types of detection. Moreover, there was also a correlation, almost linear, between the success of the treatment and the percentage of shots during which there is detected a sudden enhancement of the interference image.
- the therapeutic treatment device integrates detection means 150, which may for example be integrated into the computer 15. These detection means may be in the form of appropriate processing software.
- the detection means 150 comprise inter alia means for measuring the brightness or brightness 151 of the interference images.
- these interference means 151 make it possible to determine the positioning and the shape of the measurement zone Zm in which the average brightness for each interference image will be measured.
- the measuring means 151 will notably measure the average of the gray levels in the measurement zone Zm for each interference image.
- the detection means 150 may also comprise alert means 152 able to trigger an alert signal when the measuring means 151 detect a sudden enhancement of the brightness between two consecutive interference images.
- the warning signal may be audible or visual, for example displayed on the computer screen or on the display screen 22.
- the warning signal may also be coupled to a control of the power supply 13 in order to interrupt or modulate the ultrasonic power emitted by the transducer 1. Thanks to the invention, it is possible to monitor in real time the presence and more particularly the efficiency of the transmitted power waves, without having to interrupt the firing.
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12/999,739 US8974391B2 (en) | 2008-08-22 | 2009-08-18 | Device for therapeutic treatment |
JP2011523438A JP5531015B2 (ja) | 2008-08-22 | 2009-08-18 | 治療のための装置 |
EP09740467.7A EP2340087B1 (fr) | 2008-08-22 | 2009-08-18 | Dispositif de traitement thérapeutique |
CN200980132841.5A CN102131546B (zh) | 2008-08-22 | 2009-08-18 | 用于治疗处理的装置 |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR0855674A FR2935097A1 (fr) | 2008-08-22 | 2008-08-22 | Dispositif de traitement therapeutique |
FR0855674 | 2008-08-22 |
Publications (1)
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WO2010020730A1 true WO2010020730A1 (fr) | 2010-02-25 |
Family
ID=40409742
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PCT/FR2009/051593 WO2010020730A1 (fr) | 2008-08-22 | 2009-08-18 | Dispositif de traitement therapeutique |
Country Status (6)
Country | Link |
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US (1) | US8974391B2 (fr) |
EP (1) | EP2340087B1 (fr) |
JP (1) | JP5531015B2 (fr) |
CN (1) | CN102131546B (fr) |
FR (1) | FR2935097A1 (fr) |
WO (1) | WO2010020730A1 (fr) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP2397188A1 (fr) | 2010-06-15 | 2011-12-21 | Theraclion SAS | Tête de capteur d'ultrasons comprenant un transducteur d'imagerie avec un élément de protection |
EP2638932A1 (fr) | 2012-03-14 | 2013-09-18 | Theraclion | Dispositif pour traitement thérapeutique et procédé pour commander un dispositif de traitement |
Families Citing this family (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2013100232A1 (fr) * | 2011-12-29 | 2013-07-04 | 알피니언메디칼시스템 주식회사 | Procédé utilisant des signaux émis et reçus pour former des images ultrasonores pour diagnostic ultrasonore, et dispositif thérapeutique ultrasonore focalisé haute intensité réalisant celui-ci |
KR101772480B1 (ko) * | 2014-03-26 | 2017-08-29 | 알피니언메디칼시스템 주식회사 | 초음파 장치용 멤브레인 및 그 초음파 장치 |
JP6126051B2 (ja) * | 2014-07-17 | 2017-05-10 | 富士フイルム株式会社 | 音響波画像の撮影評価装置およびその撮影評価方法 |
CN113332620B (zh) * | 2021-07-12 | 2023-03-14 | 重庆融海超声医学工程研究中心有限公司 | 一种超声医疗设备 |
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US6508774B1 (en) * | 1999-03-09 | 2003-01-21 | Transurgical, Inc. | Hifu applications with feedback control |
FR2886534A1 (fr) * | 2005-06-03 | 2006-12-08 | Theraclion Soc Par Actions Sim | Tete d'imagerie et de traitement d'organes d'etres vivants et procede de fabrication |
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Family Cites Families (6)
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JP2001190587A (ja) * | 2000-01-06 | 2001-07-17 | Toshiba Corp | 超音波治療装置 |
FR2827149B1 (fr) * | 2001-07-13 | 2003-10-10 | Technomed Medical Systems | Sonde de traitement par ultrasons focalises |
US7534210B2 (en) * | 2004-02-03 | 2009-05-19 | Siemens Medical Solutions Usa, Inc. | Methods for adaptively varying gain during ultrasound agent quantification |
US20070083120A1 (en) | 2005-09-22 | 2007-04-12 | Cain Charles A | Pulsed cavitational ultrasound therapy |
JP4945273B2 (ja) * | 2006-04-24 | 2012-06-06 | 株式会社東芝 | 超音波診断装置、及び超音波診断装置の制御プログラム |
JP4958475B2 (ja) | 2006-05-19 | 2012-06-20 | 株式会社日立メディコ | 超音波装置 |
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2008
- 2008-08-22 FR FR0855674A patent/FR2935097A1/fr active Pending
-
2009
- 2009-08-18 EP EP09740467.7A patent/EP2340087B1/fr active Active
- 2009-08-18 JP JP2011523438A patent/JP5531015B2/ja active Active
- 2009-08-18 US US12/999,739 patent/US8974391B2/en active Active
- 2009-08-18 WO PCT/FR2009/051593 patent/WO2010020730A1/fr active Application Filing
- 2009-08-18 CN CN200980132841.5A patent/CN102131546B/zh active Active
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US6508774B1 (en) * | 1999-03-09 | 2003-01-21 | Transurgical, Inc. | Hifu applications with feedback control |
US20080051656A1 (en) * | 1999-09-17 | 2008-02-28 | University Of Washington | Method for using high intensity focused ultrasound |
FR2886534A1 (fr) * | 2005-06-03 | 2006-12-08 | Theraclion Soc Par Actions Sim | Tete d'imagerie et de traitement d'organes d'etres vivants et procede de fabrication |
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Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP2397188A1 (fr) | 2010-06-15 | 2011-12-21 | Theraclion SAS | Tête de capteur d'ultrasons comprenant un transducteur d'imagerie avec un élément de protection |
WO2011157598A1 (fr) | 2010-06-15 | 2011-12-22 | Theraclion Sas | Tête de sonde à ultrasons comprenant un transducteur d'imagerie avec un élément de protection element |
EP2638932A1 (fr) | 2012-03-14 | 2013-09-18 | Theraclion | Dispositif pour traitement thérapeutique et procédé pour commander un dispositif de traitement |
US10004921B2 (en) | 2012-03-14 | 2018-06-26 | Theraclion | Device for therapeutic treatment and method for controlling a treatment device |
Also Published As
Publication number | Publication date |
---|---|
JP2012500656A (ja) | 2012-01-12 |
EP2340087A1 (fr) | 2011-07-06 |
CN102131546B (zh) | 2015-03-11 |
CN102131546A (zh) | 2011-07-20 |
EP2340087B1 (fr) | 2016-07-06 |
FR2935097A1 (fr) | 2010-02-26 |
JP5531015B2 (ja) | 2014-06-25 |
US8974391B2 (en) | 2015-03-10 |
US20110137167A1 (en) | 2011-06-09 |
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