WO2010086909A1 - Surgical instrument insertion support system - Google Patents
Surgical instrument insertion support system Download PDFInfo
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- WO2010086909A1 WO2010086909A1 PCT/JP2009/002290 JP2009002290W WO2010086909A1 WO 2010086909 A1 WO2010086909 A1 WO 2010086909A1 JP 2009002290 W JP2009002290 W JP 2009002290W WO 2010086909 A1 WO2010086909 A1 WO 2010086909A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
- A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/02—Devices for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
- A61B6/03—Computerised tomographs
- A61B6/032—Transmission computed tomography [CT]
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/12—Devices for detecting or locating foreign bodies
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/44—Constructional features of apparatus for radiation diagnosis
- A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
- A61B6/4435—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure
- A61B6/4441—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being coupled by a rigid structure the rigid structure being a C-arm or U-arm
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/46—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with special arrangements for interfacing with the operator or the patient
- A61B6/461—Displaying means of special interest
- A61B6/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/46—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with special arrangements for interfacing with the operator or the patient
- A61B6/461—Displaying means of special interest
- A61B6/466—Displaying means of special interest adapted to display 3D data
Definitions
- This invention relates to a system for assisting insertion of a surgical instrument such as an endoscope through a lumen such as a bronchus or a blood vessel to the vicinity of a lesion in the body.
- Patent Document 1 a method using a virtual endoscopic image has been developed (for example, Patent Document 1 below).
- a virtual endoscopic image of the airway toward the lesion is created in advance based on the volume data of the subject acquired by the X-ray CT apparatus.
- the endoscope is inserted toward a lesion located deep in the bronchus.
- the bronchus becomes thinner as it goes deeper, and sputum accumulates in the peripheral part or there is bleeding, so the image obtained from the endoscope tends to be unclear. For this reason, insertion support may be difficult with a method using a virtual endoscope.
- An object of the present invention is to reliably guide a surgical instrument such as an endoscope to a lesion by utilizing an X-ray TV fluoroscopy device that is currently widely used.
- the surgical instrument insertion support system first extracts a three-dimensional lumen image of a lumen leading to a lesion from volume data of a subject acquired using a modality such as an X-ray CT apparatus or an MRI apparatus. Next, the three-dimensional lumen image is perspective-transformed to create a two-dimensional lumen image viewed from a specific direction. The obtained two-dimensional lumen image is displayed superimposed on an X-ray fluoroscopic image of the subject taken from the same direction.
- a modality such as an X-ray CT apparatus or an MRI apparatus.
- the surgical instrument such as an endoscope and the lumen leading to the lesion are simultaneously displayed in the superimposed image, the surgical instrument can be inserted close to the lesion along the lumen image.
- the three-dimensional lumen image includes an organ image serving as a mark for alignment so that the three-dimensional lumen image can be accurately superimposed on the fluoroscopic image.
- FIG. 1 shows the flow of a system as an embodiment of the present invention.
- An X-ray multi-slice CT apparatus 1 acquires volume data (three-dimensional CT data) 3 of a subject and visualizes it. Therefore, the chest cross-sectional image 5 and the 3D bronchial image 6 are reconstructed.
- the X-ray fluoroscope 2 can project the fluoroscopic image 4 of the subject on the monitor in real time.
- FIG. 2 shows a cross-sectional image 5 of the chest that has been cut so as to include the lesion 9.
- Reference numeral 17 denotes a lung parenchyma.
- FIG. 3 shows a 3D bronchial image 6 created from the volume data 3 by the volume rendering method.
- the trachea 7a extends from the central part while repeating branching, and a lesion 9 is located near the distal end 7b of the bronchus. It is projected.
- the present invention uses the X-ray fluoroscope 2 and inserts the endoscope 10 into the bronchus under X-ray fluoroscopy. Sampling the lesion.
- the X-ray fluoroscopic apparatus 2 can project an endoscope, the bronchus in the peripheral portion is not clearly captured, so an image of the bronchi corresponding to the insertion route of the endoscope is necessary.
- the root airway 11 ie, the insertion route of the endoscope
- a straight line 12 is defined substantially along the route airway. If the route airway is bent so much that it cannot be approximated by a single straight line, it may be approximated by a broken line that is a combination of multiple straight lines, or even approximated by a curved line instead of a broken line. Also good.
- the approximate straight line 12 is moved from the 3D bronchial image 6 onto the voxels of the volume data 3, and a plurality of cross-sectional images 13 orthogonal to the straight line 12 are acquired as shown in FIG. Note that when cutting out the cross section, it is recorded which voxel coordinate on the original volume data 3 each pixel coordinate on the cross-sectional image 13 corresponds to.
- cut-out cross-sectional images 13 are displayed on the display in order from the one closest to the lesion 9, and the cross-section of the root airway 11 is designated using a pointing device such as a mouse, one by one, Trace towards the center.
- a pointing device such as a mouse
- each HU value in the region is converted into a high value equivalent to metal so that the region is conspicuous.
- the three-dimensional lumen image 14 shown in FIG. 1 thus created is converted into a two-dimensional image (one-way projection image) 15 by a perspective projection method in order to be visualized.
- the completed two-dimensional image 15 of the lumen is shown in FIG. Although the lumen portion actually looks white, the figure is shown in black and white inversion to represent it on white paper.
- reference numeral 17a is the apex of the lung, and 17b is the upper edge of the diaphragm, which is reflected in the two-dimensional image 15 together with the lumen.
- the two-dimensional image 15 is used after being overlaid on a fluoroscopic image photographed by an X-ray fluoroscope. Therefore, at the time of perspective projection conversion, it is necessary to set parameters such as the viewpoint position so as to be compatible with the imaging system of the X-ray fluoroscopic apparatus 2 shown in FIG.
- the fluoroscopic image 4 of the patient's chest is projected on the display as a live image from the X-ray fluoroscopic apparatus 2.
- the two-dimensional lumen image 15 corresponding to the fluoroscopic image is exactly overlapped with the fluoroscopic image, that is, the lung apex 17a and the upper diaphragm edge 17b are made to coincide with the outline of the lung shown in the fluoroscopic image. And overlap.
- the endoscope 10 is inserted from the oral cavity along the airway while monitoring the composite image 16.
- the CT value of the lumen portion or the like is rewritten to correspond to a metal. Therefore, in the composite image 16, the lumen portion 7 c appears white and the endoscope is visible when it overlaps the endoscope. It will disappear. In order to avoid this problem, the two-dimensional lumen image projected on the composite image 16 is preferably displayed semi-transparently so that the endoscope can be seen.
- the endoscope and lumen are visible at the same time in the composite image, the endoscope is considered to be on the tracheal route. Therefore, the endoscope is advanced to the back while paying attention to whether such overlapping is maintained.
- the distal end of the endoscope comes to the branching portion of the airway, if the endoscope is operated so that the distal end of the endoscope is directed in a desired direction, the route is not deviated.
- the two-dimensional lumen image 15 is not only a front image of the subject, An image viewed from another direction is also created, and an image corresponding to the X-ray fluoroscopic angle at that time is selected from the images and superimposed on the fluoroscopic image.
- the tip of the endoscope when the tip of the endoscope reaches the vicinity of the lesion, the tip of the endoscope is directed to the lesion, and the sampling needle is projected from the tip of the endoscope to perform biological sampling.
Abstract
The issue is to perform an endoscope sampling examination of chest lesions by using an X‑ray TV fluoroscope.
Multiple cross‑sectional images approximately following the airway route and reaching near a lesion are cut from volume data obtained by using an X‑ray CT apparatus. A region of the airway cross section appearing in each of said cross‑sectional images is selected, and voxels corresponding to the selected region are extracted from the volume data to reconstruct a three‑dimensional lumen image of the airway route. Said image additionally undergoes fluoroscopic conversion to obtain a two‑dimensional lumen image that is superimposed with an X‑ray fluoroscopic image of the subject photographed from the same direction to guide a bronchial endoscope along the airway route to the lesion.
Description
この発明は、気管支や血管等の管腔を経由して内視鏡等の術具を体内の病変近くまで挿入するのを支援するためのシステムに関する。
This invention relates to a system for assisting insertion of a surgical instrument such as an endoscope through a lumen such as a bronchus or a blood vessel to the vicinity of a lesion in the body.
Ｘ線ＣＴ検査において肺野に病変が発見された場合の確定診断は、Ｘ線ＣＴ透視下またはＸ線ＣＴガイド下で行う極細径気管支鏡を使ったサンプリング検査が有効である。しかしこの方法は、これら高価な装置を長時間使用することから、ほとんど普及していない。
Sampling test using ultrathin bronchoscope performed under X-ray CT fluoroscopy or X-ray CT guide is effective for definitive diagnosis when a lesion is found in the lung field in X-ray CT test. However, this method is rarely used because these expensive devices are used for a long time.
別の方法として仮想内視像を用いる方法が開発されている（例えば下記特許文献１）。この方法では、Ｘ線ＣＴ装置で取得した被検体のボリュームデータに基づいて、病変に向かう気道の仮想内視像を予め作成する。内視鏡から得られる実際の内視像をこの仮想内視像と見比べながら、内視鏡を気管支の奥の方にある病変に向けて挿入する。しかし、気管支は奥に行くにしたがって細くなっており、末梢部では痰が溜まっていたり、出血があったりして、内視鏡から得られる画像は不明瞭になり勝ちである。このため、仮想内視鏡を用いた方法では挿入支援が困難になることがある。
As another method, a method using a virtual endoscopic image has been developed (for example, Patent Document 1 below). In this method, a virtual endoscopic image of the airway toward the lesion is created in advance based on the volume data of the subject acquired by the X-ray CT apparatus. While comparing the actual endoscopic image obtained from the endoscope with this virtual endoscopic image, the endoscope is inserted toward a lesion located deep in the bronchus. However, the bronchus becomes thinner as it goes deeper, and sputum accumulates in the peripheral part or there is bleeding, so the image obtained from the endoscope tends to be unclear. For this reason, insertion support may be difficult with a method using a virtual endoscope.
この発明は、現在広く普及しているＸ線ＴＶ透視装置を活用して、内視鏡等の術具を確実に病変に導くことを課題とする。
An object of the present invention is to reliably guide a surgical instrument such as an endoscope to a lesion by utilizing an X-ray TV fluoroscopy device that is currently widely used.
この発明に係る術具挿入支援システムは、Ｘ線ＣＴ装置やＭＲＩ装置等のモダリティを用いて取得した被検体のボリュームデータから、まず、病変に至る管腔の三次元管腔像を抽出する。次いで、その三次元管腔像を透視変換して、特定の方向から見た二次元管腔像を作成する。得られた該二次元管腔像を、それと同一方向から撮影した被検体のＸ線透視画像に重ね合わせて表示する。
The surgical instrument insertion support system according to the present invention first extracts a three-dimensional lumen image of a lumen leading to a lesion from volume data of a subject acquired using a modality such as an X-ray CT apparatus or an MRI apparatus. Next, the three-dimensional lumen image is perspective-transformed to create a two-dimensional lumen image viewed from a specific direction. The obtained two-dimensional lumen image is displayed superimposed on an X-ray fluoroscopic image of the subject taken from the same direction.
こうすれば、重ね合わせ画像に、内視鏡等の術具と病変に至る管腔が同時に映し出されるので、管腔像に沿って術具を病変近くまで挿入することができる。
In this way, since the surgical instrument such as an endoscope and the lumen leading to the lesion are simultaneously displayed in the superimposed image, the surgical instrument can be inserted close to the lesion along the lumen image.
被検体のボリュームデータから、病変に至る管腔の三次元管腔像を抽出するには、適宜のしきい値を設定して抽出してもよいが、管腔末梢では径が細くなるので正確な抽出が難しい。そこで、ボリュームデータから、管腔の軸線に沿って間隔を存して該軸線に対しほぼ直交する複数枚の断面画像を切り出し、それら各断面画像上に現れた管腔断面の領域を選択し、この選択領域に対応するボクセルをボリュームデータから抽出するようにしてもよい。
To extract a three-dimensional lumen image of the lumen leading to the lesion from the volume data of the subject, it may be extracted by setting an appropriate threshold value. Extraction is difficult. Therefore, from the volume data, cut out a plurality of cross-sectional images that are substantially orthogonal to the axial line at intervals along the lumen axis, and select a region of the lumen cross-section that appeared on each of the cross-sectional images, You may make it extract the voxel corresponding to this selection area | region from volume data.
Ｘ線透視画像に三次元管腔像を正確に重ね合わせることができるよう、三次元管腔像には、位置合わせのための目印になる臓器の像を含めることが好ましい。
It is preferable that the three-dimensional lumen image includes an organ image serving as a mark for alignment so that the three-dimensional lumen image can be accurately superimposed on the fluoroscopic image.
図１は、本発明の実施例としてのシステムの流れを示したものであり、Ｘ線マルチスライスＣＴ装置１は、被検体のボリュームデータ（三次元ＣＴデータ）３を取得し、それを可視化するため、胸部断面像５や３Ｄ気管支像６を再構成する。Ｘ線透視装置２は被検体の透視画像４をリアルタイムでモニターに写し出すことができる。
FIG. 1 shows the flow of a system as an embodiment of the present invention. An X-ray multi-slice CT apparatus 1 acquires volume data (three-dimensional CT data) 3 of a subject and visualizes it. Therefore, the chest cross-sectional image 5 and the 3D bronchial image 6 are reconstructed. The X-ray fluoroscope 2 can project the fluoroscopic image 4 of the subject on the monitor in real time.
図２は病変９を含むように輪切りにした胸部断面像５を示している。符号１７は肺実質である。図３は、ボリュームデータ３からボリュームレンダリングの手法で作成した３Ｄ気管支像６を示したものであ、気管７ａが中枢部から枝分かれを繰り返しながら延びており、気管支の末梢７ｂの近くに病変９が写し出されている。
FIG. 2 shows a cross-sectional image 5 of the chest that has been cut so as to include the lesion 9. Reference numeral 17 denotes a lung parenchyma. FIG. 3 shows a 3D bronchial image 6 created from the volume data 3 by the volume rendering method. The trachea 7a extends from the central part while repeating branching, and a lesion 9 is located near the distal end 7b of the bronchus. It is projected.
このようにＸ線ＣＴ装置１を使った検査で肺野に病変が発見された場合、この発明では、Ｘ線透視装置２を使い、Ｘ線透視下で気管支に内視鏡１０を挿入して病変のサンプリングを行う。しかし、Ｘ線透視装置２は、内視鏡を写し出すことができるが、末梢部の気管支は明瞭には写らないので、内視鏡の挿入ルートに当たる気管支の画像が必要になる。
In this way, when a lesion is found in the lung field by the examination using the X-ray CT apparatus 1, the present invention uses the X-ray fluoroscope 2 and inserts the endoscope 10 into the bronchus under X-ray fluoroscopy. Sampling the lesion. However, although the X-ray fluoroscopic apparatus 2 can project an endoscope, the bronchus in the peripheral portion is not clearly captured, so an image of the bronchi corresponding to the insertion route of the endoscope is necessary.
そのような画像を作成するために、まず、図３の３Ｄ気管支像６において、気道中枢部から枝分かれして病変の近くまで延びているルート気道１１（すなわち内視鏡の挿入ルート）を探し出し、そのルート気道にほぼ沿った１本の直線１２を定める。なお、ルート気道が大きく曲がっていて１本の直線で近似することができない場合は、複数の直線を組み合わせた折れ線を使って近似してもよいし、さらには、折れ線でなく曲線で近似してもよい。
In order to create such an image, first, in the 3D bronchial image 6 of FIG. 3, the root airway 11 (ie, the insertion route of the endoscope) that branches from the airway center and extends to the vicinity of the lesion is searched. A straight line 12 is defined substantially along the route airway. If the route airway is bent so much that it cannot be approximated by a single straight line, it may be approximated by a broken line that is a combination of multiple straight lines, or even approximated by a curved line instead of a broken line. Also good.
その近似直線１２を、３Ｄ気管支像６からボリュームデータ３のボクセル上に移し変え、図４に示すように、その直線１２に沿って、それと直交する複数の断面画像１３を取得する。なお、断面を切出す際、断面画像１３の上の各ピクセル座標が、元のボリュームデータ３上のいずれのボクセル座標に対応するか記録しておく。
The approximate straight line 12 is moved from the 3D bronchial image 6 onto the voxels of the volume data 3, and a plurality of cross-sectional images 13 orthogonal to the straight line 12 are acquired as shown in FIG. Note that when cutting out the cross section, it is recorded which voxel coordinate on the original volume data 3 each pixel coordinate on the cross-sectional image 13 corresponds to.
切り取ったこれらの断面画像１３は、病変９に最も近いものから順にディスプレイ上に表示し、ルート気道１１の断面をマウスのようなポインティングディバイスを使って領域指定しながら、１枚１枚、気道の中枢に向けて辿っていく。こうして各断面画像上で抽出されたルート気道領域を、前もって記録しておいた座標の対応関係にしたがって、ボリュームデータ３の上に移す。
These cut-out cross-sectional images 13 are displayed on the display in order from the one closest to the lesion 9, and the cross-section of the root airway 11 is designated using a pointing device such as a mouse, one by one, Trace towards the center. In this way, the route airway region extracted on each cross-sectional image is moved onto the volume data 3 according to the correspondence relationship of the coordinates recorded in advance.
こうして、末梢部の細いルート気道をボリュームデータのボクセル上にほぼ正確に領域指定することができる。他方、ルート気道の上流の中枢気道は太いので、適宜しきい値を設定することで容易に領域指定することができる。
In this way, it is possible to specify the region of the narrow root airway in the peripheral portion almost accurately on the voxel of the volume data. On the other hand, since the central airway upstream of the route airway is thick, it is possible to easily specify a region by appropriately setting a threshold value.
こうして、ボリュームデータ３から病変とそこに至る気道の各領域を抽出したら、その領域の各ＨＵ値を金属相当の高い値に変換して目立つようにする。こうして作成した三次元管腔像１４（図１に示す）は、今度は可視化するために、透視投影法により二次元像（一方向投影像）１５に変換する。出来上がった管腔の二次元像１５を図５に示す。管腔部は実際には白く見えるが、白い紙の上に表すために、同図は白黒反転して示してある。同図で符号１７ａは肺尖部、１７ｂは横隔膜上縁であり、管腔部と共に二次元像１５に映し込んである。
Thus, when each region of the lesion and the airway leading to the lesion is extracted from the volume data 3, each HU value in the region is converted into a high value equivalent to metal so that the region is conspicuous. The three-dimensional lumen image 14 (shown in FIG. 1) thus created is converted into a two-dimensional image (one-way projection image) 15 by a perspective projection method in order to be visualized. The completed two-dimensional image 15 of the lumen is shown in FIG. Although the lumen portion actually looks white, the figure is shown in black and white inversion to represent it on white paper. In this figure, reference numeral 17a is the apex of the lung, and 17b is the upper edge of the diaphragm, which is reflected in the two-dimensional image 15 together with the lumen.
この二次元像１５は、後で、Ｘ線透視装置で撮影される透視画像にオーバーレイして用いられる。したがって、透視投影変換に際しては、図６に示すＸ線透視装置２の撮影系に適合するよう、視点位置等のパラメータを設定する必要がある。
The two-dimensional image 15 is used after being overlaid on a fluoroscopic image photographed by an X-ray fluoroscope. Therefore, at the time of perspective projection conversion, it is necessary to set parameters such as the viewpoint position so as to be compatible with the imaging system of the X-ray fluoroscopic apparatus 2 shown in FIG.
実際に内視鏡を使って生検を行うときは、Ｘ線透視装置２から患者の胸部の透視画像４をライブ画像としてディスプレイに写し出す。同時にディスプレイには、透視画像に対応する二次元管腔像１５を透視画像とぴったり重なり合うよう、すなわち、肺尖部１７ａと横隔膜上縁１７ｂが透視画像に写っている肺の輪郭と一致させるようにして重ね合わせる。こうして合成画像１６をモニタしながら内視鏡１０を口腔部から気道に沿って挿入していく。
When actually performing a biopsy using an endoscope, the fluoroscopic image 4 of the patient's chest is projected on the display as a live image from the X-ray fluoroscopic apparatus 2. At the same time, on the display, the two-dimensional lumen image 15 corresponding to the fluoroscopic image is exactly overlapped with the fluoroscopic image, that is, the lung apex 17a and the upper diaphragm edge 17b are made to coincide with the outline of the lung shown in the fluoroscopic image. And overlap. In this way, the endoscope 10 is inserted from the oral cavity along the airway while monitoring the composite image 16.
なお、二次元管腔像１５では管腔部等のＣＴ値を金属相当に書き換えたので、合成画像１６では管腔部７ｃは真っ白に写り、内視鏡と重なった場合、内視鏡が見えなくなってしまう。この問題を回避するため、合成画像１６に写し出される二次元管腔像は、半透明に表示し、内視鏡も見えるようにするとよい。
In the two-dimensional lumen image 15, the CT value of the lumen portion or the like is rewritten to correspond to a metal. Therefore, in the composite image 16, the lumen portion 7 c appears white and the endoscope is visible when it overlaps the endoscope. It will disappear. In order to avoid this problem, the two-dimensional lumen image projected on the composite image 16 is preferably displayed semi-transparently so that the endoscope can be seen.
合成画像において内視鏡と管腔とが同時に見えていれば、内視鏡は気管ルートに乗っていると考えられる。したがって、そのような重なりが維持されているか注意を払いながら、内視鏡を奥に進めていく。内視鏡先端が気道の枝分かれ部分に来たときは、内視鏡を操作して、内視鏡先端を行きたい方向に向けるようにすれば、ルートを外れることがない。
If the endoscope and lumen are visible at the same time in the composite image, the endoscope is considered to be on the tracheal route. Therefore, the endoscope is advanced to the back while paying attention to whether such overlapping is maintained. When the distal end of the endoscope comes to the branching portion of the airway, if the endoscope is operated so that the distal end of the endoscope is directed in a desired direction, the route is not deviated.
Ｘ線透視装置２は、図６に矢印で示すように、正面からだけでなく、体軸周りに回転させながら透視を行うので、二次元管腔像１５は被検体の正面像だけでなく、別の方向から見た像も作成しておき、その中から、その時々のＸ線透視角度に対応するものを選び出して、透視画像に重ね合わせるようにする。
Since the X-ray fluoroscopic apparatus 2 performs fluoroscopy while rotating around the body axis as shown by an arrow in FIG. 6, the two-dimensional lumen image 15 is not only a front image of the subject, An image viewed from another direction is also created, and an image corresponding to the X-ray fluoroscopic angle at that time is selected from the images and superimposed on the fluoroscopic image.
こうして内視鏡の先端が病変近くまで達したら、内視鏡の先端を病変に向け、内視鏡の先からサンプリング針を突出させて生体サンプリングを行う。
Thus, when the tip of the endoscope reaches the vicinity of the lesion, the tip of the endoscope is directed to the lesion, and the sampling needle is projected from the tip of the endoscope to perform biological sampling.
１ Ｘ線ＣＴ装置
２ Ｘ線透視装置
３ ボリュームデータ
４ 透視画像
７ａ 気管
７ｂ 末梢気管支
７ｃ 気道（管腔）
９ 病変
１０ 内視鏡
１３ 管腔断面画像
１４ 三次元管腔像
１５ 二次元管腔像
１６ 合成画像 DESCRIPTION OFSYMBOLS 1 X-ray CT apparatus 2 X-ray fluoroscope 3 Volume data 4 A fluoroscopic image 7a Trachea 7b Peripheral bronchi 7c Airway (lumen)
9Lesions 10 Endoscope
13Lumen section image 14 Three-dimensional lumen image 15 Two-dimensional lumen image 16 Composite image
２ Ｘ線透視装置
３ ボリュームデータ
４ 透視画像
７ａ 気管
７ｂ 末梢気管支
７ｃ 気道（管腔）
９ 病変
１０ 内視鏡
１３ 管腔断面画像
１４ 三次元管腔像
１５ 二次元管腔像
１６ 合成画像 DESCRIPTION OF
9
13
Claims (3)
- 被検体のボリュームデータから、病変に至る管腔を抽出して三次元管腔像を作成する手段と、
該三次元管腔像を透視変換して、特定の方向から見た二次元管腔像を作成する手段と、
得られた該二次元管腔像を、それと同一方向から撮影した該被検体のＸ線透視画像に重ね合わせて表示する手段から成る、
術具挿入支援システム。 Means for extracting a lumen leading to a lesion from volume data of a subject and creating a three-dimensional lumen image;
Means for perspective-transforming the three-dimensional lumen image to create a two-dimensional lumen image viewed from a specific direction;
The obtained two-dimensional lumen image is composed of means for superimposing and displaying the X-ray fluoroscopic image of the subject taken from the same direction as the two-dimensional lumen image.
Surgical tool insertion support system. - 該三次元管腔像を作成する手段が、該ボリュームデータから、該管腔の軸線に沿って該軸線に対しほぼ直交する複数枚の断面画像を切り出し、それら各断面画像上に現れた管腔断面の領域を選択し、この選択領域に対応するボクセルを該ボリュームデータから抽出することを特徴とする請求項１に記載の術具挿入支援システム。 The means for creating the three-dimensional lumen image cuts out a plurality of cross-sectional images substantially orthogonal to the axis along the axis of the lumen from the volume data, and the lumens appearing on each of the cross-sectional images The surgical instrument insertion support system according to claim 1, wherein a cross-sectional area is selected, and voxels corresponding to the selected area are extracted from the volume data.
- 該三次元管腔像が、位置合わせのための目印になる臓器の像を含んでいる請求項１に記載の術具挿入支援システム。 The surgical instrument insertion support system according to claim 1, wherein the three-dimensional lumen image includes an image of an organ that serves as a mark for alignment.
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| CN106572827A (en) * | 2014-07-02 | 2017-04-19 | 柯惠有限合伙公司 | Intelligent display |
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| US11464474B2 (en) | 2016-12-12 | 2022-10-11 | Canon Medical Systems Corporation | Medical image processing apparatus, X-ray diagnostic apparatus, and medical image processing method |
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| CN106572827A (en) * | 2014-07-02 | 2017-04-19 | 柯惠有限合伙公司 | Intelligent display |
| US11188285B2 (en) | 2014-07-02 | 2021-11-30 | Covidien Lp | Intelligent display |
| US11793389B2 (en) | 2014-07-02 | 2023-10-24 | Covidien Lp | Intelligent display |
| WO2017043150A1 (en) * | 2015-09-09 | 2017-03-16 | 富士フイルム株式会社 | Mapping image display control device, method and program |
| JPWO2017043150A1 (en) * | 2015-09-09 | 2018-03-08 | 富士フイルム株式会社 | Mapping image display control apparatus and method, and program |
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