WO2010086909A1 - Système de support d'insertion d'instrument chirurgical - Google Patents

Système de support d'insertion d'instrument chirurgical Download PDF

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Publication number
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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WO
WIPO (PCT)
Prior art keywords
image
dimensional
lumen
cross
volume data
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Application number
PCT/JP2009/002290
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English (en)
Japanese (ja)
Inventor
須田祐司
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財団法人仙台市医療センター
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Application filed by 財団法人仙台市医療センター filed Critical 財団法人仙台市医療センター
Publication of WO2010086909A1 publication Critical patent/WO2010086909A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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]
    • 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
    • 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
    • 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
    • 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

La présente invention concerne la réalisation d'un examen d'échantillonnage d'endoscope de lésions de la poitrine au moyen d'un fluoroscope TV à rayons X. Des images multiples de section transversale suivant approximativement les voies respiratoires et arrivant aux environs d'une lésion sont coupées à partir de données de volume obtenues au moyen d'un appareil de tomodensitométrie à rayons X. Une région de la section transversale des voies respiratoires apparaissant dans chacune desdites images de section transversale est sélectionnée, et des voxels correspondant à la région sélectionnée sont extraits des données de volume pour permettre la reconstruction d'une image de lumière tridimensionnelle des voies respiratoires. Ladite image subit en outre une conversion fluoroscopique, ce qui permet d'obtenir une image de lumière bidimensionnelle qui est superposée avec une image fluoroscopique à rayons X du sujet photographié depuis la même direction, afin de guider un endoscope bronchique le long des voies respiratoires jusqu'à la lésion.
PCT/JP2009/002290 2009-01-27 2009-05-25 Système de support d'insertion d'instrument chirurgical WO2010086909A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2009014869A JP2010172350A (ja) 2009-01-27 2009-01-27 術具挿入支援システム
JP2009-014869 2009-01-27

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WO2010086909A1 true WO2010086909A1 (fr) 2010-08-05

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2017043150A1 (fr) * 2015-09-09 2017-03-16 富士フイルム株式会社 Dispositif, procédé et programme de commande d'affichage d'images de mappage
CN106572827A (zh) * 2014-07-02 2017-04-19 柯惠有限合伙公司 智能显示器

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Publication number Priority date Publication date Assignee Title
JP5918548B2 (ja) * 2012-01-24 2016-05-18 富士フイルム株式会社 内視鏡画像診断支援装置およびその作動方法並びに内視鏡画像診断支援プログラム
US9459770B2 (en) * 2013-03-15 2016-10-04 Covidien Lp Pathway planning system and method
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
JP7356714B2 (ja) 2020-05-25 2023-10-05 国立大学法人山口大学 画像処理装置と画像処理プログラムと画像処理方法

Citations (1)

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Publication number Priority date Publication date Assignee Title
JP2005270652A (ja) * 2004-03-22 2005-10-06 Siemens Ag インターベンションまたは外科手術時の画像形成方法および装置

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Publication number Priority date Publication date Assignee Title
JP4473358B2 (ja) * 1999-01-21 2010-06-02 株式会社東芝 診断装置
DE102004043676B4 (de) * 2004-09-09 2014-01-09 Siemens Aktiengesellschaft Verfahren zur Visualisierung von Plaqueablagerungen aus 3D-Bilddatensätzen von Gefäßstrukturen

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005270652A (ja) * 2004-03-22 2005-10-06 Siemens Ag インターベンションまたは外科手術時の画像形成方法および装置

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106572827A (zh) * 2014-07-02 2017-04-19 柯惠有限合伙公司 智能显示器
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 (fr) * 2015-09-09 2017-03-16 富士フイルム株式会社 Dispositif, procédé et programme de commande d'affichage d'images de mappage
JPWO2017043150A1 (ja) * 2015-09-09 2018-03-08 富士フイルム株式会社 マッピング画像表示制御装置および方法並びにプログラム
US10568705B2 (en) 2015-09-09 2020-02-25 Fujifilm Corporation Mapping image display control device, method, and program

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