WO2012147652A1

WO2012147652A1 - Puncture treatment support method, puncture treatment support device, and program for puncture treatment support device

Info

Publication number: WO2012147652A1
Application number: PCT/JP2012/060725
Authority: WO
Inventors: 岩田　完成; 岩田　靖; 川村　雅文; 誠之中塚; 英樹屋代
Original assignee: 株式会社デージーエス・コンピュータ
Priority date: 2011-04-27
Filing date: 2012-04-20
Publication date: 2012-11-01
Also published as: JPWO2012147652A1

Abstract

Provided are a novel puncture treatment support method, puncture treatment support device, and program for a puncture treatment support device, whereby the position of a puncture target point relative to a lesion site viewed from the puncture path direction can be accurately ascertained during a puncture treatment. Three-dimensional image data relating to a subject (110) is acquired by CT imaging, and a puncture point (S) and target point (T) for a puncture tool for puncturing the subject (110) are set on the basis of this data. A tomographic image of a first tomographic plane and a tomographic image of a second tomographic plane, which comprise a puncture path (R) linking the set puncture point (S) and target point (T), are acquired, a tomographic image of a third tomographic plane comprising the target point (T) and forming a predetermined angle (β) with the first and second tomographic planes is acquired, and the tomographic images are displayed. This makes it possible to accurately ascertain the position of a puncture target point (T) relative to a lesion site (Q) viewed from the direction of the puncture path (R) during a puncture treatment.

Description

Puncture treatment support method, puncture treatment support device, and program for puncture treatment support device

The present invention relates to a method, a support device, and a puncture treatment support program for assisting puncture of a puncture tool in a subject and performing a treatment such as cryotherapy.

In modern medical practice, many devices are used for inspecting or treating by intruding or puncturing an intruder or puncture device into the body of a subject. For example, a stomach camera, a monitoring optical fiber, a sampling device for cutting and collecting tissue, an injection device for injecting a drug into a specific site, a therapeutic device for irradiating a lesion site with energy such as heat or electromagnetic waves, etc. .

A fluoroscopic monitoring method for obtaining and displaying a fluoroscopic image in real time for monitoring by such an intruder or a puncture tool and monitoring an intrusion by obtaining a fluoroscopic monitoring method or an X-ray CT tomographic image in real time and displaying them in two or three dimensions are monitored. There is a CT monitoring method. These fluoroscopic monitoring methods and CT monitoring methods take a method of performing medical treatment while an operator observes while looking at the screen and the operator determines and confirms the position and route from the monitoring image.

The CT monitoring method is a treatment in which a CT image and / or a three-dimensional image thereof are displayed in real time while performing CT imaging of an intrusion route and an affected area, and an intruder is invaded and treated while the operator monitors the display screen. It is to do the law. Therefore, this CT monitoring method is suitable for monitoring a complicated part or a deepened part of the body (lung, heart, prostate, pancreas, etc.).

The latest example using CT monitoring method is a cryotherapy method that measures necrosis of malignant tumor such as lung cancer tissue. This freezing treatment method is based on the principle that the cells at the lesion site are frozen and then thawed, and the inside of the cells is destroyed by the generation of a difference in salt concentration in the process of thawing, leading to cell death. Two high-pressure gases are used for freezing and thawing. There are two types of high-pressure gas, one with a sudden increase in volume and one with a sudden decrease in temperature. This is one of the physical phenomena, Joule-Thompson. Called the effect.

For example, high-pressure argon gas is used as a gas for raising the temperature, and high-pressure helium gas is used as a gas for lowering the temperature. For this cryotherapy, a hollow metallic puncture device called a guide needle is used. Under the CT monitoring described above, the puncture device is punctured into a patient (subject) and the tip thereof is guided to the affected part in the body, and the two gases are alternately discharged from the inside of the hollow portion or the outside of the hollow portion to the outside portion. Then, cryotherapy to the affected area is performed using the heat exchange action.

Non-patent document 1 as shown below exists as a document of such a general cryotherapy method. Furthermore, there is Non-Patent Document 2 as shown below as a document explaining a mechanical system including a therapeutic child used for a cryotherapy method, and a treatment method and an actual case. In addition, the present inventors have invented a treatment device that can realize this cryotherapy more safely, and have already filed patent applications (for example,

Patent Documents

1 and 2 below).

Non-Patent Document 2 describes a technique in which a puncture state of a puncture device serving as a therapeutic child is photographed in real time with an X-ray CT apparatus, and this is reconstructed and displayed as a tomographic image in real time. The X-ray CT apparatus is multi-slice imaging, and obtains and displays a large number of tomographic images at one time. The intrusion of the treatment child can be monitored, and it can be viewed as an image in almost real time along the tracking to the affected part position and the procedure.

On the other hand, this puncture tool uses a stainless steel double tube (coaxial needle) whose tip protrudes like a blade. In the treatment, with the double tube placed on the body surface, a long and thin guide needle is inserted along the central axis of the double tube, and the guide needle is punctured to the affected area. Next, the double tube is penetrated to the affected part along the guide needle, and the double tube is further advanced to penetrate the tumor.

After this, the guide needle is removed, and the frozen terminal body is inserted and loaded along the hollow shaft in the double tube instead. At this time, the terminal tip that becomes the freezing / thawing portion of the freezing terminal main body is brought into contact with or close to the rounded inner surface of the double tube. The freezing terminal body is connected to a high-pressure argon gas inlet and a high-pressure helium gas inlet via a switching valve. After the filling is confirmed, the switching valve is switched to inject high-pressure helium gas, then high-pressure argon gas is injected, and freezing and thawing are performed in a short time. This cycle may be repeated multiple times. A series of these operations are performed while observing and confirming under CT monitoring with displaying a real-time CT image.

Japanese Patent No. 4448818 JP 2007-167101 A JP 2007-209651 A

By the way, in this CT image, the route (Shooting Route) connecting the puncture point (Skin Point) on the body surface where the puncture device is punctured and the target lesion point (Tumor Point) serving as the affected part is seen from only one predetermined direction. Since it is a tomographic image, it is difficult to accurately grasp whether the puncture tool is moving accurately along a predetermined route. That is, since the tomographic image viewed only from one predetermined direction is a two-dimensional image in the X and Y directions, it is difficult to grasp the shift in the line-of-sight direction of the tomographic image that is the Z direction.

Therefore, the present inventors, in addition to the tomographic image viewed from one predetermined direction as shown in the above-mentioned Patent Document 3, etc., the second shifted by a predetermined angle (for example, 90 °) with respect to the tomographic image. Devised a novel therapeutic device path display device that simultaneously displays the tomographic images of the patient. According to this therapeutic element path display device, it is possible to accurately guide the puncture tool along a predetermined path by simultaneously displaying two tomographic images and grasping the shift in the line-of-sight direction of the tomographic image in the Z direction. It becomes.

However, in the method of displaying two tomographic images simultaneously as described above, the puncture tool can be guided along a predetermined path, but the puncture target point has a predetermined size such as a tumor, It is not easy to accurately grasp which position of a lesion site having a shape.

Therefore, the present invention has been devised to solve these problems. The purpose of the present invention is to provide a novel device that can accurately grasp the position of a puncture target point with respect to a lesion site viewed from the puncture route direction during puncture treatment. A puncture treatment support method, a puncture treatment support device, and a puncture treatment support device program are provided.

In order to solve the above-mentioned problem, the first invention is a method for supporting a subject to perform a predetermined treatment by puncturing a subject with a puncture tool from outside the body and reaching the tip to a target point in the body, Based on the image data acquisition step of acquiring 3D image data obtained by superimposing tomographic images obtained by tomographic imaging of a subject in a direction orthogonal to the tomographic plane, and the 3D image data acquired in the image data acquisition step A puncture point setting step for setting a puncture point and a target point of a puncture device for puncturing the subject, and a puncture path connecting the puncture point and the target point from the three-dimensional image data acquired in the image data acquisition step A first tomographic image acquisition step for acquiring a tomographic image of the first tomographic plane including the puncture path connecting the puncture point and the target point from the three-dimensional image data acquired in the image data acquisition step; A second tomographic image acquisition step of acquiring a tomographic image of a second tomographic plane having a predetermined angle with respect to the first tomographic plane; and the target point from the three-dimensional image data acquired in the image data acquisition step. A third tomographic image acquisition step for acquiring a tomographic image of a third tomographic plane that includes the first and second tomographic planes and forms a predetermined angle with the first and second tomographic planes; and a tomographic image of the first to third tomographic planes And a tomographic image display step for displaying the puncture treatment support method.

According to such a method, not only can the two tomographic images be displayed at the same time to grasp the shift in the line-of-sight direction of the tomographic image and accurately guide the puncture device along the predetermined path, but also the third tomographic plane Since the tomographic images can be displayed at the same time, the position of the puncture target point of the puncture tool with respect to the lesion site viewed from the direction of the invasion path can be accurately grasped. The tomographic imaging referred to in the present invention specifically refers to computed tomography (CT imaging) using radiation such as X-rays or MRI (Magnetic Resonance Imaging) tomography using magnetism, This refers to tomography using ultrasonic inspection (Ultrasonography, US Echo) (the same applies to the following inventions and embodiments).

A second invention further comprises a fourth tomographic image acquisition step of acquiring one or more fourth tomographic planes parallel to the third tomographic plane in the first invention, wherein the tomographic image display step comprises: A puncture treatment support method characterized by displaying the tomographic plane of the fourth tomographic plane acquired in the fourth tomographic image acquiring step together with the tomographic images of the first to third tomographic planes. According to such a method, the tomographic image of the third tomographic plane and the tomographic plane of the fourth tomographic plane are displayed simultaneously or alternately so that the size and shape of the lesion site viewed from the direction of the invasion path can be accurately determined. I can grasp it.

The third invention is the puncture treatment support method according to the first or second invention, wherein the predetermined angle between the first tomographic plane and the second tomographic plane is 90 °. According to such a method, it is possible to more accurately grasp the deviation of the puncture tool from the intrusion route during the intrusion.

The fourth invention is the puncture treatment support method according to any one of the first to third inventions, wherein the predetermined angle between the first tomographic plane and the third tomographic plane is 90 °. According to such a method, the position of the puncture target point of the puncture device with respect to the lesion site viewed from the intrusion route direction can be grasped more accurately.

According to a fifth aspect of the present invention, in the first to fourth aspects, the tomographic image display step includes the target point by the puncture tool during freezing treatment with the puncture tool punctured at the target point of the tomographic image of the third tomographic plane. This is a puncture treatment support method characterized by displaying a virtual frozen region centering on the. According to such a method, it is possible to accurately grasp how much region should be frozen with respect to a lesion site (tumor) serving as a puncture target point.

A sixth aspect of the invention is an apparatus for assisting in performing predetermined treatment by puncturing a subject from outside the body and having the tip of the puncture tool reach a target point in the body, in which tomographic imaging of the subject is performed. Three-dimensional image data acquisition means for acquiring three-dimensional image data obtained by superimposing the obtained tomographic images in a direction orthogonal to the tomographic plane, and the subject based on the three-dimensional image data acquired by the image data acquisition means A puncture point setting means for setting a puncture point and a target point of a puncture tool to be punctured, and a first tomography including a puncture path connecting the puncture point and the target point from the three-dimensional image data acquired by the image data acquisition means A first tomographic image acquisition unit for acquiring a tomographic image of a plane; a puncture path connecting the puncture point and a target point from the three-dimensional image data acquired by the image data acquisition unit; and the first tomographic plane Make a certain angle to Second tomographic image acquisition means for acquiring a tomographic image of two tomographic planes, and the target point from the three-dimensional image data acquired by the image data acquisition means, and the first and second tomographic planes and a predetermined A third tomographic image acquisition unit configured to acquire a tomographic image of the third tomographic plane forming an angle; and a tomographic image display unit configured to display the tomographic images of the first to third tomographic planes. This is a puncture treatment support device.

According to such an apparatus, similarly to the first invention, two tomographic images can be displayed at the same time so as to grasp the shift in the line-of-sight direction of the tomographic image and accurately guide the puncture tool along a predetermined route. In addition, since the tomographic image of the third tomographic plane can be displayed at the same time, the position of the puncture target point of the puncture tool relative to the lesion site viewed from the direction of the invasion path can be accurately grasped.

A seventh invention further comprises a fourth tomographic image acquisition means for acquiring one or a plurality of fourth tomographic planes parallel to the third tomographic plane in the sixth invention, wherein the tomographic image display means comprises: A puncture treatment support apparatus for displaying a tomographic image of the fourth tomographic plane acquired by the fourth tomographic image acquiring means together with the tomographic images of the first to third tomographic planes. According to such an apparatus, similarly to the second invention, the tomographic image of the third tomographic plane and the tomographic plane of the fourth tomographic plane are displayed simultaneously or alternately so that the lesion site viewed from the direction of the invasion path is displayed. The size and shape can be accurately grasped.

The eighth invention is the puncture treatment support device according to the sixth or seventh invention, wherein the predetermined angle between the first tomographic plane and the second tomographic plane is 90 °. According to such an apparatus, as in the third aspect of the invention, it is possible to grasp the displacement of the puncture tool with respect to the entry path more accurately during the entry.

A ninth invention is the puncture treatment support apparatus according to any of the sixth to eighth inventions, wherein the predetermined angle between the first tomographic plane and the third tomographic plane is 90 °. According to such an apparatus, the position of the puncture target point of the puncture device with respect to the lesion site viewed from the intrusion route direction can be grasped more accurately as in the fourth aspect of the invention.

According to a tenth aspect of the present invention, in the sixth to ninth aspects, the tomographic image display means performs the freezing treatment with the puncture device that has punctured the target point of the tomographic image of the third tomographic plane, and the target point by the puncture device. This is a puncture treatment support device characterized by displaying a virtual frozen region centering on the. According to such an apparatus, it is possible to accurately grasp how much of the region should be frozen with respect to a lesion site (tumor) serving as a puncture target point, as in the fifth invention.

An eleventh invention is a computer program for supporting a subject to perform a predetermined treatment by puncturing a subject with a puncture tool from outside the body and reaching a target point in the body, and the computer is connected to the subject. Based on the 3D image data acquisition means for acquiring 3D image data obtained by superimposing tomographic images obtained by tomographic imaging in a direction orthogonal to the tomographic plane, and the 3D image data acquired by the image data acquisition means A puncture point setting unit that sets a puncture point and a target point of a puncture device that punctures the subject, and a puncture path that connects the puncture point and the target point from the three-dimensional image data acquired by the image data acquisition unit A first tomographic image acquisition unit that acquires a tomographic image of a first tomographic plane; a puncture path that connects the puncture point and a target point from the three-dimensional image data acquired by the image data acquisition unit; and Second tomographic image acquisition means for acquiring a tomographic image of a second tomographic plane that makes a predetermined angle with respect to one tomographic plane; and the target point from the three-dimensional image data stored in the image data storage means, And displaying a tomographic image of a third tomographic plane that forms a predetermined angle with the first and second tomographic planes, and displaying a tomographic image of the first to third tomographic planes. A puncture treatment support program which functions as a tomographic image display means.

According to such a program, similarly to the first invention, it is possible to display two tomographic images at the same time to grasp the shift in the line-of-sight direction of the tomographic image and accurately guide the puncture tool along a predetermined route. In addition, since the tomographic image of the third tomographic plane can be displayed at the same time, the position of the puncture target point of the puncture tool relative to the lesion site viewed from the direction of the invasion path can be accurately grasped.

In a twelfth aspect based on the eleventh aspect, the computer functions as fourth tomographic image acquisition means for acquiring one or a plurality of fourth tomographic planes parallel to the third tomographic plane, and The display means is a puncture treatment support program for displaying the tomographic image of the fourth tomographic plane acquired by the fourth tomographic image acquiring means together with the tomographic images of the first to third tomographic planes. According to such a program, similar to the second invention, the tomographic image of the third tomographic plane and the tomographic plane of the fourth tomographic plane are displayed simultaneously or alternately, so that the lesion site viewed from the direction of the invasion path is displayed. The size and shape can be accurately grasped.

The thirteenth invention is the puncture treatment support program according to the eleventh or twelfth invention, wherein the predetermined angle between the first tomographic plane and the second tomographic plane is 90 °. According to such a program, as in the third aspect of the invention, it is possible to more accurately grasp the deviation of the puncture tool from the intrusion route during intrusion.

The fourteenth invention is the puncture treatment support program according to any of the eleventh to thirteenth inventions, wherein the predetermined angle between the first tomographic plane and the third tomographic plane is 90 °. According to such a program, the position of the puncture target point of the puncture tool with respect to the lesion site viewed from the intrusion route direction can be grasped more accurately as in the fourth invention.

According to a fifteenth aspect, in the eleventh to fourteenth aspects, the tomographic image display means performs the freezing treatment with the puncture device that has punctured the target point of the tomographic image of the third tomographic plane, and the target point by the puncture device. This is a puncture treatment support program characterized by displaying a virtual freezing region centering on. According to such a program, as in the fifth aspect, it is possible to accurately grasp how much region should be frozen with respect to a lesion site (tumor) that is a puncture target point.

According to the present invention, by displaying simultaneously two tomographic images including an intrusion path connecting a puncture point and a target point, a shift in the line-of-sight direction of the tomographic image can be grasped and the puncture tool can be accurately moved along a predetermined path. Can be guided. Further, since the tomographic image of the third tomographic plane can be displayed at the same time, the position of the puncture target point of the puncture tool with respect to the lesion site viewed from the invasion path direction can be accurately grasped. Further, since the tomographic image of the third tomographic plane parallel to the tomographic image of the third tomographic plane can be displayed, the size and shape of the lesion site viewed from the direction of the invasion path can be accurately grasped. In addition, since the virtual frozen region of the target point by the puncture tool can be displayed together on the tomographic image of the third tomographic plane, it is possible to accurately determine how much region should be frozen with respect to the lesion site serving as the puncture target point. I can grasp it.

It is explanatory drawing which shows the relationship between the X, Y, Z coordinate system with respect to the subject 110, and several CT tomographic planes. FIG. 6 is a life diagram showing the relationship among a puncture insertion point S, a puncture target point T, and a tomographic plane for a subject 110. (A) is a diagram showing a tomographic image of the tomographic plane Mk including the puncture insertion point S, and (B) is a diagram showing a tomographic image of the tomographic plane Mi including the puncture target point T. FIG. It is a figure which shows A tomographic plane containing the puncture path | route R which connects the puncture insertion point S and the puncture target point T. FIG. It is a figure which shows the tomogram (1st tomogram) of A tomographic plane. It is a figure which shows the B tomographic plane which included the puncture path | route R which connects the puncture insertion point S and the puncture target point T, and shifted | deviated the predetermined angle (alpha) with respect to A tomographic plane. It is a figure which shows the tomographic image (2nd tomographic image) of B tomographic plane. It is a figure which shows C tomographic plane which included only the puncture target point T, and shifted | deviated the predetermined angle with respect to A tomographic plane. It is a figure which shows the tomogram (3rd tomogram) of C tomographic plane. The relationship between the X, Y, Z coordinate system and the A tomographic plane, the B tomographic plane, and the C tomographic plane and the relationship with the puncture insertion point S, the puncture target point T, and the puncture route R with respect to the subject 110 viewed from another angle. It is a schematic diagram shown. FIG. 11 is a schematic diagram illustrating a relationship among an X, Y, Z coordinate system, an A tomographic plane, a puncture insertion point S, a puncture target point T, and a puncture route R with respect to the subject 110 in FIG. FIG. 11 is a schematic diagram illustrating a relationship among an X, Y, Z coordinate system, a B tomographic plane, a puncture insertion point S, a puncture target point T, and a puncture route R with respect to the subject 110 in FIG. FIG. 11 is a schematic diagram illustrating a relationship among an X, Y, Z coordinate system, a C tomographic plane, a puncture insertion point S, a puncture target point T, and a puncture route R with respect to the subject 110 in FIG. It is a figure which shows the tomographic image (1st tomographic image) of A tomographic plane in FIG. It is a figure which shows the tomographic image (2nd tomographic image) of the B tomographic plane in FIG. It is a figure which shows the tomographic image (3rd tomographic image) of C tomographic plane in FIG. It is a figure which shows the some CT tomogram centering on the body-axis direction (Z direction) of a subject. 18 is a three-dimensional contour image created from a plurality of CT tomographic images shown in FIG. A composition showing the relationship between the A tomographic plane (a), the B tomographic plane (b), the C tomographic plane (c), the puncture insertion point S, the puncture target point T, and the puncture route (Shoting Route) for the three-dimensional image in FIG. It is an image. It is a figure which shows the relationship between the tomogram (a) of the A tomographic plane with respect to the three-dimensional image in FIG. 18, and a puncture path | route (Shoting Route). It is a figure which shows the relationship between the tomogram (b) of the B tomographic plane with respect to the three-dimensional image in FIG. 18, and a puncture path | route (Shoting Route). It is a figure which shows the relationship between the tomographic image (c) of the C tomographic plane with respect to the three-dimensional image in FIG. It is a figure which shows the relationship between the tumor and virtual frozen area | region in the tomogram (3rd tomogram) of a C tomographic plane. It is a pixel value matrix figure in each pixel position of A tomographic plane, B tomographic plane, and C tomographic plane. It is a block diagram which shows the basic composition of the puncture route assistance apparatus 120 which concerns on this invention. It is a processing flow for making and displaying the A tomographic plane, the B tomographic plane, and the C tomographic plane 2 of the puncture route support method according to the present invention. It is a block diagram which shows the structure of the puncture cryotherapy apparatus 50 which can utilize the puncture route assistance method which concerns on this invention. It is a processing flow in the puncture cryotherapy apparatus 50. It is a figure which shows the Example of the double tube of the freezing terminal as a puncture device. It is a figure which shows the specific example of a freezing terminal. It is a cycle example figure of freezing and thawing by a freezing terminal. It is another processing flow by the puncture cryotherapy apparatus 50. It is explanatory drawing which shows other embodiment of this invention. Is a diagram illustrating an example of a D ₁ fault plane which is one fourth of the tomographic image. Is a diagram illustrating an example of a D ₂ fault plane is one of the fourth tomogram. Is a diagram illustrating an example of a D ₃ tomographic plane which is one fourth of the tomographic image.

Next, an embodiment of the puncture treatment support method of the present invention will be described with reference to the accompanying drawings.
FIG. 1 is a diagram showing a relationship between a tomographic plane (plane) in a subject 110 obtained by a multi-scan CT imaging apparatus (not shown) and the coordinate system XYZ. There are a large number of tomographic planes at a predetermined pitch in the body axis direction, and the figure schematically shows three tomographic planes Mi, Mj, and Mk.

The tomographic plane itself can be defined as an XY coordinate system, the body axis direction can be defined as a Z coordinate system, and an arbitrary point of the subject 110 can be defined by an X, Y, Z coordinate system. The pitch of the tomographic plane in the body axis direction is 1 mm or less, for example, 1/100 mm. The tomographic image is a CT image obtained by CT measurement, and a CT image of a new tomographic surface may be obtained by interpolation in order to make the pitch fine.

FIG. 2 shows a puncture insertion point S when a puncture tool (not shown) is inserted into the body from the outer skin of the subject 110, and a puncture target point (arrival) set at a lesion site in the body. Point) FIG. In this example, the S point on the tomographic plane Mk is designated as the puncture insertion point, and the puncture target point T on the tomographic plane Mi is designated as the puncture target. 3A is a tomographic image of the tomographic plane Mk in which the puncture insertion point S is set, and FIG. 3B is a tomographic image of the tomographic plane Mi in which the puncture target point T is set, and the puncture insertion point S is the subject 110. The skin position and the T point are set at the lesion site in the subject 110.

FIG. 4 is a diagram showing a setting example of the A tomographic plane that is a new tomographic plane including the puncture insertion point S and the puncture target point T. The A tomographic plane is not parallel to the original CT tomographic plane (... Mi,... Mj,... Mk,...) Obtained by a multi-scan CT imaging apparatus or the like. FIG. 5 shows an example of a tomographic image (first tomographic image) composed of calculated pixel values on the A tomographic plane. Here, since the calculated pixel value is on the A tomographic plane, it is obtained by calculating from the pixel values of the measured CT tomographic plane (... Mi,... Mj,... Mk,...). . This calculation method will be described later.

FIG. 6 is a diagram showing an example of setting the B fault plane, which is another new fault plane having a predetermined angle α with the A fault plane. The B tomographic plane is a plane including the puncture insertion point S and the puncture target point T as in the A tomographic plane, and the angle α is, for example, 90 ° (orthogonal). FIG. 7 is a tomographic image (second tomographic image) of the B tomographic plane, and all are obtained by calculating from pixel values calculated by a method described later.

By displaying tomographic images (first and second tomographic images) of the A tomographic plane and the B tomographic plane, which are two tomographic planes including the puncture insertion point S and the puncture target point T, from the puncture insertion point S It is possible to know what the puncture route R leading to the puncture target point T is, and whether there is an obstacle on the way, and monitoring from the puncture insertion point S to the puncture target point T becomes possible. Also, the insertion angle θ of the puncture device can be set and evaluated. If it is determined that another puncture insertion point S, puncture target point T, and insertion angle θ are set appropriately, these S, T, and θ are separately reset, and the same display is performed for evaluation. Just do it.

FIG. 8 is a diagram showing a setting example of the C tomographic plane that includes only the puncture target point T that is the arrival point of the puncture tool and forms a predetermined angle β with respect to the A tomographic plane and the B tomographic plane. This C tomographic plane is a plane that crosses the puncture route R of the A tomographic plane and the B tomographic plane, and the angle β is, for example, 90 ° (orthogonal). FIG. 9 is a tomographic image (third tomographic image) of the C tomographic plane, which is obtained by calculation from pixel values calculated by a method described later.

FIG. 10 to FIG. 16 explain the relationship between the three tomographic planes A, B, and C and their tomographic images in an easy-to-understand manner. In FIG. 10, for example, the symbol X is the height direction of the subject 110 that is in the supine state, Y is the width direction of the subject 110 that is also in the supine state, and Z is the body of the subject 110 that is also in the supine state. The axial direction is shown. In addition, a puncture insertion point S and a puncture target point T and a puncture route R (Shoting Route) that connects these points S and T with straight lines are shown.

FIG. 11 shows an example in which the A tomographic plane, which is the first new tomographic plane passing through the puncture insertion point S and the puncture target point T, is shown. FIG. An example of acquiring a B tomographic plane that is a second new tomographic plane passing through the puncture target point T is shown. The B tomographic plane is a plane rotated with respect to the A tomographic plane by a predetermined angle α (for example, 90 °) about the puncture route R connecting the puncture insertion point S and the puncture target point T.

FIG. 13 shows a setting example of a C tomographic plane (third tomographic plane) that includes only the puncture target point T and forms a predetermined angle β with respect to the A tomographic plane and the B tomographic plane. The C tomographic plane is a plane that is crossed at a predetermined angle (for example, 90 °) at the end point (puncture target point T) of the puncture route R of the A tomographic plane and the B tomographic plane.

FIGS. 14 to 16 show examples of tomographic images of these three tomographic planes A, B, and C. FIG. FIG. 14 is an example of a first tomographic image which is a cross-sectional image of the A tomographic plane. The puncture path R from the puncture insertion point S to the puncture target point T viewed from about the X-axis direction, the puncture target point T, and The shape of the lesion site Q is shown. In this example, the lesion site Q has a slightly elliptical shape, and it can be seen that the puncture target point T is set at a position slightly deviated from the center of the lesion site Q.

FIG. 15 is an example of a second tomographic image that is a cross-sectional image of the B tomographic plane. The puncture path R from the puncture insertion point S to the puncture target point T viewed from the Z-axis direction, and the puncture target point The shape of T and its lesion site Q is shown. In this example, the lesion site Q has a vertically long oval shape, and it can be seen that the puncture target point T is set at a position slightly deviated from the center of the lesion site Q.

Furthermore, FIG. 16 is an example of a third tomographic image which is a cross-sectional image of the C tomographic plane, and shows the shape of the puncture target point T and its lesion site Q viewed from about the Y-axis direction. In this example, the lesion site Q has a horizontally long saddle shape, and it can be seen that the puncture target point T is set at a position deviated to the left from the center of the lesion site Q.

FIG. 17 shows a plurality of CT tomograms obtained based on actual data with the body axis direction (Z direction) of the actual subject as an axis. FIG. 18 shows these CT tomograms. It is the three-dimensional outline image created from In the drawing, S is a puncture point (Skin Point), and T is a puncture target point (Target Point) (the same applies hereinafter). FIG. 19 shows the A tomographic plane (a), B tomographic plane (b), C tomographic plane (c) (Tumor Plane), puncture insertion point S, puncture target point T, and puncture path for the three-dimensional image in FIG. It is a synthesized image showing the relationship with (Shoting Route).

20 shows the relationship between the tomographic image (a) of the A tomographic plane with respect to the three-dimensional contour image in FIG. 18 and the puncture route (Shoting Route), and FIG. 21 shows the three-dimensional image in FIG. The relationship between the tomographic image (b) of the B tomographic plane and the puncture route (Shoting Route) is shown. Furthermore, FIG. 22 shows the relationship between the tomographic image (c) of the C tomographic plane and the puncture target point T with respect to the three-dimensional contour image in FIG. As shown in these images, a tomographic image of an arbitrary part and angle can be accurately grasped based on a three-dimensional contour image obtained from a plurality of CT tomographic images.

Next, the setting of these three new fault planes, A fault plane, B fault plane, and C fault plane, will be described. First, the setting of the A fault plane that is the first fault plane and the B fault plane that is the second fault plane will be described. Assuming that the A fault plane and the B fault plane are orthogonal to each other, when the A fault plane is determined, there is only one B fault plane and it is uniquely determined. However, the A tomographic plane is an infinite number of planes including the puncture insertion point S and the puncture target point T. Therefore, in advance, there are some A tomographic plane candidates that are on the puncture route R, have no intruding obstacles (for example, blood vessels and bones), and are easy to monitor the route. On the other hand, B tomographic plane candidates orthogonal to each of these candidates are determined. It is necessary that the obstacle is not on the puncture route R even if it is in the B tomographic plane candidate.

Among these candidates, planes having no obstacles and having easy-to-monitor paths are determined as A fault plane and B fault plane. These determination methods are performed while viewing the screen by the surgeon, but there is also a method performed by software (a computer program for supporting puncture treatment).

Here, the A fault plane and the B fault plane are not necessarily orthogonal. For example, when an appropriate orthogonal plane cannot be found, a plane other than the orthogonal plane may be selected as the B tomographic plane. Further, a plane with an angle other than the orthogonal plane may be suitable for route monitoring. Also in such a case, the B tomographic plane having a predetermined rotational angle β (≠ 90 °) corresponding to the A tomographic plane is determined in advance. For example, in the case of β = 60 °, there are two B fault planes (60 °, 120 °) with respect to the A fault plane, and one of them is specified.

On the other hand, even when the C tomographic plane is set, there are some A tomographic plane candidates that facilitate confirmation of the relationship between the puncture target point T and the lesion site Q. Therefore, the C fault plane, the A fault plane, and the B fault plane do not necessarily have to be orthogonal. For example, when an appropriate orthogonal plane cannot be found, a plane other than the orthogonal plane may be selected as the C tomographic plane. Further, a plane having an angle other than the orthogonal plane may be suitable for confirming the relationship between the puncture target point T and the lesion site Q.

Next, a method of calculating pixel values on each tomographic plane for obtaining the tomographic images of these three new tomographic planes, the A fault plane, the B fault plane, and the C fault plane will be described with reference to FIG. Each of the tomographic planes A to C has a matrix configuration of m × n pixels. This pixel value calculation is performed using three-dimensional image data of a subject 110 centered on a lesion site Q acquired by a multi-scan CT imaging apparatus or the like, dedicated image processing software (computer program), and an information processing apparatus (computer) using them. System).

First, when the A tomographic plane selected first and the CT tomographic plane do not completely match (in most cases, they do not match), the angle between the A fault plane and the CT tomographic plane is a predetermined angle γ other than 90 °. ing. This is because the puncture insertion point S is the outer skin surface and the puncture target point T is inside the body, so that the A tomographic plane including S and T is at an angle other than 90 ° with respect to the CT tomographic plane. Then, the pixel position on the A tomographic plane is J, K, the pixel position on the CT tomographic plane is X, Y, the coordinate in the body axis direction of the CT tomographic plane is Z, and the CT tomographic plane is M1, M2 from the front. ... Mn. These CT tomographic planes M1, M2,... Mn are arranged in the body axis direction which is the Z direction, and the A tomographic plane cuts the CT tomographic planes M1, M2,. It is a relationship that

Therefore, if the coordinates J, K of the A tomographic plane at all the intersection positions and the coordinates X, Y of the CT tomographic planes M1, M2,. Let this be the pixel value of the corresponding coordinates of the A tomographic plane. In many cases, the coordinates X and Y do not have a pixel value as in the non-hatched pixel position in FIG. 24. In this case, the approximate pixel value calculated by approximation from the pixel values such as two or four points around the coordinates X and Y Is a pixel value of coordinates J and K. This calculation may be an average value or a proportional distribution value considering a distance difference. You may use the pixel value of the most different position as it is, without calculating.

In this way, by calculating the pixel values of the B tomographic plane and the C tomographic plane using the three-dimensional image data of the subject 110, the dedicated image processing software, and the information processing apparatus, the three tomographic planes A Each tomographic image (first to third tomographic image) of the tomographic plane, the B tomographic plane, and the C tomographic plane can be obtained.

The puncture treatment support method of the present invention displays a normal CT tomographic image and performs two new tomographic planes including a puncture insertion point S and a puncture target point T when performing the puncture cryotherapy as described above. A new tomographic plane (C tomographic plane) including the puncture target point T is set in addition to (A tomographic plane and B tomographic plane), and tomographic images of these three tomographic planes (A to C tomographic planes) are displayed. It is a thing. This makes it possible to simultaneously display tomographic images of two tomographic planes (A tomographic plane and B tomographic plane) including the puncture route R connecting the puncture insertion point S and the puncture target point. It is possible to accurately guide the puncture device along the predetermined route R by grasping the deviation in direction. In addition to this, since the tomographic image of the C tomographic plane, which is the third tomographic plane, can be displayed at the same time, the position of the puncture target point T of the puncture tool with respect to the lesion site Q viewed from the intrusion route R direction can be accurately grasped. be able to.

As a result, it is possible to perform an accurate treatment such as resetting the position of the puncture target point T to an optimum position, or setting an optimum freezing range when performing the puncture cryotherapy as described above. For example, as shown in FIG. 16, when the lesion site Q has a saddle shape and the puncture target point T is shifted to the left side of the central portion, the position of the puncture target point T is reset from the central portion. Appropriate treatment such as setting the freezing range so as to cover the entire lesion site Q around the puncture target point T can be performed.

Next, FIG. 23 shows the relationship between a tumor (focal site) and a virtual frozen region in a tomographic image of the C tomographic plane (third tomographic image: Tumor Plane). In the figure, T is a puncture point reached by a puncture tool, which will be described later, and a concentric circle extending around the puncture point T is an isotherm centered on the puncture point T. ) Shows the virtual frozen region of the tumor. Here, in actual puncture cryotherapy using helium gas or the like, the size of the frozen region of the tumor has a positive correlation with the freezing time at the puncture target point T. That is, for example, FIG. 23A shows that the virtual freezing region is a part of the tumor because the freezing time is short, and FIG. 23B shows that the freezing time is shorter than that in FIG. Since it is long, it indicates that the virtual frozen region covers almost the entire tumor. On the other hand, FIG. 23 (C) shows that the virtual frozen region has reached a healthy tissue around the tumor because the freezing time is longer than that in FIG. 23 (B). Since the minimum freezing temperature of the bed part Q such as a tumor is about −3 ° C., the contour (outer edge portion) of the virtual frozen region is about −3 ° C., and the central portion of the virtual frozen region is about −180 ° C.

The relationship between the freezing area and the freezing time for a tumor (focal site Q) in such puncture cryotherapy has been previously known as data depending on the freezing refrigerant used, the type of tumor, the location, and the like. For this reason, the relationship between the freezing region and the freezing time for these tumors (focal sites) is made data-based by the configuration described later, and the tomographic image of the C tomographic plane obtained by the method described above (c) In addition, optimal cryotherapy can be supported by displaying a virtual freezing region as shown in FIG.

In the example of FIG. 23, in FIG. 23A, the freezing time is short (for example, about several minutes), and the virtual frozen region is a part of the tumor, so that a sufficient therapeutic effect cannot be obtained. On the other hand, in FIG. 23B, since the freezing time is longer than this (for example, around 10 minutes) and the virtual frozen region covers almost the entire tumor (lesion site), a sufficient therapeutic effect is expected. On the other hand, in FIG. 23C, since the freezing time is longer and the virtual freezing area is larger than this, it is expected that not only the tumor but also the surrounding healthy tissue will be adversely affected.

Therefore, when the C tomographic image as described above is displayed on the monitor, if the relationship between the tumor (focal site) and the virtual frozen region as shown in FIG. Since not only the puncture target point T but also the relationship between the freezing region around the puncture target point T and the freezing time can be displayed in an easy-to-understand manner, optimal cryotherapy can be supported. As will be described later, the frozen region by the puncture cryotherapy is not limited to a concentric circle (round circle) centered on the puncture target point T as shown in FIG. It is also possible to set a frozen region having a heat directing characteristic in the direction.

Next, FIG. 25 shows the basics of the puncture treatment support apparatus (computer system) 120 incorporating the three-dimensional image data of the subject 110 for puncture treatment support and dedicated image processing software (computer program) as described above. It is a system diagram. This puncture treatment support device 120 includes a computing device (CPU) 121, a main storage device (RAM) 122, an input device 123 such as a keyboard (KB), a display device 124 such as a monitor, and a read-only storage device (ROM). ) 126 and other devices are connected.

The ROM stores an operating system (OS) for operation and a dedicated image processing program (computer program), and the RAM 122 stores tomographic images of a plurality of tomographic planes acquired in advance as shown in FIG. The three-dimensional image data and the like are stored and read by the operation of the CPU 121 according to the instruction of the keyboard 123, and the tomographic images created by the image processing program are sequentially displayed on the monitor 124, or on a plurality of monitors 124 or divided screens. A tomographic image is displayed simultaneously. From there, the surgeon looks at the display screen and instructs the puncture insertion point S and the puncture target point T. When displaying each tomographic image sequentially, it takes time. Therefore, there is a method in which all the tomographic images are displayed three-dimensionally and the puncture insertion point S and the puncture target point T are designated therefrom.

Further, in FIG. 25, the A tomographic plane and the B tomographic plane passing through the puncture insertion point S and the puncture target point T and the C tomographic plane including the puncture target point T are designated manually or automatically. For example, an instruction is given using the keyboard 123. In response to this instruction, the CPU 121 calculates the tomographic image data D1, D2, and D3 of the A to C tomographic planes.

FIG. 26 shows the processing flow in FIG. First, three-dimensional CT image data is acquired and stored in the memory 122 in the first step S100, and the process proceeds to the next step 102. In step S102, CT tomograms of necessary CT tomographic planes are sequentially displayed, and one of the tomographic planes Mk serving as the puncture insertion point S and any other tomographic plane Mi serving as the puncture target point T are displayed. Is selected and instructed to proceed to the next step S104.

Step S104 designates the puncture insertion point S and the puncture target point T on each of the tomographic planes Mk and Mi, and proceeds to the next step S106. In step S106, the A tomographic plane passing through the puncture insertion point S and the puncture target point T and the B tomographic plane intersecting the A tomographic plane at a predetermined angle α are designated, and the process proceeds to the next step S108. In step S108, the CT pixel values of the designated A tomographic plane and B tomographic plane are calculated to obtain the respective tomographic image data D1 and D2, and the process proceeds to the next step S110.

In step S110, the tomographic image data D1 and D2 are respectively displayed as tomographic images (first tomographic image and second tomographic image) of the A tomographic plane and the B tomographic plane, and the process proceeds to the next determination step S112. In this determination step S112, it is checked whether or not the set puncture route R is an appropriate route by looking at the image. If it is inappropriate (No), the process returns to step S102, and if it is appropriate (Yes) The tomographic planes Mj and Mk, the tomographic image data D1 and D2, the A tomographic plane, the B tomographic plane, and the insertion angle θ are determined, and the process proceeds to the next step S116.

In step S116, a C tomographic plane that includes only the puncture target point T and is substantially orthogonal to the A tomographic plane is set, the CT pixel value is calculated to obtain tomographic image data D3, and the process proceeds to the last step S118. In the last step S118, the tomographic image data D3 is displayed as a tomographic image of the C tomographic plane (third tomographic image), and the process is terminated.

When a plurality of lesion sites Q are scattered, the coordinates X, Y, and Z of the puncture target point T are different from each other when viewed on the X, Y, and Z axes, and T1 (X, Y, Z), T2 ( X, Y, Z), T3 (X3, Y3, Z3), etc. Basically, one of the points is determined as the puncture target point, and the other point is the CT monitor under the puncture tool. Take the way to move. In this case, the puncture route R is checked in advance by the combination of the puncture insertion point S and the puncture target points T1, S and T2, and S and T3, and the new tomographic plane and the corresponding new tomographic image are calculated and displayed. It is preferable to check the obstacles for all puncture target points T.

Next, a CT image forming method for monitoring the puncturing process along the puncture route R in real time will be described. In order to monitor the puncturing operation process as described above in real time, it is not necessary to measure and reconfigure every CT tomographic plane M1, M2,... Mn regardless of the position of the puncture tool. A CT tomogram of a tomographic plane only in the vicinity of the puncture tool as a center is measured and reconstructed, and CT tomograms of other tomographic planes use past tomographic images obtained so far. For example, when the tip position of the puncture tool at a certain point in time is Zi, an in-width tomographic plane of i = i ± γ in the vicinity of Zi (γ is a nearby value, and several to tens of faults And obtain a tomographic image. Thus, CT measurement and reconstruction can be performed while maintaining real-time characteristics. In this case, CT plane values where the tomographic plane of i = i ± γ maintains the real-time property among the CT tomographic planes for the A fault plane and the B fault plane, and the other fault planes are measured and measured before that time. This is a reconstructed CT pixel value.

Next, an example of a cryotherapy apparatus for realizing the puncture treatment support method of the present invention will be described. FIG. 27 is an overall configuration diagram of this cryotherapy apparatus 50. The cryotherapy apparatus 50 includes a CT scanner 51, an image processing unit 52, a display unit 53, an operation unit 54, a drive control unit 55, a planning unit 56, a treatment element (puncture tool) 57, and a gas supply. The unit 58 and the monitoring unit 59 are mainly provided.

The CT scanner 51, the image processing unit 52, the display unit 53, and the operation unit 54 are original CT apparatuses. Using this CT apparatus, a plurality of tomographic images are acquired in advance to form a three-dimensional image. There is also an example in which an interpolation image for filling the gap from a plurality of tomographic images is used as a three-dimensional image.

The CT scanner 51 is also used to obtain a real-time CT image during the puncturing operation. This real-time image is also obtained by superimposing the puncture operation of the treatment element (puncture tool) 57 in the monitoring unit 59, and is used for puncture monitoring and treatment monitoring. The planning unit 56 cooperates with the image processing unit 52 based on data obtained in advance or based on this and shape (and / or structure) data of the treatment element 57 (puncture insertion point S). Then, the treatment site (puncture target point T) and the progression route (puncture route R) of the treatment child are determined by data processing to create plan data. In addition, a gas supply control method based on heat retention and physical property values (including physiological values) of the lesion site is determined.

The drive control unit 55 performs drive control such as movement of the treatment element (puncture tool) 57 and supply control of the gas supply unit 58 based on the plan data of the plan unit 56, and performs alternating operations of freezing and thawing. The monitoring unit 59 monitors drive control. There are two types of monitoring: CT image monitoring and control mechanism monitoring. The monitoring unit 59 may be combined with the display unit 53. Here, a part of the image processing unit 52 and the planning unit 56 corresponds to the route display device. This treatment device 50 is an example using a freezing terminal as a treatment child, and there is a prior application regarding the freezing terminal and its treatment device.

The cryotherapy apparatus 50 of the present invention performs the following processing and operations.

(1) First, as described above, the puncture insertion point S and the puncture target point T (lesion position) of the freezing terminal as the puncture tool are determined. This determination is made by selecting from a plurality of CT tomographic images imaged and reconstructed in the body axis direction (Z direction) as described above, and for example, the coordinate position (Xa, Ya) of the tomographic plane Zi is set as the puncture insertion point S and the tomographic plane Zj. The coordinate position (Xb, Yb) is set as the puncture target point T. For example, CT tomograms are displayed one after another along the body axis direction, and the operator specifies the tomographic planes Zi and Zj, and the puncture insertion point S and puncture target point T as coordinates on the plane. In the same manner as in the previous application, the three-dimensional contour image of the three-dimensional image along the body axis is determined.

(2) The A tomographic plane passing through the puncture insertion point S and the puncture target point T, the B tomographic plane orthogonal to the A tomographic plane, and the A tomographic plane orthogonal to the A tomographic plane or having the predetermined angle β and the puncture target point A C cross-sectional layer including only T is determined. This uses processing by dedicated software (program) using the image processing unit 52 and the planning unit 56.

(3) The puncture operation is started by the operation of the drive control unit 56. The monitoring is performed by the monitoring unit 59. In order to monitor the puncturing operation, CT tomography and reconstruction are performed by an X-ray CT apparatus, for example, by multi-slice measurement (a structure that enables imaging of a plurality of cross sections at one time) to obtain a CT tomogram. The imaging range is in the vicinity of the tip of the freezing terminal (puncture tool), and the tip position advances as the freezing terminal punctures. CT imaging and reconstruction are performed one after another in the vicinity of the tip. A CT tomogram is obtained.

(4) The latest tomographic image obtained under CT monitoring is stored in the memory by the monitoring unit 59 and displayed one after another on the display unit 53 to be used for monitoring the progress of the puncture tool. In addition to this, the image processing unit 52 and the planning unit 56 perform CT on each plane of the A tomographic plane, the B tomographic plane, and the C tomographic plane determined in (2), which is one of the features of the present invention. The pixel value is calculated, embedded tomographic image data D1, D2, and D3 are acquired corresponding to the pixel position (coordinate position) on each plane and displayed on the display device. When obtaining the three tomographic image data D1, D2, and D3, the plurality of tomographic planes included in the vicinity of the tip of the freezing terminal have the tomographic images obtained in real time, and the other tomographic planes before that It has the acquired tomographic image. Here, the previous tomographic image includes a tomographic image obtained before entering the puncturing operation or a previous tomographic image obtained by photographing on the near side of the tip position when the tip position advances.

(5) In this way, the puncture route R of the frozen terminal can be monitored in real time by displaying the latest CT tomographic image and the tomographic images of the A tomographic plane, B tomographic plane, and C tomographic plane. If there is a situation where the puncture route R is shifted, the direction of the freezing terminal can be corrected by viewing the latest tomographic image and the tomographic images on the A tomographic plane, the B tomographic plane, and the C tomographic plane. For example, it is possible to determine whether the distance on the A tomographic plane is 2 mm or the distance on the B tomographic plane is 3 mm, and the operation for returning it to the correct puncture route R is performed on the frozen terminal. At this time, if the freezing terminal is automatically moved by the actuator, a correction operation command is given, or if it is manually performed by the operator, it is manually returned to the normal route.

In addition, since a tomographic image (third tomographic image) on the C tomographic plane can be simultaneously viewed, the size and shape of the lesion site Q, the position of the puncture target point T in the lesion site Q, etc. can be accurately monitored in real time. . As a result, when the puncture target point T is not optimal as will be described later, the puncture route R and the puncture target point T can be set again, or the determination of the freezing range can be accurately performed.

The puncture route support method of the present invention can also be used for creating and confirming a puncture route R. For planning and confirmation of the puncture route R, real-time properties are not necessary, and thus all tomographic images that have been imaged and reconstructed in advance are used for creation and confirmation. After storing such tomographic images in the storage device, tomographic images of the two A tomographic planes and the B tomographic plane passing through the puncture insertion point S and the puncture target point T are created (calculated) and displayed to display the puncture insertion point S. The puncture target point T is set. Here, since the puncture target point T is a lesion site, it is usually fixed, but its position can be corrected by viewing the tomographic image of the C tomographic plane as described above.

If the puncture target point T is set, the point is where the puncture insertion point S is set. In order to obtain such an appropriate puncture insertion point S, the tomographic images of the A tomographic plane and the B tomographic plane are created and displayed, searched and determined. Although the above is for preparation, the same display can be performed to check whether the setting is appropriate or not when confirming the route to the puncture insertion point S and the puncture target point T created by another method. In the above example, the case of a freezing terminal is used. However, other therapeutic elements, for example, an element for inspection or treatment that peels off the affected area, an element that enters for monitoring of the affected area (micro camera or optical fiber) Terminal) and ultrasonic waves can be applied to various elements such as an element that irradiates an affected area with energy such as electromagnetic waves.

FIG. 28 shows a processing flow of a treatment apparatus using a freezing terminal as a treatment child (puncture tool). In the first step S200, a plurality of CT image data (several tens or more) are acquired along the body axis direction (Z direction), and the process proceeds to the next step S202. In step S202, the treatment parameter including the puncture insertion point S that is an intrusion parameter, the puncture target point T of the lesion site Q to be treated, and the insertion angle θ is determined, and the process proceeds to the next step S202. This is due to the CT apparatus. In addition, an image stored in the memory of the subject 110 acquired in advance by the CT apparatus and stored in the memory may be used. In the next step S202, the treatment element (puncture tool) is operated (automatic, semi-automatic, manual) using the puncture route support apparatus 120 of the present invention. In the final step S206, actual puncturing and treatment operations are performed using the parameters. In the treatment, if the treatment child (puncture device) reaches the lesion site Q that is the puncture target point T, the lesion site Q is necrotized by repeating freezing and thawing at the tip of the freezing terminal. This operation may be automatic, semi-automatic, or manual.

FIG. 29 is a schematic view of the therapeutic element 100 serving as a freezing terminal that is also one of the puncture devices. This therapeutic element 100 includes a double tube (an example of a single tube, the same applies hereinafter) 1, a freezing terminal body 2 and a conduit 6 connected thereto, a switching valve 5, a high-pressure helium gas supply source 3, and a high-pressure argon. And a gas supply source 4. When the length L1 of the double tube 1 and the length L2 of the externally exposed portion of the freezing terminal main body 2 are assumed, the therapeutic element 100 may be considered as a linear component having a length of approximately (L1 + L2). Assuming that the leading edge 20B is intruded from the puncture insertion point S to the puncture target point T, which is one point of the lesion site Q, the insertion angle θ, the puncture insertion point S, and the puncture The target point T and the puncture route R can be calculated.

FIG. 30 is a specific example of a freezing terminal. Reference numeral 40 denotes a freezing terminal main body, which is made of a material having low thermal conductivity, for example, metal, and has a heat exchange mechanism 41 therein. A high-pressure gas flows in through the switching valve 5 and is discharged from the tip opening portion 42 to the inside of the main body 40 and exhausted to the outside. Here, the codes |

symbols

31 and 32 are the cocks for each gas.

Next, this temperature characteristic (temperature change) will be described. A specific example is shown in FIG. FIG. 31 (a) shows an example of one cycle in which the freezing peak temperature and the thawing peak temperature are set to the same absolute value T1 (actually -T1 during freezing and + T1 during thawing). Since it is preferable that the thermal energy is offset by both, the area determined by (temperature) × (time) during freezing and thawing is the same area (S1). FIG. 31B shows an example in which the absolute values of the freezing peak temperature and the thawing peak temperature are T1 and T2 (T1> T2). Since T1> T2, the thawing period is set longer than the freezing period in order to achieve the same area S1. In addition, as a modified example of FIGS. 31A and 31B, there may be an example of one cycle of one freezing and two thawings.

Fig. 31 (c) is an example of two-cycle donation with freezing and thawing. There are also examples of more than 3 cycles. Although the area was the same for freezing and thawing, strict identity is not required if the goal of necrosis of the lesion can be achieved. Since a human treatment site has a body temperature of 38 ° C., an actual temperature characteristic is often determined in consideration of such body temperature. In order to realize such various temperature characteristics (temperature changes), the gas supply of both helium and argon to the treatment element may be controlled using the amount and time as parameters.

The realization of temperature characteristics (temperature change) and determination of the gas supply control method will be described. (1) Taking into account the thermal constants such as the specific heat and conductivity of the lesion site Q of the subject 110 and the physical constants such as the shape of the lesion site Q incorporating the volume weight, the time change of the temperature of the object is measured. decide. (2) The temperature change with respect to the time around the puncture target point T in consideration of the thermal constant and physical constant of the subject 110 can be calculated, and the dynamic change with respect to the set temperature or the set time leading to the dynamic change can be determined. Determine as follows. (3) The rotation angle of the puncture device is determined so that the thermal time change in the vicinity of the determined puncture device target point T has a set target temperature change. (4) The time change of the thermal temperature around the puncture target point T and the vicinity thereof is determined for the insertion of a plurality of puncture tools having different heat retention properties.

(5) The intruder having the plurality of thermal directions repeats the temporal change of the thermal temperature at the arrival point and in the vicinity thereof under the geometrical constant determined as described above, and the test operation is performed. As a result, at least one of the entry start position to the subject 110, the arrival point on the outline of the puncture tool, the entry direction, the angle and rotation angle of the puncture tool, and the puncture route R from the puncture insertion point S to the puncture target point T One of them is obtained and determined, and the temperature distribution and temporal change of the surrounding objects are determined. (6) Gas amount and supply sequence (timing) such that the gas changeover switch of the gas inflow passage for switching the heat generation and heat absorption of the heat exchanger provided at the tip of the puncture tool becomes a predetermined temperature change near the arrival point. The gas supply control method is determined. At the time of treatment, puncture is performed according to the intrusion parameters, and after the puncture target point T is reached, gas supply is performed by the gas supply control method.

FIG. 32 shows a processing flow considering temperature characteristics. Compared with FIG. 28, new steps S203-1, S203-2, and S203-3 are added between step S202 and step S204. In step S203-1, the above-described temperature characteristic is determined, and the gas supply control method is calculated based on the determination. In step S203-2, a treatment simulation is performed based on the parameters calculated in step S202, the temperature characteristics, and the gas supply control method. If it is determined that there is no therapeutic effect as a result of the simulation, the process returns to step S202. If it is determined that there is a therapeutic effect, the process proceeds to step S203-3 and a final decision is made.

FIG. 33 to FIG. 36 show another embodiment of the present invention. As shown in FIG. 33, in the present embodiment, in addition to a tomographic image (third tomographic image) of the third tomographic plane (C tomographic plane), a fourth tomographic plane (D tomographic plane) parallel to the C tomographic plane is obtained. And a tomographic image of the D tomographic plane (fourth tomographic image) is displayed simultaneously or sequentially with the C tomographic plane. As described above, the tomographic image (fourth tomographic plane) of the fourth tomographic plane (D tomographic plane) parallel to the tomographic image (third tomographic image) of the third tomographic plane (C tomographic plane) is displayed. The size and shape of the lesion site Q viewed from the route R direction can be accurately grasped.

For example, Figure 34 shows a third tomogram (C tomographic plane) and the fourth tomogram position away several mm from its C tomographic plane which is parallel as shown in FIG. 16 (D ₁ slice plane) It can be seen that the shape of the lesion site Q is smaller on the left and right. FIG. 35 shows a fourth tomogram (D ₂ tomographic plane) at a position several mm away from the D ₁ tomographic plane in FIG. 34, and the lesion site Q has a smaller shape. Recognize. Further, FIG. 36, there is shown a fourth tomogram location remote D ₂ even several mm from the tomographic plane of FIG. 35 (D ₃ tomographic plane), the shape of the lesion region Q is even smaller I understand. By displaying these multiple D tomographic planes simultaneously on a plurality of monitors or sequentially on one monitor, the lesion site Q is gradually reduced in the vertical and horizontal directions as it moves away from the puncture target point (arrival point) T. You can see that

This makes it possible to accurately determine whether or not the entire tumor site centered on the puncture target point (arrival point) T can be frozen in one freezing treatment. Further, for example, even when the tumor site needs to be frozen twice or more times, an optimal puncture target point (arrival point) T can be determined, so that more accurate cryotherapy can be performed. The number of the fourth tomographic planes (D tomographic planes) (D ₁ , D ₂ , D ₃ ...) And their intervals are not particularly limited. The larger the number, the greater the interval. The smaller the size, the more accurately the size and shape of the lesion site can be grasped.

100 ... Treatment child (puncture device)
DESCRIPTION OF SYMBOLS 110 ... Subject 120 ... Puncture treatment support device M ... Tomographic plane Q ... Focal site R ... Puncture route S ... Puncture insertion point T ... Puncture target point

Claims

A method for supporting a subject to perform a predetermined treatment by puncturing a puncture tool from outside the body and causing the tip to reach a target point in the body,
An image data acquisition step of acquiring three-dimensional image data obtained by superimposing a tomographic image obtained by tomographic imaging of the subject in a direction orthogonal to a tomographic plane;
A puncture point setting step for setting a puncture point and a target point of a puncture device that punctures the subject based on the three-dimensional image data acquired in the image data acquisition step;
A first tomographic image acquisition step of acquiring a tomographic image of a first tomographic plane including a puncture path connecting the puncture point and a target point from the three-dimensional image data acquired in the image data acquisition step;
A tomographic image of a second tomographic plane that includes a puncture path connecting the puncture point and a target point from the three-dimensional image data acquired in the image data acquisition step and forms a predetermined angle with respect to the first tomographic plane. A second tomographic image acquisition step of acquiring
A third tomographic image that acquires a tomographic image of a third tomographic plane that includes the target point and forms a predetermined angle with the first and second tomographic planes from the three-dimensional image data acquired in the image data acquisition step. An acquisition step;
And a tomographic image display step for displaying a tomographic image of the first to third tomographic planes.
The puncture treatment support method according to claim 1,
A fourth tomographic image acquisition step of acquiring one or more fourth tomographic planes parallel to the third tomographic plane;
The tomographic image display step displays the tomographic image of the fourth tomographic plane acquired in the fourth tomographic image acquiring step together with the tomographic images of the first to third tomographic planes.
The puncture treatment support method according to claim 1 or 2,
A puncture treatment support method, wherein a predetermined angle between the first tomographic plane and the second tomographic plane is 90 °.
The puncture treatment support method according to any one of claims 1 to 3,
A puncture treatment support method, wherein the predetermined angle between the first tomographic plane and the third tomographic plane is 90 °.
The puncture treatment support method according to any one of claims 1 to 4,
In the tomographic image display step, a virtual frozen region centered on the target point by the puncture tool is displayed together with the cryotherapy by the puncture tool punctured at the target point of the tomographic image of the third tomographic plane. A puncture treatment support method.
A device that assists in performing a predetermined treatment by puncturing a subject with a puncture tool from outside the body and causing the tip to reach a target point in the body,
Three-dimensional image data acquisition means for acquiring three-dimensional image data obtained by superimposing tomographic images obtained by tomographic imaging of the subject in a direction orthogonal to the tomographic plane;
A puncture point setting means for setting a puncture point and a target point of a puncture tool for puncturing the subject based on the three-dimensional image data acquired by the image data acquisition means;
First tomographic image acquisition means for acquiring a tomographic image of a first tomographic plane including a puncture path connecting the puncture point and a target point from the three-dimensional image data acquired by the image data acquisition means;
A tomographic image of a second tomographic plane that includes a puncture path connecting the puncture point and a target point from the three-dimensional image data acquired by the image data acquisition means and forms a predetermined angle with respect to the first tomographic plane. Second tomographic image acquisition means for acquiring
A third tomographic image that acquires a tomographic image of a third tomographic plane that includes the target point and forms a predetermined angle with the first and second tomographic planes from the three-dimensional image data acquired by the image data acquisition means. Acquisition means;
A puncture treatment support apparatus comprising: a tomographic image display means for displaying a tomographic image of the first to third tomographic planes.
The puncture treatment support device according to claim 6,
A fourth tomographic image acquisition means for acquiring one or more fourth tomographic planes parallel to the third tomographic plane;
The puncture treatment support apparatus, wherein the tomographic image display means displays the tomographic image of the fourth tomographic plane acquired by the fourth tomographic image acquiring means together with the tomographic images of the first to third tomographic planes.
The puncture treatment support device according to claim 6 or 7,
A puncture treatment support apparatus in which a predetermined angle between the first tomographic plane and the second tomographic plane is 90 °.
The puncture treatment support device according to any one of claims 6 to 8,
A puncture treatment support apparatus in which a predetermined angle between the first tomographic plane and the third tomographic plane is 90 °.
The puncture treatment support device according to any one of claims 6 to 9,
The tomographic image display means also displays a virtual frozen region centered on the target point by the puncture tool in combination with a puncture tool punctured at the target point of the tomographic image of the third tomographic plane. A puncture treatment support device.
A computer program for supporting a subject to perform a predetermined treatment by puncturing a subject with a puncture tool from outside the body and causing the tip to reach a target point in the body,
Computer
Three-dimensional image data acquisition means for acquiring three-dimensional image data obtained by superimposing tomographic images obtained by tomographic imaging of the subject in a direction orthogonal to the tomographic plane;
A puncture point setting means for setting a puncture point and a target point of a puncture tool for puncturing the subject based on the three-dimensional image data acquired by the image data acquisition means;
First tomographic image acquisition means for acquiring a tomographic image of a first tomographic plane including a puncture path connecting the puncture point and a target point from the three-dimensional image data acquired by the image data acquisition means;
A tomographic image of a second tomographic plane that includes a puncture path connecting the puncture point and a target point from the three-dimensional image data acquired by the image data acquisition means and forms a predetermined angle with respect to the first tomographic plane. Second tomographic image acquisition means for acquiring
A third tomographic image that acquires a tomographic image of a third tomographic plane that includes the target point and forms a predetermined angle with the first and second tomographic planes from the three-dimensional image data stored in the image data storage means. Acquisition means;
A puncture treatment support program which functions as tomogram display means for displaying tomograms of the first to third tomographic planes.
The puncture treatment support program according to claim 11,
The computer,
Functioning as fourth tomographic image acquisition means for acquiring one or more fourth tomographic planes parallel to the third tomographic plane;
The puncture treatment support program, wherein the tomographic image display means displays the tomographic image of the fourth tomographic plane acquired by the fourth tomographic image acquiring means together with the tomographic images of the first to third tomographic planes.
The puncture treatment support program according to claim 11 or 12,
A puncture treatment support program, wherein a predetermined angle between the first tomographic plane and the second tomographic plane is 90 °.
The puncture treatment support program according to any one of claims 11 to 13,
A puncture treatment support program, wherein a predetermined angle between the first tomographic plane and the third tomographic plane is 90 °.
The puncture treatment support program according to any one of claims 11 to 14,
The tomographic image display means also displays a virtual frozen region centered on the target point by the puncture tool in combination with a puncture tool punctured at the target point of the tomographic image of the third tomographic plane. A puncture treatment support program.