WO2016084373A1 - シミュレータ、該シミュレータを備える注入装置又は撮像システム、及びシミュレーションプログラム - Google Patents
シミュレータ、該シミュレータを備える注入装置又は撮像システム、及びシミュレーションプログラム Download PDFInfo
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Definitions
- the present invention relates to a simulator for predicting a temporal change in pixel values (CT values) of a captured image in a tissue of a subject, an injection apparatus or an imaging system including the simulator, and a simulation program.
- CT values temporal change in pixel values
- the heart and blood vessels are one compartment.
- the other organ is assumed to be one compartment having an intravascular space and an extracellular space.
- prediction is performed on the assumption that the contrast agent diffuses throughout the compartment as soon as the contrast agent arrives.
- the prediction result may be greatly different from the actual change of the pixel value.
- the contrast agent injection amount is small, when the contrast agent injection time is short, or when the contrast agent concentration is low, the diffusion rate in the actual tissue is slow. Therefore, the prediction result is likely to be greatly different from the actual change in pixel value.
- a simulator as an example of the present invention is a simulator that predicts a temporal change in pixel values in a tissue of a subject, a subject information acquisition unit that acquires information on the subject, and a contrast agent injection Based on the protocol acquisition unit for acquiring a protocol, the tissue information acquisition unit for acquiring the tissue information, the subject information, the injection protocol, and the tissue information, the tissue is moved along the blood flow direction. And a prediction unit that predicts a change with time of each pixel value of the plurality of compartments.
- another example of the injection apparatus according to the present invention includes an injection head for injecting a contrast medium according to an injection protocol, and the simulator.
- An imaging system as another example of the present invention includes a medical imaging apparatus that images a subject and the simulator.
- a simulation program as another example of the present invention is a simulation program for causing a computer to predict a temporal change of a pixel value in a tissue of a subject, and the simulation program causes the computer to obtain information on the subject.
- the protocol acquisition unit for acquiring the contrast medium injection protocol the tissue information acquisition unit for acquiring the tissue information, the subject information, the injection protocol, and the tissue information, It functions as a predicting unit that predicts a temporal change in pixel values of a plurality of compartments obtained by dividing the tissue along the blood flow direction.
- a simulator (perfusion simulator) 20 that predicts a temporal change in pixel values in a tissue of a subject includes a prediction unit 16. Then, the prediction unit 16 is caused by at least the contrast agent of each pixel value of the plurality of compartments obtained by dividing the subject tissue along the blood flow direction based on the subject information, the injection protocol, and the tissue information. Predict changes over time. Note that the pixel value changes under the influence of physiological saline and blood in addition to the contrast agent.
- the simulator 20 includes a subject information acquisition unit 11 that acquires subject information. Then, the prediction unit 16 receives subject information related to the subject such as the hemoglobin amount (g / dL) and the weight (kg) of the subject from the subject information acquisition unit 11. Here, the subject information acquisition unit 11 acquires subject information input by the operator via the input unit 27 of the simulator 20.
- the subject information acquisition unit 11 may acquire subject information from the storage unit 24 of the simulator 20 or an external storage device (server). Examples of such servers include RIS (Radiology Information System), PACS (Picture Archiving Information System), HIS (Hospital Information System), an imaging system, and an image creation workstation. Furthermore, the subject information acquisition unit 11 may acquire subject information from the imaging device 3 (FIG. 8) or the injection device 2 (FIG. 8). Subject information includes lean body mass, circulating blood volume, subject number (subject ID), subject name, sex, date of birth, age, height, blood volume, blood flow rate, body surface area, subject disease, side effects. A history, a creatinine value, a heart rate, and a cardiac output may be included.
- the simulator 20 includes a protocol acquisition unit 12 that acquires a contrast medium injection protocol. Then, the prediction unit 16 acquires an injection protocol such as a contrast medium injection speed (mL / sec) and a contrast medium injection time (sec) from the protocol acquisition unit 12.
- the protocol acquisition unit 12 acquires the injection protocol input by the operator via the input unit 27.
- the injection protocol may include information regarding injection conditions such as an injection method, a contrast agent injection location, an injection amount, injection timing, a contrast agent concentration, and an injection pressure.
- the protocol acquisition unit 12 may acquire the injection protocol from the storage unit 24, the external storage device, or the injection device 2.
- the contrast agent injection location can be input from the injection setting screen of the simulator 20, and the upper limb vein is selected in the standard case.
- hepatic artery hepatic arteriography: CTHA
- superior mesenteric artery portography: CTAP
- right ventricle ascending aorta
- the injection protocol includes a fixed contrast medium injection speed, presence / absence of back-injection of contrast medium, physiological saline injection speed, physiological saline injection time, increase / decrease of injection speed, and volume of injection tube, etc. Information may be included.
- the simulator 20 includes a tissue information acquisition unit 13 that acquires information on the tissue of the subject. Then, the prediction unit 16 receives from the tissue information acquisition unit 13 the number of compartments in the tissue (the number of divided compartments of blood vessels and organs), the volume of the tissue (volume of the blood vessel cavity), the volume of the capillary blood vessel, the volume of the extracellular fluid space, Blood flow volume per unit tissue (blood flow velocity), contrast agent seepage rate in the tissue (capillary permeable surface area), contrast agent seepage return rate in the tissue (capillary permeable surface area), and pixel values inherent in the tissue Get organization information such as.
- the tissue information acquisition unit 13 the number of compartments in the tissue (the number of divided compartments of blood vessels and organs), the volume of the tissue (volume of the blood vessel cavity), the volume of the capillary blood vessel, the volume of the extracellular fluid space, Blood flow volume per unit tissue (blood flow velocity), contrast agent seepage rate in the tissue (capillary permeable surface area), contrast agent seepage return rate in the tissue
- the organization information acquisition unit 13 acquires subject information input by the operator via the input unit 27.
- the tissue includes the heart (right and left ventricles), blood vessels, other organs and muscles, and the like.
- the prediction unit 16 acquires the pixel value inherent in the tissue, the degree of enhancement by the contrast agent is predicted based on the pixel value inherent in each tissue.
- the tissue information acquisition unit 13 may acquire tissue information from the storage unit 24, the external storage device, or the injection device 2.
- the simulator 20 includes a chemical solution information acquisition unit 14 that acquires chemical solution information related to chemical solutions. Then, the predicting unit 16 receives the contrast agent concentration (mgI / mL), the contrast agent amount (mL), the total iodine amount (mgI), the half-life of the contrast agent (contrast agent discharge rate), etc. Get chemical information. Furthermore, the prediction unit 16 can calculate the iodine amount (kgI / kg) per kg body weight from the total iodine amount and the weight of the subject.
- the chemical information acquisition unit 14 acquires the chemical information input by the operator via the input unit 27.
- medical solution information may contain product name, product ID, chemical classification, a content component, density
- the drug solution information acquisition unit 14 may acquire drug solution information from the storage unit 24, the external storage device, or the injection device 2. Further, the chemical information acquisition unit 14 may acquire chemical information from a reading unit built in the injection device 2. And a reading part reads the data carrier attached to the syringe mounted in an injection
- the data carrier includes an RFID chip, an IC tag, a barcode, and the like, and medicinal solution information related to the medicinal solution is stored.
- the prediction unit 16 can acquire inspection information such as a tube voltage (kVp) via the input unit 27.
- This inspection information may include an inspection number (inspection ID), an inspection site, an inspection date and time, a chemical type, a chemical name, an imaging condition (imaging site, etc.) and the like.
- the prediction unit 16 can acquire additional information such as presence / absence of local perfusion (bolus transmission) and analysis time (sec) via the input unit 27.
- the analysis time is the length of time to be predicted, and corresponds to the length of the X axis of the graph (FIG. 6) showing the time density curve (TDC curve) 43.
- TDC curve time density curve
- the prediction unit 16 predicts a change in the pixel value with time for each of a plurality of compartments obtained by dividing the tissue along the blood flow direction based on the subject information, the injection protocol, and the tissue information. Thereafter, the prediction unit 16 stores the pixel value of each compartment for each time in the storage unit 24 of the simulator 20 in association with each tissue.
- the simulator 20 includes a control unit 25 such as a CPU, and the storage unit 24 that stores the prediction result by the prediction unit 16 stores a control program and the like.
- the control unit 25 controls the simulator 20 according to the control program stored in the storage unit 24.
- the control unit 25 includes a display control unit 15 that controls the subject information acquisition unit 11, the protocol acquisition unit 12, the tissue information acquisition unit 13, the drug solution information acquisition unit 14, and the display unit 26. And each part is logically implement
- the storage unit 24 stores a simulation program that allows a computer (control unit) to predict a temporal change in pixel values in a subject tissue.
- This simulation program includes a subject information acquisition unit 11 that acquires subject information, a protocol acquisition unit 12 that acquires a contrast medium injection protocol, a tissue information acquisition unit 13 that acquires tissue information, and subject information Based on the injection protocol and the information on the tissue, it functions as the prediction unit 16 that predicts the temporal change of the pixel values of the plurality of compartments obtained by dividing the tissue along the blood flow direction.
- This simulation program can be stored in a computer-readable recording medium.
- the storage unit 24 includes a RAM (Random Access Memory) that is a system work memory for the control unit 25 to operate, a ROM (Read Only Memory) that stores programs or system software, a hard disk drive, and the like.
- a RAM Random Access Memory
- ROM Read Only Memory
- the control unit 25 performs various operations according to a program stored in a portable recording medium such as a CD (Compact Disc), a DVD (Digital Versatile Disc), or a CF (Compact Flash) card, or an external storage medium such as a server on the Internet. Processing can also be controlled.
- the simulator 20 includes a display unit 26 that displays the compartments of each tissue in a color having a density corresponding to the pixel value.
- the display control part 15 changes the lightness and darkness of the compartment of each structure
- the display control unit 15 reads the pixel value of the compartment at a predetermined time from the storage unit 24 and changes the density of the compartment.
- an operation screen such as an input screen is displayed on the display unit 26.
- Various information such as an injection protocol, an input state of the apparatus, a setting state, and an injection result may be displayed.
- the input unit 27 of the simulator 20 is connected to the subject information acquisition unit 11, the protocol acquisition unit 12, the tissue information acquisition unit 13, and the chemical solution information acquisition unit 14.
- a keyboard etc. can be used as the input part 27, the input part 27 and the display part 26 can also be used together by using a touch panel.
- the simulator 20 described above can be mounted on the imaging system 100 including the medical imaging apparatus 3 described later in FIG. 8 or the injection apparatus 2 for injecting a contrast agent.
- the simulator 20 can also be mounted on an external computer that is wired or wirelessly connected to the imaging device 3 or the injection device 2.
- the imaging apparatus 3 include an MRI (Magnetic Resonance Imaging) apparatus, a CT (Computed Tomography) apparatus, an angio imaging apparatus, a PET (Positron Emission Tomography) apparatus, a SPECT (Single Photon Emission Computed Tomography) apparatus, and a CT angio apparatus.
- MRI Magnetic Resonance Imaging
- CT Computed Tomography
- angio imaging apparatus an angio imaging apparatus
- PET Positron Emission Tomography
- SPECT Single Photon Emission Computed Tomography
- CT angio apparatus there are various medical imaging apparatuses such as an MR angiography apparatus, an ultrasonic diagnostic apparatus, and a blood vessel imaging apparatus. In this specification, a CT apparatus
- FIG. 2 a schematic diagram in the case where the blood vessel A1, the organ A2, the blood vessel A3, and the organ A4 communicating in series in the blood flow direction D each correspond to one compartment is shown.
- the prediction unit 16 performs prediction on the assumption that the pixel value of each entire tissue changes immediately after the contrast medium reaches each tissue. Then, regardless of the actual diffusion speed and position, it is predicted that the pixel value of the entire tissue has changed.
- the pixel value does not change in most parts of the organ A4, but the pixel value of the entire organ A4 increases (white). ).
- the contrast agent is hardly moved to the organ A4, but it is predicted that the pixel value of the entire blood vessel A3 is reduced (gray).
- the contrast agent is actually left, but it is predicted that the pixel value of the entire organ A2 is reduced (black). For this reason, particularly when the diffusion rate in the actual tissue is slow, it becomes impossible to accurately predict the change in the pixel value of the tissue.
- FIG. 1 a schematic diagram according to the first embodiment is shown on the lower side of FIG.
- a blood vessel B1, an organ B2, a blood vessel B3, and an organ B4 communicating in series in the blood flow direction D are each divided into a plurality of 15 compartments along the blood flow direction D. That is, each tissue is divided into a plurality of compartments along the blood flow direction D according to the number of division compartments of the tissue acquired from the tissue information acquisition unit 13.
- the prediction unit 16 divides the volume of the tissue including the prediction target compartment, the capillary volume of the tissue, and the extracellular fluid volume of the tissue by the number of divided compartments, and predicts each compartment. I do. For example, when the number of divided compartments is 15, the predicting unit 16 changes the pixel values over time based on the values obtained by dividing the tissue volume, the capillary volume, and the extracellular fluid volume by 15, respectively. Predict.
- the organ B4 where the pixel value does not change in most parts in practice, it is predicted that the pixel value of only the compartment located on the blood vessel B3 side is increased (white).
- the contrast agent since the contrast agent hardly moves to the organ B4 in practice, it is predicted that the pixel value of only the compartment located on the organ B2 side is reduced (gray).
- the contrast agent since the contrast agent actually remains, it is predicted that the pixel value of only the compartment located on the blood vessel B1 side is reduced (black).
- the tissue of the subject in the first embodiment is the right ventricle, aorta, vein, artery, brain (head), upper limb, right coronary artery (myocardium in which the right coronary artery is dominant), anterior descending branch (anterior)
- the contrast medium injected from the upper limb vein moves to each organ through the right ventricle, lungs, left ventricle, and aorta (ascending aorta and descending aorta), and then reaches the right ventricle through the vein. Then, the contrast medium injected into the body is discharged out of the body through the kidney.
- the prediction unit 16 predicts the temporal change of the pixel value of each tissue in order from the right ventricle toward the upstream and downstream in the blood flow direction. That is, the prediction unit 16 first performs prediction of 1-right ventricle, and then performs 2-vena cava and 2-vein located upstream in the blood flow direction with respect to the right ventricle and blood flow with respect to the right ventricle. The second tissue group including the 2-artery located downstream in the direction is predicted.
- the prediction unit 16 includes a third tissue group including a vein, a brain, an upper limb, a right coronary artery, an anterior descending branch, a circumflex branch, and a lung, a fourth tissue group including an artery, a vein and a liver, a left ventricle, an artery, and an ascending aorta.
- the fifth tissue group including the descending aorta, the kidney and the lower limbs, the sixth tissue group including the abdominal aorta, stomach, spleen, pancreas, intestine and artery, and the seventh tissue group including the artery are predicted in this order.
- the order of prediction is shown by the number attached
- the prediction unit 16 may predict the temporal change of the pixel value of each tissue in order from the tissue close to the injection site of the contrast medium toward the upstream and downstream in the blood flow direction. For example, when the contrast medium is injected into the hepatic artery (CTHA), the prediction unit 16 may first perform prediction of the liver. Thereafter, the prediction unit 16 predicts a tissue group including an artery located upstream in the blood flow direction with respect to the liver and a vein located downstream in the blood flow direction with respect to the liver.
- CTHA hepatic artery
- the prediction unit 16 uses a differential equation such as Equation 1 below in order to obtain a change in pixel value in each tissue (blood vessel and organ) as a time function. It is noted that the concentration of the contrast medium flowing into the compartment and C 1, the concentration of the contrast medium flowing out of the compartment and C 2, the volume of the compartment and is V, blood flow rate per unit tissue in compartment (the blood flow rate) Q It is said.
- the prediction unit 16 determines the rate of seepage when the contrast agent permeates from the capillary blood vessel to the extracellular fluid space, and the extracellular volume in order to obtain changes in the pixel values in tissues other than the right ventricle, left ventricle, and blood vessel. Considering the rate of stain return when penetrating from the fluid cavity into the capillary. Therefore, the prediction unit 16 uses a differential equation such as the following formula 2 and formula 3, for example. Note that the volume of the extracellular fluid space is Vec, the concentration of the contrast agent in the extracellular fluid space is Cec, the volume of the capillary is Viv, the concentration of the contrast medium in the capillary is Civ, and the bleeding rate is PS 1. and then, that the stains return rate as a PS 2.
- FIG. 4 shows a table of values for each tissue of the stomach, spleen, pancreas, and intestinal tract.
- the prediction unit 16 predicts a temporal change in pixel values using the stomach, spleen, pancreas, and intestine as separate tissues.
- Per blood flow rate arterial blood flow velocity
- a bleeding speed of 15 to 25 and a stain return speed of 15 to 25 are used.
- tissue volume of 120 mL to 160 mL, capillary volume of 10 mL to 15 mL, extracellular fluid volume of 45 mL to 65 mL, blood flow volume per unit tissue of 150 mL / min to 250 mL / min, 15 A bleed-out speed of 15-25 or more and 25 or less and a bleed-back speed of 15 or more and 25 or less are used.
- tissue volume of 120 mL to 150 mL, capillary volume of 3 mL to 6 mL, extracellular fluid volume of 30 mL to 50 mL, blood flow per unit tissue of 120 mL / min to 180 mL / min, 15 A seepage rate of 25 or less and a return rate of 15 or more and 25 or less are used.
- the tissue volume is 1800 mL to 2000 mL
- the capillary volume is 30 mL to 40 mL
- the extracellular fluid volume is 500 mL to 600 mL
- the unit tissue is 0.4 mL / min to 0.5 mL / min.
- a blood flow rate, a leaching rate of 150 to 250 and a return rate of 150 to 250 are used.
- the oozing rate and the oozing rate can be calculated by the product of the capillary area and the permeability. For example, assuming that the total area of capillaries in the human body is 800 m 2 , the area of capillaries corresponding to the weight of each organ is assigned. Then, assuming that the permeability of all organs is 1 ml / min / g, the seepage rate and the return rate can be obtained.
- the prediction unit 16 sequentially stores the prediction results in the storage unit 24 (FIG. 1). This prediction result includes pixel value information for each time associated with the tissue. And the display part 26 (FIG. 1) displays typically the estimated image of each structure
- FIG. 5 shows a change in shading in the predicted image as an example, and corresponds to a horizontal section in the head-to-tail direction of the body. However, unlike the actual cross section, all the organizations are shown so that each organization can be listed.
- a window width 350 and a window level 40 are set.
- the window width corresponds to the contrast range of the pixel value
- the window level corresponds to the brightness of the screen.
- the display unit 26 displays in black.
- the display unit 26 displays in white.
- FIG. 5 shows an image N1 of each tissue immediately after the contrast medium is injected into the upper limb vein, and the upper limb vein is indicated by a natural pixel value (dark gray). And all the blood vessels including the abdominal aorta and the celiac artery have not yet reached the contrast agent, and all the blood vessels are indicated by natural pixel values (dark gray).
- an image N2 of each tissue when about 25 seconds have elapsed from the start of injection is shown in the center of FIG. 5, and the abdominal aorta, celiac artery, internal jugular vein, and the like are particularly white.
- the vein of the upper limb is shown in light gray because the contrast value has flowed out at an early stage and the pixel value has decreased.
- an image N3 of each tissue when about 120 seconds have elapsed from the start of injection is shown. Since the contrast medium is diffused and uniformly distributed in blood vessels and organs throughout the body, the pixel value is lower than the image N2, and the whole is shown in light gray.
- the display control unit 15 reads the pixel value of each compartment from the storage unit 24 at a predetermined time, for example, the time selected by the operator. Then, the display control unit 15 causes the read pixel value to be reflected in the predicted image 41 and displayed on the display unit 26. For example, in FIG. 6, a time point of 9.90 seconds is selected, and a predicted image 41 at the time point is displayed. In the initial setting, the predicted image 41 at the time of injection, that is, at the time of 0 second is displayed.
- the window width 350 and the window level 40 are set, and the respective values are displayed in the upper right corner of the predicted image 41. Further, -1000HU is displayed as a pixel value below the window width and window level. This displays the pixel value at the position corresponding to the portion indicated by the pointer indicated by the arrow in the predicted image 41.
- the operator can input the window width (WW) and the window level (WL) via the input unit 27.
- An operation button 42 is displayed below the predicted image 41.
- the operation buttons 42 include a stop button, a playback button, a 2 ⁇ speed playback button, a 3 ⁇ speed playback button, and a 10 ⁇ speed playback button in order from the left in FIG.
- the playback button When the operator selects the playback button, the predicted image 41 is continuously played back as a moving image along the elapsed time. Thus, the operator can visually recognize the position of the contrast medium in each tissue at a desired time.
- the time density curve 43 is displayed on the left side of the predicted image 41.
- the X axis (horizontal axis) corresponds to the elapsed time from the start of injection
- the Y axis corresponds to the pixel value.
- the Y axis has a first axis and a second axis, and a plurality of tissues can be displayed on one graph. For example, in FIG. 6, time concentration curves of the liver, portal vein, and hepatic artery are displayed.
- the operator can select the tissue to be displayed on the time concentration curve 43 in the display option 44 below the time concentration curve 43.
- the liver, portal vein, and hepatic artery are selected from the brain, liver, portal vein, hepatic artery, and right ventricle. It is also possible to display the amount of contrast agent discharged from the body.
- Other selectable tissues include upper limb, lung, left ventricle, myocardium, right coronary artery, anterior descending branch, circumflex branch, bronchus, spleen, intestine, kidney, lower limb, pancreas, pulmonary artery, pulmonary vein, ascending aorta, Descending aorta, abdominal aorta, celiac artery, superior mesenteric artery, inferior abdominal aorta, hepatic vein, renal artery, renal vein, cerebral artery, brain vein, upper limb artery, upper limb vein, lower limb artery, lower limb vein, upper vena cava and Examples include the inferior vena cava.
- a Y-axis input box 45 is displayed on the right side of the display option 44.
- the operator can select an automatic setting in the Y-axis input box 45 or input a desired value.
- automatic setting is selected for the first axis, and the maximum value and the minimum value of the first axis are automatically set.
- 100 is input as the maximum value and 50 is input as the minimum value.
- a current time point box 46 is displayed below the Y-axis input box 45.
- a current time point bar 47 is displayed on the time density curve 43.
- the current time point bar 47 indicates the time corresponding to the predicted image 41 (9.90 seconds in FIG. 6). Then, when the predicted image 41 is continuously reproduced, the current time point bar 47 moves along the X axis corresponding to the elapsed time.
- a helical scan box 48 is displayed below the current time point box 46. Then, the operator can select the helical scan box 48 and input the bed moving speed (cm / sec). In FIG. 6, a bed moving speed of 8.0 cm / sec is input.
- the display control unit 15 acquires a delay time due to the helical scan.
- the delay time corresponds to the elapsed time from when the head is imaged until each tissue is imaged (the movement time of the bed), and is obtained based on the length from the upper end of the predicted image 41 to each tissue.
- the display control unit 15 reads out the pixel value at the time obtained by adding the delay time to the predetermined time from the storage unit 24. That is, the display control unit 15 reads the pixel value of each tissue at a time obtained by adding the acquired delay time to a predetermined time (current time). For example, in the predicted image 41 of FIG. 6, the head (brain) shows the pixel value at the time when 9.90 seconds, which is the current time, and the right ventricle shows the pixel value at the time when 14.90 seconds have passed. .
- the display control unit 15 may acquire the delay time by calculating. Further, the delay time associated with the bed moving speed may be stored in advance in the storage unit 24, and the display control unit 15 may acquire the delay time from the storage unit 24.
- FIG. 7 shows a change in light and shade of a predicted image as an example at the time of helical scanning. Note that the image in FIG. 7 corresponds to a horizontal section in the head-to-tail direction of the body, but shows all tissues different from the actual section. A window width 350 and a window level 40 are set.
- the upper limb vein indicates a pixel value at the time when the delay time is added. Therefore, the upper limb vein is stained white with the contrast medium. The contrast medium has not yet reached the other blood vessels, and the other blood vessels are indicated by natural pixel values (dark gray).
- an image H2 of each tissue when about 25 seconds have elapsed from the start of injection is shown in the center of FIG. 7, and the internal jugular vein is stained white because the contrast agent has reached.
- the image N2 in FIG. 5 since the pixel values at the time when the delay time is added are shown, the abdominal aorta and the celiac artery from which the contrast medium has already flowed are shown in light gray with the pixel values decreased. Has been. Further, since the contrast medium circulates and reaches the portal vein, the portal vein is stained white.
- an analysis button 49 is displayed below the helical scan box 48.
- the prediction unit 16 starts predicting the pixel value. Note that the prediction unit 16 may start the prediction of the pixel value when the subject information, the injection protocol, and the tissue information are acquired.
- the imaging system 100 includes an injection device 2 for injecting a contrast agent, and a medical imaging device 3 that is connected to the injection device 2 by wire or wireless and images a subject.
- the injection device 2 or the imaging device 3 includes the simulator 20 described above.
- the imaging device 3 includes an imaging unit 31 that images a subject according to an imaging plan, a control device 32 that controls the entire imaging device 3, and a display 33 as a display unit 26.
- the control apparatus 32 and the display 33 can also be comprised integrally.
- the imaging device 3 is connected to the injection device 2 by wire or wirelessly, for example, via a gateway device (not shown).
- the imaging plan of the imaging device 3 includes information such as imaging site, effective tube voltage, model name, manufacturer name, imaging time, tube voltage, imaging range, rotation speed, helical pitch, exposure time, dose, and imaging method. be able to.
- the control apparatus 32 controls the imaging part 31 so that it may follow an imaging plan, and image
- the control device 32 is connected to a display 33, and the display 33 displays the input state of the device, the setting state, the imaging result, various information, and the like.
- the imaging unit 31 includes a bed, an X-ray source that irradiates a subject who is a subject with X-rays, an X-ray detector that detects X-rays transmitted through the subject, and the like. Then, the imaging unit 31 irradiates the subject with X-rays, and back-projects the inside of the subject based on the X-rays transmitted through the subject, thereby capturing a fluoroscopic image of the subject. Note that the imaging unit 31 may perform imaging using radio waves or ultrasonic waves instead of X-rays.
- the control device 32 can communicate with the imaging unit 31, the injection device 2, and the like in a wired or wireless manner.
- the injection device 2 for injecting a contrast agent injects a chemical solution filled in a syringe, for example, various contrast agents and physiological saline into a subject's body as a subject.
- the injection device 2 includes an injection head 21 for injecting a contrast medium according to an injection protocol.
- the injection device 2 includes a stand 22 that holds the injection head 21 and a console 23 that is connected to the injection head 21 by wire or wirelessly.
- the console 23 functions as a control device for controlling the injection head 21 and also functions as the simulator 20.
- the console 23 includes a touch panel that functions as the input unit 27 and the display unit 26, and can communicate with the injection head 21, the imaging device 3, and the like by wire or wirelessly.
- the injection device 2 may include a display as the display unit 26 and a user interface such as a keyboard as the input unit 27 instead of the touch panel.
- the simulator 20, the input unit 27, and the display unit 26 can be configured separately.
- the injection device 2 includes a control device connected to the injection head 21 and a display unit 26 (touch panel display or the like) connected to the control device and displaying the injection status of the chemical solution. You may have.
- a control device also functions as the simulator 20.
- the injection head 21 and the control device can be configured integrally with the stand 22. Moreover, it can replace with the stand 22 and can provide a ceiling suspension member, and can also suspend the injection
- the injection device 2 may include a power source or a battery, a hand switch connected to the console 23, a remote operation device for remotely operating the injection head 21, and the like.
- This remote control device can start or stop injection by operating the injection head 21 remotely.
- the power source or the battery can be provided in either the injection head 21 or the control device (console 23), and can be provided separately from these.
- the injection head 21 includes a first holding unit 214 on which a syringe filled with a contrast agent is mounted, and a second holding unit 215 on which a syringe filled with physiological saline as a chemical solution for boosting the contrast agent is mounted. And have.
- the injection head 21 has a drive mechanism (not shown) that pushes out the chemical solution in the syringe mounted on the first holding unit 214 according to the injection protocol, and the chemical solution in the syringe mounted on the second holding unit 215 according to the injection protocol. And a drive mechanism (not shown) for extruding.
- the injection head 21 has a head display 211 on which injection conditions, injection status, apparatus input status, setting status, various injection results, and the like are displayed, and an operation unit 212 for inputting the operation of the drive mechanism. is doing.
- the head display 211 can be omitted.
- the head display 211 can also be used as the operation unit 212 by being configured from a touch panel or the like.
- the operation unit 212 is provided with a forward button of the drive mechanism, a reverse button of the drive mechanism, a final confirmation button, or the like. And when inject
- This mixing tube functions as a mixer for the contrast agent and the diluted drug solution.
- Examples of such a mixer include “SPIRAL FLOW (registered trademark)” manufactured by Kyorin Nemoto Co., Ltd.
- the injection head 21 can be mounted with various syringes such as a prefilled syringe having a data carrier such as an RFID chip, an IC tag, and a barcode.
- the injection head 21 incorporates a reading unit (not shown) that reads the data carrier attached to the syringe.
- the data carrier stores chemical information related to the chemical.
- the injection device 2 can receive information from a server (external storage device) (not shown) via an internal or external gateway device, and can also transmit information to the server.
- the imaging device 3 can receive information from the server and can transmit information to the server.
- an inspection order is stored in advance.
- the inspection order includes subject information regarding the subject and inspection information regarding the inspection content.
- the server can store information related to the imaging result such as image data transmitted from the imaging device 3 and information related to the injection result transmitted from the injection device 2.
- the operator can operate the imaging apparatus 3 while confirming the predicted image 41 on the display 33. Further, the imaging device 3 may change the imaging plan according to the prediction result by the prediction unit 16. For example, when the operator inputs a desired pixel value to the imaging device 3 and the desired pixel value is different from the pixel value predicted by the prediction unit 16 for the tissue to be imaged, the imaging device 3 has a desired prediction result.
- the tube voltage, the tube current, or the like may be changed so as to match the pixel value.
- the operator can operate the injection device 2 while confirming the predicted image 41 on the console 23.
- the injection device 2 may change the injection protocol according to the prediction result by the prediction unit 16. For example, when the operator inputs a desired pixel value to the injection device 2 and the desired pixel value is different from the pixel value predicted by the prediction unit 16 for the tissue to be imaged, the injection device 2 has a desired prediction result. The injection speed or the injection time may be changed so as to coincide with the pixel value.
- the invention according to the first embodiment described above, it is possible to perform more accurate prediction that approximates the temporal change of the pixel value in the actual tissue.
- highly accurate prediction can be performed.
- the position of the contrast agent in each tissue can be predicted.
- the operator can visually recognize the position of the contrast medium in each tissue at a desired time.
- the pixel value of each tissue can be predicted even if the injection protocol includes boost injection of a contrast medium or increase / decrease of the injection speed.
- an actual captured image can be predicted even in the case of the so-called cross injection method in which the injection rate of the contrast medium is gradually decreased and the injection rate of the physiological saline is increased at the same time.
- an actual captured image can be predicted.
- each organization is divided into the same number of compartments.
- a tissue having a large volume is divided into a larger number of compartments. That is, the prediction unit 16 according to the second embodiment predicts a temporal change in pixel values in each of a plurality of compartments obtained by dividing a tissue having a small volume (first tissue), and also has a tissue having a large volume (second Predict the change in pixel value over time in each of a plurality of compartments that divide the tissue) into a larger number than a tissue with a small volume.
- the volume of the organ A8 in FIG. 9 is several times larger than the volume of the organ A6. Therefore, the volume of each compartment of the organ A8 is several times larger than the volume of each compartment of the organ A6.
- the prediction is performed in the same manner as in the first embodiment, even if the pixel value of one compartment is changed in the predicted image 41, the change is small in the organ A6 (the moving distance of the contrast agent is short). Is displayed.
- the organ A8 is displayed as a large change (the moving distance of the contrast agent is long) compared to the organ A6. This makes it difficult for the operator to accurately recognize the position of the contrast medium in each tissue visually.
- the tissue having a large volume is divided into a larger number of compartments than the tissue having a small volume.
- the organ B6 is divided into three compartments and the organ B8 is divided into 15 compartments.
- the optimum number of divided compartments corresponding to the volume of each tissue is obtained in advance and stored in the storage unit 24.
- the organization information acquisition part 13 acquires the division
- the invention according to the second embodiment described above it is possible to perform prediction with higher accuracy approximating the temporal change of the pixel value in the actual tissue.
- highly accurate prediction can be performed.
- the position of the contrast agent in each tissue can be predicted.
- the operator can visually recognize the position of the contrast medium in each tissue at a desired time.
- the operator visually recognizes the contrast agent in each tissue.
- the position can be recognized accurately.
- the blood vessel A5, the blood vessel A7, the blood vessel B5, and the blood vessel B7 are each divided into the same number, that is, 15 compartments.
- a vessel with a large volume may be divided into a larger number of compartments compared to a vessel with a small volume.
- the number of compartments may be set so that the volume of each compartment of the tissue B8 having a large volume and the tissue B6 having a small volume substantially coincide.
- the display unit 26 can display the predicted image 41 of the coronal section as well as the horizontal section of the body. Further, the number of division compartments of the tissue is not limited to 15, and an arbitrary number of 2 or more is selected.
- the noise information of the pixel value may be stored in the storage unit 24 in advance, and the display control unit 15 may read the noise information from the storage unit 24 and add the noise information to the predicted image 41 of each compartment.
- this noise information for example, there is an image showing a radial noise generated between tissues stained white by a contrast agent. By adding an image showing noise superimposed on the predicted image 41, a predicted image 41 that more closely approximates the actual captured image can be obtained.
- the display unit 26 arranges the compartments so as to form a schematic diagram in which a plurality of tissues are continuous in the blood flow direction, and displays each compartment with a color of density corresponding to the pixel value. It was. However, the display unit 26 may arrange the compartments so that each tissue is displayed independently, and display each compartment with a color having a density corresponding to the pixel value.
- the display control unit 15 may control the display unit 26 so that the number of compartments in each organization is different. In this case, the display control unit 15 displays each tissue so as to include the number of compartments set by the operator or the number of compartments stored in the storage unit 24 in advance.
- the display unit 26 may display each compartment in a color other than black and white.
- the injection head 21 is not limited to a type that holds two syringes, and may be a type having three or more syringe holding parts or a type having only one syringe holding part.
- the display control unit 15 displays the maximum pixel value read on the image of the predetermined tissue or in the vicinity of the image of the predetermined tissue when the predetermined tissue reaches the maximum pixel value in the predicted image 41 illustrated in FIG. You may let them. For example, when the liver, portal vein, and hepatic artery are selected in the display option 44, the display control unit 15 has the maximum pixel of each selected tissue in the vicinity of the liver, portal vein, and hepatic artery in the predicted image 41. A value may be displayed. Note that the maximum pixel value can be displayed in a color other than black and white, for example, blue, green, red, or yellow.
- the display control unit 15 may display each tissue (compartment) in a color other than black and white shades (grayscale), for example, shades of blue, green, red, or yellow in the predicted image 41 shown in FIG. Good. Furthermore, the display control unit 15 may display the predetermined organization with shades of colors other than black and white. For example, when the liver, portal vein, and hepatic artery are selected in the display option 44, the display control unit 15 displays the liver, portal vein, and hepatic artery in the predicted image 41 in shades of red, blue, and green, respectively. be able to.
- the prediction unit 16 may take into account a change in blood flow rate (blood flow velocity) per unit tissue due to the injection of the chemical solution. That is, when a drug solution is injected, in a tissue (compartment) downstream in the blood flow direction from the injection site, the blood flow velocity is changed by being pushed by the injected drug solution. In particular, when the drug solution is injected at a speed higher than the normal blood flow speed, the blood flow speed increases in the downstream tissue. Therefore, the predicting unit 16 adds the difference obtained by subtracting the blood flow velocity from the injection velocity to the blood flow velocity when the injection rate of the drug solution is higher than the normal blood flow velocity, thereby increasing the blood flow velocity. Can be considered.
- the prediction unit 16 predicts a change in the pixel value with time based on the blood flow velocity obtained by the addition. That is, the predicting unit 16 adds the obtained difference to the blood flow velocity Q per unit tissue in the compartment when predicting the temporal change of the pixel value using the above-described mathematical formula. Specifically, as shown in the flowchart of the addition process in FIG. 10, the prediction unit 16 uses the normal blood flow velocity of the tissue corresponding to the injection site as the subject information from the subject information acquisition unit 11, that is, the tissue into which the drug solution is injected. Is acquired (S101). Further, the prediction unit 16 acquires the injection speed of the chemical solution included in the injection protocol received from the protocol acquisition unit 12 (S102). Note that the prediction unit 16 may acquire the blood flow velocity after the injection velocity. Further, the prediction unit 16 may acquire the blood flow velocity by calculating from the body weight of the subject instead of the acquisition from the subject information acquisition unit 11.
- the prediction unit 16 compares the blood flow rate with the injection rate to determine whether the injection rate is faster than the blood flow rate (S103). If the injection rate is equal to or lower than the blood flow rate (NO in S103), the prediction unit 16 ends the process without performing addition. On the other hand, when the injection speed is faster than the blood flow speed (YES in S103), the prediction unit 16 calculates the difference by subtracting the blood flow speed of the tissue corresponding to the injection site from the injection speed (S104). Then, the prediction unit 16 adds the calculated difference to the blood flow velocity (S105), and ends the process.
- the injection speed is the injection amount of the chemical solution per unit time. Therefore, when simultaneously injecting a contrast agent and physiological saline, the prediction unit 16 performs addition based on the total injection speed of both. Moreover, when performing boost injection with a physiological saline having a speed higher than the normal blood flow velocity, the prediction unit 16 performs addition based on the injection rate of the physiological saline. After the addition process, the prediction unit 16 divides the tissue along the blood flow direction based on the subject information including the blood flow velocity obtained by the addition, the injection protocol, and the tissue information. For each compartment, the pixel value over time is predicted. Thereby, the blood flow velocity can be made closer to the actual velocity, and the prediction accuracy of the pixel value can be improved.
- the prediction unit 16 can add a difference to the blood flow velocity for all of a plurality of tissues as an addition target.
- the prediction unit 16 may add only a part of a plurality of organizations.
- the difference is added to the blood flow velocity for only the tissue from the tissue immediately downstream in the blood flow direction to the tissue corresponding to the injection location to the tissue corresponding to the injection location in the blood flow direction. May be.
- FIG. 11 an example in which a difference is added to blood flow velocities of only a part of a plurality of tissues when a medical solution is injected from an upper limb vein will be described. In FIG.
- the vein constitutes a closed circuit starting from the right ventricle. That is, these tissues constitute a closed circuit starting from the right ventricle immediately downstream in the blood flow direction with respect to the tissue corresponding to the injection site. Therefore, the prediction unit 16 sets only the tissue from the right ventricle to the vein included in the closed circuit as an addition target, and does not add a difference to the blood flow velocity of the lower limb tissue, for example. Thereby, since the influence of addition can be kept in a closed circuit, simulation can be simplified and calculation time can be reduced.
- the prediction unit 16 predicts a temporal change of the pixel value by adding a difference to the blood flow velocity of all tissues to be added simultaneously with the start of the injection of the chemical solution.
- the prediction unit 16 may predict a change in the pixel value over time on the assumption that a difference is added to the blood flow velocity when a predetermined time has elapsed from the start of injection. That is, in the tissue located downstream of the tissue corresponding to the injection site, the blood flow velocity may change after a predetermined time has elapsed from the start of injection. Therefore, the prediction unit 16 predicts a change in the pixel value with time on the assumption that the difference corresponding to the blood flow velocity is added to the tissue corresponding to the injection location at the same time as the injection of the chemical solution is started. On the other hand, for a tissue that is far from the tissue in the blood flow direction, the predicting unit 16 predicts a change in the pixel value over time on the assumption that a difference is added when a time that increases according to the distance has elapsed.
- FIG. 12 is a graph showing a time density curve that is a prediction result obtained by performing the addition processing according to the modified embodiment.
- FIG. 12 shows a time density curve of the hepatic artery, with the horizontal axis corresponding to the elapsed time from the start of injection and the vertical axis corresponding to the pixel value.
- the height of the subject is set to 170 cm
- the weight of the subject is set to 70 kg
- the contrast agent concentration is set to 300 mgI / mL.
- the time when 100 mL of contrast medium is injected for 50 seconds at an injection rate of 2.0 mL / sec, and then 30 mL of physiological saline is boosted and injected for 15 seconds at an injection rate of 2.0 mL / sec.
- the density curve is displayed.
- the time density curve when the addition process is performed is indicated by a solid line
- the time density curve when the addition process is not performed is indicated by a broken line.
- the addition process When the addition process is not performed, the time for the contrast medium to reach the tissue is delayed. Therefore, compared with the case where addition processing is performed, the contrast medium is simulated as if it arrived at a delayed timing. Therefore, in the time density curve indicated by the broken line, a second peak of the pixel value occurs as indicated by an arrow A in FIG. On the other hand, when the addition process is performed, circulation of the contrast agent is simulated. Therefore, as shown in the time density curve indicated by the solid line, the second peak does not occur.
- boost injection with saline can be simulated. Specifically, according to the boost injection, the contrast agent that has remained after the completion of the injection of the contrast agent is pushed out at an earlier timing. Then, in the time density curve shown by the solid line in FIG. 12, as a result of the simulated boost injection, the prediction accuracy of the pixel value at the peak is improved, and the pixel value is higher.
- the prediction unit 16 may consider the diffusion of the contrast agent between adjacent compartments. That is, if there is a contrast agent concentration difference between adjacent compartments, the contrast agent diffuses from a higher concentration compartment to a lower concentration compartment. Accordingly, the prediction unit 16 may predict the pixel value so as to increase the contrast agent concentration in the compartment with a low concentration by decreasing the contrast agent concentration in the compartment with a high concentration, and may consider the diffusion of the contrast agent. .
- the prediction unit 16 increases the decrease amount and the increase amount of the contrast agent concentration. Further, the prediction unit 16 acquires the osmotic pressure of the contrast agent from the drug solution information acquisition unit 14, and increases the decrease amount and the increase amount of the contrast agent concentration when the osmotic pressure is large. Furthermore, when the contact area between the compartments is large, the prediction unit 16 increases the decrease amount and the increase amount of the contrast agent concentration. For example, when the compartments of different tissues are adjacent to each other, the prediction unit 16 reduces the amount of decrease and increase in the contrast agent concentration because the contact area decreases. When the compartments of the same tissue are adjacent to each other, the contact area increases, and thus the predicting unit 16 increases the decrease amount and the increase amount of the contrast agent concentration.
- the prediction unit 16 may calculate the contact area, and if the calculated contact area is large, the prediction unit 16 may increase the decrease amount and the increase amount of the contrast agent concentration.
- transformation mentioned above can be suitably combined with other embodiment or a deformation
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Abstract
Description
図1に示すように、被写体の組織における画素値の経時変化を予測するシミュレータ(灌流シミュレータ)20は、予測部16を備えている。そして、予測部16は、被写体の情報と、注入プロトコルと、組織の情報とに基づいて、被写体の組織を血流方向に沿って分割した複数のコンパートメントのそれぞれの画素値の少なくとも造影剤に起因する経時変化を予測する。なお、画素値は、造影剤の他に生理食塩水及び血液等の影響を受けて変化する。
第2実施形態について、図9を参照して説明する。第1実施形態では、各組織がそれぞれ同じ数のコンパートメントに分割されていた。一方、第2実施形態では、大きな体積を有する組織が、より多くの数のコンパートメントに分割される。すなわち、第2実施形態に係る予測部16は、小さな体積を有する組織(第1組織)を分割した複数のコンパートメントのそれぞれにおける画素値の経時変化を予測すると共に、大きな体積を有する組織(第2組織)を、小さな体積を有する組織よりも多くの数に分割した複数のコンパートメントのそれぞれにおける画素値の経時変化を予測する。
予測部16は、薬液の注入による単位組織あたりの血流量(血流速度)の変化を考慮してもよい。すなわち、薬液を注入すると、注入箇所よりも血流方向おいて下流にある組織(コンパートメント)では、注入された薬液に押されて血流速度が変化する。特に、通常の血流速度よりも速い速度で薬液を注入した場合、下流にある組織では血流速度が上昇する。そこで、予測部16は、薬液の注入速度が通常の血流速度よりも速い場合には、注入速度から血流速度を差し引いて得られた差分を血流速度に加算し、血流速度の上昇を考慮することができる。
1.5mL/sec+(注入速度2.0mL/sec-1.5mL/sec)=2.0mL/sec
Claims (15)
- 被写体の組織における画素値の経時変化を予測するシミュレータであって、
前記被写体の情報を取得する被写体情報取得部と、
造影剤の注入プロトコルを取得するプロトコル取得部と、
前記組織の情報を取得する組織情報取得部と、
前記被写体の情報と、前記注入プロトコルと、前記組織の情報とに基づいて、前記組織を血流方向に沿って分割した複数のコンパートメントのそれぞれの画素値の経時変化を予測する予測部とを備える、シミュレータ。 - 前記組織の情報は、前記組織におけるコンパートメント数を含む、請求項1に記載のシミュレータ。
- 前記組織の情報は、前記組織における前記造影剤の染み出し速度と染み戻り速度とを含む、請求項1又は2に記載のシミュレータ。
- 前記コンパートメントを前記画素値に応じた濃度の色で表示する表示部と、
前記表示部を制御する表示制御部とを備え、
前記表示制御部は、前記画素値の経時変化に応じて前記コンパートメントの濃淡を変更する、請求項1から3のいずれか1項に記載のシミュレータ。 - 前記予測部による予測結果を記憶する記憶部を備え、
前記表示制御部は、前記記憶部から所定の時間における前記コンパートメントの前記画素値を読み出して前記コンパートメントの濃淡を変更する、請求項4に記載のシミュレータ。 - 前記表示制御部は、ヘリカルスキャンによる遅延時間を取得すると共に、前記所定の時間に前記遅延時間を加算した時間における前記画素値を読み出す、請求項5に記載のシミュレータ。
- 前記組織は、胃と、脾臓と、膵臓と、腸管とを含み、
前記予測部は、前記胃と、前記脾臓と、前記膵臓と、前記腸管とをそれぞれ別の組織として前記画素値の経時変化を予測する、請求項1から6のいずれか1項に記載のシミュレータ。 - 前記組織は、右心室を含み、
前記予測部は、前記血流方向における上流及び下流のそれぞれに向かって前記右心室から順に各組織の前記画素値の経時変化を予測する、請求項1から7のいずれか1項に記載のシミュレータ。 - 前記予測部は、前記血流方向における上流及び下流のそれぞれに向かって前記造影剤の注入箇所に近い組織から順に各組織の前記画素値の経時変化を予測する、請求項1から7のいずれか1項に記載のシミュレータ。
- 前記予測部は、第1組織を分割した複数のコンパートメントのそれぞれにおける前記画素値の経時変化を予測すると共に、前記第1組織よりも大きな体積を有する第2組織を、前記第1組織よりも多くの数に分割した複数のコンパートメントのそれぞれにおける前記画素値の経時変化を予測する、請求項1から9のいずれか1項に記載のシミュレータ。
- 薬液の注入速度が血流速度よりも速い場合、前記予測部は、前記注入速度から前記血流速度を差し引いて得られた差分を前記血流速度に加算して前記画素値の経時変化を予測する、請求項1から10のいずれか1項に記載のシミュレータ。
- 前記複数のコンパートメントのうち隣り合うコンパートメント間において前記造影剤の濃度が異なる場合、前記予測部は、前記造影剤の濃度が高いコンパートメントの濃度を低下させ、且つ前記造影剤の濃度が低いコンパートメントの濃度を増加させて前記画素値の経時変化を予測する、請求項1から11のいずれか1項に記載のシミュレータ。
- 注入プロトコルに従って造影剤を注入する注入ヘッドと、
請求項1から12のいずれか1項に記載のシミュレータとを備える、注入装置。 - 被写体を撮像する医療用の撮像装置と、
請求項1から12のいずれか1項に記載のシミュレータとを備える、撮像システム。 - 被写体の組織における画素値の経時変化をコンピューターに予測させるシミュレーションプログラムであって、前記シミュレーションプログラムは前記コンピューターを、
前記被写体の情報を取得する被写体情報取得部、
造影剤の注入プロトコルを取得するプロトコル取得部、
前記組織の情報を取得する組織情報取得部、及び
前記被写体の情報と、前記注入プロトコルと、前記組織の情報とに基づいて、前記組織を血流方向に沿って分割した複数のコンパートメントのそれぞれの画素値の経時変化を予測する予測部として機能させる、シミュレーションプログラム。
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US10555773B2 (en) | 2020-02-11 |
US20170281278A1 (en) | 2017-10-05 |
JP7034218B2 (ja) | 2022-03-11 |
JP2020179229A (ja) | 2020-11-05 |
JP7256315B2 (ja) | 2023-04-11 |
US20200146751A1 (en) | 2020-05-14 |
JP2022066310A (ja) | 2022-04-28 |
JP6740136B2 (ja) | 2020-08-12 |
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