WO2021085505A1 - 脳梗塞治療支援システム - Google Patents
脳梗塞治療支援システム Download PDFInfo
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Definitions
- the present invention relates to a cerebral infarction treatment support system and a cerebral infarction treatment support method, and more particularly to a cerebral infarction treatment support system and a cerebral infarction treatment support method that support diagnosis and treatment of an acute cerebral infarction patient.
- the above-mentioned Japanese Patent No. 4509531 discloses an acute cerebral infarction diagnostic treatment support device incorporated in an X-ray computed tomography apparatus.
- the acute cerebral infarction diagnosis and treatment support device of Patent No. 4509531 processes a contrast-enhanced image obtained by threshold processing or clustering processing of a CT image obtained by non-contrast CT imaging and a continuous image obtained by dynamic CT imaging.
- a cerebral blood flow image that quantitatively represents the blood flow dynamics of the capillaries in the obtained brain tissue is provided, and the first ROI identified from the contrast-enhanced image and the second ROI identified from the cerebral blood flow image are described above. It is superimposed on the CT image and displayed.
- Patients in the acute phase who have developed cerebral infarction are typically diagnosed and treated according to the following procedures (1) to (4).
- a CT (Computed Tomography) image or an MRI (Magnetic Resonance Imaging) image as in Japanese Patent No. 4509531 is taken on the patient's head.
- Diagnosis such as determination of the type of cerebral infarction and identification of the location of a thrombus is performed based on the captured image.
- Drug treatment such as a thrombolytic agent for dissolving the thrombus is attempted.
- Thrombus collection by catheter treatment endovascular treatment is performed as needed.
- the types of cerebral infarction are classified into three types: cardiogenic cerebral embolism, lacunar infarction, and atherothrombotic cerebral infarction.
- cardiogenic cerebral embolism CADCAD
- lacunar infarction CADCAD
- atherothrombotic cerebral infarction CADCAD
- therapeutic devices used for catheter treatment of cerebral infarction, and they are selected according to the type of cerebral infarction that has developed.
- the type of cerebral infarction is visually judged by a doctor from CT images and MRI images, and there is a problem that skill is required and it is difficult to identify the type of cerebral infarction.
- the doctor who specified the type of cerebral infarction may be different from the doctor who performs catheter treatment. Since treatment of cerebral infarction patients is highly urgent, there is no time to prepare documents, etc., and there is a high possibility that the type of cerebral infarction will be verbally communicated to the treating doctor. There is a problem that the certainty is low in oral communication, and there is no means to confirm the type of cerebral infarction again at the time of catheter treatment for selecting a treatment device.
- the present invention has been made to solve the above-mentioned problems, and one object of the present invention is to allow a doctor to identify the type of cerebral infarction in diagnosing or treating cerebral infarction in the acute phase. It is to provide a cerebral infarction treatment support system and a cerebral infarction treatment support method that can present useful support information.
- the cerebral infarction treatment support system in the first aspect of the present invention is a detection device that measures a biological sample collected from a patient and generates first information as to whether or not the biological sample has a susceptibility gene for cerebral infarction.
- the image control unit is provided with an image control unit that receives at least one of the first information generated by the detection device and the second information related to the susceptibility gene generated based on the first information. And a video output unit that outputs at least one of the received first information and the second information to the display unit.
- the second information is information related to cerebral infarction that can be derived from the first information as to whether or not the susceptibility gene is related to cerebral infarction and medical scientific knowledge regarding the susceptibility gene. Is.
- the method for supporting cerebral infarction treatment in the second aspect of the present invention includes a step of measuring a biological sample collected from a patient and generating first information as to whether or not the biological sample has a susceptibility gene for cerebral infarction.
- the step of receiving at least one of the generated first information and the second information related to the susceptibility gene generated based on the first information, and at least one of the received first information and the second information are displayed.
- the display unit includes at least one of a catheter room in which a blood vessel X-ray imaging device is arranged and an image interpretation room in which an image viewing terminal for a radiodiagnosis image or an MRI image is arranged. Is located in.
- the cerebral infarction treatment support system in the first phase and the cerebral infarction treatment support method in the second phase whether or not the patient has a susceptibility gene for cerebral infarction in the treatment of the cerebral infarction patient in the acute phase according to the above configuration.
- At least one of the first information of the above and the second information generated based on the first information is displayed on the display unit arranged in the interpretation room for determining the type of cerebral infarction, identifying the location of the blood clot, and the like. be able to.
- the doctor can read the image in addition to the conventional CT image or MRI image. Therefore, the type of cerebral infarction can be determined in consideration of information based on the presence or absence of a susceptibility gene that cannot be obtained from image information. Further, if at least one of the first information and the second information is displayed on the display unit arranged in the catheter chamber for treating the patient who has developed cerebral infarction, the doctor who actually treats the patient is based on the presence or absence of the susceptibility gene.
- a therapeutic device for catheter treatment can be selected according to the type of cerebral infarction. As described above, it is possible to present support information useful for a doctor to identify the type of cerebral infarction when diagnosing or treating cerebral infarction in the acute phase.
- the configuration of the cerebral infarction treatment support system 100 will be described.
- the cerebral infarction treatment support system 100 is a system that supports the diagnosis and treatment of cerebral infarction patients in the acute stage.
- the cerebral infarction treatment support system 100 is provided in a medical facility such as a hospital, for example.
- the cerebral infarction treatment support system 100 is configured to provide doctors and the like with useful information for diagnosis and treatment when diagnosing and treating an acute cerebral infarction patient who has been transported to a facility.
- the cerebral infarction treatment support system 100 provides support information different from the medical image, such as a doctor, separately from the medical image (X-ray image, CT image, MRI image, etc.) used for diagnosis and treatment of the cerebral infarction patient in the acute stage. Can be provided to.
- the cerebral infarction treatment support system 100 includes at least a gene detection device 10, an image control unit 20, and a display unit 30.
- the detection device 10 is configured to measure the biological sample 2 collected from the patient 1 and generate the first information 41 as to whether or not the biological sample 2 has a susceptibility gene for cerebral infarction.
- the detection device 10 is installed in a laboratory of a medical facility such as a hospital, for example.
- the biological sample 2 is a liquid collected from the patient 1 and containing at least the genomic DNA of the patient 1.
- the biological sample 2 includes, for example, a sample such as blood or saliva collected from the patient 1.
- blood includes either whole blood, plasma, or serum.
- the sample may be a tissue such as hair, nails, skin, mucous membrane, or cells.
- the biological sample 2 may contain a component used for measurement of the detection device 10 in addition to the sample.
- the biological sample 2 may contain, for example, a lysate for eluting a gene from the sample, a reaction solution for amplifying a gene, and the like.
- the reaction solution is designed to specifically react with the susceptibility gene for cerebral infarction to be detected.
- a biological sample is a concept that includes not only the sample itself collected from patient 1, but also a prepared sample prepared by the sample and other components.
- the susceptibility gene for cerebral infarction significantly correlates with the likelihood of developing a particular type of cerebral infarction. That is, the presence of a susceptibility gene for cerebral infarction in biological sample 2 means that the likelihood of developing a type of cerebral infarction related to the susceptibility gene is significantly higher than that in the absence of the susceptibility gene. Indicates low.
- the susceptibility gene for cerebral infarction can be a mutation in a particular gene or a gene polymorphism.
- the first information 41 indicates whether such a gene mutation or gene polymorphism is present or absent in the DNA in the biological sample 2.
- the first information 41 is at least information that can determine whether or not a susceptibility gene for cerebral infarction exists.
- the first information 41 may be binary information indicating either "with a susceptibility gene for cerebral infarction (positive)” or "without a susceptibility gene for cerebral infarction (negative)".
- the second information 42 related to the diagnosis or treatment of cerebral infarction can be generated based on the first information 41 whether or not a susceptibility gene related to cerebral infarction exists.
- the second information 42 may include, for example, information indicating the type of cerebral infarction that is significantly associated with the susceptibility gene for cerebral infarction.
- a patient having a susceptibility gene may develop a characteristic (trait) that facilitates the development of cerebral infarction.
- the characteristics that make cerebral infarction more likely to occur are, for example, that the blood vessels in the brain tend to be thin and the blood vessel walls tend to be weak.
- the second information 42 is secondary information generated by taking the first information 41 as to whether or not a susceptibility gene for cerebral infarction is present as the primary information and adding other medical scientific knowledge.
- the second information 42 does not need to be generated by the detection device 10.
- the second information 42 can be generated by, for example, a computer or server capable of acquiring the first information 41 from the detection device 10 via a network.
- the image control unit 20 acquires at least one of the first information 41 generated by the detection device 10 and the second information 42 related to the susceptibility gene generated based on the first information 41.
- the image control unit 20 controls the display unit 30 so as to display at least one of the acquired first information 41 and second information 42.
- the image control unit 20 includes, for example, a computer configured to be able to communicate with the detection device 10 and the display unit 30.
- the image control unit 20 includes a reception unit 21 and a video output unit 22.
- the receiving unit 21 receives at least one of the first information 41 generated by the detection device 10 and the second information 42 related to the susceptibility gene generated based on the first information 41.
- the receiving unit 21 can directly communicate with the detection device 10 by wire or wirelessly, for example.
- the receiving unit 21 can communicate with the detection device 10 via a network, for example.
- the receiving unit 21 does not need to receive information from the detection device 10, and is connected to a device that stores the first information 41 generated by the detection device 10 and the second information 42 generated based on the first information 41 via a network. It suffices if it is accessible.
- the video output unit 22 outputs at least one of the received first information 41 and second information 42 to the display unit 30.
- the video output unit 22 is electrically connected to the display unit 30 by wire or wirelessly.
- FIG. 1 shows an example in which the image control unit 20 is installed outside the image interpretation chamber 901 and the catheter chamber 902. In the example of FIG. 1, the image control unit 20 delivers at least one of the first information 41 and the second information 42 to the display unit 30 installed in the image interpretation chamber 901 and the catheter chamber 902.
- the display unit 30 is a monitor that displays information.
- the display unit 30 is arranged in at least one of the catheter chamber 902 in which the blood vessel X-ray imaging apparatus is arranged and the interpretation chamber 901 in which the image viewing terminal of the radiodiagnosis image or the MRI image is arranged. ..
- the image control unit 20 outputs the received information (first information 41 and / or second information 42) to the display unit 30.
- the display unit 30 displays the information (first information 41 and / or second information 42) output from the image control unit 20.
- the information output from the image control unit 20 (at least one of the first information 41 and the second information 42) is displayed on the display unit 30 at least during the treatment or diagnosis of the patient 1. ..
- CT images or MRI images for diagnosis are taken by a CT device or MRI device in the hospital, and diagnosis is performed in the interpretation room 901 in the hospital.
- diagnosis is performed in the interpretation room 901 in the hospital.
- the information received by the image control unit 20 is output to the display unit 30 installed in the interpretation room 901.
- the image interpretation room 901 is a room in which a radiological diagnostic device (X-ray imaging device, CT device, etc.) or an image viewing terminal (PC) for diagnostic images such as MRI is arranged.
- the cerebral infarction treatment support system 100 After diagnosis, at the stage of treatment of cerebral infarction patients, for example, catheter treatment is performed on the infarcted site in the cerebrovascular.
- the information received by the image control unit 20 is output to the display unit 30 installed in the catheter room 902.
- the catheter room 902 is a room in which a blood vessel X-ray imaging device used at the time of catheter treatment is installed.
- the display unit 30 is arranged in at least one of the catheter room 902 and the interpretation room 901 in the hospital.
- the cerebral infarction treatment support system 100 may include another display unit in addition to the display unit 30 of the catheter room 902 and the interpretation room 901.
- Such a display unit 30 can be a display unit of a portable information terminal such as a tablet terminal carried by a doctor or the like.
- the detection device 10 detects a susceptibility gene (gene to be detected) related to cerebral infarction from the biological sample 2.
- a susceptibility gene is to detect a specific base sequence in the genomic DNA contained in the biological sample 2.
- the detection device 10 generates first information 41 as to whether or not the biological sample 2 has a susceptibility gene for cerebral infarction.
- the susceptibility gene detected by the detection device 10 is not limited to one (one type). If the presence or absence of susceptibility genes for a plurality of types of cerebral infarction significantly correlates with the likelihood of developing any type of cerebral infarction, the first information 41 may represent the presence or absence of each of the plurality of types of susceptibility genes. ..
- the detection device 10 amplifies, for example, the gene to be detected in the biological sample 2.
- the detection device 10 binds the gene to be detected to the labeling substance, for example.
- the detection device 10 detects a susceptibility gene related to cerebral infarction, for example, by detecting a labeling substance bound to a gene to be detected.
- the labeling substance is not particularly limited as long as it is a substance that generates a signal that can be detected by the detection device 10, and includes, for example, a fluorescent substance (fluorescent label). In this case, the detection device 10 irradiates the biological sample 2 with excitation light and detects the fluorescence generated from the labeling substance.
- the detection device 10 is a gene amplification detection device that amplifies and detects a gene to be detected by using a PCR (Polymerase Chain Reaction) method.
- the detection device 10 includes a container mounting unit 11, a detection unit 12, a temperature adjusting unit 13, and a data processing unit 14.
- the container mounting portion 11 is configured so that the sample container 3 containing the biological sample 2 can be installed.
- the sample container 3 is a translucent reaction container, and may be a so-called PCR tube, a well plate, or the like.
- the temperature adjusting unit 13 is configured to heat and / or cool the sample container 3 installed in the container mounting unit 11 to adjust the temperature of the biological sample 2.
- the temperature adjusting unit 13 performs a thermal cycle process for periodically raising and lowering the temperature of the biological sample 2.
- the gene to be detected susceptibility gene for cerebral infarction
- the detection unit 12 includes a light source 12a and a photodetector 12b.
- the light source 12a includes, for example, an LED (light LED diode) element, and generates excitation light of a fluorescent probe contained in the biological sample 2.
- the light source 12a irradiates the biological sample 2 in the sample container 3 installed in the container mounting portion 11 with excitation light.
- the fluorescent probe contained in the biological sample 2 is excited by irradiation with excitation light to generate fluorescence.
- the photodetector 12b is configured to detect the fluorescence generated from the fluorescent probe contained in the biological sample 2.
- the photodetector 12b outputs a detection signal according to the fluorescence intensity generated from the biological sample 2.
- the photodetector 12b includes, for example, a photomultiplier tube (PMT) or a photodiode.
- PMT photomultiplier tube
- the detection device 10 contains a sample 2a containing blood or saliva collected from patient 1 and a reaction solution 2c containing a component that suppresses the influence of an inhibitor in the sample 2a. It is configured to perform gene amplification processing on the biological sample 2 obtained. That is, the detection device 10 is a direct PCR device that performs PCR processing on a biological sample 2 prepared without performing purification treatment for purifying DNA from sample 2a. "Direct PCR" means performing the PCR process without going through the DNA purification process.
- the reaction solution 2c containing a component that suppresses the influence of the inhibitor contains a PCR enzyme, a fluorescent probe, a primer, and a component that suppresses the influence of the inhibitor in the sample 2a.
- a component that suppresses the influence of the inhibitor for example, it is preferable to use Ampdirect (registered trademark) buffer manufactured by Shimadzu Corporation.
- the detection device 10 is configured to perform a real-time PCR method in which labeling treatment with a labeling substance is performed in the process of gene amplification. That is, the detection device 10 specifically binds the fluorescent probe to the gene to be detected (susceptibility gene for cerebral infarction) in the gene amplification process by PCR treatment, instead of performing labeling treatment on the amplification product after gene amplification by PCR treatment. Let me.
- the sample 2a collected from the patient 1 is mixed with the cytolytic solution 2b.
- the mixed solution of the sample 2a and the cytolytic solution 2b is mixed with the reaction solution 2c in the sample container 3.
- the reaction solution 2c contains a PCR enzyme, a fluorescent probe, a primer, and a component that suppresses the influence of the inhibitor in the sample 2a.
- the biological sample 2 is prepared.
- PCR processing can be performed without DNA (deoxyribonucleic acid) purification treatment.
- the detection unit 12 detects fluorescence indicating the presence of the gene to be detected in the process of gene amplification by real-time PCR processing, and outputs a detection signal according to the fluorescence intensity to the data processing unit 14.
- the data processing unit 14 is composed of a computer including a processor 14a such as a CPU (Central Processing Unit), a storage unit 14b that stores a program 15 for gene analysis, and a communication unit 14c.
- the storage unit 14b includes a volatile and / or non-volatile storage device.
- the communication unit 14c includes a communication interface that can be connected to a network of a medical facility such as a hospital.
- the processor 14a acquires the detection signal output from the detection unit 12.
- the processor 14a analyzes the detection signal by executing the program 15 stored in the storage unit 14b.
- the processor 14a generates the first information 41 as to whether or not the biological sample 2 has a susceptibility gene for cerebral infarction by analysis.
- the processor 14a causes the server 50 to transmit the first information 41 via the network by the communication unit 14c.
- the first information 41 may be directly transmitted to the image control unit 20.
- Patient information 45 is added to the biological sample 2 collected from the patient 1.
- the patient information 45 includes unique identification information that identifies the patient 1.
- the detection device 10 adds the patient information 45 of the patient 1 from which the biological sample 2 was collected to the first information 41.
- FIG. 2 shows an example in which a prepared sample in which the sample 2a, the cell lysate 2b, and the reaction solution 2c are mixed is supplied to the detection device 10 as the biological sample 2, but instead of this, for example, a sample.
- a biological sample 2 containing only 2a may be supplied to the detection device 10.
- the detection device 10 is provided with a mechanism for dispensing the cytolytic solution 2b and the reaction solution 2c into the sample container 3 containing the biological sample 2, and is configured to prepare a sample for measurement in the detection device 10. It may have been done.
- the susceptibility gene for cerebral infarction may be a single nucleotide polymorphism (SNP; Single Nucleotide Polymorphism) in the base sequence of a specific gene.
- SNP detection methods include RFLP (restricted enzyme fragment length polymorphism) method, PCR-SCSP (single-strand DNA higher-order structure polymorphism analysis) method, ASO (Allele Specific Oligonucleotide) hybridization method, and sequencing method.
- the detection device 10 may be a device capable of implementing any of the above detection methods in addition to the configuration example shown in FIG.
- the susceptibility gene for cerebral infarction is, for example, RNF213p. Contains a genetic polymorphism of R4810K.
- RNF213 (Ring finger protein 213) (GenBank accession number NM_001256071.1) is present in the human chromosomal region 17q25.3.
- the R4810K gene polymorphism is a single nucleotide polymorphism (SNP; Single Nucleotide Polymorphism) of 73097 G> A in the nucleotide sequence represented by SEQ ID NO: 2.
- the detection device 10 detects the SNP of 73097 G> A in the biological sample 2.
- SEQ ID NO: 2 is a partial nucleotide sequence of human chromosome 17 DNA containing the mysterin gene and genes in the peripheral region [FLJ3520, NPTX1, CARD14, and Raptor (KIAA1303)], and is registered in NCBI as Contig # NT010783. Corresponds to nucleotides 43560001 to 43795000 of .15.
- nucleotide sequence represented by SEQ ID NO: 2 in addition to the SNP at position 73097 (73097 G> A) which is G or A, the SNP at position 4766 (4766 T> C) which is T or C, The SNP at position 120764 (120764 G> A), which is G or A, the SNP at position 152917 (152917 G> A), which is G or A, and the SNP at position 232102 (232102 G> A), which is G or A. ) Can also exist.
- SNP at position 73097 means the SNP at the nucleotide at position 73097 in the nucleotide sequence represented by SEQ ID NO: 2.
- SNP at position 73097 means the SNP at the nucleotide at position 73097 in the nucleotide sequence represented by SEQ ID NO: 2.
- nucleotide sequence is described as a DNA sequence unless otherwise specified, but when the polynucleotide is RNA (ribonucleic acid), thymine (T) should be appropriately read as uracil (U). To do.
- the polynucleotide may contain any additional sequence in addition to the contiguous subsequence of the nucleotide sequence represented by SEQ ID NO: 2 or its complementary sequence.
- RNF213 p The R4810K polymorphism was found to increase the risk of ischemic stroke (ie, atherothrombotic stroke) due to aortic atherosclerosis.
- the inventors of the present application have filed a patent application based on this finding.
- the application numbers of the patent applications filed by the inventors of the present application are Japanese Patent Application No. 2018-233549, PCT / JP2018 / 045915, and the present specification incorporates the entire disclosure contents of these applications by reference.
- FIGS. 3A to 3 (F) show the RNF 213 p.I. This is an example of the detection result of the R4810K gene polymorphism.
- the vertical axis indicates the signal intensity (fluorescence intensity) of the detection signal of the detection device 10
- the horizontal axis indicates the number of PCR processing cycles in the detection device 10. ..
- FIG. 3 (A) shows the detection result of the wild-type positive control of the RNF213 gene.
- FIG. 3B shows the detection result of the mutant positive control of the RNF213 gene.
- the wild type is p. It means a base sequence in which the R4810K gene polymorphism does not exist, and the mutant type means p. It means the base sequence in which the R4810K gene polymorphism is present.
- the positive control is a synthesis of DNA having wild-type and mutant sequences, respectively.
- FIG. 3C shows the detection results of positive control of heterozygotes, one of which is wild-type and the other of which is a mutant in the RNF213 allele.
- FIG. 3 (D) shows the detection result using blood collected from the subject.
- FIG. 3 (E) shows the detection results using saliva collected from the subject.
- FIG. 3F shows the detection result of the negative control for verifying the determination result of the detection device 10. Negative controls are samples that do not contain either wild-type or mutant forms of
- the intensity of the fluorescent signal (referred to as wild-type signal 16) generated from the fluorescent probe that specifically binds to the wild-type of the RNF213 gene is increased, and the fluorescent probe that specifically binds to the mutation of the RNF213 gene is increased.
- the intensity of the fluorescent signal (referred to as mutant signal 17) generated from the above has not changed.
- the intensity of the wild-type signal 16 does not change, and the intensity of the mutant signal 17 increases.
- the intensities of both the wild-type signal 16 and the mutant signal 17 are increased. Therefore, from the detection result of the detection device 10, based on the intensity change of the mutant signal 17, RNF213 p. It is possible to determine the presence or absence of the R4810K gene polymorphism.
- the data processing unit 14 shown in FIG. 2 determines the presence or absence of a susceptibility gene (RNF213 p.R4810K gene polymorphism) related to cerebral infarction based on the intensity change of the mutant signal 17.
- the data processing unit 14 creates the first information 41 according to the determination result. That is, the first data processing unit 14 shows that the data processing unit 14 has the susceptibility gene for cerebral infarction when the intensity of the signal (mutant signal 17) derived from the labeling substance for the susceptibility gene for cerebral infarction increases. Generate information 41.
- a threshold value is set for the signal strength as a criterion for determining the presence or absence of a susceptibility gene in the detection result.
- the data processing unit 14 acquires, for example, a difference value between the signal strength at the start of the PCR process and the signal strength at the end of the PCR process, and determines that there is a susceptibility gene when the acquired difference value exceeds the threshold value. .. Simply, when the signal strength of the mutant signal 17 exceeds the threshold value, it may be determined that there is a susceptibility gene.
- the susceptibility gene for cerebral infarction is RNF213 p. It may be other than the R4810K gene polymorphism. Recent genetic studies have suggested a correlation between cardiogenic cerebral infarction and related genes PITX2 (human chromosomal region 4q25) and ZFHX3 (human chromosomal region 16q22). A correlation between lacunar infarction and ALDH2 (human chromosomal region 12q24) as a related gene has been suggested. Sensitivity genes for cerebral infarction can include one or more of these genes.
- the susceptibility gene for cerebral infarction may be any gene that shows a significant correlation with a specific cerebral infarction, and is not limited to the above-mentioned genes.
- the second information 42 includes information 42a regarding the type of cerebral infarction, information 42b regarding the cerebrovascular of patient 1, and a therapeutic device recommended or deprecated for use in the treatment of cerebral infarction catheter of patient 1. It includes at least one of the indicated information 42c (hereinafter referred to as “device information 42c”).
- the second information 42 is generated, for example, in the form of a message (sentence) to the user.
- Information 42a regarding the type of cerebral infarction is information indicating the type of cerebral infarction that significantly correlates with the susceptibility gene whose presence or absence was detected by the first information 41.
- the types of cerebral infarction are classified into three types: cardiogenic cerebral embolism, lacunar infarction, and atherothrombotic cerebral infarction.
- the presence of a susceptibility gene indicates, for example, that the likelihood of developing any type of stroke is significantly higher or lower.
- Information 42a regarding the type of stroke can be a message indicating the type of stroke that is significantly or less likely to develop.
- Information 42b regarding the cerebrovascular of patient 1 is information on the morphology or properties of the cerebrovascular of patient 1 estimated based on the presence or absence of a susceptibility gene.
- Information 42b about the cerebral blood vessels of patient 1 can be a message indicating that the cerebral blood vessels tend to be thick or thin, for example, when they have a susceptibility gene.
- Information 42b about the cerebral blood vessels of patient 1 can be a message indicating that the cerebral blood vessels tend to be strong (hard to be damaged) or weak (vulnerable), for example, when they have a susceptibility gene.
- Device information 42c is information indicating the type or shape of a treatment device that is an option in catheter treatment.
- Treatment devices for catheter treatment of cerebral infarction include a thrombus recovery device 5a, a thrombus suction device 5b, and a percutaneous angioplasty device 5c shown in FIG.
- the thrombus recovery device 5a has a coiled wire for entwining and collecting the thrombus.
- the thrombus suction device 5b has a hollow tubular shape and is configured so that the thrombus can be removed by sucking the thrombus inside.
- the percutaneous angioplasty device 5c comprises a balloon catheter and a stent.
- the device information 42c may be, for example, a message indicating a therapeutic device whose use is recommended or deprecated among the thrombus recovery device 5a, the thrombus suction device 5b, and the percutaneous angioplasty device 5c.
- RNF213 p The presence of the R4810K gene polymorphism significantly increases the likelihood of developing atherosclerotic cerebral infarction.
- the relatively thick blood vessels in the brain which is the infarct site due to atherothrombotic cerebral infarction, tend to be thinner than the same site in the group not having this gene polymorphism.
- relatively large blood vessels in the brain tend to be thinner than normal, so the use of thrombus recovery devices that are prone to contact with blood vessels can lead to reocclusion due to endothelial damage to the occluded blood vessels.
- the first information 41 is RNF213 p.
- the information 42a regarding the type of cerebral infarction indicates that the type of cerebral infarction developed by the patient 1 from which the biological sample 2 was collected is "highly likely to be atherothrombotic cerebral infarction". Includes a message.
- the information 42b regarding the cerebral blood vessels of the patient 1 includes a message to the effect that "the cerebral blood vessels tend to be thin" of the patient 1 from which the biological sample 2 was collected.
- the device information 42c is a message stating that "the use of the thrombus recovery device 5a is deprecated” and / or "the use of the thrombus aspiration device 5b or the percutaneous angioplasty device 5c is recommended”. Includes a message.
- the device information 42c may include a message stating that "use of a smaller diameter therapeutic device than usual is recommended”.
- the cerebral infarction treatment support system 100 is communicably connected to the detection device 10 and the image control unit 20, and includes a server 50 that stores the first information 41. As shown in FIG. 4, the server 50 is configured to generate the second information 42 based on the first information 41.
- the server 50 has a second information generation table 51 for generating the second information 42 according to the content of the first information 41 (with / without the susceptibility gene).
- the second information generation table 51 is a data table in which the presence / absence of a specific susceptibility gene and the content of the second information 42 to be generated corresponding to the presence / absence of the susceptibility gene are recorded in association with each other.
- the server 50 acquires the first information 41 from the detection device 10
- the server 50 generates the second information 42 by referring to the second information 42 corresponding to the contents of the first information 41 from the second information generation table 51.
- the second information 42 is associated with the first information 41 or the patient information 45 assigned to the first information 41.
- the patient information 45 given to the first information 41 may also be given to the second information 42.
- the second information 42 may be generated by the server 50 in the hospital, or may be generated by a cloud server or the like via the Internet.
- the detection device 10 may generate the second information 42 together with the first information 41.
- the server 50 includes, for example, at least one of a radiological information system server and a medical image management system server connected to a network in a hospital.
- the radiological information system server is called a RIS (Radiology Information Systems) server 52 (see FIG. 7), and is a server that mainly executes inspection by a radiological device and processing of a system that manages inspection results.
- the medical image management system server is a server that collects and records medical image data, and is also called a DICOM server 53 (see FIG. 7) because it handles medical image data conforming to the DICOM standard, which is a standard.
- the image control unit 20 (see FIG. 1) is configured to receive at least the second information 42 from the server 50, for example.
- the image control unit 20 outputs at least the received second information 42 to the display unit 30 and displays it.
- the image control unit 20 may receive both the first information 41 and the second information 42 and display them on the display unit 30.
- the image control unit 20 may display only the first information 41 on the display unit 30, and in this case, the cerebral infarction treatment support system 100 does not have to generate the second information 42.
- FIG. 7 shows a more specific configuration example of the cerebral infarction treatment support system 100.
- the cerebral infarction treatment support system 100 may be configured as part or all of the in-hospital network.
- Radiation equipment such as CT device 101 and MRI device 102 and detection device 10 are connected to the hospital network.
- Various portable terminals 103 such as tablet-type information terminals and various servers such as RIS server 52 and DICOM server 53 are connected to the hospital network.
- the blood vessel X-ray imaging device 70 installed in the catheter room 902 and the image viewing terminal 80 installed in the image interpretation room 901 are connected to the in-hospital network.
- a blood vessel X-ray apparatus 70, a catheter apparatus 104, and the like are installed in the catheter chamber 902. At the time of treatment, the treatment device 5 to be used is prepared.
- the blood vessel X-ray imaging device 70 is an angiography apparatus that performs fluoroscopic imaging of blood vessels.
- the blood vessel X-ray imaging apparatus 70 detects and images the X-rays emitted from the X-ray source by the X-ray detector.
- the blood vessel X-ray imaging device 70 includes a first control device 71 that performs control processing of the device, and a first display unit 72 that displays an captured X-ray image.
- the blood vessel X-ray imaging apparatus 70 performs fluoroscopic imaging of the catheter and the treatment device 5 introduced into the blood vessel at the time of catheter treatment in a moving image format, and displays them on the first display unit 72. The details of the blood vessel X-ray imaging apparatus 70 will be described later.
- the image viewing terminal 80 installed in the image interpretation room 901 is, for example, a PC (personal computer), and includes a second control device 81 constituting the PC main body and a second display unit 82.
- a doctor or the like browses a medical image of the patient 1 using an image viewing terminal 80, identifies a thrombus site of the cerebral infarction patient 1, diagnoses, and determines a treatment policy.
- the medical image includes a CT image taken by the CT device 101 and an MRI image taken by the MRI device.
- the image control unit 20 includes a first control device 71 included in the blood vessel X-ray imaging device 70 installed in the catheter chamber 902.
- the first control device 71 includes a receiving unit 21 and a video output unit 22.
- the display unit 30 includes a first display unit 72 that is installed in the catheter chamber 902 and displays an X-ray image 73 of the blood vessel X-ray imaging apparatus 70.
- the first control device 71 includes at least one of the first information 41 and the second information 42 received during the catheter treatment of the patient 1 in the catheter room 902, and the patient 1 photographed by the blood vessel X-ray imaging device 70.
- X-ray image 73 is output to the first display unit 72.
- the information received by the image control unit 20 (at least one of the first information 41 and the second information 42) is displayed when the patient 1 is treated in the catheter room 902.
- the image control unit 20 includes a second control device 81 included in the image viewing terminal 80 installed in the image interpretation room 901.
- the second control device 81 includes a receiving unit 21 and a video output unit 22.
- the display unit 30 includes a second display unit 82 installed in the image interpretation room 901 and displaying the screen of the image viewing terminal 80.
- the second control device 81 receives at least one of the first information 41 and the second information 42 and the CT image 6 or the MRI image 7 of the patient 1 at the time of diagnosing the patient 1 in the interpretation room 901. Therefore, it is configured to output to the second display unit 82. As a result, the information received by the image control unit 20 (at least one of the first information 41 and the second information 42) is displayed at the time of diagnosing the patient 1 in the interpretation room 901.
- the first information 41 and the second information 42 are provided with the patient information 45, or are recorded in the server 50 (RIS server 52 or DICOM server 53) in association with the patient information 45. Further, patient information 45 is added to the X-ray image 73, CT image 6 and MRI image 7 by the blood vessel X-ray imaging apparatus 70 at the time of imaging. It can be identified that these images and the first information 41 and the second information 42 were obtained from the same patient 1 based on the patient information 45.
- the image control unit 20 receives the image of the patient 1 to which the patient information 45 is given, and includes the image having the same patient information 45 and at least one of the first information 41 and the second information 42. Is output to the display unit 30.
- the image of the patient 1 includes any one of the X-ray image 73, the CT image 6 and the MRI image 7 taken by the angiography apparatus 70, and may include a medical image other than these.
- the cerebral infarction treatment support system 100 is configured to provide at least one of the first information 41 and the second information 42 to a doctor or the like at the time of postoperative evaluation or confirmation of the progress of treatment after the treatment of the cerebral infarction patient 1. May be done.
- patient 1 who is presumed to have developed cerebral infarction is brought to the hospital as an emergency.
- patient information 45 and triage information are input to the in-hospital network system.
- the triage information is information indicating the priority of the treatment sequence determined based on the severity of the patient 1.
- sample 2a is obtained from patient 1.
- CT image 6 or MRI image 7 is taken by the CT device 101 or MRI device 102 in the imaging room.
- a biological sample 2 is prepared from the sample 2a and supplied to the detection device 10 in parallel with the imaging of the patient 1.
- the cerebral infarction treatment support system 100 detects the susceptibility gene by the detection device 10 in parallel with the imaging of the patient 1.
- the patient 1 is diagnosed based on the captured CT image 6 or MRI image 7.
- the image control unit 20 displays at least one of the first information 41 and the second information 42 together with the image of the patient 1 based on the patient information 45 (see FIG. 6). Based on the provided information, doctors and the like diagnose that patient 1 has cerebral infarction, identify the thrombus site, and determine the treatment policy.
- the first treatment is performed according to the treatment policy.
- the first treatment is administration of a thrombolytic agent to patient 1. If the administration of the thrombolytic agent does not sufficiently improve the blood flow in the cerebrovascular disease, a second treatment is performed as necessary.
- the second treatment is catheter treatment.
- the image control unit 20 displays at least one of the first information 41 and the second information 42 together with the X-ray image 73 (see FIG. 7) of the patient 1 based on the patient information 45.
- the doctor in charge of treatment selects the treatment device 5 with reference to the provided information, and performs catheter treatment with reference to the intravascular X-ray image 73.
- the cerebral infarction treatment support system 100 implements the cerebral infarction treatment support method of the present embodiment.
- the detection device 10 shall be referred to FIG. 2, and the first information 41, the second information 42, and the patient information 45 shall be referred to FIGS. 4 and 6.
- step 91 the detection device 10 measures the biological sample 2 collected from the patient 1 and generates the first information 41 as to whether or not the biological sample 2 has a susceptibility gene for cerebral infarction.
- step 92 the detection device 10 adds the patient information 45 of the patient 1 to the first information 41 generated by the biological sample 2 collected from the patient 1 brought in as an emergency case.
- step 93 the second information 42 can be generated based on the first information 41. If the second information 42 is not displayed, step 93 is unnecessary.
- step 94 the receiving unit 21 (see FIGS. 1 and 7) of the image control unit 20 receives at least one of the first information 41 and the second information 42.
- step 95 the video output unit 22 (see FIGS. 1 and 7) of the image control unit 20 outputs at least one of the first information 41 and the second information 42 received by the image control unit 20 to the display unit 30.
- the image control unit 20 receives the first information 41 of the patient 1 from which the biological sample 2 has been collected based on the patient information 45, and outputs the first information 41 to the display unit 30 (see FIGS. 1 and 7).
- the display of the first information 41 and / or the second information 42 may be performed only at the time of treatment and the time of diagnosis of patient 1.
- the treatment of the acute cerebral infarction patient 1 needs to be carried out in a short period of time. Therefore, if it takes time to detect the susceptibility gene, it is possible that the generation of the first information 41 has not been completed at the time of diagnosis of patient 1. Even in that case, in the present embodiment, the received information is displayed on the display unit 30 together with the patient information 45 by at least the time of treatment of the patient 1.
- the treating doctor can select the treatment device 5 with reference to the first information 41 and / or the second information 42.
- the cerebral infarction treatment support system 200 implements the cerebral infarction treatment support method of the present embodiment.
- the cerebral infarction treatment support system 200 includes a detection device 210, a server 250, and a modality 105.
- the server 250 is an example of a "management unit" in the claims.
- the server 250 includes a RIS server 252, a DICOM server 253, and a hospital information system server connected to a network in the hospital.
- the hospital information system server is called a HIS (Hospital Information Systems) server 254, and includes, for example, an automatic reception system, an electronic medical record management system, a medical accounting system, a medical appointment system, a pharmacy management system, and the like.
- the HIS server 254 is configured to store patient information 245. Since the RIS server 252 and the DICOM server 253 have the same configurations as the RIS server 52 (see FIG. 7) and the DICOM server 53 (see FIG. 7, respectively), detailed description thereof will be omitted.
- Modality 105 includes a blood vessel X-ray imaging apparatus 270 (see FIG. 11), an image viewing terminal 80 (see FIG. 11), a CT apparatus 101 (see FIG. 7), an MRI apparatus 102 (see FIG. 7), and the like.
- “modality” means a generic term for these medical imaging devices. Since the blood vessel X-ray imaging apparatus 270 has the same configuration as the blood vessel X-ray imaging apparatus 70, detailed description thereof will be omitted. Further, the blood vessel X-ray imaging apparatus 270 is an example of the "device used for treating a patient" in the claims.
- the detection device 210 measures the biological sample 2 collected from the patient 1 and generates gene-related information 240 related to the susceptibility gene for cerebral infarction.
- the gene-related information 240 includes first information 241 whether or not the biological sample 2 has a susceptibility gene for cerebral infarction, and second information 242 related to the susceptibility gene generated based on the first information 241. Including.
- the server 250 is configured to generate the second information 242 related to the susceptibility gene based on the first information 241 included in the gene-related information 240 generated by the detection device 210.
- the first information 241 is the same information as the first information 41 (see FIG. 4). That is, the first information 241 includes patient information 245 and information with / without gene polymorphism. Further, the patient information 245 is the same information as the patient information 45 (see FIG. 4), and includes the identification information 245a.
- the identification information 245a is unique information that can identify the patient 1.
- the identification information 245a includes, for example, a patient identification number.
- the second information 242 is the same information as the second information 42 (see FIG. 4).
- the second information 242 is at least information 42a regarding the type of cerebral infarction, information 42b regarding the cerebrovascular of patient 1, and information 42c indicating a therapeutic device recommended or deprecated for use in the treatment of the cerebral infarction catheter of patient 1. Including either.
- the HIS server 254 transmits an inspection request 201 to the detection device 210.
- the HIS server 254 also transmits the identification information 245a of the patient 1 to be examined.
- the detection device 210 that has received the inspection request 201 performs the inspection and generates the first information 241. Further, the detection device 210 associates the generated first information 241 with the identification information 245a transmitted together with the inspection request 201. The detection device 210 transmits the first information 241 associated with the identification information 245a to the HIS server 254.
- the HIS server 254 manages the first information 241 transmitted from the detection device 210. Note that managing the first information 241 includes storing the first information 241 in the HIS server 254. Further, the management of the first information 241 includes transmitting the first information 241 to the blood vessel X-ray imaging apparatus 270 and the like.
- the server 250 is configured to generate the second information 242 related to the susceptibility gene based on the first information 241 included in the gene-related information 240 generated by the detection device 210.
- the server 250 is configured to store the identification information 245a of the patient 1. Further, the server 250 is communicably connected to the detection device 210. Further, the server 250 associates the set identification information 245a of the patient 1 with the stored identification information 245a of the patient 1, and also associates the set identification information 245a of the patient 1 with the stored identification information 245a of the patient 1 or the identification information 245a of the patient 1. It is configured to manage at least one of the patient information 245 of the patient 1 in association with the gene-related information 240. In the present embodiment, the process of setting the identification information 245a of the patient 1 in the gene-related information 240 is executed by the detection device 210 that generates the gene-related information 240.
- the server 250 associates at least one of the first information 241 and the second information 242 with the identification information 245a that identifies the patient 1 (see FIG. 1), thereby causing the first information 241 and the second information. It is configured to manage at least one of 242 in association with patient information 245 of patient 1.
- the HIS server 254 is configured to associate the second information 242 with the patient information 245. Further, the HIS server 254 is configured to store the second information 242 in a state associated with the patient information 245.
- the HIS server 254 transmits the imaging request 202 of the patient 1 to the RIS server 252.
- the RIS server 252 transmits the shooting request 202 to the modality 105 based on the received shooting request 202. Specifically, when the request for acquiring the CT image 6 of the patient 1 is transmitted, the RIS server 252 transmits the imaging request 202 to the CT device 101. Further, when the request for acquiring the MRI image 7 of the patient 1 is transmitted, the RIS server 252 transmits the imaging request 202 to the MRI apparatus 102.
- the imaging request 202 may include patient information 245.
- the modality 105 (here, the CT device 101 or the MRI device 102) that has received the imaging request 202 photographs the patient 1. After the imaging is completed, the modality 105 transmits the acquired image (CT image 6 or MRI image 7) to the DICOM server 253.
- the DICOM server 253 stores the transmitted image (CT image 6 or MRI image 7).
- CT image 6 or MRI image 7 the transmitted image
- the DICOM server 253 transmits the imaging completion information 203 indicating that the imaging of the image (CT image 6 or MRI image 7) has been completed to the HIS server 254.
- the HIS server 254 that has received the shooting completion information 203 stores that the shooting in the transmitted shooting request 202 has been completed.
- the modality 105 acquires the first information 241 and the second information 242 and the image (CT image 6 or MRI image 7) by transmitting the request (request 204, 206, and 207) to the server 250. To do.
- the image viewing terminal 80 when diagnosing a cerebral infarction, is configured to acquire an image (CT image 6 or MRI image 7) from the DICOM server 253 by being operated by a doctor or the like. ing.
- the image viewing terminal 80 transmits an image transmission request 204 to the DICOM server 253 by being operated by a doctor or the like.
- the DICOM server 253 Upon receiving the image transmission request 204, transmits an image (CT image 6 or MRI image 7) to the image viewing terminal 80.
- a doctor or the like creates a diagnostic report 205 regarding a stenosis site or the like based on an image (CT image 6 or MRI image 7) transmitted to the image viewing terminal 80.
- the created diagnostic report 205 is transmitted to, for example, the DICOM server 253.
- the DICOM server 253 stores the transmitted diagnostic report 205.
- the angiography apparatus 270 acquires at least one of the first information 241 and the second information 242 and an image (CT image 6 or MRI image 7) when treating a cerebral infarction. Therefore, request 206 and request 207 are transmitted to the server 250.
- the angiography device 270 acquires information and images transmitted from the server 250 in response to requests 206 and 207.
- the server 250 refers to at least one of the first information 241 and the second information 242 and an image (CT image 6 or MRI image 7) with respect to the angiography apparatus 270.
- the configuration for transmitting the image will be described.
- the blood vessel X-ray imaging apparatus 270 requests the RIS server 252 to acquire at least one of the first information 241 and the second information 242 by being operated by a doctor or the like. It is configured to transmit 206.
- the blood vessel X-ray imaging apparatus 270 also transmits the identification information 245a when transmitting the transmission request 206.
- the RIS server 252 that has received the request 206 transmits the request 206 and the identification information 245a to the HIS server 254.
- the HIS server 254 that has received the request 206 transmits at least one of the first information 241 and the second information 242 associated with the identification information 245a to the RIS server 252 based on the received identification information 245a. ..
- the RIS server 252 transmits at least one of the received first information 241 and second information 242 to the blood vessel X-ray imaging apparatus 270.
- the blood vessel X-ray imaging apparatus 270 transmits a transmission request 207 of an image (CT image 6 or MRI image 7) to the DICOM server 253 based on an operation by a doctor or the like.
- the blood vessel X-ray imaging apparatus 270 also transmits the identification information 245a when transmitting the transmission request 207.
- the DICOM server 253 Upon receiving the transmission request 207, the DICOM server 253 uses the image of the patient 1 (CT image 6 or MRI image 7) from among the plurality of stored images (CT image 6 or MRI image 7) based on the identification information 245a. ) Is specified. The DICOM server 253 transmits the specified image (CT image 6 or MRI image 7) to the blood vessel X-ray imaging apparatus 270 via the RIS server 252.
- the server 250 is configured to associate the second information 242 with the CT image 6 or the MRI image 7 of the patient 1 using the identification information 245a. Further, the server 250 is configured to transmit at least one of the first information 241 and the second information 242 to the blood vessel X-ray imaging apparatus 270. In the present embodiment, the server 250 obtains the CT image 6 or MRI image 7 of the patient 1 and the second information 242 based on the request 206 and the request 207 from the blood vessel X-ray imaging device 270. It is configured to send to 270.
- the RIS server 252 adopts a configuration in which at least one of the first information 241 and the second information 242 is transmitted to the vascular X-ray imaging apparatus 270, but is stored in the DICOM server 253. If at least one of the first information 241 and the second information 242 is stored in the CT image 6 or the MRI image 7 of the patient 1, at least one of the first information 241 and the second information 242 by the RIS server 252. No need to send. In this case, at least one of the first information 241 and the second information 242 can be stored in the header of the CT image 6 or the MRI image 7 of the patient 1.
- the detection device 210 measures the biological sample 2 collected from the patient 1 and generates gene-related information 240 related to the susceptibility gene related to cerebral infarction.
- the detection device 210 transmits the generated gene-related information 240 to the server 250.
- step 302 the detection device 210 sets the identification information 245a of the patient 1 in the gene-related information 240.
- step 303 the server 250 associates the set patient 1 identification information 245a with the patient identification information 245a stored in the server 250.
- the server 250 manages the gene-related information 240 in association with at least one of the patient 1 identification information 245a or the patient 1 patient information 245 related to the patient 1 identification information 245a stored in the server 250.
- the gene-related information 240 includes first information 241 whether or not the biological sample 2 has a susceptibility gene for cerebral infarction, and second information 242 related to the susceptibility gene generated based on the first information 241.
- the server 250 has at least one of the patient 1 identification information 245a or the patient 1 patient information 245 related to the patient 1 identification information 245a stored in the server 250, and the first information 241 and the second information. It is managed in association with at least one of 242.
- the server 250 manages the second information 242 in association with the patient information 245.
- step 305 the server 250 determines whether or not there is a request 206 for transmitting the first information 241 and / or the second information 242 from the blood vessel X-ray imaging apparatus 270. If there is a request 206, the process proceeds to step 306. If there is no request 206, the process ends.
- step 306 the server 250 transmits at least one of the first information 241 and the second information 242 to the blood vessel X-ray imaging apparatus 270. After that, the process ends.
- the HIS server 254 associates the second information 242 with the patient information 245 and immediately or after a preset period of time has elapsed, or the treatment from the angiography device 270 ends.
- the first information 241 is deleted and the second information 242 in a state associated with the patient information 245 is stored based on the information 208 (see FIG. 10).
- the HIS server 254 associates the second information 242 with the patient information 245, and then deletes the first information 241 based on the information 208 indicating the end of treatment from the blood vessel X-ray apparatus 270. It is configured in.
- step 401 the server 250 determines whether or not the information 208 indicating the end of treatment has been transmitted from the blood vessel X-ray imaging apparatus 270.
- the process proceeds to step 402. If the server 250 does not receive the information 208 indicating the end of treatment from the blood vessel X-ray apparatus 270, the server 250 repeats the process of step 401.
- step 402 the server 250 deletes the first information 241. After that, the process ends.
- step 410 the DICOM server 253 determines whether or not there is a transmission request 207 for an image (CT image 6 or MRI image 7) from the blood vessel X-ray imaging apparatus 270. If there is an image transmission request, the process proceeds to step 411. If there is no image transmission request, the process of step 410 is repeated. When the transmission request 207 is transmitted from the blood vessel X-ray imaging apparatus 270, the identification information 245a is also transmitted.
- the DICOM server 253 (server 250) associates the second information 242 with the CT image 6 or the MRI image 7 of the patient 1 using the identification information 245a.
- the DICOM server 253 that has received the transmission request 207 has an image (CT image) of the patient 1 from among a plurality of stored images (CT image 6 or MRI image 7) based on the identification information 245a.
- the second information 242 is associated with the image (CT image 6 or MRI image 7).
- the DICOM server 253 (server 250) transmits the specified image (CT image 6 or MRI image 7) to the angiography apparatus 270 via the RIS server 252. That is, the DICOM server 253 (server 250) transmits the CT image 6 or MRI image 7 of the patient 1 and the second information 242 to the blood vessel X-ray based on the request 206 and the request 207 from the blood vessel X-ray apparatus 270. It is transmitted to the photographing apparatus 270. After that, the process ends.
- CT image 6 or MRI image 7 the specified image
- the DICOM server 253 server 250 transmits the CT image 6 or MRI image 7 of the patient 1 and the second information 242 to the blood vessel X-ray based on the request 206 and the request 207 from the blood vessel X-ray apparatus 270. It is transmitted to the photographing apparatus 270. After that, the process ends.
- the angiography apparatus 270 (see FIG. 11) installed in the catheter chamber 902 is, for example, the angiography apparatus 500 shown in FIG.
- a configuration example of the angiography apparatus 500 will be described in detail.
- the angiography apparatus 500 of the present embodiment includes a top plate 501 on which the patient 1 is placed, an imaging unit 502 including an X-ray source 521 and a detection unit 522, and image processing.
- a unit 503, a control unit 504, and a display unit 505 are provided.
- the top plate 501 is formed in a rectangular flat plate shape in a plan view.
- the top plate 501 is placed on the top plate so that the head-foot direction of the patient 1 is along the long side of the rectangle and the left-right direction of the patient 1 is along the short side of the rectangle.
- the head and foot direction of the patient 1 is the X direction
- the left-right direction of the patient 1 is the Z direction
- the X direction and the direction orthogonal to the Z direction are the Y direction.
- the imaging unit 502 is configured to irradiate the patient 1 with X-rays from the X-ray source 521, and the detection unit 522 detects the X-rays transmitted through the patient 1.
- the X-ray source 521 is attached to one end of the C-shaped holding portion 523.
- the X-ray source 521 can irradiate the patient 1 with X-rays by applying a voltage by an X-ray tube driving unit (not shown).
- the X-ray source 521 has a collimator capable of adjusting the X-ray irradiation field, which is the irradiation range of X-rays.
- the detection unit 522 is attached to the other end of the holding unit 523. That is, the detection unit 522 is arranged on the opposite side of the top plate 501 from the X-ray source 521. Since the detection unit 522 is arranged so as to face the X-ray source 521, it is configured to be able to detect the X-rays that have passed through the patient 1.
- the detection unit 522 includes, for example, an FPD (flat panel detector).
- the image processing unit 503 is a computer configured to include a processor such as a GPU (Graphics Processing Unit) or an FPGA (Field-Programmable Gate Array) configured for image processing.
- the image processing unit functions as an image processing device by executing an image processing program.
- the image processing unit 503 is configured to generate a fluoroscopic image 520 (see FIG. 17) of the patient 1 based on the detection signal output from the detection unit 522.
- the control unit 504 is a computer configured to include a CPU (Central Processing Unit), a ROM (Read Only Memory), a RAM (Random Access Memory), and the like.
- a CPU Central Processing Unit
- ROM Read Only Memory
- RAM Random Access Memory
- the control unit 504 is configured to acquire the CT image 6 or the MRI image 7 from the server 506. Since the server 506 has the same configuration as the server 250 (see FIGS. 10 and 11), detailed description thereof will be omitted.
- control unit 504 acquires a CT image 6 or an MRI image 7 of the patient 1 undergoing fluoroscopic imaging from the server 506 based on the patient information 545 of the patient 1 undergoing fluoroscopic imaging. It is configured to do.
- the control unit 504 selects the CT image 6 or the MRI image 7 having the same spatial coordinates as the fluoroscopic image 520 generated by the image processing unit 503 among the CT image 6 or the MRI image 7 of the patient 1 undergoing fluoroscopic imaging. It is configured as follows.
- FIG. 17 is a schematic view showing a process of generating a superposed image 530 of the head 550 of the patient 1.
- the control unit 504 is configured to control the fluoroscopic image 520 to be superimposed (stacked) on the CT image 6 or the MRI image 7 acquired by the display unit 505 and displayed.
- the control unit 504 controls the display unit 505 to display the treatment position 511 together with the superimposed image 530. Is configured to do.
- the treatment position 511 is marked with a mark 531.
- the mark 531 may be a figure surrounding the treatment position 511, and an arrow may be displayed.
- the control unit 504 is configured to control the acquisition of the gene information 540 that matches the patient information 545 of the patient 1 on which fluoroscopy is performed from the server 506.
- the genetic information 540 includes at least one of the first information 541 and the second information 542.
- the first information 541 is the same information as the first information 41 (see FIG. 4). That is, the first information 541 includes patient information 545 and information with / without gene polymorphism.
- the second information 542 is the same information as the second information 42 (see FIG. 4).
- the second information 542 is at least information 42a regarding the type of cerebral infarction, information 42b regarding the cerebrovascular of patient 1, and information 42c indicating a therapeutic device recommended or deprecated for use in the treatment of the cerebral infarction catheter of patient 1. Including either.
- the control unit 504 is configured to control the gene information 540 to be further displayed on the image in which the fluoroscopic image 520 displayed on the display unit 505 and the CT image 6 or the MRI image 7 are superimposed.
- the control unit 504 is configured to control the genetic information 540 to be displayed at a position that does not overlap the treatment position 511. As shown in FIG. 17, the position that does not overlap with the treatment position 511 is a position that does not overlap with the mark 531 when the mark 531 indicating the treatment position 511 is displayed.
- the display unit 505 is a monitor provided in the angiography apparatus 500.
- the catheter 512 is clearly imaged, but the blood vessel 513 is not. Therefore, by superimposing the CT image 6 or the MRI image 7, a superposed image 530 in which the catheter 512 and the blood vessel 513 are superposed is generated.
- the pixel value of the blood vessel 513 is inverted in order to clarify the catheter 512.
- the pixel value of the catheter 512 may be inverted.
- the superimposed image displays the mark 531 indicating the treatment position 511 and the gene information 540.
- the gene information 540 is represented by characters.
- Doctors and the like take a CT image 6 or an MRI image 7 when the patient 1 who has a cerebral infarction is transported to a hospital.
- FIG. 18A a plurality of two-dimensional image data are generated in CT imaging.
- FIG. 18A shows an image taken while moving in the cephalopod direction (X direction).
- three-dimensional image data can be generated by reconstructing a plurality of two-dimensional CT images 6 continuously captured as shown in FIG. 18B.
- a desired CT image 6 can be obtained by cutting the three-dimensional data in an arbitrary direction. For example, when the blood vessel 513 extends along the head-foot direction, the three-dimensional image data reconstructed as shown in FIG. 18C may be cut in a direction parallel to the head-foot direction (X direction).
- three-dimensional image data can be generated by reconstructing the MRI image 7.
- An image of the blood vessel 513 can be generated by cutting the generated three-dimensional image data in the extending direction of the blood vessel.
- the doctor or the like confirms the treatment position 511, which is the treatment position, from the CT image 6 or the MRI image 7 taken in the interpretation room 901.
- the doctor or the like marks the treatment position 511 and associates the treatment position 511 with the CT image 6 or the MRI image 7.
- the doctor or the like can determine the treatment position 511 from the CT value which is the absorption value of X-rays.
- a thrombus is formed in the blood vessel 513 at the treatment position 511.
- the thrombus has a higher CT value because it absorbs X-rays than the blood vessel to which the contrast medium is administered, and is displayed in black as compared with the blood vessel without the thrombus.
- the doctor or the like identifies the treatment position 511 from the difference in the CT value.
- the doctor or the like can determine the treatment position 511 from the detection signal. Since the detection signal is strong in the place where the blood flow is fast and the detection signal is weak in the place where the blood flow is slow, the blood vessel with slow blood flow (cerebral infarction occurs) is displayed darker than other blood vessels. Therefore, the doctor or the like specifies the treatment position 511.
- the doctor or the like starts the treatment to remove the thrombus.
- a superposed image 530 and genetic information 540 in which a fluoroscopic image 520, a CT image 6 or an MRI image 7 are superimposed are displayed on a display unit 505. Is displayed.
- the treatment position 511 of the CT image 6 or the MRI image 7 is marked with a mark 531, the treatment position 511 can be confirmed even if the doctor performing the treatment and the doctor diagnosing in the interpretation room 901 are different. can do. Since the superimposed image 530 and the genetic information 540 are displayed on the display unit 505, the doctor or the like can smoothly perform the operation.
- step 601 the angiography apparatus 500 starts fluoroscopy by accepting the input of the user.
- the angiography apparatus 500 irradiates patient 1 with X-rays from the X-ray source 521.
- the detection unit 522 detects the X-rays that have passed through the patient 1 and outputs a detection signal.
- step 602 the image processing unit 503 generates a fluoroscopic image 520 based on the detection signal.
- control unit 504 controls to acquire the CT image 6 or the MRI image 7 having the same spatial position coordinates as the fluoroscopic image 520 generated in step 602 from the server 506.
- step 604 the control unit 504 controls to superimpose the fluoroscopic image 520 on the acquired CT image 6 or MRI image 7 and display it on the display unit 505.
- step 605 the control unit 504 controls to acquire the gene information 540 in which the patient information 545 matches from the server.
- step 606 the control unit 504 controls the display unit 505 to display the acquired gene information 540 and the superimposed image 530 on which the CT image 6 or the MRI image 7 and the fluoroscopic image 520 are superimposed.
- the cerebral infarction treatment support system 100 of the present embodiment measures the biological sample 2 collected from the patient 1 as described above, and provides the first information 41 as to whether or not the biological sample 2 has a susceptibility gene for cerebral infarction.
- the display unit 30 and the image control unit 20 that controls the display unit 30 are provided, and the image control unit 20 has the sensitivity generated based on the first information 41 generated by the detection device 10 and the first information 41.
- a receiving unit 21 that receives at least one of the second information 42 related to the gene, and a video output unit 22 that outputs at least one of the received first information 41 and the second information 42 to the display unit 30. Including.
- the biological sample 2 collected from the patient 1 is measured, and the first information 41 as to whether or not the biological sample 2 has a susceptibility gene for cerebral infarction.
- the step of receiving at least one of the generated first information 41 and the second information 42 related to the susceptibility gene generated based on the first information 41, and the received first information 41 and A step of outputting at least one of the second information 42 to the display unit 30 is provided, and the display unit 30 includes the inside of the catheter chamber 902 in which the blood vessel X-ray imaging apparatus 70 is arranged, and a radiodiagnosis image or an MRI image.
- the image viewing terminal 80 is arranged in at least one of the reading room 901 in which the image viewing terminal 80 is arranged.
- the cerebral infarction treatment support system 100 and the cerebral infarction treatment support method of the present embodiment in the treatment of the cerebral infarction patient 1 in the acute phase, whether or not the patient 1 has a susceptibility gene for cerebral infarction
- the display unit 30 arranged in the interpretation chamber 901 for determining the type of cerebral infarction, identifying the location of the thrombus, and the like, at least one of the information 41 and the second information 42 generated based on the first information 41. It can be displayed on (second display unit 82).
- the doctor can display the conventional CT image 6 or MRI image 7.
- the type of cerebral infarction can be determined in consideration of information based on the presence or absence of a susceptibility gene that cannot be obtained from image information, in addition to the interpretation by.
- at least one of the first information 41 and the second information 42 should be displayed at the time of treatment on the display unit 30 (first display unit 72) arranged in the catheter room 902 for treating the patient 1 who has developed cerebral infarction.
- the actual treating doctor can select a treatment device for catheter treatment according to the type of cerebral infarction in consideration of information based on the presence or absence of a susceptibility gene.
- a treatment device for catheter treatment according to the type of cerebral infarction in consideration of information based on the presence or absence of a susceptibility gene.
- the image control unit 20 is configured to receive at least the second information 42 and output it to the display unit 30, and the second information 42 is information 42a regarding the type of cerebral infarction and patient 1. Includes at least one of information 42b regarding cerebrovascular disease and information 42c indicating therapeutic devices that are recommended or deprecated for use in the treatment of cerebral infarction catheters in Patient 1. With this configuration, it is particularly useful for doctors involved in the diagnosis and treatment of cerebral infarction in the acute phase as the second information 42 derived based on the first information 41 whether or not it has a susceptibility gene for cerebral infarction. Support information can be presented.
- the detection device 10 imparts the patient information 45 of the patient 1 from which the biological sample 2 has been collected to the first information 41, and the image control unit 20 assigns the patient information 45 to the patient 1.
- the image is received, and the image having the same patient information 45 and at least one of the first information 41 and the second information 42 are output to the display unit 30.
- the image used for treatment or diagnosis can be associated with the first information 41 and / or the second information 42 via the patient information 45. Therefore, even in an emergency such as treatment or diagnosis of patient 1 of acute cerebral infarction, these images and information are collected and surely provided to doctors without using uncertain communication means such as oral communication. can do.
- the image control unit 20 includes a first control device 71 included in the blood vessel X-ray imaging device 70 installed in the catheter room 902, and the display unit 30 is installed in the catheter room 902 to emit blood vessel X-rays.
- a first display unit 72 that displays an X-ray image 73 of the photographing device 70 is included.
- the first control device 71 is photographed by at least one of the first information 41 and the second information 42 received at the time of catheter treatment of the patient 1 in the catheter room 902 and the blood vessel X-ray imaging device 70.
- the X-ray image 73 of the patient 1 is configured to be output to the first display unit 72.
- the first information 41 and / or the second information 42 can be displayed together with the X-ray image 73 showing the catheter during catheter treatment. Therefore, the first information 41 and / or the second information 42 can be reliably presented to the doctor who actually performs the catheter treatment.
- the image control unit 20 includes a second control device 81 included in the image viewing terminal 80 installed in the image reading room 901, and the display unit 30 is installed in the image reading room 901 and is the image viewing terminal 80.
- a second display unit 82 that displays a screen is included.
- the second control device 81 obtains at least one of the first information 41 and the second information 42 and the CT image 6 or the MRI image 7 of the patient 1 at the time of diagnosing the patient 1 in the interpretation room 901. It is configured to receive and output to the second display unit 82.
- the first information 41 and / or the second information 42 can be displayed together with the CT image 6 or the MRI image 7 used for the diagnosis. Therefore, the first information 41 and / or the second information 42 can be reliably presented to the doctor who actually identifies the type of cerebral infarction.
- a server 50 that is communicably connected to the detection device 10 and the image control unit 20 and stores the first information 41 is further provided, and the server 50 is based on the first information 41 and the second information 42.
- the image control unit 20 receives at least the second information 42 from the server 50.
- the second information 42 can be automatically generated based on the first information 41 generated by the detection device 10 and presented to a doctor or the like at the time of treatment or diagnosis. Therefore, useful support information can be surely presented to the doctors involved in the diagnosis and treatment even in an emergency such as the treatment or the diagnosis of the patient 1 of the acute cerebral infarction.
- the server 50 includes at least one of a radiological information system server (RIS server 52) and a medical image management system server (DICOM server 53) connected to a network in the hospital.
- the second information 42 can be generated by the server (52 or 53) of the existing network constructed in the hospital.
- each of the above servers (52 or 53) handles a radiographic image or a medical image, images (CT image 6, MRI image 7, at the time of treatment) referred to by a doctor at the time of treatment or diagnosis of patient 1 of cerebral infarction
- the X-ray image 73) and the second information 42 can be easily linked, managed and provided.
- the susceptibility gene for cerebral infarction is RNF213p.
- RNF213p The first information 41 as to whether or not the gene polymorphism of R4810K is possessed can be presented to the doctor. Based on this first information 41, doctors and the like tend to have a significantly higher possibility that the type of cerebral infarction developed by patient 1 is atherothrombotic cerebral infarction, and that the diameter of major cerebral blood vessels is small. As a result, it is necessary to be careful when using a thrombosis recovery device during catheter treatment, and even when it is used, it is preferable to use a thrombosis recovery device having a smaller diameter than usual. be able to.
- the detection device 10 is a biological sample containing a sample 2a containing blood or saliva collected from patient 1 and a reaction solution 2c containing a component that suppresses the influence of an inhibitor in the sample 2a.
- 2 includes a gene amplification detection device configured to perform gene amplification processing.
- the detection device 10 directly measures the biological sample 2 collected from the patient 1 without purifying the gene by removing the inhibitory substance in the biological sample 2, and the first information 41. Can be generated. Therefore, as compared with the case where the purification treatment is performed, a part of the pretreatment (purification treatment) for the measurement by the detection device 10 becomes unnecessary, so that the first information 41 can be generated quickly. Therefore, the above configuration is particularly useful in that the first information 41 can be provided to the doctor as early as possible at the time of treatment or diagnosis of the patient 1 of the acute cerebral infarction.
- the detection device 10 includes a gene amplification detection device that performs a real-time PCR method that performs labeling treatment with a labeling substance in the gene amplification process.
- the first information 41 can be generated more quickly than a normal (non-real-time) PCR method in which amplification is performed and then labeling is performed. Therefore, the above configuration is particularly useful in that the first information 41 can be provided to the doctor as early as possible at the time of treatment or diagnosis of the patient 1 of the acute cerebral infarction.
- the step of adding the patient information 45 of the patient 1 to the first information 41 generated by the biological sample 2 collected from the patient 1 brought in as an emergency case is further provided, and at least during the treatment of the patient 1.
- at least one of the received first information 41 and second information 42 is displayed on the display unit 30 together with the patient information 45.
- the inventor of the present application photographed an MRI image and an MRA (Magnetic Resonance Angiography) image for one patient who was transported by emergency, and confirmed that he had developed a cerebral infarction in the main artery of the brain.
- MRA Magnetic Resonance Angiography
- the inventor of the present application treated the patient to remove the thrombus in the blood vessel using the thrombus suction device 5b ⁇ cerebral infarction treatment 1>. After cerebral infarction treatment 1, reocclusion was observed in the patient's blood vessels. Therefore, the inventor of the present application placed a stent in the blood vessel using the percutaneous angioplasty device 5c to perform a treatment for dilating the blood vessel ⁇ cerebral infarction treatment 2>. After performing cerebral infarction treatment 2, reocclusion was observed in the blood vessels of the patient, so the inventor of the present application performed treatment to dilate the blood vessels again using the percutaneous angioplasty device 5c ⁇ cerebral infarction. Treatment 3>. In addition, this patient is RNF213 p. A test was performed to determine whether or not the R4810K gene polymorphism was present. As a result, the patient received RNF213 p. It had an R4810K gene polymorphism.
- RNF213 p patients with the R4810K gene polymorphism tend to have thinner blood vessels (fragility of the intracranial vascular endothelium) than patients without this gene polymorphism. It was concluded that endothelial damage may have occurred, leading to reocclusion of blood vessels. In this way, RNF213 p. It was confirmed that patients with R4810K gene polymorphism and fragile vascular endothelium have a relatively high risk of reocclusion of blood vessels.
- RNF213 p Providing information on whether or not a patient has the R4810K gene polymorphism in advance prior to treatment avoids treatment devices that come into direct contact with blood vessels and provides physical stimulation even when a treatment device that does not come into contact with blood vessels is used. It is possible to make the doctor aware that care must be taken not to give to the blood vessels. The above results also suggest that genetic information may be useful in assessing the risk of postoperative reocclusion.
- the second information 42 shows an example including at least one of information 42a regarding the type of cerebral infarction, information 42b regarding cerebrovascular disease, and device information 42c, but the present invention is not limited thereto. ..
- the second information 42 may include information other than the above-mentioned information as long as it is information derived from the first information 41.
- the present invention is not limited to this. In the present invention, the patient information 45 does not have to be added to the first information 41.
- an example in which an image such as a CT image 6, an MRI image 7, an X-ray image 73 and at least one of the first information 41 and the second information 42 is displayed on the display unit 30 is shown.
- the invention is not limited to this. At least one of the first information 41 and the second information 42 may be displayed on the display unit 30 without displaying the image.
- the detection device 10 may perform a PCR treatment on the biological sample 2 prepared by performing a purification treatment for purifying DNA from the sample 2a.
- the detection device 10 performs the real-time PCR method, but the present invention is not limited to this.
- the detection device 10 may be configured to perform a non-real-time PCR method.
- a detection device that measures a biological sample collected from a patient and generates first information on whether or not the biological sample has a susceptibility gene for cerebral infarction.
- a display unit arranged in at least one of a catheter room in which a blood vessel X-ray imaging apparatus is arranged and an image interpretation room in which an image viewing terminal for a radiodiagnosis image or an MRI image is arranged. It is provided with an image control unit that controls the display unit.
- the image control unit A receiving unit that receives at least one of the first information generated by the detection device and the second information related to the susceptibility gene generated based on the first information.
- a cerebral infarction treatment support system including a video output unit that outputs at least one of the received first information and the second information to the display unit.
- the image control unit is configured to receive at least the second information and output it to the display unit.
- the second information includes at least one of information about the type of cerebral infarction, information about the patient's cerebrovascular disease, and information indicating a therapeutic device that is recommended or deprecated for use in the patient's cerebral infarction catheter treatment.
- the cerebral infarction treatment support system according to item 1.
- the detection device adds the patient information of the patient from which the biological sample was collected to the first information.
- the image control unit Upon receiving the image of the patient to which the patient information is given, The cerebral infarction treatment support system according to item 1 or 2, wherein the image having the same patient information and at least one of the first information and the second information are output to the display unit.
- the image control unit includes a first control device included in the blood vessel X-ray imaging device installed in the catheter room.
- the cerebral infarction treatment support system according to any one of items 1 to 3, wherein the display unit includes a first display unit installed in the catheter room and displaying an X-ray image of the blood vessel X-ray imaging apparatus.
- the first control device includes at least one of the first information and the second information received at the time of catheter treatment of the patient in the catheter room, and the X-ray image of the patient taken by the blood vessel X-ray imaging device.
- the cerebral infarction treatment support system according to item 4, wherein is configured to output to the first display unit.
- the image control unit includes a second control device included in the image viewing terminal installed in the image reading room.
- the cerebral infarction treatment support system according to any one of items 1 to 5, wherein the display unit includes a second display unit installed in the image interpretation room and displaying a screen of the image viewing terminal.
- the second control device receives at least one of the first information and the second information and a CT image or an MRI image of the patient at the time of diagnosing the patient in the reading room, and receives the CT image or the MRI image of the patient, and the second display unit.
- a server that is communicably connected to the detection device and the image control unit and stores the first information is further provided.
- the server generates the second information based on the first information.
- the cerebral infarction treatment support system according to any one of items 1 to 7, wherein the image control unit receives at least the second information from the server.
- the cerebral infarction treatment support system according to item 8, wherein the server includes at least one of a radiological information system server and a medical image management system server connected to a network in a hospital.
- the susceptibility gene for cerebral infarction is described in RNF213 p.
- the cerebral infarction treatment support system according to any one of items 1 to 9, which comprises a gene polymorphism of R4810K.
- the detection device performs gene amplification processing on the biological sample containing a sample containing blood or saliva collected from the patient and a reaction solution containing a component that suppresses the influence of an inhibitor in the sample.
- the cerebral infarction treatment support system according to any one of items 1 to 10, which comprises a gene amplification detection device configured to perform.
- the cerebral infarction treatment support system according to any one of items 1 to 11, wherein the detection device includes a gene amplification detection device that performs a real-time PCR method that performs labeling treatment with a labeling substance in a gene amplification process.
- the detection device includes a gene amplification detection device that performs a real-time PCR method that performs labeling treatment with a labeling substance in a gene amplification process.
- a step of outputting at least one of the received first information and the second information to the display unit is provided.
- the display unit is arranged in at least one of a catheter room in which a blood vessel X-ray imaging device is arranged and an image interpretation room in which an image viewing terminal for a radiodiagnosis image or an MRI image is arranged. Support method.
- Detection device 20 Image control unit 21 Receiver 22 Video output 30 Display 41 First information 42 Second information 42a Information about the type of stroke 42b Information about the patient's cerebrovascular 42c device information (information indicating a therapeutic device) 45 Patient information 50 servers 52 server 52 RIS server (radiology information system server) 53 DICOM server (medical image management system server) 70 Vascular X-ray imaging device 71 First controller 72 1st display unit 73 X-ray image 80 image viewing terminal 81 Second controller 82 Second display unit 100 Cerebral infarction treatment support system 901 Reading room 902 Catheter room
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Abstract
Description
(1)患者頭部に対して、上記特許第4509531号公報のようなCT(Computed Tomography)画像や、MRI(Magnetic Resonance Imaging)画像が撮影される。
(2)撮影された画像に基づいて脳梗塞の種類の判定、血栓の存在箇所の特定などの診断が行われる。
(3)血栓を溶解させるための血栓溶解剤などの薬剤治療が試みられる。
(4)必要に応じてカテーテル治療(血管内治療)による血栓回収等が行われる。
検出装置10は、生体試料2中から、脳梗塞に関する感受性遺伝子(検出対象遺伝子)を検出する。感受性遺伝子を検出するとは、生体試料2に含まれるゲノムDNAにおける特定の塩基配列を検出することである。検出装置10は、検出結果として、生体試料2が脳梗塞に関する感受性遺伝子を有するか否かの第1情報41を生成する。
脳梗塞に関する感受性遺伝子は、たとえば、RNF213p.R4810Kの遺伝子多型を含む。
次に、第2情報42について説明する。図4に示す例では、第2情報42は、脳梗塞の種類に関する情報42a、患者1の脳血管に関する情報42b、患者1の脳梗塞カテーテル治療において使用が推奨または非推奨とされる治療デバイスを示す情報42c(以下、「デバイス情報42c」とする)、の少なくともいずれかを含む。第2情報42は、たとえば使用者に対するメッセージ(文章)の形式で生成される。
図7は、より具体的な脳梗塞治療支援システム100の構成例を示す。脳梗塞治療支援システム100は、病院内ネットワークの一部または全部として構成されうる。
次に、図8を参照して、急性期の脳梗塞患者1の治療の流れを簡単に説明する。
次に、図9を参照して、脳梗塞治療支援システム100の動作を説明する。脳梗塞治療支援システム100により、本実施形態の脳梗塞治療支援方法が実施される。なお、検出装置10については図2を参照し、第1情報41、第2情報42および患者情報45については図4および図6を参照するものとする。
次に、図10および図11を参照して、他の構成例による脳梗塞治療支援システム200を説明する。脳梗塞治療支援システム200により、本実施形態の脳梗塞治療支援方法が実施される。
検出装置210は、患者1から採取された生体試料2を測定し、脳梗塞に関する感受性遺伝子に関連する遺伝子関連情報240を生成する。また、遺伝子関連情報240は、生体試料2が脳梗塞に関する感受性遺伝子を有するか否かの第1情報241と、第1情報241に基づいて生成された感受性遺伝子に関連する第2情報242とを含む。
サーバ250は、検出装置210により生成された遺伝子関連情報240に含まれる第1情報241に基づいて、感受性遺伝子に関連する第2情報242を生成するように構成されている。なお、第1情報241は、第1情報41(図4参照)と同様の情報である。すなわち、第1情報241は、患者情報245と、遺伝子多型あり/なしの情報とを含む。また、患者情報245は、患者情報45(図4参照)と同様の情報であり、識別情報245aが含まれる。識別情報245aは、患者1を特定可能なユニークな情報である。識別情報245aは、たとえば、患者識別番号を含む。また、第2情報242は、第2情報42(図4参照)と同様の情報である。すなわち、第2情報242は、脳梗塞の種類に関する情報42a、患者1の脳血管に関する情報42b、患者1の脳梗塞カテーテル治療において使用が推奨または非推奨とされる治療デバイスを示す情報42cの少なくともいずれかを含む。
次に、図12を参照して、サーバ250が第1情報241および第2情報242を生成する処理について説明する。
本実施形態では、HISサーバ254は、第2情報242と患者情報245とを関連付けた後、直ちに、または、予め設定された期間が経過した後、または、血管X線撮影装置270からの治療終了を示す情報208(図10参照)に基づいて、第1情報241を削除するとともに、患者情報245と関連付けた状態の第2情報242を記憶するように構成されている。本実施形態では、HISサーバ254は、第2情報242と患者情報245とを関連付けた後、血管X線撮影装置270からの治療終了を示す情報208に基づいて、第1情報241を削除するように構成されている。
次に、図14を参照して、サーバ250が、第2情報242と、患者1のCT画像6またはMRI画像7とを血管X線撮影装置270へ送信する処理について説明する。
カテーテル室902に設置された血管X線撮影装置270(図11参照)は、たとえば図15に示す血管撮影装置500である。以下、血管撮影装置500の構成例について詳細に説明する。
図15および図16に示すように、本実施形態の血管撮影装置500は、患者1が載置される天板501と、X線源521と検出部522とを含む撮影部502と、画像処理部503と、制御部504と、表示部505とを備える。
医師等は、脳梗塞を発症している患者1が病院に搬送されたときに、CT画像6またはMRI画像7を撮影する。
本実施形態では、以下のような効果を得ることができる。
本願発明者が、脳梗塞を発症した患者に対してRNF213 p.R4810K多型の有無を確認した結果(症例)について説明する。
なお、今回開示された実施形態は、すべての点で例示であって制限的なものではないと考えられるべきである。本発明の範囲は、上記した実施形態の説明ではなく請求の範囲によって示され、さらに請求の範囲と均等の意味および範囲内でのすべての変更(変形例)が含まれる。
上記した例示的な実施形態は、以下の態様の具体例であることが当業者により理解される。
患者から採取された生体試料を測定し、前記生体試料が脳梗塞に関する感受性遺伝子を有するか否かの第1情報を生成する検出装置と、
血管X線撮影装置が配置されたカテーテル室内と、放射線診断画像またはMRI画像の画像閲覧端末が配置された読影室内と、の少なくともいずれか一方に配置された表示部と、
前記表示部を制御する画像制御部とを備え、
前記画像制御部は、
前記検出装置により生成された前記第1情報、および前記第1情報に基づき生成された前記感受性遺伝子に関連する第2情報の少なくともいずれか一方を受信する受信部と、
受信した前記第1情報および前記第2情報の少なくともいずれか一方を前記表示部に出力する映像出力部とを含む、脳梗塞治療支援システム。
前記画像制御部は、少なくとも前記第2情報を受信して前記表示部に出力するように構成され、
前記第2情報は、脳梗塞の種類に関する情報、前記患者の脳血管に関する情報、前記患者の脳梗塞カテーテル治療において使用が推奨または非推奨とされる治療デバイスを示す情報、の少なくともいずれかを含む、項目1に記載の脳梗塞治療支援システム。
前記検出装置は、前記生体試料が採取された前記患者の患者情報を前記第1情報に付与し、
前記画像制御部は、
前記患者情報が付与された前記患者の画像を受信し、
同一の前記患者情報を有する前記画像と前記第1情報および前記第2情報の少なくとも一方とを、前記表示部に出力する、項目1または2に記載の脳梗塞治療支援システム。
前記画像制御部は、前記カテーテル室に設置された前記血管X線撮影装置が備える第1制御装置を含み、
前記表示部は、前記カテーテル室に設置され前記血管X線撮影装置のX線画像を表示する第1表示部を含む、項目1~3のいずれか1項に記載の脳梗塞治療支援システム。
前記第1制御装置は、前記カテーテル室における前記患者のカテーテル治療時に、受信した前記第1情報および前記第2情報の少なくとも一方と、前記血管X線撮影装置により撮影した前記患者の前記X線画像とを、前記第1表示部に出力するように構成されている、項目4に記載の脳梗塞治療支援システム。
前記画像制御部は、前記読影室に設置された前記画像閲覧端末が備える第2制御装置を含み、
前記表示部は、前記読影室に設置され前記画像閲覧端末の画面表示を行う第2表示部を含む、項目1~5のいずれか1項に記載の脳梗塞治療支援システム。
前記第2制御装置は、前記読影室における前記患者の診断時に、前記第1情報および前記第2情報の少なくとも一方と、前記患者のCT画像またはMRI画像とを受信して、前記第2表示部に出力するように構成されている、項目6に記載の脳梗塞治療支援システム。
前記検出装置および前記画像制御部と通信可能に接続され、前記第1情報を記憶するサーバをさらに備え、
前記サーバは、前記第1情報に基づいて前記第2情報を生成し、
前記画像制御部は、前記サーバから少なくとも前記第2情報を受信する、項目1~7のいずれか1項に記載の脳梗塞治療支援システム。
前記サーバは、病院内のネットワークに接続された放射線科情報システムサーバおよび医療用画像管理システムサーバの少なくともいずれかを含む、項目8に記載の脳梗塞治療支援システム。
前記脳梗塞に関する感受性遺伝子は、RNF213 p.R4810Kの遺伝子多型を含む、項目1~9のいずれか1項に記載の脳梗塞治療支援システム。
前記検出装置は、前記患者から採取された血液または唾液を含む検体と、検体中の阻害物質の影響を抑制する成分を含む反応液とを含有した前記生体試料に対して、遺伝子の増幅処理を行うように構成された遺伝子増幅検出装置を含む、項目1~10のいずれか1項に記載の脳梗塞治療支援システム。
前記検出装置は、遺伝子の増幅過程で標識物質による標識処理を行うリアルタイムPCR法を行う遺伝子増幅検出装置を含む、項目1~11のいずれか1項に記載の脳梗塞治療支援システム。
患者から採取された生体試料を測定し、前記生体試料が脳梗塞に関する感受性遺伝子を有するか否かの第1情報を生成するステップと、
生成された前記第1情報、および前記第1情報に基づき生成された前記感受性遺伝子に関連する第2情報の少なくともいずれかを受信するステップと、
受信した前記第1情報および前記第2情報の少なくともいずれか一方を、表示部に出力するステップと、を備え、
前記表示部は、血管X線撮影装置が配置されたカテーテル室内と、放射線診断画像またはMRI画像の画像閲覧端末が配置された読影室内と、の少なくともいずれか一方に配置されている、脳梗塞治療支援方法。
急患として搬入された前記患者から採取された前記生体試料により生成された前記第1情報に前記患者の患者情報を付与するステップをさらに備え、
少なくとも前記患者の治療時までに、受信された前記第1情報および前記第2情報の少なくともいずれかが前記患者情報とともに前記表示部に表示される、項目13に記載の脳梗塞治療支援方法。
2 生体試料
2a 検体
2c 反応液
5 治療デバイス
6 CT画像
7 MRI画像
10 検出装置
20 画像制御部
21 受信部
22 映像出力部
30 表示部
41 第1情報
42 第2情報
42a 脳梗塞の種類に関する情報
42b 患者の脳血管に関する情報
42c デバイス情報(治療デバイスを示す情報)
45 患者情報
50 サーバ
52 サーバ
52 RISサーバ(放射線科情報システムサーバ)
53 DICOMサーバ(医療用画像管理システムサーバ)
70 血管X線撮影装置
71 第1制御装置
72 第1表示部
73 X線画像
80 画像閲覧端末
81 第2制御装置
82 第2表示部
100 脳梗塞治療支援システム
901 読影室
902 カテーテル室
Claims (14)
- 患者から採取された生体試料を測定し、前記生体試料が脳梗塞に関する感受性遺伝子を有するか否かの第1情報を生成する検出装置と、
血管X線撮影装置が配置されたカテーテル室内と、放射線診断画像またはMRI画像の画像閲覧端末が配置された読影室内と、の少なくともいずれか一方に配置された表示部と、
前記表示部を制御する画像制御部とを備え、
前記画像制御部は、
前記検出装置により生成された前記第1情報、および前記第1情報に基づき生成された前記感受性遺伝子に関連する第2情報の少なくともいずれか一方を受信する受信部と、
受信した前記第1情報および前記第2情報の少なくともいずれか一方を前記表示部に出力する映像出力部とを含む、脳梗塞治療支援システム。 - 前記画像制御部は、少なくとも前記第2情報を受信して前記表示部に出力するように構成され、
前記第2情報は、脳梗塞の種類に関する情報、前記患者の脳血管に関する情報、前記患者の脳梗塞カテーテル治療において使用が推奨または非推奨とされる治療デバイスを示す情報、の少なくともいずれかを含む、請求項1に記載の脳梗塞治療支援システム。 - 前記検出装置は、前記生体試料が採取された前記患者の患者情報を前記第1情報に付与し、
前記画像制御部は、
前記患者情報が付与された前記患者の画像を受信し、
同一の前記患者情報を有する前記画像と前記第1情報および前記第2情報の少なくとも一方とを、前記表示部に出力する、請求項1に記載の脳梗塞治療支援システム。 - 前記画像制御部は、前記カテーテル室に設置された前記血管X線撮影装置が備える第1制御装置を含み、
前記表示部は、前記カテーテル室に設置され前記血管X線撮影装置のX線画像を表示する第1表示部を含む、請求項1に記載の脳梗塞治療支援システム。 - 前記第1制御装置は、前記カテーテル室における前記患者のカテーテル治療時に、受信した前記第1情報および前記第2情報の少なくとも一方と、前記血管X線撮影装置により撮影した前記患者の前記X線画像とを、前記第1表示部に出力するように構成されている、請求項4に記載の脳梗塞治療支援システム。
- 前記画像制御部は、前記読影室に設置された前記画像閲覧端末が備える第2制御装置を含み、
前記表示部は、前記読影室に設置され前記画像閲覧端末の画面表示を行う第2表示部を含む、請求項1に記載の脳梗塞治療支援システム。 - 前記第2制御装置は、前記読影室における前記患者の診断時に、前記第1情報および前記第2情報の少なくとも一方と、前記患者のCT画像またはMRI画像とを受信して、前記第2表示部に出力するように構成されている、請求項6に記載の脳梗塞治療支援システム。
- 前記検出装置および前記画像制御部と通信可能に接続され、前記第1情報を記憶するサーバをさらに備え、
前記サーバは、前記第1情報に基づいて前記第2情報を生成し、
前記画像制御部は、前記サーバから少なくとも前記第2情報を受信する、請求項1に記載の脳梗塞治療支援システム。 - 前記サーバは、病院内のネットワークに接続された放射線科情報システムサーバおよび医療用画像管理システムサーバの少なくともいずれかを含む、請求項8に記載の脳梗塞治療支援システム。
- 前記脳梗塞に関する感受性遺伝子は、RNF213 p.R4810Kの遺伝子多型を含む、請求項1に記載の脳梗塞治療支援システム。
- 前記検出装置は、前記患者から採取された血液または唾液を含む検体と、検体中の阻害物質の影響を抑制する成分を含む反応液とを含有した前記生体試料に対して、遺伝子の増幅処理を行うように構成された遺伝子増幅検出装置を含む、請求項1に記載の脳梗塞治療支援システム。
- 前記検出装置は、遺伝子の増幅過程で標識物質による標識処理を行うリアルタイムPCR法を行う遺伝子増幅検出装置を含む、請求項1に記載の脳梗塞治療支援システム。
- 患者から採取された生体試料を測定し、前記生体試料が脳梗塞に関する感受性遺伝子を有するか否かの第1情報を生成するステップと、
生成された前記第1情報、および前記第1情報に基づき生成された前記感受性遺伝子に関連する第2情報の少なくともいずれかを受信するステップと、
受信した前記第1情報および前記第2情報の少なくともいずれか一方を、表示部に出力するステップと、を備え、
前記表示部は、血管X線撮影装置が配置されたカテーテル室内と、放射線診断画像またはMRI画像の画像閲覧端末が配置された読影室内と、の少なくともいずれか一方に配置されている、脳梗塞治療支援方法。 - 急患として搬入された前記患者から採取された前記生体試料により生成された前記第1情報に前記患者の患者情報を付与するステップをさらに備え、
少なくとも前記患者の治療時までに、受信された前記第1情報および前記第2情報の少なくともいずれかが前記患者情報とともに前記表示部に表示される、請求項13に記載の脳梗塞治療支援方法。
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US17/770,374 US20220401043A1 (en) | 2019-10-29 | 2020-10-28 | Cerebral infarction treatment support system |
KR1020227017151A KR20220082914A (ko) | 2019-10-29 | 2020-10-28 | 뇌경색 치료 지원 시스템 |
EP20881310.5A EP4052650A4 (en) | 2019-10-29 | 2020-10-28 | SYSTEM TO SUPPORT THE TREATMENT OF STROKE |
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