WO2023237083A1

WO2023237083A1 - Nodule positioning method and apparatus, and auxiliary measuring tool

Info

Publication number: WO2023237083A1
Application number: PCT/CN2023/099302
Authority: WO
Inventors: 成兴华
Original assignee: 上海市胸科医院
Priority date: 2022-06-09
Filing date: 2023-06-09
Publication date: 2023-12-14
Also published as: CN115024741A; CN115024741B

Abstract

The present application provides a nodule positioning method and apparatus, and an auxiliary measuring tool. The method comprises: acquiring a thin-layer CT image of a patient, and constructing, on the basis of the thin-layer CT image, a three-dimensional digital model of a target part of the patient, wherein a nodule is marked in the three-dimensional digital model; determining, on the basis of the three-dimensional digital model, a projection point and a plurality of anatomical mark points of the nodule on a surface of the target part; and determining, on the basis of the projection point, the plurality of anatomical mark points and the auxiliary measuring tool, an actual nodule position of the patient. In the method, only one-time initial diagnosis CT is needed for three-dimensional modeling, and the patient is under general anesthesia throughout the entire process, without involving a puncture process, such that radiation exposure can be reduced, the pain of the patient is relieved, risks are reduced, cross infection is prevented, positioning time and labor costs are reduced, and dependence on equipment is reduced, facilitating popularization of pulmonary nodule precise resection operation.

Description

Nodule positioning methods, devices and auxiliary measurement tools

Cross-references to related applications

This application claims priority to the Chinese patent application with application number 202210653301.9 and titled "Nodule positioning method, device and auxiliary measurement tool" submitted to the State Intellectual Property Office of China on June 9, 2022, the entire content of which is incorporated by reference. incorporated in this application.

Technical field

The present application relates to the technical field of medical devices, and in particular to a nodule positioning method, device and auxiliary measurement tool.

Background technique

Pulmonary nodule localization technology is a key technology in minimally invasive and precise resection of early-stage lung cancer. At present, preoperative puncture placement of markers under the guidance of optical or magnetic navigation is mainly relied upon to locate and visualize nodules. During the operation, the surgeon predicts the corresponding location of the pulmonary nodule based on the location of the lung surface markers, thereby achieving precise resection of the pulmonary nodule under minimally invasive thoracoscopic surgery. Preoperative CT (Computed Tomography)-guided placement of lung surface markers to assist in nodule localization is the most common method.

However, since CT equipment is usually not installed in the operating room and the patient needs to be awake to complete the puncture, the above method mainly has the following shortcomings: (1) The patient is undergoing puncture (about 15-30 minutes) and while waiting for the operation after puncture (several seconds). (10 minutes to several hours) are subject to great pain and fear; (2) repeated CT irradiation increases radiation exposure; (3) anesthesiologists and nurses are required to provide care and management after puncture positioning; (4) complications such as pneumothorax and bleeding cannot be Timely treatment, high risk; (5) Limited by space, equipment and personnel, many hospitals are unable to carry out this technology, thus limiting the promotion of precise pulmonary nodule resection surgery.

Contents of the invention

In view of this, this application provides a nodule positioning method, a nodule positioning device and an auxiliary measurement tool, which can reduce radiation exposure, reduce patient pain, reduce risks, prevent cross-infection, reduce positioning time and labor costs, and reduce equipment costs. Dependence is conducive to the promotion of accurate pulmonary nodule resection surgery.

Embodiments of the present application provide a nodule positioning method. The nodule positioning method may include: acquiring a thin-section CT image of a patient, and constructing a three-dimensional digital model of the patient's target part based on the thin-section CT image; wherein, the three-dimensional digital model There are nodules marked in the center; the projection point of the nodule on the surface of the target site and multiple anatomical landmark points are determined based on the three-dimensional digital model; the actual nodule position of the patient is determined based on the projection point, multiple anatomical landmark points and auxiliary measurement tools.

In an optional embodiment of the present application, the target site may be the lungs, and the anatomical landmark points may include at least one of the following: the apex of the right upper lung, the apex of the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, and the horizontal fissure of the right lung. The intersection point with the oblique fissure, the intersection point between the horizontal fissure and the medial edge of the right upper lung, the first costal indentation of the right upper lung, the intersection point of the lower edge of the right lower lung and the thoracic indentation, the medial end point of the lower edge of the right lower lung, the lowest point of the right middle lung, the upper right The lowest point of the pulmonary tracheal pressure trace, the right lower pulmonary vein pressure trace, and the lateral end of the lower edge of the right lower lung point.

In an optional embodiment of the present application, the above-mentioned anatomical landmark points may include: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the intersection of the horizontal fissure and the oblique fissure of the right lung; wherein, the right upper lung The apex point is the first point, the intersection point of the posterior segment of the right upper lung and the dorsal segment of the lower lung is the second point, and the intersection point of the horizontal fissure and oblique fissure of the right lung is the third point; based on projection points, multiple anatomical landmark points and auxiliary measurements The steps for the tool to determine the patient's actual nodule location may include: connecting the first point and the third point as a first line segment; connecting the second point and the projection point as a second line segment; determining the extension line of the second line segment and The intersection point of the first line segment is the first relative position on the first line segment; the intersection point of the second point, the extension line of the second line segment and the first line segment is regarded as the third line segment; determine where the projection point is on the third line segment The second relative position; determines the patient's actual nodule position based on the anatomical landmark point, the first relative position, the second relative position and the auxiliary measurement tool.

In an optional embodiment of the present application, the patient's lungs may be provided with actual landmark points that correspond one-to-one to the anatomical landmark points; wherein the first actual landmark point corresponds to the first point, and the second actual landmark point corresponds to The second point corresponds to the third actual landmark point and the third point corresponds to the third point.

In an optional embodiment of the present application, the above-mentioned auxiliary measurement tool can be provided with a fixed component, a first sliding component and a second sliding component in sequence; based on the anatomical landmark points, the first relative position, the second relative position and the auxiliary measurement tool The step of determining the patient's actual nodule location may include: setting the auxiliary measurement tool in the patient's chest; wherein the auxiliary measurement tool is curved and set based on the patient's lung surface shape; connecting the fixed component of the auxiliary measurement tool with the first actual landmark point Coincide, move the second sliding part to the third actual mark point, and move the first sliding part based on the first relative position; mark the first position on the patient's lungs based on the position of the first sliding part; fix the auxiliary measurement tool The component coincides with the second actual landmark point, the second sliding component is moved to the first position, and the first sliding component is moved based on the second relative position; the second position is marked on the patient's lungs based on the position of the first sliding component, and the second sliding component is moved to the first position. The second location serves as the patient's actual nodule location.

In an optional embodiment of the present application, the first location and the second location may be marked on the patient's lungs by electrocautery.

Embodiments of the present application also provide a nodule positioning device. The nodule positioning device may include: a three-dimensional digital model building module for acquiring a thin-section CT image of a patient, and constructing a three-dimensional model of the patient's target part based on the thin-section CT image. Digital model; wherein, the three-dimensional digital model is marked with nodules; a projection point and anatomical landmark point determination module is used to determine the projection point of the nodule on the surface of the target site and multiple anatomical landmark points based on the three-dimensional digital model; the actual nodule position Determination module for determining the patient's actual nodule location based on projection points, multiple anatomical landmark points, and auxiliary measurement tools.

In an optional embodiment of the present application, the target site may be the lungs, and the anatomical landmark points may include at least one of the following: the apex of the right upper lung, the apex of the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, and the horizontal fissure of the right lung. The intersection point with the oblique fissure, the intersection point with the horizontal fissure and the medial edge of the right upper lung, the first costal indentation of the right upper lung, the intersection point of the lower edge of the right lower lung and the thoracic indentation, the medial end point of the lower edge of the right lower lung, the lowest point of the right middle lung, the upper right The lowest point of the pulmonary tracheal indentation, the indentation of the right lower pulmonary vein, and the lateral end point of the lower edge of the right lower lung.

In an optional embodiment of the present application, the above-mentioned anatomical landmark points may include: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the intersection of the horizontal fissure and the oblique fissure of the right lung; wherein, the right upper lung The apex point is the first point, the intersection point of the posterior segment of the right upper lung and the posterior segment of the lower lung is the second point, and the intersection point of the horizontal fissure and oblique fissure of the right lung is the third point; the actual nodule location determination module can also be configured to use In: connect the first point and the third point as the first line segment; connect the second point and the projection point as the second line segment; determine the intersection point of the extension line of the second line segment and the first line segment, at the first line segment the first relative position on The relative position, the second relative position and the auxiliary measurement tool determine the patient's actual nodule position.

In an optional embodiment of the present application, the above-mentioned auxiliary measurement tool can be provided with a fixed component, a first sliding component, and a second sliding component in sequence; the actual nodule position determination module can also be configured to: use the auxiliary measurement tool Set in the patient's chest; wherein, the auxiliary measurement tool is curved and set based on the shape of the patient's lung surface; the fixed part of the auxiliary measurement tool is coincident with the first actual landmark point, the second sliding part is moved to the third actual landmark point, and based on Move the first sliding part to the first relative position; mark the first position on the patient's lungs based on the position of the first sliding part; coincide the fixed part of the auxiliary measurement tool with the second actual marking point, and move the second sliding part to the first relative position. a position, and move the first sliding part based on the second relative position; mark a second position on the patient's lungs based on the position of the first sliding part, and use the second position as the actual nodule position of the patient.

The embodiment of the present application also provides an auxiliary measurement tool, which is used to perform the above nodule positioning method; the auxiliary measurement tool may include: an elastic component, an elastic measuring ruler with a scale, a fixed component, and a first sliding component. and a second sliding component; the elastic component is configured to be curved based on the surface shape of the patient's target site; the elastic measuring ruler is provided with a percentage scale, and the elastic measuring ruler expands and contracts in equal proportion to the elastic component; the fixed component is fixed at the top of the elastic component The starting side, and the fixed component is fixed at the starting end of the elastic measuring ruler; the second sliding component is fixed at the end end of the elastic measuring ruler, and the second sliding component is slidably arranged in the elastic component; the first sliding component is arranged between the fixed component and the second Between the sliding components, the first sliding component is slidably disposed in the elastic component.

In an optional embodiment of the present application, the elastic component may include: a hose, a soft ruler or a spring.

In an optional embodiment of the present application, the fixed part, the first sliding part and the second sliding part may all be clips; or the fixed part may be a scaler, and the first sliding part and the second sliding part may be a vernier.

The embodiments of the present application at least bring the following beneficial effects:

The embodiments of this application provide a nodule positioning method, device and auxiliary measurement tool based on the patient's thin-slice CT The image constructs a three-dimensional digital model of the patient's target site marked with nodules; determines the projection point of the nodule on the surface of the target site and multiple anatomical landmark points based on the three-dimensional digital model; based on the projection point, multiple anatomical landmark points and auxiliary measurement tools Determine the patient's actual nodule location. In this method, only one initial diagnostic CT is needed for three-dimensional modeling. The patient is under general anesthesia throughout the entire process, and no puncture process is involved. It can reduce radiation exposure, reduce patient pain, reduce risks, prevent cross-infection, reduce positioning time and labor costs, and reduce the risk of Dependence on equipment is conducive to the promotion of precise pulmonary nodule resection surgery.

Other features and advantages of the present disclosure will be set forth in the subsequent description, or some of the features and advantages may be inferred or unambiguously determined from the description, or may be learned by practicing the above-mentioned techniques of the present disclosure.

In order to make the above-mentioned objects, features and advantages of the present disclosure more obvious and understandable, preferred embodiments are given below and described in detail with reference to the accompanying drawings.

Description of the drawings

In order to more clearly explain the technical solutions in the specific embodiments of the present application or related technologies, the drawings that need to be used in the description of the specific embodiments or related technologies will be briefly introduced below. Obviously, the drawings in the following description are: For some embodiments of the present application, those of ordinary skill in the art can also obtain other drawings based on these drawings without exerting creative efforts.

Figure 1 is a schematic diagram of a nodule positioning method provided by an embodiment of the present application;

Figure 2 is a flow chart of a nodule positioning method provided by an embodiment of the present application;

Figure 3 is a flow chart of another nodule positioning method provided by an embodiment of the present application;

Figure 4 is a schematic diagram of a three-dimensional digital model provided by an embodiment of the present application;

Figure 5 is a schematic diagram of an anatomical landmark point provided by an embodiment of the present application;

Figure 6 is a schematic diagram of a technical path for pulmonary nodule resection provided by an embodiment of the present application;

Figure 7 is a schematic structural diagram of an auxiliary measurement tool provided by an embodiment of the present application;

Figure 8 is a schematic structural diagram of a nodule positioning device provided by an embodiment of the present application;

Figure 9 is a schematic structural diagram of an electronic device provided by an embodiment of the present application.

Detailed ways

In order to make the purpose, technical solutions and advantages of the embodiments of the present application clearer, the technical solutions of the present application will be clearly and completely described below in conjunction with the accompanying drawings. Obviously, the described embodiments are part of the embodiments of the present application, not all of them. Embodiments. Based on the embodiments in this application, all other embodiments obtained by those of ordinary skill in the art without creative efforts fall within the scope of protection of this application.

At present, preoperative puncture placement of markers under the guidance of optical or magnetic navigation is mainly relied upon to locate and visualize nodules. During the operation, the surgeon predicts the corresponding location of the pulmonary nodule based on the location of the lung surface markers, thereby achieving precise resection of the pulmonary nodule under minimally invasive thoracoscopic surgery. Referring to the schematic diagram of a nodule localization method shown in Figure 1, the most commonly used method is to place lung surface markers to assist nodule localization through preoperative CT guidance.

Based on this, the embodiments of this application provide a nodule positioning method, device and auxiliary measurement tool, which mainly relate to the design of an auxiliary measurement tool for the lung surface during surgery. Through this measurement tool and supplemented by three-dimensional lung reconstruction model planning, intraoperative measurement and positioning of pulmonary nodules can be achieved. At the same time, this tool can also avoid measurement errors caused by the mismatch between the preoperative reconstruction model and the real collapsed lung caused by patient's lung collapse. This method can avoid many problems caused by traditional preoperative CT-guided puncture pulmonary nodule localization methods, such as patient pain, repeated radiation exposure, pneumothorax and bleeding risks, and at the same time reduce the cost of pulmonary nodule localization on manpower, space, and equipment. Dependence is conducive to promotion.

In order to facilitate understanding of this embodiment, a nodule positioning method disclosed in the embodiment of this application is first introduced in detail.

Example 1:

The embodiment of the present application provides a nodule positioning method. Refer to the flow chart of a nodule positioning method shown in Figure 2. The nodule positioning method may include the following steps:

Step S202: Obtain a thin-section CT image of the patient, and construct a three-dimensional digital model of the patient's target part based on the thin-section CT image; wherein the three-dimensional digital model is marked with nodules.

CT is a technology that uses accurately collimated X-ray beams, gamma rays, ultrasound, etc., together with extremely sensitive detectors, to conduct cross-sectional scans around a certain part of the human body one after another. It has the advantages of fast scanning time, clear images, etc. Features. Among them, thin layer refers to the situation where the single scanning layer is ≤5mm, and the interval between each scan of thin layer CT scan is small.

Through thin-section CT scans of thin-section CT images, a three-dimensional digital model of the patient's target part can be constructed. The target site of the patient in this embodiment may be the patient's lungs, which will not be described again in this embodiment.

Step S204: Determine the projection point of the nodule on the surface of the target site and multiple anatomical landmark points based on the three-dimensional digital model.

Anatomical landmark points are all points on the surface of the target part, which can be understood as the points where the patient's actual landmark points and actual nodule positions are projected on the surface of the target part through the Euler space shortest module projection algorithm. Multiple actual landmark points can be marked on the patient's lungs in advance. The actual landmark points correspond to the anatomical landmark points in the three-dimensional digital model. The actual nodule position of the patient corresponds to the projection point in the three-dimensional digital model. Among them, the selection criteria for actual landmark points may include: (1) being an anatomical point common in all cases; (2) being easy to find during thoracoscopic surgery; (3) its location being less affected by respiration or cardiac pulsation.

Step S206: Determine the patient's actual nodule location based on the projection point, multiple anatomical landmark points and auxiliary measurement tools.

The relative positional relationship between the patient's actual nodule position and the actual landmark point at the patient's target position can be determined based on the projection point and multiple anatomical landmark points, and the patient's actual nodule position can be determined in the patient's lungs through auxiliary measurement tools and relative positional relationships. .

An embodiment of the present application provides a nodule positioning method that constructs a three-dimensional digital model of the patient's target site marked with nodules based on the patient's thin-section CT images; determines the projection point of the nodule on the surface of the target site based on the three-dimensional digital model and Multiple anatomical landmark points; determine the patient's actual nodule location based on projection points, multiple anatomical landmark points, and auxiliary measurement tools. In this method, only one initial diagnostic CT is needed for three-dimensional modeling. The patient is under general anesthesia throughout the entire process, and no puncture process is involved. It can reduce radiation exposure, reduce patient pain, reduce risks, prevent cross-infection, reduce positioning time and labor costs, and reduce the risk of Dependence on equipment is conducive to the promotion of precise pulmonary nodule resection surgery.

Example 2:

This embodiment provides another nodule positioning method. This method is implemented on the basis of the above embodiment. Refer to the flow chart of another nodule positioning method shown in Figure 3. The nodule positioning method may include the following steps. :

Step S302: Obtain a thin-section CT image of the patient, and construct a three-dimensional digital model of the patient's target part based on the thin-section CT image; wherein the three-dimensional digital model is marked with nodules.

For example, modeling can be performed based on thin-section CT images of patients' physical examinations, and a three-dimensional digital model can be generated and the locations of nodules can be marked at the same time. See Figure 4 for a schematic diagram of a three-dimensional digital model. The three-dimensional digital model can be marked with nodules. .

Step S304: Determine the projection point of the nodule on the surface of the target site and multiple anatomical landmark points based on the three-dimensional digital model.

Specifically, the target site may be the lungs, and the anatomical landmark points may include at least one of the following: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the intersection of the horizontal and oblique fissures of the right lung, the horizontal The intersection point of the fissure and the medial edge of the right upper lung, the first costal indentation of the right upper lung, the intersection of the lower edge of the right lower lung and the indentation of the thoracic spine, the medial end point of the lower edge of the right lower lung, the lowest point of the right middle lung, the lowest point of the tracheal indentation of the right upper lung, Right lower pulmonary vein pressure trace, lateral endpoint of the lower edge of the right lower lung.

Refer to the schematic diagram of an anatomical landmark point shown in Figure 5. Point A in Figure 5 is the apex of the right upper lung, point B is the apex of the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, and point C is the horizontal fissure of the right lung and the dorsal segment of the lower lung. The intersection point of the oblique fissure, point D is the intersection point of the horizontal fissure and the medial edge of the right upper lung, and point N is the projection point.

This embodiment does not necessarily require all the anatomical landmarks mentioned above, only some of the anatomical landmarks are required. The anatomical landmarks may include: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the apex of the right upper lung, and the dorsal segment of the lower lung. Take the intersection point of horizontal fissure and oblique fissure as an example. Among them, the apex of the right upper lung is the first point (hereinafter referred to as point A), the apex of the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung is the second point (hereinafter referred to as point B), and the intersection of the horizontal and oblique fissures of the right lung. The point is the third point (hereinafter referred to as point C).

Step S306: Determine the patient's actual nodule position based on the anatomical landmark point, the first relative position, the second relative position and the auxiliary measurement tool.

Specifically, the first point and the third point can be connected as a first line segment; the second point and the projection point can be connected as a second line segment; Determine the intersection point of the extension line of the second line segment and the first line segment, and the first relative position on the first line segment; use the intersection point of the second point, the extension line of the second line segment and the first line segment as the third line segment; Determine the second relative position of the projection point on the third line segment; determine the patient's actual nodule position based on the anatomical landmark point, the first relative position, the second relative position and the auxiliary measurement tool.

As shown in Figure 5, in the three-dimensional digital model, connect the AC point (line segment AC is the first line segment), connect the BN point (line segment BN is the first line segment) and extend it to intersect AC at point P (point P is the above-mentioned intersection point). ), and calculate the length of the shortest path of AP, AC, BN, and PN, where line segment BP is the third line segment. Calculate the first relative position of point P on AC, expressed by X%. X=AP/AC*100; calculate the second relative position of point N on BP, represented by Y%, Y=BN/BP*100.

In this embodiment, the patient's lungs may be provided with actual landmark points that correspond to the anatomical landmark points one-to-one; wherein, the first actual landmark point corresponds to the first point, the second actual landmark point corresponds to the second point, and the third actual landmark point corresponds to the second point. The marker point corresponds to the third point.

The auxiliary measurement tool in this embodiment may be provided with a fixed component, a first sliding component and a second sliding component in sequence. Specifically, the patient's actual nodule position can be determined based on the anatomical landmark point, the first relative position, the second relative position and the auxiliary measurement tool through the following steps: placing the auxiliary measurement tool in the patient's chest; wherein, the auxiliary measurement The tool is curved and set based on the shape of the patient's lung surface; the fixed component of the auxiliary measurement tool is coincident with the first actual landmark point, the second sliding component is moved to the third actual landmark point, and the first sliding component is moved based on the first relative position; Mark a first position on the patient's lungs based on the position of the first sliding part; coincide the fixed part of the auxiliary measurement tool with the second actual landmark point, move the second sliding part to the first position, and move based on the second relative position a first sliding component; marking a second position on the patient's lungs based on the position of the first sliding component, and using the second position as the patient's actual nodule position.

Due to the effect of artificial pneumothorax, the patient's lungs are likely to collapse in equal proportions. Therefore, the positions of the anatomical landmark points and the actual landmark points are likely to be different. However, the positions of the anatomical landmark points and the actual landmark points generally change in equal proportions. .

Referring to the schematic diagram of a technical path for pulmonary nodule resection shown in Figure 6, points A', B', and C' in Figure 6(a) are the first actual landmark point, the second actual landmark point, and the third actual landmark point respectively. For the actual landmark point, place the auxiliary measurement tool into the patient's chest, coincide the O point on the tool (that is, the fixed part of the auxiliary measurement tool) with the first actual landmark point A', and record the third actual landmark point C' Corresponding scale on the elastic part of the auxiliary measuring tool.

In order to avoid the difficulty of moving the cursor in the body during thoracic surgery, the auxiliary measurement tool can be taken out of the body and the second sliding part Q is moved to the position corresponding to the third actual landmark point C’. Then move and fix the first sliding part Z of the cursor to the X% position (i.e., the first relative position) calculated before surgery on the elastic measuring ruler, so that OZ/ZQ=AP/PC.

The auxiliary measurement tool is placed into the chest again. Point O of the fixed component and point Q of the second sliding component coincide with the first actual landmark point A' and the third actual landmark point C' respectively. The cursor on the auxiliary measurement tool is the first sliding component Z. The position corresponds to point P', which is the moving position of the first sliding component. The first position P' can be marked on the patient's lungs through electrocautery.

Coincide point O of the fixed component of the auxiliary measurement tool with point B' of the second actual mark point, and record point P' on the elastic component corresponding scale.

Take out the auxiliary measuring tool, move point Q of the second sliding part to the position corresponding to point P', adjust the first sliding part Z on the elastic ruler and fix it to the Y% position calculated before surgery (i.e. the second correct position), so that OZ /ZQ=BN/NP.

As shown in Figure 6(b), put the auxiliary measurement tool into the chest cavity again, overlap point O of the second sliding part with point B' of the second actual landmark point, and overlap point Q of the second sliding part with point P'. The corresponding position of a sliding component Z is the N' point position. As shown in Figure 6(c), point N’ is the calculated projection point position of the pulmonary nodule on the lung surface, that is, the second position N’ can be marked on the patient’s lungs through electrocautery. Afterwards, local lung resection can be performed according to the position marked by electrocautery to complete the resection of pulmonary nodules.

The traditional CT-guided pulmonary nodule localization method requires additional CT equipment before surgery and requires professional operations. Patients are repeatedly exposed to additional radiation and often experience unbearable pain. During the puncture process, there are also risks such as pneumothorax and bleeding. , reducing the safety of minimally invasive surgery.

The above method provided by the embodiments of the present application uses CT three-dimensional reconstruction technology to achieve intraoperative measurement and positioning of pulmonary nodules through measurement tools after three-dimensional surface distance measurement, which can completely avoid the shortcomings of traditional CT-guided pulmonary nodule puncture positioning methods. It allows patients to complete nodule positioning under general anesthesia, which is safe, non-invasive and accurate. Specifically, it has the following advantages:

(1) Reduce radiation exposure: The traditional CT guidance method requires additional CT scans before surgery after the patient completes the initial diagnostic CT. During the puncture process, repeated CT irradiation is required to determine the position of the positioning marker. The method provided by this embodiment only requires one initial diagnostic CT for three-dimensional modeling, which greatly reduces radiation damage.

(2) Reduce pain: Local anesthesia for patients during the traditional CT-assisted positioning method often causes unbearable pain. After the puncture is completed, the metal markers remain in the body, and the patient needs to be awake to wait for the operation to begin, further increasing the pain. During the positioning process of the method provided by this embodiment, the patient is under general anesthesia throughout the entire process without additional trauma or pain.

(3) Risk reduction: The traditional CT-guided puncture positioning method may cause damage to the lungs, blood vessels, etc. during the puncture process, causing the patient risks such as pneumothorax and bleeding. While the patient completes the puncture and waits for the operation, if the related complications cannot be treated in time , which may cause shock and other risks. The auxiliary measurement tool provided by this embodiment can complete the positioning during the operation, does not involve the puncture process, and avoids the risk of hemothorax and pneumothorax.

(4) Prevent cross-infection: With the traditional CT guidance method, multiple patients often share a CT to complete the operation during preoperative positioning, which greatly increases the risk of cross-infection between medical staff and patients during the operation. This embodiment can achieve individualized positioning without the need to share puncture equipment, thus avoiding the risk of cross-infection during the positioning process.

(5) Reduce time: The traditional CT positioning method takes about 30 minutes. The positioning time of the auxiliary equipment of this application can be controlled to 5-10 minutes, which greatly reduces the time required for positioning.

(6) Labor costs: The traditional CT positioning method requires additional radiology nurses to assist in completing the operation, which wastes labor costs. However, the method provided by this embodiment only requires the surgeon to complete the operation during the operation, which reduces labor costs.

(7) Equipment dependence: This operation does not require high-cost fixed equipment such as CT, which reduces the dependence of positioning technology on equipment and is conducive to the promotion of this technology.

Embodiment three:

This embodiment provides an auxiliary measurement tool, which is applied to the nodule positioning method provided in the above embodiment. The auxiliary measurement tool may include: an elastic component, an elastic measuring ruler with a scale, a fixed component, a first sliding part and second sliding part.

The elastic component is configured to be curved based on the surface shape of the patient's target site; the elastic measuring ruler is provided with a percentage scale, and the elastic measuring ruler expands and contracts in equal proportion to the elastic component; the fixed component is fixed to the starting side of the elastic component, and the fixed component is fixed at the starting end of the elastic measuring ruler; the second sliding part is fixed at the end end of the elastic measuring ruler, and the second sliding part is slidably arranged in the elastic part; the first sliding part is arranged between the fixed part and the second sliding part, A sliding component is slidably disposed in the elastic component.

Specifically, the elastic component may include: a hose, a flexible ruler or a spring.

Specifically, the fixed component, the first sliding component, and the second sliding component may all be clips; or, the fixed component may be a scaler, and the first sliding component and the second sliding component may be a vernier.

Among them, for example, the elastic component includes a hose, the fixed component is the calibration, and the first sliding component and the second sliding component are both cursors. Refer to the structural diagram of an auxiliary measurement tool shown in Figure 7. The calibration O is the fixed component. components, the cursor Z is the first sliding component, and the cursor Q is the second sliding component.

During the operation, the surgeon can hold the graduated plastic hose to measure within the chest cavity, and it can be bent to a certain extent according to the shape of the lung surface. The scale of the elastic measuring ruler with scale has a percentage on it, and the elastic measuring ruler can expand and contract in equal proportions.

Calibration O is always located on one side of the shaping hose and is connected to one end of the elastic measuring ruler. Vernier Q is connected to the other end of the elastic measuring ruler and can be moved and fixed on the hose. Vernier Z can be manually slid on the elastic measuring ruler.

Those skilled in the art can clearly understand that for the convenience and simplicity of description, the specific working process of the above-described auxiliary measurement tool can be referred to the corresponding process in the embodiment of the nodule positioning method, and will not be described again here. .

Embodiment 4:

Corresponding to the above method embodiments, embodiments of the present application provide a nodule positioning device. Refer to Figure 8 for a schematic structural diagram of a nodule positioning device. The nodule positioning device may include:

Three-dimensional digital model building module 81. The three-dimensional digital model building module 81 is configured to obtain a thin-section CT image of the patient, and construct a three-dimensional digital model of the patient's target part based on the thin-section CT image; wherein, the markers in the three-dimensional digital model There are nodules;

Projection point and anatomical landmark point determination module 82, the projection point and anatomical landmark point determination module 82 is configured to determine the projection point of the nodule on the surface of the target site and a plurality of anatomical landmark points based on the three-dimensional digital model;

The actual nodule position determination module 83 is configured to determine the patient's actual nodule position based on the projection point, a plurality of anatomical landmark points and auxiliary measurement tools.

An embodiment of the present application provides a nodule positioning device that constructs a three-dimensional digital model of the patient's target site marked with nodules based on the patient's thin-section CT images; determines the projection point of the nodule on the surface of the target site based on the three-dimensional digital model and Multiple anatomical landmark points; determine the patient's actual nodule location based on projection points, multiple anatomical landmark points, and auxiliary measurement tools. In this method, only one initial diagnostic CT is needed for three-dimensional modeling. The patient is under general anesthesia throughout the entire process, and no puncture process is involved. It can reduce radiation exposure, reduce patient pain, reduce risks, prevent cross-infection, reduce positioning time and labor costs, and reduce the risk of Dependence on equipment is conducive to the promotion of precise pulmonary nodule resection surgery.

The above-mentioned target part can be the lungs, and the anatomical landmark points can include at least one of the following: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the intersection of the horizontal fissure and the oblique fissure of the right lung, the horizontal fissure and the upper right lung. The intersection of the medial edges of the lungs, the first costal indentation of the right upper lung, the intersection of the lower edge of the right lower lung and the indentation of the thoracic spine, the medial end point of the lower edge of the right lower lung, the lowest point of the right middle lung, the lowest point of the tracheal indentation of the right upper lung, and the right lower pulmonary vein Indentation, lateral end point of the lower edge of the right lower lung.

The above-mentioned anatomical landmark points may include: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the intersection of the horizontal and oblique fissures of the right lung; among them, the apex of the right upper lung is the first point, and the posterior segment of the right upper lung is the first point. The intersection point with the dorsal segment of the lower lung is the second point, and the intersection point of the horizontal fissure and the oblique fissure of the right lung is the third point; the above-mentioned actual nodule position determination module can also be configured to connect the first point and the third point is the first line segment; connect the second point and the projection point as the second line segment; determine the intersection point of the extension line of the second line segment and the first line segment, and the first relative position on the first line segment; connect the second point , the intersection point of the extension line of the second line segment and the first line segment is used as the third line segment; determine the second relative position of the projection point in the third line segment; based on the anatomical landmark point, the first relative position, the second relative position and auxiliary measurement tools Determine the patient's actual nodule location.

The lungs of the above-mentioned patient can be provided with actual landmark points that correspond to the anatomical landmark points one-to-one; wherein the first actual landmark point corresponds to the first point, the second actual landmark point corresponds to the second point, and the third actual landmark point corresponds to The third point corresponds.

The above-mentioned auxiliary measurement tool can be provided with a fixed part, a first sliding part and a second sliding part in sequence; the above-mentioned actual nodule position determination module can also be configured to set the auxiliary measurement tool in the patient's chest; wherein, the auxiliary measurement tool Curved setting based on the patient's lung surface shape; coincident the fixed component of the auxiliary measurement tool with the first actual landmark point, moves the second sliding component to the third actual landmark point, and moves the first sliding component based on the first relative position; based on The position of the first sliding part marks the first position on the patient's lungs; the fixed part of the auxiliary measurement tool is coincident with the second actual landmark point, the second sliding part is moved to the first position, and the second sliding part is moved based on the second relative position. A sliding component; marking a second location on the patient's lungs based on the position of the first sliding component, and using the second location as the patient's actual nodule location.

The first and second locations are marked on the patient's lungs by electrocautery.

Those skilled in the art can clearly understand that for the convenience and simplicity of description, the specific working process of the nodule positioning device described above can be referred to the corresponding process in the embodiment of the nodule positioning method, and will not be described here. Repeat.

Embodiment five:

Embodiments of the present application also provide an electronic device, the electronic device is used to run the above nodule positioning method; see FIG. 9 for a schematic structural diagram of an electronic device. The electronic device may include a memory 100 and a processor 101 , wherein the memory 100 is configured to store one or more computer instructions, and the one or more computer instructions are executed by the processor 101 to implement the above nodule positioning method.

Further, the electronic device shown in FIG. 9 may also include a bus 102 and a communication interface 103. The processor 101, the communication interface 103 and the memory 100 are connected through the bus 102.

Among them, the memory 100 may include high-speed random access memory (RAM, Random Access Memory), and may also include non-volatile memory (non-volatile memory), such as at least one disk memory. The communication connection between the system network element and at least one other network element is realized through at least one communication interface 103 (which can be wired or wireless), and the Internet, wide area network, local network, metropolitan area network, etc. can be used. The bus 102 may be an ISA bus, a PCI bus, an EISA bus, etc. The bus can be divided into address bus, data bus, control bus, etc. For ease of presentation, only one bidirectional arrow is used in Figure 9, but it does not mean that there is only one bus or one type of bus.

The processor 101 may be an integrated circuit chip with signal processing capabilities. During the implementation process, each step of the above method can be completed by instructions in the form of hardware integrated logic circuits or software in the processor 101 . The above-mentioned processor 101 can be a general-purpose processor, including a central processing unit (Central Processing Unit, referred to as CPU), a network processor (Network Processor, referred to as NP), etc.; it can also be a digital signal processor (Digital Signal Processor, referred to as DSP). ), Application Specific Integrated Circuit (ASIC for short), Field-Programmable Gate Array (FPGA for short) or other programmable logic devices, discrete gate or transistor logic devices, and discrete hardware components. Each method, step and logical block diagram disclosed in the embodiment of this application can be implemented or executed. A general-purpose processor may be a microprocessor or the processor may be any conventional processor, etc. The steps of the method disclosed in conjunction with the embodiments of the present application can be directly implemented by a hardware decoding processor, or executed by a combination of hardware and software modules in the decoding processor. The software module can be located in random access memory, flash memory, read-only memory, programmable read-only memory or electrically erasable programmable memory, registers and other mature storage media in this field. The storage medium is located in the memory 100. The processor 101 reads the information in the memory 100 and completes the steps of the method in the foregoing embodiment in combination with its hardware.

Embodiments of the present application also provide a computer-readable storage medium. The computer-readable storage medium stores computer-executable instructions. When the computer-executable instructions are called and executed by a processor, the computer-executable instructions cause processing The processor implements the above nodule positioning method. For specific implementation, please refer to the method embodiments, which will not be described again here.

The computer program products of the nodule positioning method, device and auxiliary measurement tool provided by the embodiments of the present application include a computer-readable storage medium storing program codes. The instructions included in the program codes can be used to execute the methods in the previous method embodiments. For specific implementation, please refer to the method embodiments and will not be described again here.

Those skilled in the art can clearly understand that for the convenience and simplicity of description, the specific working process of the system and/or device described above can be referred to the corresponding process in the foregoing method embodiment, and will not be described again here.

In addition, in the description of the embodiments of this application, unless otherwise clearly stated and limited, the terms "installation", "connection" and "connection" should be understood in a broad sense. For example, it can be a fixed connection or a detachable connection. , or integrally connected; it can be a mechanical connection or an electrical connection; it can be a direct connection or an indirect connection through an intermediate medium; it can be an internal connection between two components. For those of ordinary skill in the art, the specific meanings of the above terms in this application can be understood on a case-by-case basis.

If the functions are implemented in the form of software functional units and sold or used as independent products, they can be stored in a computer-readable storage medium. Based on this understanding, the technical solution of the present application is essentially or contributes to the relevant technology or part of the technical solution can be embodied in the form of a software product. The computer software product is stored in a storage medium and includes several The instructions are used to cause a computer device (which may be a personal computer, a server, or a network device, etc.) to execute all or part of the steps of the methods described in various embodiments of this application. The aforementioned storage media include: U disk, mobile hard disk, read-only memory (ROM, Read-Only Memory), random access memory (RAM, Random Access Memory), magnetic disk or optical disk and other media that can store program code. .

In the description of this application, it should be noted that the terms "center", "upper", "lower", "left", "right", "vertical", "horizontal", "inner", "outer", etc. The indicated orientation or positional relationship is based on the orientation or positional relationship shown in the drawings. It is only for the convenience of describing the present application and simplifying the description. It does not indicate or imply that the device or element referred to must have a specific orientation or a specific orientation. construction and operation, and therefore should not be construed as limitations on this application. Furthermore, the terms “first”, “second” and “third” are used for descriptive purposes only and are not to be construed as indicating or implying relative importance.

Finally, it should be noted that the above-mentioned embodiments are only specific implementation modes of the present application, and are used to illustrate the technical solutions of the present application, but not to limit them. The protection scope of the present application is not limited thereto. Although refer to the foregoing The embodiments describe the present application in detail. Those of ordinary skill in the art should understand that any person familiar with the technical field can still modify the technical solutions recorded in the foregoing embodiments within the technical scope disclosed in the present application. It is possible to easily think of changes, or to make equivalent substitutions for some of the technical features; and these modifications, changes or substitutions do not cause the essence of the corresponding technical solutions to deviate from the spirit and scope of the technical solutions of the embodiments of this application, and they should all be covered by this application. within the scope of protection. Therefore, the protection scope of this application should be determined by the protection scope of the claims.

Industrial applicability

This application provides a nodule positioning method, device and auxiliary measurement tool. The method includes: acquiring a thin-section CT image of the patient, and constructing a three-dimensional digital model of the patient's target part based on the thin-section CT image; wherein the three-dimensional digital model is marked with nodules; and determining the location of the nodule on the surface of the target part based on the three-dimensional digital model. Projection points and multiple anatomical landmark points; determine the patient's actual nodule location based on the projection point, multiple anatomical landmark points and auxiliary measurement tools. In this method, only one initial diagnostic CT is needed for three-dimensional modeling. The patient is under general anesthesia throughout the entire process, and no puncture process is involved. It can reduce radiation exposure, reduce patient pain, reduce risks, prevent cross-infection, reduce positioning time and labor costs, and reduce the risk of Dependence on equipment is conducive to the promotion of precise pulmonary nodule resection surgery.

Furthermore, it will be appreciated that the nodule localization method and nodule localization device of the present application are reproducible and can be used in a variety of applications. For example, the nodule positioning method and nodule positioning device of the present application can be used in any application that requires reducing radiation exposure, alleviating patient pain, reducing risks, preventing cross-infection, etc.

Claims

A nodule positioning method, wherein the nodule positioning method includes:

Obtain a thin-section CT image of the patient, and construct a three-dimensional digital model of the patient's target part based on the thin-section CT image; wherein the three-dimensional digital model is marked with nodules;

Determine the projection point of the nodule on the surface of the target site and a plurality of anatomical landmark points based on the three-dimensional digital model;

The patient's actual nodule location is determined based on the projection point, a plurality of the anatomical landmark points and an auxiliary measurement tool.
The nodule positioning method according to claim 1, wherein the target site is the lungs, and the anatomical landmark points include at least one of the following: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung. , the intersection point of the horizontal fissure and the oblique fissure of the right lung, the intersection point of the horizontal fissure and the medial edge of the right upper lung, the first costal indentation of the right upper lung, the intersection point of the lower edge of the right lower lung and the thoracic indentation, the medial end point of the lower edge of the right lower lung, the middle right The lowest point of the lung, the lowest point of the right upper lung tracheal indentation, the right lower pulmonary vein indentation, and the lateral end point of the lower edge of the right lower lung.
The nodule positioning method according to claim 2, wherein the anatomical landmark points include: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the intersection of the horizontal fissure and the oblique fissure of the right lung; wherein , the apex of the right upper lung is the first point, the apex of the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung is the second point, and the intersection of the horizontal and oblique fissures of the right lung is the third point;

The step of determining the actual nodule position of the patient based on the projection point, the plurality of anatomical landmark points and auxiliary measurement tools includes:

Connect the first point and the third point as a first line segment;

Connect the second point and the projection point into a second line segment;

Determine the intersection point of the extension line of the second line segment and the first line segment, and the first relative position on the first line segment;

The intersection point of the second point, the extension line of the second line segment and the first line segment is regarded as the third line segment;

Determine the second relative position of the projection point on the third line segment;

The actual nodule position of the patient is determined based on the anatomical landmark point, the first relative position, the second relative position and an auxiliary measurement tool.
The nodule positioning method according to claim 3, wherein the patient's lungs are provided with actual landmark points corresponding to the anatomical landmark points; wherein the first actual landmark point corresponds to the first point , the second actual landmark point corresponds to the second point, and the third actual landmark point corresponds to the third point.
The nodule positioning method according to claim 4, wherein the auxiliary measurement tool is provided with a fixed component, a first sliding component and a second sliding component in sequence;

The anatomical landmark is determined based on the first relative position, the second relative position and the auxiliary measurement tool. The steps to describe the patient's actual nodule location include:

The auxiliary measurement tool is arranged in the chest cavity of the patient; wherein the auxiliary measurement tool is curved and arranged based on the shape of the patient's lung surface;

Coincide the fixed part of the auxiliary measuring tool with the first actual landmark point, move the second sliding part to the third actual landmark point, and move the first sliding part based on the first relative position part;

marking a first location in the patient's lungs based on the position of the first sliding member;

Coincide the fixed component of the auxiliary measurement tool with the second actual landmark point, move the second sliding component to the first position, and move the first sliding component based on the second relative position;

A second position is marked on the patient's lungs based on the position of the first sliding member, and the second position is used as the patient's actual nodule position.
The method of locating a nodule according to claim 5, wherein the first position and the second position are marked on the patient's lungs by electrocautery.
A nodule positioning device, wherein the nodule positioning device includes:

A three-dimensional digital model building module, the three-dimensional digital model building module is configured to acquire a thin-section CT image of a patient, and construct a three-dimensional digital model of a target part of the patient based on the thin-section CT image; wherein, the three-dimensional digital model building module Nodules are marked in the digital model;

a projection point and anatomical landmark point determination module, the projection point and anatomical landmark point determination module is configured to determine the projection point of the nodule on the surface of the target site and a plurality of anatomical landmark points based on the three-dimensional digital model ;

and an actual nodule position determination module configured to determine the actual nodule position of the patient based on the projection point, a plurality of the anatomical landmark points and an auxiliary measurement tool.
The nodule positioning device according to claim 7, wherein the target site is the lungs, and the anatomical landmark points include at least one of the following: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung. , the intersection point of the horizontal fissure and the oblique fissure of the right lung, the intersection point of the horizontal fissure and the medial edge of the right upper lung, the first costal indentation of the right upper lung, the intersection point of the lower edge of the right lower lung and the thoracic indentation, the medial end point of the lower edge of the right lower lung, the middle right The lowest point of the lung, the lowest point of the right upper lung tracheal indentation, the right lower pulmonary vein indentation, and the lateral end point of the lower edge of the right lower lung.
The nodule positioning device according to claim 8, wherein the anatomical landmark points include: the apex of the right upper lung, the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung, the intersection of the horizontal fissure and the oblique fissure of the right lung; wherein , the apex of the right upper lung is the first point, the apex of the intersection of the posterior segment of the right upper lung and the dorsal segment of the lower lung is the second point, and the intersection of the horizontal and oblique fissures of the right lung is the third point;

The actual nodule position determination module is further configured to: connect the first point and the third point as a first line segment; connect the second point and the projection point as a second line segment; determine The intersection point of the extension line of the second line segment and the first line segment is at the first relative position on the first line segment; connect the second point, the extension line of the second line segment and the The intersection point of the first line segment is used as the third line segment; determine the second relative position of the projection point on the third line segment; based on the anatomical landmark point, the first relative position, the second relative position and Auxiliary measurement tools determine the patient's actual nodule location.
The nodule locating device according to claim 9, wherein the patient's lungs are provided with actual landmark points corresponding to the anatomical landmark points; wherein the first actual landmark point corresponds to the first point , the second actual landmark point corresponds to the second point, and the third actual landmark point corresponds to the third point.
The nodule positioning device according to claim 10, wherein the auxiliary measurement tool is provided with a fixed component, a first sliding component and a second sliding component in sequence; the actual nodule position determination module is further configured to: The auxiliary measurement tool is arranged in the patient's chest; wherein the auxiliary measurement tool is curved and arranged based on the shape of the patient's lung surface; and the fixed component of the auxiliary measurement tool coincides with the first actual landmark point , move the second sliding component to the third actual landmark point, and move the first sliding component based on the first relative position; based on the position of the first sliding component in the patient's lungs Mark the first position; coincide the fixed part of the auxiliary measuring tool with the second actual mark point, move the second sliding part to the first position, and move the second relative position based on the second relative position. a first sliding component; marking a second location in the patient's lungs based on the position of the first sliding component, and using the second location as the patient's actual nodule location.
The nodule locating device of claim 11, wherein the first location and the second location are marked on the patient's lungs by electrocautery.
An auxiliary measurement tool, wherein the auxiliary measurement tool is used to perform the nodule positioning method according to any one of claims 1 to 6; the auxiliary measurement tool includes: an elastic component, an elastic measuring ruler with a scale, a fixed component, a first sliding component and a second sliding component;

The elastic member is configured for flexural placement based on a surface shape of the target site of the patient;

The elastic measuring ruler is provided with a percentage scale, and the elastic measuring ruler expands and contracts in equal proportion to the elastic component;

The fixing component is fixed on the starting side of the elastic component, and the fixing component is fixed on the starting end of the elastic measuring scale;

The second sliding component is fixed at the end end of the elastic measuring ruler, and the second sliding component is slidably disposed in the elastic component;

The first sliding component is disposed between the fixed component and the second sliding component, and the first sliding component is slidably disposed in the elastic component.
The auxiliary measuring tool according to claim 13, wherein the elastic component includes: a hose, a soft ruler or a spring.
The auxiliary measuring tool according to claim 13 or 14, wherein the fixed part, the first sliding part and the second sliding part are all clips; or, the fixed part is a calibration, and the first sliding part and The second sliding components are all cursors.