JP3409415B2 - Surgical instrument position display device - Google Patents

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention is also called a surgical navigation system, in which a surgical instrument such as a suction tube is inserted into a subject for a surgical operation or a biological sample collection. At this time, the present invention relates to a device for displaying the position of the surgical instrument in the subject, and in particular, an X-ray CT image collected before the operation,
The present invention relates to a position display device for a surgical instrument that can be displayed on an MRI image or an X-ray fluoroscopic image and select a desired function from a plurality of functions such as storing the position of the surgical instrument. 2. Description of the Related Art Conventionally, as a position display device of a surgical instrument, a position detecting means for detecting the position of the surgical instrument, and a predetermined image data and a surgical instrument corresponding to the position information from the position detecting means. There is a surgical instrument position display device that includes a data processing unit that superimposes and displays a pattern, an input unit that gives an instruction to the data processing unit, and a display unit that displays image data from the data processing unit. In such an apparatus, the position information of the surgical instrument during the operation is stored (recording start) or the storage operation is canceled (recording) in order to mainly examine the adequacy of the operation after the operation. Release), and has a plurality of functions such as superimposing and displaying (redisplaying) the image data and the surgical instrument based on the stored position information. Then, a desired function among these functions is selected from input means such as a keyboard and a mouse connected to the data processing means. [0004] Normally, the surgical instrument, the position detecting means and the display means are located in a so-called clean area near the subject together with the surgeon, but the data processing means and the input means are different from each other. In order to prevent contamination of the specimen, it is installed outside the clean area several meters away from the subject. Therefore, in order for an operator to perform a desired operation such as recording of positional information of a surgical instrument during an operation, the contents are verbally conveyed to a person who can handle the device,
It is necessary to convey by gesture and have the operation be performed on your behalf. However, since the surgeon wears a mask to perform the operation, it is difficult for the voice to pass when verbally conveyed, and it may not be possible to convey the desired operation accurately. In addition, there is a problem that it is necessary to perform an unnecessary operation for the operation near the camera. Furthermore, humans involved in the surgery have sterilized their hands, etc., so that they cannot touch the input means, so there is a problem that it is necessary to have a dedicated human being just to operate the device. . The present invention has been made in view of such circumstances, and has as its object to provide a surgical instrument position display device that allows an operator to easily select a desired function. . [0007] In order to achieve the above object, the present invention has the following configuration. That is, the position display device of the surgical instrument superimposes and displays the position of the surgical instrument inserted into the subject during the operation on the image of the region of interest of the subject that has been collected in advance, and displays the position of the surgical instrument. In a position display device for a surgical instrument capable of selecting a desired function from a plurality of functions such as storing a position, (a) position detecting means for sequentially detecting the position of the surgical instrument, and (b) interest of a subject. Image data storage means for storing image data of a tomographic image for each position of a part; (c) image selection means for selecting image data corresponding to position information from the position detection means from the image data storage means;
(D) reference coordinate storage means for storing coordinates of a predetermined coordinate area including a region of interest of the subject; (e) position information from the position detection means; and reference coordinates of the reference coordinate storage means. And (f) when the result of the determination by the position determining means is within the reference area, the position determining means determines whether the surgical instrument is within the reference area. A first pattern indicating the position of the surgical instrument is superimposed on the position detected by the position detecting means, and if the result of the judgment by the position judging means is out of the reference area, the function is selected. Image synthesizing means for displaying a second pattern indicating the predetermined pattern of (g);
Display means for displaying an image synthesized by the image synthesis means; and (h) instructing means for selecting and instructing a pattern corresponding to a desired function by the second pattern displayed on the display means. It is characterized by the following. The operation of the present invention is as follows. That is, the position detecting means sequentially detects the position of the surgical instrument and provides the position information to the image selecting means, the position determining means and the image synthesizing means. The position determination means compares the coordinates of the preset reference coordinate storage means with the position information of the surgical instrument, and determines whether the position of the surgical instrument is within the reference area. As a result, if the position is within the reference area, the position on the image data selected by the image selection means from the image data storage means according to the position information, and the position detected by the position detection means indicates the position of the surgical instrument. The image synthesizing means superimposes one pattern. On the other hand, if it is outside the reference area, the image synthesizing means displays the second pattern for function selection. Then, a pattern corresponding to a desired function is selected and instructed by the instructing means according to the second pattern displayed on the display means. As a result, the display means selectively displays the first pattern indicating the position and the second pattern for function selection in accordance with the position of the surgical instrument, so that a desired function can be selected. it can. An embodiment of the present invention will be described below with reference to the drawings. FIG. 1 is a diagram showing a schematic configuration of one embodiment of a position display device for a surgical instrument according to the present invention. In FIG. 1, reference numeral 1 denotes an operating table on which a subject M is placed. Reference numeral 2 denotes a surgical instrument inserted into the subject M by the operator during the operation. A magnetic source 3a for generating a magnetic field in three dimensions is provided on the operating table 1 so that the relative position with respect to the subject M does not change. The magnetic source 3a may be attached and fixed to the subject M itself. A magnetic sensor 3b for detecting a three-dimensional magnetic field generated from a magnetic source 3a is attached to the rear end of the surgical instrument 2. As shown in FIG. 2, the magnetic source 3a
It is composed of three coils 3 _aX , 3 _aY , 3 _aZ for generating magnetic fields in the dimensional directions X, Y, Z, respectively. The magnetic source 3a is connected to the drive circuit 4, and generates a three-dimensional magnetic field H by receiving an alternating current from the drive circuit 4. Similarly, the magnetic sensor 3b also includes three coils 3 _bX , 3 _bY , and 3 _bZ orthogonal to each other. The magnetic sensor 3b is connected to the detection circuit 5. This detection circuit 5
Amplifies the detection signals from the coils 3 _bX , 3 _bY , and 3 _bZ and outputs position data converted into appropriate digital signals. The magnetic source 3a, the magnetic sensor 3b, the drive circuit 4, the detection circuit 5, and the position calculation unit 9 described later correspond to a position detection unit in the present invention. The image processing computer 8 mainly calculates the position of the surgical instrument 2, selects an image according to the position information, synthesizes the pattern of the surgical instrument 2 on the selected image, and displays a pattern for selecting a function. The internal configuration is roughly divided into functional components, and includes a position calculating unit 9, an image selecting unit 10, an image synthesizing unit 11, a position determining unit 12, and a reference coordinate memory 13. The image processing computer 8
Are examples of functions that can be selected by the operator, such as storing calculated position information (function 1: start recording), stopping recording of position information (function 2: canceling recording), and displaying recorded position information (function 3: Redisplay). The position calculator 9 calculates the three-dimensional position and direction of the magnetic sensor 3b based on the position data from the detection circuit 5, and further considers the size of the surgical instrument 2 given as data in advance. Then, finally, the three-dimensional position and direction of the distal end of the surgical instrument 2 are obtained. The method of calculating the three-dimensional position and direction of the magnetic sensor 3b using the magnetic source 3a and the magnetic sensor 3b described above is known, for example, from Japanese Patent Application Laid-Open No. Sho 59-218539, and a description thereof will be omitted. I do. The image selecting section 10 selects a required tomographic image from the image / position information memory 14 based on the position information of the surgical instrument 2 given from the position calculating section 9. Equivalent to. The image / position information memory 14 stores image data of a tomographic image of a site of interest for each site of interest of the subject M, and corresponds to an image storage unit in the present invention. Further, the image selecting section 10 compares the position information of the position calculating section 9 with the contents of the reference coordinate memory 13, and as a result of the judgment by the position judging section 12, if the position information is within the reference area,
A required tomographic image is selected from the position information memory 14. On the other hand, if it is outside the reference area, the image selection operation is stopped,
One of the above three functions is executed according to the behavior of the surgical instrument 2 described later. The reference coordinate memory 13
Corresponds to reference coordinate storage means in the present invention. If the result of the determination by the position determining unit 12 is within the reference area, the image synthesizing unit 11 places the surgical instrument 2 at the position detected by the position calculating unit 9 on the image selected by the image selecting unit 10. The first pattern indicating the position is superimposed, and if the result of determination by the position determination unit 12 is outside the reference area,
A second pattern for selecting a function is displayed in a predetermined area.
The image synthesizing unit 11 corresponds to an image synthesizing unit according to the present invention. The image synthesized by the image synthesizing unit 11 is provided to a monitor 15 corresponding to a display unit in the present invention. First, the acquisition of tomographic images stored in the image / position information memory will be described with reference to FIG. FIG.
As shown in (a), pointers P ₁ , P ₂ , and 3 are located at three places on the body surface near a site of interest of a subject M placed on an operating table 1.
Paste the P _3. Then, each of the pointers P ₁ , P ₂ , P
The position ₃ is measured using the magnetic source 3a and the magnetic sensor 3b described in FIG. Specifically, surgical instrument 2
Can be obtained as three-dimensional position coordinates by contacting the tips of the pointers with the pointers P ₁ , P ₂ , and P ₃ . [0018] Then, the captured by such a tomographic image of a plurality of slice planes S ₁ to S _n in the region including the region of interest of the patient M X-ray CT apparatus. A schematic diagram of the resulting tomographic image I ₁ ~I _n shown in FIG. 3 (b). Since the positions of the _three pointers P ₁ , P ₂ , and P ₃ appearing in these tomographic images are measured and determined in advance, the positions of the tomographic images are also uniquely determined. In this embodiment, as an example, the tomographic images I ₁ and I ₁
Coordinates R _{1 to} R ₄ and R _{5 to} R of the four points on the outermost periphery of _n
8 is the position determination unit 1 stored in the reference coordinate memory 13.
2 is compared with the position information of the surgical instrument 2. In addition,
Reference numeral 0 in FIG. 3B is an appropriately determined origin,
The origin 0 is also used for detecting the position of the surgical instrument 2 described later. Each of the tomographic images I ₁ -I obtained as described above
I _n are stored are assigned a unique file name in the appropriate image / position data memory 14 as a file. The tomographic image file is stored in the image / position information memory 14 with a unique file name given so that each of the plurality of subjects M can be identified. This storage state is schematically shown in FIG. 4 as an example. When the collection of tomographic images is completed as described above, the operation proceeds to an operation. The operation during the operation will be described with reference to the flowcharts of FIGS. FIG. 5 is a flowchart showing a processing program of this apparatus. The processing is terminated by pressing a specific interrupt key set on an input means such as a keyboard (not shown). In step S1, a tomographic image file name containing a tomographic image of the subject M to be operated is input from input means such as a keyboard (not shown). In step S2, the process proceeds to a subroutine for performing a position display process of the surgical instrument 2. Referring to FIG. In step S10, the image selecting unit 10 acquires the position information of the surgical instrument 2 from the position detecting unit 9. Then, after setting the determination flag to “0”, the position determining unit 12 determines whether the coordinates indicated by the position information are within a reference area preset in the reference coordinate memory 13 (step S11). ). That is, FIG.
Surgical instrument 2 in a region surrounded by the coordinates R ₁ to R ₈ shown in (b) to determine whether or not the position. If the result of the determination in step S11 is within the reference area, in step S12, the image selector 10 selects image data corresponding to the position information from the image / position information memory 14, and the selected image data is selected. On the image,
The first pattern P ₁ image synthesizing unit 11 is superimposed showing the position of the surgical instrument 2 to a position corresponding to the position information (step S13). The superimposed image is output to the monitor 15, so that the operator can proceed with the operation while checking which position of the site of interest the surgical instrument 2 is located at.
FIG. 7A shows an example of display contents output to the monitor 15 at this time. In this embodiment, six tomographic images I _{1 to} I ₆ are displayed at a time, and the monitor 15
In the lower part of the display area, function buttons F1 to F3 labeled function 1 to function 3 are displayed. After step S13, step S3 in FIG.
And the process branches depending on the state of the confirmation flag. In this case, since the confirmation flag remains "0", the process returns to step S2, and the position display processing of the surgical instrument is executed again. Next, a case will be described in which the surgical instrument 2 is taken out of the region of interest of the subject M, and the operator selects the function of this apparatus. That is, the coordinates R ₁ shown in FIG.
Surgical instrument 2 to the outside of the reference region surrounded by to R ₈ is when moving. In this case, in step S11,
The position determination unit 12 determines whether the reference coordinate memory 13
As a result of the comparison with the position information acquired in step 2, it is determined that the position is outside the reference area. Then, the process proceeds to step S20 in FIG. [0029] At step S20, among the function buttons F1~F3 displayed below the display area of the monitor 15, displaying the image synthesis unit 11 is a second pattern P ₂ for function selection part of the function button F2 (See FIG. 7). Then, “2” is set to the variable FUNC indicating the function. In step S21, the position judging unit 12 acquires position information from the position calculating unit 9. And operating table 1
Is set as a reference (Z _ref ). In step S22, the position judging unit 12 compares the position information acquired in step S21 with the reference coordinates in the reference coordinate memory 13 to determine whether or not the surgical instrument 2 is in the reference area. As a result, if it is within the reference area, the process returns to step S12 in FIG. 6 to perform a tomographic image display process. Since the surgical instrument 2 is currently outside the reference area, step S23 is executed. In step S23, position information is acquired after waiting for an appropriate time. In this embodiment, for example, the standby time is set to 200 ms. In step S24, the direction of the surgical instrument 2 is obtained from the position information obtained in step S23, and as a result, it is determined whether or not the surgical instrument 2 is in a substantially vertical state, and the process branches. Specifically, the sensor 3b attached to the rear end of the surgical instrument 2 is positioned above the distal end so that the surgical instrument 2 is along the Y coordinate set so as to be orthogonal to the operating table 1. Determine if you are. Here, the surgical instrument 2 is not in a vertical state, i.e., the operator, illustrating the functional second pattern P ₂ is being functional buttons F2 functions located for selection as not desired. Attention is paid to the Z coordinate in the position information acquired in step S21, and it is determined whether or not the surgical instrument 2 has moved a predetermined distance (step S25). Specifically, the reference Z _ref set in step S21 and the Z
The absolute value of the difference from the coordinates is determined, and this value is set to a predetermined value (for example,
5 cm) is determined. The predetermined value for determining the presence or absence of the movement may be set to an appropriate value according to the operator. If there is no movement, the flow branches to step S21 to acquire the position information of the surgical instrument 2 again. Therefore, the reference _{Zref of the} Z coordinate serving as a reference for recognizing the movement of the surgical instrument 2 is reset in step S21 if there is no movement exceeding a predetermined value within 200 ms. Therefore, when the surgeon moves the surgical instrument 2 carelessly, it is possible not to recognize the movement. In step S26, the process branches according to the moving direction of the surgical instrument 2. Specifically, the sign of the difference between _Zref and Z is checked. That is, only 1 along with the function variable FUNC code indicating the moving direction "Z _ref -Z 'from the reference position is moved to (function button F1) to" negative "if feature left pattern P ₂ for selecting subtraction Then, if the sign is "positive", it moves rightward (function button F3) and adds 1 to the function variable FUNC (step S28). Each step S2
7. In S28, if the function variable FUNC exceeds the number of functions prepared in advance (FUNC = 4) or falls below (FUNC = 0), it is adjusted. That is, when the value exceeds a predetermined value, 1 is subtracted (FUNC = 3), and when the value falls below 1, only 1 is added (FUNC = 3).
NC = 1). Then, the process branches to step S21 for acquiring position information, and a new reference _{Zref of the} Z coordinate is newly set. Thus, steps S21 to S27,
In iteration S28, it is possible to move the pattern P ₂ for function selection in accordance with the moving direction of the surgical instrument 2, the operator does not need to select the function via the operator of the apparatus, the operator The user can accurately select a desired function. The surgical instrument 2 is a magnetic source 3
approaching a if (symbol "Z _ref -Z" is "negative"), to move the pattern P ₂ for function selection to the left, away from the magnetic source 3a (symbol "Z _ref -Z" is " True ")
If, while you move the pattern P ₂ for function selection to the right,
Depending on the state where the monitor 15 and the operator face each other, the monitor 15 may be moved in the opposite direction. Furthermore, although moves the pattern P ₂ for function selection in conjunction with the movement of the Z-coordinate of the surgical instrument 2 may be linked to the movement of the X-coordinate on or Y coordinate. The reference Z _{ref as} a reference for recognizing the movement of the surgical instrument 2 is reset if there is no movement of the surgical instrument 2 beyond a predetermined distance within 200 ms after the setting. For example, even when the number of selectable functions is large, the moving distance of the surgical instrument 2 does not increase accordingly. That is, when the surgeon moves the surgical instrument 2 on the spot over a time of 200 ms or more at an appropriate distance, or moves the surgical instrument 2 within a predetermined distance at an appropriate time,
Since the reference Z _ref is set to a new value, the operator can perform the function selection without removing the surgical instrument 2 from the body. Next, in step S24, the surgical instrument 2
Will be described in the case where the state becomes substantially vertical along the Y coordinate. The act of bringing the surgical instrument 2 into a substantially vertical state corresponds to an intention of the operator to confirm the selected function. In step S29, position information is acquired after a standby time of 200 ms, and it is determined whether or not the surgical instrument 2 has been displaced by about 90 ° based on the information (step S30). That is, if the distal end portion of the surgical instrument 2 swings about the magnetic sensor 3b of the surgical instrument 2 as a fulcrum and there is a displacement of about 90 °, the determination flag is updated to “1” and the process returns to the processing of FIG. 6 (step S31). ), And then goes to step S3 in FIG. If the surgical instrument 2 has not been displaced by about 90 °, the determination flag is not updated, and the process proceeds to step S21 to acquire the position information of the surgical instrument 2. As described above, the surgical instrument 2 is outside the reference area (step S22), and the operator naturally operates the surgical instrument 2
After confirming that the vertical state is different from the state in which the surgical instrument 2 is held (step S24), the surgical instrument 2 is set within a predetermined time.
Since the confirmation flag is set based on the displacement of the direction, it is possible to prevent the operator from inadvertently selecting a function. Note that steps S21 to S31 correspond to the instruction means in the present invention. The operation of confirming the selected function was performed by the predetermined swing operation of the surgical instrument 2 as described above.
This can be implemented in various modifications. For example, a fixing switch is attached to the surgical instrument 2 and the switch is pressed to fix the function. If the second pattern is located on a certain function button for a predetermined time or more, the function is set. May be determined. Further, a determination button may be displayed on the monitor in addition to the display of the function button indicating the function, and the determination may be made if the second pattern is located in this area. Referring to FIG. In step S3, after the confirmation flag is updated to "1" in step S31, it is determined that the function has been selected and confirmed, and in step S4, the process branches to execute the function selected from the plurality of functions. Specifically, according to the value of the function variable FUNC, FUNC =
If it is 1, the function 1 is "record start" (step S5),
If FUNC = 2, the function 2 is “record release” (step S6), and if FUNC = 3, the function 3 is “redisplay”.
(Step S7). In the “record start” set in the function 1, the position information of the surgical instrument 2 is stored in the image / position information memory 14.
Is set, and the position of the surgical instrument 2 in the position display processing of the surgical instrument in step S2 is recorded. Specifically, a position information file as shown in FIG. 9 is created. As the file name, a file name indicating a tomographic image of the subject M with a serial number added thereto is automatically determined. In addition, of the tomographic image files of the plurality of subjects M,
The file name of the tomographic image file currently used is written, and the time at which "recording start" is selected is written, and the area where the time when "recording release" of function 2 is executed is written is secured. I do. Thereafter, the position information of the surgical instrument 2 is recorded. The position information is recorded when steps S10 to S13 are being executed, that is, when the surgical instrument 2 is located in the reference area. The "recording start" process is executed until "recording release" set in the function 2 is selected, that is, "recording release" in step S6 is selected. The time at the end is written in the area that has been set. In the "redisplay" set for the function 3,
The position information stored in the file by “recording start” and “recording release” is superimposed and displayed on the monitor together with the image data of the corresponding tomographic image file name. Thus, the trajectory of the surgical instrument 2 during the operation can be confirmed. In this embodiment, the surgical instrument 2
As the coordinates of the reference area used as a reference when switching the first indicating the position of the pattern P ₁ and the second pattern P ₂ for function selection, each of the outermost periphery of the slice image tomogram I ₁ and I _n 4 Using the coordinates R _{1 to} R ₄ and R _{5 to} R ₈ of the points,
The present invention is not limited to this, and various modifications can be made. For example, reference coordinates may be set on a boundary line between a tomographic portion and its periphery in a slice image tomographic image. With this setting, when the operator attempts to select a function, the distance over which the surgical instrument 2 is moved can be minimized, and the burden on the operator can be reduced. In this embodiment, the position of the surgical instrument 2 is detected by using the magnetic source 3a and the magnetic sensor 3b. However, the present invention is not limited to this.
By attaching the surgical instrument 2 to the tip of the multi-joint arm and detecting the angle of the arm at each joint, the surgical instrument 2
May be configured to detect the tip position. As is apparent from the above description, according to the present invention, the first pattern indicating the position of the surgical instrument is:
Since it is selectively switched to the second pattern for function selection according to the position information of the surgical instrument, the operator can easily select a desired function by the selection instruction means. Therefore, the operator can concentrate on the operation alone, and there is no need to have an operator who is not involved in the operation attend the operation.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a view showing a schematic configuration of a position display device of a surgical instrument according to an embodiment. FIG. 2 is an explanatory diagram of a magnetic source and a magnetic sensor. FIG. 3 is a diagram provided for explanation of tomographic image collection. FIG. 4 is a schematic diagram of an image file stored in an image / position information memory. FIG. 5 is a flowchart illustrating a processing program according to the embodiment. FIG. 6 is a flowchart showing a position display process of a surgical instrument. FIG. 7 is a schematic diagram of an image displayed on a monitor. FIG. 8 is a flowchart illustrating a function selection process. FIG. 9 is a schematic diagram of a position information file stored in an image / position information memory. [Description of Signs] 1 ... Operating table 2 ... Surgical instrument 3a ... Magnetic source 3b ... Magnetic sensor 4 ... Drive circuit 5 ... Detection circuit 8 ... Image processing computer 9 ... Position calculation unit 10 ... Image selection unit 11 ... Image synthesis unit 12 ... Position judging unit 13 ... Reference coordinate memory 14 ... Image / position information memory 15 ... Monitor M ... Subject

Claims (1)

(57) [Claims 1] A position of a surgical instrument inserted into a subject during an operation is superimposed and displayed on an image of a region of interest of the subject which has been collected in advance. A surgical instrument position display device that can select a desired function from a plurality of functions such as storing the position of a surgical instrument, wherein (a) position detecting means for sequentially detecting the position of the surgical instrument; Image data storage means for storing image data of a tomographic image for each position of a region of interest of a specimen; and (c) image selection means for selecting image data corresponding to position information from the position detection means from the image data storage means (D) reference coordinate storage means for storing coordinates of a predetermined coordinate area including a region of interest of the subject; (e) position information from the position detection means; and a reference of the reference coordinate storage means. Compare with coordinates Position determining means for determining whether the surgical instrument is within the reference area; and (f) detecting the position on the selected image data when the result of the determination by the position determining means is within the reference area. A first pattern indicating the position of the surgical instrument is superimposed on the position detected by the means, and when the result of the judgment by the position judging means is out of the reference area, a predetermined pattern for selecting the function is shown. Image synthesizing means for displaying a second pattern; (g) display means for displaying an image synthesized by the image synthesizing means; and (h) a desired function by the second pattern displayed on the display means. A position display device for a surgical instrument, comprising: an instruction unit for selecting and instructing a corresponding pattern.