JP5269232B2 - Image display device - Google Patents

Description

  The present invention relates to image display devices and, more particularly, to improved endovascular treatment, particularly the depiction of wire route planning lines for the passage of complete occlusions.

  Conventionally, a treatment method called endovascular treatment is known. In this treatment method, a device such as a guide wire (hereinafter referred to as a wire) or a catheter is inserted into a blood vessel to proceed, and the affected part is treated with the device. Because it is obtained, it is a healing method that has been rapidly expanding in recent years. When formulating a treatment plan for this treatment, it will be mainstream to use CT images in the future.

  A CT image is a volume (CT) that is acquired and reconstructed by a CT (Computed Tomography) device that collects 360-degree X-ray projection images around the human body, reconstructs them, and reconstructs them into two-dimensional tomographic images. 3D) data. The volume data is very convenient because a blood vessel cross-sectional image can be observed.

  For example, in the treatment of complete occlusion in which a blood vessel is completely clogged, as shown in FIG. 18, the operator creates a blood vessel cross-sectional image 1 from CT volume data, and in this blood vessel cross-sectional image 1, the blood vessel 2 A hard part (calcified part or the like) 5 or a soft part (soft plaque or the like) 6 or a soft part (soft plaque or the like) 6 is observed, and it is planned to advance the wire to either side of the blood vessel 2. In the example of this figure, it can be seen that the fiberized portion 4 on the left side of the blood vessel center line 3 is a portion through which the wire can be easily passed. As a known document, for example, there is the following non-patent document 1.

Morton J.M. Kern, “Cardiac Catheter Handbook” Medical School

  When an operator who has made a treatment plan using the aforementioned blood vessel cross-sectional image enters the catheter room for actual treatment, the image obtained in real time by the X-ray imaging system in the catheter room is not a blood vessel cross-sectional image but a blood vessel projection image. It is. For this reason, the surgeon converts the three-dimensional geometric positional relationship between the cross-sectional image at the time of planning and the currently visible projection image in his / her head, and is displayed in front of the eyes from the planned blood vessel cross-sectional image. It is necessary to convert the treatment plan into a blood vessel projection image.

  However, such conversion in the head is painful, especially for young surgeons, and there is a risk of getting lost or mistaken.

  Accordingly, the present invention has been made in view of the above circumstances, and makes it easy to understand the three-dimensional geometric positional relationship, and in particular, it is possible to display the relationship between a blood vessel cross-sectional image and a blood vessel projection image in an easy-to-understand manner. An object is to provide an apparatus.

An image display device according to an embodiment includes a volume data acquisition unit that acquires volume data, a cross-sectional image generation unit that generates a plurality of cross-sectional images from the volume data acquired by the volume data acquisition unit, and X-ray projection data A projection image creating means for creating an X-ray projection image from the display, a display means for displaying the plurality of slice images and projection images, and a designation for specifying a plurality of points on the plurality of slice images displayed on the display means The projected image in which at least the display unit displays the plan line and the blood vessel center line, which are plan lines generated by connecting the plurality of designated points and indicating the plan through which the wire passes. And a control means for displaying above .

  According to the present invention, it is possible to provide an image display device that makes it easy to understand the three-dimensional geometric positional relationship, and in particular can display the relationship between the blood vessel cross-sectional image and the blood vessel projection image.

(A) is a block diagram showing the configuration of the image display device according to the first embodiment of the present invention, (b) is a block diagram showing the configuration of the image display device according to the fourth embodiment of the present invention. 3 is a flowchart for explaining an operation of the image display apparatus in the first embodiment of the present invention. BRIEF DESCRIPTION OF THE DRAWINGS It is for demonstrating operation | movement of the image display apparatus in the 1st Embodiment of this invention, (a) is the figure which showed the example of CT apparatus, (b) is the figure which showed the example of volume data, (C) is the figure which showed the example of the blood vessel cross-sectional image. It is a figure for demonstrating operation | movement of the image display apparatus in the 1st Embodiment of this invention, and was the figure which showed the example of the some blood vessel cross-sectional image. It is a figure for demonstrating calculation of the curve of the wire plan line in the 1st Embodiment of this invention. It is a figure for demonstrating the relationship between the blood vessel cross-sectional image and a projection image in the 1st Embodiment of this invention. It is the figure which showed the example of a display of two lines displayed on a projection image. It is the figure which showed the example of the image displayed on a monitor in the 1st Embodiment of this invention. It is a flowchart for demonstrating operation | movement of the image display apparatus in the 2nd Embodiment of this invention. It is a figure for demonstrating the operation | movement of the image display apparatus in the 2nd Embodiment of this invention, and was the figure which showed the example of the some blood vessel cross-sectional image. It is a figure for demonstrating the relationship between the blood vessel cross-sectional image and a projection image in the 2nd Embodiment of this invention. It is a flowchart for demonstrating operation | movement of the image display apparatus in the 3rd Embodiment of this invention. It is the figure which showed the example of the blood vessel projection image in the 3rd Embodiment of this invention. It is a figure for demonstrating the three-dimensional geometric relationship in the 3rd Embodiment of this invention. It is the figure which showed the relationship between a projection line and a blood vessel cross-sectional image. It is a figure for demonstrating the relationship between the blood vessel cross-sectional image and a projection image in the 3rd Embodiment of this invention. It is the figure which showed the example of the image displayed on a monitor in the 4th Embodiment of this invention. It is the figure which showed the example of the blood vessel cross-sectional image of complete obstruction.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings.

(First embodiment)
FIG. 1A is a block diagram showing a configuration of an image display apparatus according to the first embodiment of the present invention.

  In FIG. 1A, an image display device 20 includes a CT volume data acquisition unit 21, a system control unit 22, an operation unit 23, an image storage unit 24, a calculation unit 25, an image creation unit 27, and the like. The display control unit 28 and the monitor 30 are included.

  The CT volume data acquisition unit 21 is for acquiring desired CT volume data from the CT apparatus 10. The system control unit 22 controls the overall control operation of the image display device 20. The operation unit 23 is used to perform an operation for clicking a wire plan line on a blood vessel cross section, an image selection, and the like, and includes a control panel or the like.

  The image storage unit 24 is storage means for storing coordinates and images for the wire planned lines. The calculation unit 25 is for performing various calculations such as calculating a curve in a 3D image. The image creation unit 27 creates an image to be displayed on the monitor 30 together with the image storage unit 24. The display control unit 28 displays the cross-sectional image of the 3D image created by the image storage unit 24 and the image creation unit 27 on the monitor 17. Furthermore, the monitor 30 displays a 3D image or the like output via the display control unit 28 on the screen.

  Next, the operation of the image display apparatus according to the first embodiment of the present invention will be described with reference to the flowchart of FIG.

  First, in step S1, a blood vessel cross-sectional image is created from CT volume data acquired by the CT volume data acquisition unit 21 from the CT apparatus 10. That is, the volume data 35 as shown in FIG. 3B is obtained from the CT apparatus 10 shown in FIG. Then, the blood vessel center line 37 in the blood vessel 36 is extracted from the volume data 35 by the system control unit 22. Next, an MPR image perpendicular to the blood vessel center line 37 is created, and this becomes a blood vessel cross-sectional image 38 as shown in FIG.

  Next, in step S2, a projection image is created from the CT volume data 35 obtained in step S1. This projection image creation is the same as a general CT image display operation.

  In step S3, the wire plan line is clicked on the blood vessel cross-sectional image 38. Here, as shown in FIG. 4, on the plurality of blood vessel cross-sectional images 38, the operator sequentially clicks on arbitrary points desired to pass through the wire. A wire plan line is formed by continuously connecting the clicked points. In this case, the location of the wire plan line 41 is created in the blood vessel 36, for example, in a portion avoiding the calcified portion 40.

  In creating the wire plan line, first, a portion to be a wire plan line on a certain blood vessel cross-sectional image 38 is clicked. Next, in step S4, it is determined whether there is a blood vessel cross-sectional image to be clicked next. Here, if the click has not been completed yet, the process proceeds to step S5, and the blood vessel cross-sectional image adjacent to the blood vessel cross-sectional image clicked first is displayed on the monitor 30. Then, the process proceeds to step S3 again, and a portion to be a further wire plan line is clicked. In this manner, the processing operations in steps S3 to S5 are repeated until the click is completed in step S4, and a portion to be a wire plan line on the adjacent blood vessel cross-sectional image is clicked. At this time, for example, when the previous image is clicked, the page is turned and a new adjacent blood vessel cross-sectional image is displayed on the near side of the previous image. Thereby, a line in the three-dimensional space is defined, and the wire plan line is displayed as a line on the projection image.

  That is, if the click is completed in step S4, the blood vessel center line 37 and the wire plan line 41 are displayed on the projection image in step S6 as shown in FIG. A point clicked on one cross-sectional image (for example, 46) has three-dimensional coordinates. Therefore, if a click is made on a plurality of cross-sectional images (for example, 46 and 47), a curve in a three-dimensional space in which three-dimensional coordinates are connected can be calculated.

  The calculated curve in the three-dimensional space is projected and depicted on the projection image as shown in FIG. The surgeon operates the wire while viewing the same direction perspective image as the projection image. When the two lines of the blood vessel center line 37 and the wire plan line 41 overlap, the three-dimensional positional relationship is taken into consideration, and as shown in FIG. So that priority is displayed.

  Note that the plurality of cross-sectional images when clicked are not limited to the superimposed display as shown in FIG. 6A. For example, a plurality of cross-sectional images are displayed on the monitor 30 at the same time. You may make it choose from.

  Thereafter, in step S7, the blood vessel cross-sectional image and the blood vessel projection image are displayed side by side on the monitor 30. Note that this blood vessel projection image is not only a CT blood vessel projection image, but also, for example, as shown in FIG. 8, a CT blood vessel cross-sectional image 50a, a CT volume rendering (VR) image, a maximum intensity projection (MIP), and a CatView. (Projected image of slice data of a specific blood vessel) 50b, an X-ray contrast image 50c, and an X-ray fluoroscopic image 50d may be displayed side by side on the monitor 30.

  In addition, an operation for clicking a portion that becomes a wire plan line is performed by a mouse, a keyboard, a touch panel, or the like in the operation unit 23. Furthermore, the next blood vessel cross-sectional image may be automatically displayed by clicking.

  In the above-described embodiment, the blood vessel center line and the wire plan line are displayed on the blood vessel projection image. However, the present invention is not limited to the blood vessel center line, and displays a line connecting at least two arbitrary points including the wire plan line. I just need it. In addition, for example, if two lines can be identified, the lines displayed on these blood vessel projection images may be displayed in a color display or a display in which the line thickness or line type is changed.

  Furthermore, as a modified example, an interface may be provided that corrects a click in the vicinity of step S4 described above when a mistake is made.

  In addition, a plurality of planned lines may be drawn near step S4 described above.

(Second Embodiment)
Next, a second embodiment of the present invention will be described.

  In the first embodiment described above, the click on the blood vessel cross-sectional image serving as the wire plan line is performed on a plurality of cross-sectional images, but this takes time. Therefore, in the second embodiment, only one specific blood vessel cross-sectional image is clicked to improve the operation effort.

  FIG. 9 is a flowchart for explaining the operation of the image display apparatus in the second embodiment of the present invention.

  First, in step S11, a blood vessel cross-sectional image is created from the CT volume data acquired by the CT volume data acquisition unit 21, as in step S1 of the flowchart of FIG. Next, in step S12, a projection image is created from the CT volume data 35 obtained in step S11 as in step S2 of the flowchart of FIG.

  In step S13, a portion to be a wire plan line is clicked on a certain blood vessel cross-sectional image 38. For example, as shown in FIG. 10, on the plurality of blood vessel cross-sectional images 38a to 38e displayed on the monitor, a specific image, in this case, the blood vessel cross-sectional image 38c, an arbitrary point 52c to be passed through the wire by the operator. Is clicked. Then, in the subsequent step S14, the system control unit 22 clicks the same two-dimensional coordinates as the clicked point 52c for the front and rear images, in this case, the blood vessel cross-sectional images 38a, 38b, 38d, and 38e. As a result (points 52a, 52b, 52d, 52e), a straight line (wire plan line) in three dimensions is calculated.

  Next, in step S15, as shown in FIG. 11B, the blood vessel center line 37 and the wire plan line 56 are displayed on the projection image. In step S16, the blood vessel cross-sectional image and the blood vessel projection image are displayed side by side on the monitor 30.

  As described above, according to the second embodiment, the relationship between the blood vessel cross-sectional image and the blood vessel projection image can be displayed in an easy-to-understand manner.

(Third embodiment)
Next, a third embodiment of the present invention will be described.

  In contrast to the first embodiment described above, the third embodiment is an example in which a line is drawn on a cross-sectional image when a specific point is designated on the projection image.

  FIG. 12 is a flowchart for explaining the operation of the image display apparatus in the third embodiment of the present invention.

  First, in step S21, a blood vessel cross-sectional image is created from the CT volume data acquired by the CT volume data acquisition unit 21 in the same manner as in step S1 of the flowchart of FIG. 2 described above. Similar to step S2 in the flowchart of FIG. 2, a projection image is created from the CT volume data 35 obtained in step S21.

  In step S23, one point is clicked on a certain blood vessel projection image 60 as shown in FIG. Then, in the subsequent step S24, the projection line is calculated, and the intersection of the projection line and the blood vessel cross-sectional image is calculated. For example, as shown in FIG. 14, a line connecting the clicked point 58 and the X-ray source 45 is a projection line 62. Next, by calculating the projection line 62, it is determined in step S25 whether or not there is an intersection between the projection line and the blood vessel cross-sectional image. If there is no intersection, the process proceeds to step S23. If there is an intersection, the process proceeds to step S26, and the projection line 62 is projected onto the blood vessel cross-sectional image 38 as shown in FIG. Portrayed. At this time, a line 64 in which the projection line 62 is put on the cross-sectional image 38 is also displayed.

  Thereafter, in step S27, the blood vessel cross-sectional image and the blood vessel projection image are displayed side by side on the monitor 30.

  Thus, according to the third embodiment, the relationship between the blood vessel cross-sectional image and the blood vessel projection image can be displayed in an easy-to-understand manner.

(Fourth embodiment)
Next, a fourth embodiment of the present invention will be described.

  The first to third embodiments described above all relate to the relationship between CT projection images and cross-sectional images. The first and second embodiments are examples of designating (clicking) on the CT tomographic image and drawing a line on the CT projection image, and the third embodiment designates the CT tomographic image and designates the CT tomographic image. An example of drawing a line was explained. However, the present invention is not limited to this, and X-ray images can also be used. For example, it is also preferable to use an X-ray image in cases where it is desired to refer to a CT image suddenly during treatment.

  Therefore, in the fourth embodiment, an example of designating on a CT tomographic image and drawing a line on the X-ray projection image and an example of designating on the X-ray projection image and drawing a line on the CT tomographic image will be described. .

  FIG. 1B is a block diagram showing a configuration of an image display apparatus according to the fourth embodiment of the present invention.

  1B, an X-ray diagnostic treatment apparatus 70 includes a bed 71 on which a patient (subject) K is placed, a pedestal 72, and an arrow that is supported by the pedestal 72 and that is centered on the illustrated P axis. A C arm 73 rotatable in the R direction; an X-ray source 74 provided at one end of the C arm 73; an X-ray detector 75 provided at the other end of the C arm 73; A monitor 76 for displaying the generated image, a 3D position detection device 77 for detecting the position of a device such as a catheter to be inserted into the body of the patient K, and a control unit 20a for controlling these devices in a coordinated manner. Configured.

  The bed 11 is movable in the vertical direction and the horizontal direction, so that the patient K is appropriately disposed between the X-ray source 14 and the X-ray detector 15.

  The C-arm 13 has a structure in which the X-ray source 14 and the X-ray detector 15 are arranged to face each other and are held. Although not shown, the X-ray source 14 has an X-ray tube that irradiates the patient K with X-rays and a collimator that collimates the X-rays irradiated from the X-ray tube. On the other hand, the X-ray detector 15 is, for example, I.D. I. (Image intensifier) and an optical system. I. The X-ray information transmitted through the patient K is converted into optical information, and this optical information is collected by the optical lens by the optical system. I.I. I. An X-ray flat panel detector may be used as a detection device other than the above.

  The control unit 20a includes the CT volume data acquisition unit 21, the system control unit 22, the operation unit 23, the image storage unit 24, the calculation unit 25, the image creation unit 27, the display control unit 28, and the X-ray detector 75 described above. A projection image acquisition unit 26 for acquiring the projection image data of the X-ray source, and a projection angle information input unit 29 for acquiring the projection angle information of the X-ray source based on the position information from the 3D position detection device 77. Yes.

  An X-ray projection image is obtained from the X-ray diagnosis and treatment apparatus 70 having such a configuration via the projection image acquisition unit 26.

  In addition, as a premise of the fourth embodiment, it is assumed that CT data and X-ray data have been aligned. As a simple method of the fourth embodiment, there is a method that assumes that the center of CT volume data coincides with the support rotation center of the X-ray imaging system. As a technique for improving the accuracy, there is known a method of obtaining matching between the images after acquiring both projection images. If the CT data and the X-ray data are aligned, then only the X-ray projection image is used instead of the CT projection image.

  As an example of designating on a CT tomographic image and drawing a line on an X-ray projection image, the same processing operation as in the first and second embodiments described above is performed, and a line is drawn on the CT projection image. Instead, the only difference is that the line is drawn on the X-ray projection image.

  Further, as an example of designating on the X-ray projection image and drawing a line on the CT tomographic image, the processing operation similar to that of the third embodiment described above is performed, and instead of designating on the CT projection image, X What is specified on the line projection image is different.

  An example displayed on the monitor in this way is shown in FIG. In FIG. 17, a CT blood vessel cross-sectional image 65a, an X-ray contrast image 65b, and an X-ray fluoroscopic image 65c are displayed side by side on the monitor 30.

  In the first to fourth embodiments described above, the wire route for passing through the complete occlusion has been described as an example, but the present invention is not limited to this. For example, the present invention can be used when it is desired to confirm the direction of plaque adhesion.

  Furthermore, in the first to fourth embodiments described above, the volume data of the cardiovascular vessel by CT has been described as an example. However, the present invention is not limited to the heart and can be applied to any blood vessel in the whole body. is there. The present invention is not limited to blood vessels, and can be applied to any luminal organ.

  The present invention is not limited to CT volume data, but can be applied to volume data obtained by an X-ray diagnostic apparatus. In particular, since volume data of an X-ray diagnostic apparatus can be created during treatment, CT Often better than volume data.

  Furthermore, the present invention is not limited to CT volume data, but can be applied to any 3D data such as MRI, PET, and the like.

  Although the embodiments of the present invention have been described above, the present invention can be variously modified without departing from the gist of the present invention other than the above-described embodiments.

  Further, the above-described embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements. For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the column of the effect of the invention Can be extracted as an invention.

  DESCRIPTION OF SYMBOLS 10 ... CT apparatus, 20 ... Image display apparatus, 21 ... CT volume data acquisition part, 22 ... System control part, 23 ... Operation part, 24 ... Image storage part, 25 ... Calculation part, 26 ... Projection image acquisition part, 27 ... Image creation unit, 28 ... display control unit, 29 ... projection angle information input unit, 30, 76 ... monitor, 35 ... volume data, 36 ... blood vessel, 37 ... blood vessel center line, 38 ... blood vessel cross-sectional image, 40 ... calcified Portion 41, wire planned line, 46, 47 ... cross-sectional image, 50a ... CT blood vessel cross-sectional image, 50b ... VR image of CT, 50c ... X-ray contrast image, 50d ... X-ray fluoroscopic image.

Claims (8)

Volume data acquisition means for acquiring volume data;
A cross-sectional image creating means for creating a plurality of cross-sectional images from the volume data acquired by the volume data acquiring means;
Projection image creating means for creating an X-ray projection image from the X-ray projection data;
Display means for displaying the plurality of cross-sectional images and projection images;
Designation means for designating a plurality of points on the plurality of cross-sectional images displayed on the display means;
The plan line generated by connecting the plurality of designated points and indicating the plan through which the wire is passed and the blood vessel center line are displayed on at least the projection image displayed on the display means. and control means for,
An image display device comprising: Said control means, wherein a line is present on the front side as viewed from the viewpoint, to claim 1, characterized in that the display above the other lines on the X-ray projection image displayed on the display means Image display device. Said control means, specifying a specific image among the plurality of cross-sectional image displayed on said display means by said designating means, any one of claims 1 or 2, characterized in that to display the next cross-sectional image The image display device according to one item. It said control means, the image display apparatus according to any one of claims 1 to 3, characterized in that displaying a line on the X-ray projection image displayed on the display unit in a different color. The designation means designates a plurality of points on the plurality of projection images displayed on the table means,
The control unit displays a projection line indicating a projection direction on the cross-sectional image displayed on the display unit by connecting a plurality of designated points on the plurality of projection images;
The image display device as claimed in any one of claims 1 to 4, characterized in. The image display apparatus according to claim 5 , wherein the control unit displays at least two arbitrary points on the cross-sectional image displayed on the display unit. The image display apparatus according to claim 6 , wherein the control unit displays at least a projection line on the cross-sectional image displayed on the display unit. The image display device according to claim 6 or 7 , wherein the control means displays the points on the cross-sectional image displayed on the display means in different colors.

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