JP6157864B2 - Medical diagnostic imaging apparatus and puncture support apparatus - Google Patents

Description

  Embodiments described herein relate generally to a medical image diagnostic apparatus and a puncture support apparatus.

  Puncture systems using a plurality of puncture needles are on the market. In puncture using a plurality of puncture needles, while observing an ultrasonic image being scanned, the plurality of puncture needles are inserted to a target position to cauterize the ablation target site. In such an ablation puncture plan, the correlation between the ablation site and the actual patient's body is not visualized. Therefore, the actual position and range of cauterization can only be imagined based on the experience and intuition of the surgeon, and puncture planning is very difficult.

JP 2010-158294 A

  An object is to provide a medical image diagnostic apparatus and a puncture support device that improve the simplification and certainty of the puncture.

The medical image processing apparatus according to the present embodiment includes a puncture storage unit that stores an image data set in which insertion paths and ablation areas of a plurality of puncture needles generated in advance are depicted, and medical image data relating to a subject an image generator for generating a setting unit that sets an ablation region where on the medical image in accordance with an instruction from the user, the position of the ablation region where at least one of the shape and size of the ablation region where based on the geometrical properties including, by adjusting at least one of the spacing and number of the plurality of puncture needle insertion path included in the image data sets, a plurality of puncture needles in ablation of execution scheduled Table candidates for usage number and a determining section for determining a plurality of expected insertion path for said plurality of candidates for usage number fraction of the puncture needle, the plurality of scheduled insertion path superimposed and displayed on the medical image Comprising a part, a.

1 is a diagram showing a configuration of an ultrasonic diagnostic apparatus according to the present embodiment. The figure which shows typically the puncture file memorize | stored in the puncture file storage part of FIG. The figure which shows the typical flow of the puncture assistance process performed under control of the system control part which concerns on Example 1 of this embodiment. The figure for demonstrating the setting process of the ablation planned area | region performed by the puncture plan part in step SA1 of FIG. The figure for demonstrating the selection process of the puncture file performed by the puncture plan part in step SA2 of FIG. The figure for demonstrating the determination process of the planned puncture path | route and cauterization possible area | region of the puncture needle for the number of puncture needles performed by the puncture plan part in step SA3 of FIG. The figure which shows an example of the display screen displayed by the display control part in step SA4 of FIG. The figure which shows the ultrasonic image on which the ablation planned area | region, the puncture guideline, and the ablation possible area | region displayed by the display control part in FIG. The figure which shows the change of the image observation direction of the ultrasonic image on which the cauterization scheduled area | region, the puncture guideline, and the cauterization possible area | region were superimposed performed on the display screen of FIG. The figure for demonstrating correction of the puncture guideline and cauterization possible area | region performed on the display screen of FIG. The figure which shows an example of the display screen during puncture displayed by the display control part in step SA8 of FIG. The figure for demonstrating the calculation process of the single cauterization possible range based on several overlapping one puncture needle cauterization possible range R3 performed by the display control part in step SA8 of FIG. The figure which shows the typical flow of the puncture assistance process performed under control of the system control part which concerns on Example 2 of this embodiment. The figure for demonstrating the determination process of the planned puncture path | route and cauterization possible area | region of the puncture needle for the number of use candidates performed by the puncture plan part in step SB2 of FIG. FIG. 14 is another diagram for explaining a process of determining the planned insertion paths and cauterization areas of the puncture needles for the number of use candidates, which is executed by the puncture planning unit in step SB2 of FIG. FIG. 14 is another diagram for explaining a process of determining the planned insertion paths and cauterization areas of the puncture needles for the number of use candidates, which is executed by the puncture planning unit in step SB2 of FIG. FIG. 14 is another diagram for explaining a process of determining the planned insertion paths and cauterization areas of the puncture needles for the number of use candidates, which is executed by the puncture planning unit in step SB2 of FIG. The figure which shows the structure of the puncture assistance apparatus which concerns on the modification 5 of this embodiment.

  Hereinafter, a medical image diagnostic apparatus and a puncture support apparatus according to the present embodiment will be described with reference to the drawings.

  The medical image diagnostic apparatus according to this embodiment may be any apparatus as long as it is used in puncture using a puncture needle and can generate a medical image. Specifically, as the medical image diagnostic apparatus according to the present embodiment, an ultrasonic diagnostic apparatus, an X-ray computed tomography apparatus, a magnetic resonance diagnostic apparatus, a nuclear medicine diagnostic apparatus, or the like can be used. However, for the sake of specific description, it is assumed that the medical image diagnostic apparatus is an ultrasonic diagnostic apparatus.

  FIG. 1 is a diagram illustrating a configuration of an ultrasonic diagnostic apparatus 1 according to the present embodiment. As shown in FIG. 1, the ultrasonic diagnostic apparatus 1 has an ultrasonic probe 13, a transmission / reception unit 15, a transmission / reception control unit 17, a signal processing unit 19, an image generation unit 21, and an image storage unit 23 with a system control unit 11 as a center. A puncture needle position detection unit 25, a high frequency generation unit 27, an ablation control unit 29, a puncture file storage unit 31, a puncture planning unit 33, a display control unit 35, a display unit 37, and an operation unit 39.

  The ultrasonic probe 13 has a plurality of transducers arranged in one or two dimensions. The vibrator receives a transmission drive signal from the transmission / reception unit 15 and generates an ultrasonic wave. Ultrasound is reflected one after another at discontinuities (echo sources) of the acoustic impedance of the body tissue of the subject. The reflected ultrasonic wave is received by the vibrator. When receiving the ultrasonic wave, the transducer converts it into an echo signal (electrical signal) derived from the received ultrasonic wave. The echo signal is supplied to the transmission / reception unit 15.

  The transmission / reception unit 15 transmits / receives ultrasonic waves via the ultrasonic probe 13 under the control of the transmission / reception control unit 17. Specifically, the transmission / reception unit 15 repeatedly transmits a transmission drive signal to the ultrasonic probe 13 in order to transmit ultrasonic waves. Thereby, the ultrasonic probe 13 generates a beam-like ultrasonic wave having a focal point at a predetermined transmission focus position with respect to a predetermined transmission direction. In order to receive the ultrasonic wave, the transmission / reception unit 15 generates a reception signal regarding an ultrasonic beam having a focal point at a predetermined reception focus position with respect to a predetermined reception direction based on an echo signal from the ultrasonic probe 13. The generated reception signal is supplied to the signal processing unit 19.

  The transmission / reception control unit 17 controls the transmission / reception unit 15 so that an ultrasonic scan is executed according to a predetermined scan condition or the like.

  The signal processing unit 19 performs signal processing on the reception signal from the transmission / reception unit 15. Specifically, the signal processing unit 19 performs B-mode processing such as logarithmic compression and envelope detection processing on the received signal, and generates a B-mode signal that expresses the intensity of the received signal with luminance. The B mode signal is supplied to the image generator 21.

  The image generation unit 21 generates ultrasonic image data related to the subject based on the B-mode signal from the signal processing unit 19. The ultrasonic image data is supplied to the image storage unit 23. The ultrasonic image is immediately displayed on the display unit 37 according to the control by the display control unit 35. The ultrasonic image is used to guide the puncture needle 41 in puncture.

  The puncture needle 41 according to the present embodiment uses at least one puncture needle 41. Although two puncture needles 41 are illustrated in FIG. 1, the number of puncture needles 41 used for the puncture may be one, or three or more.

  The puncture needle position detection unit 25 detects the position of the distal end portion of the puncture needle 41 electrically, magnetically, or electromagnetically. Specifically, a position sensor is provided at the distal end portion of the puncture needle 41. The puncture needle position detection unit 25 calculates the position of the tip portion of each puncture needle 41 based on the electrical signal from the position sensor. The data regarding the tip position of the puncture needle 41 and the puncture needle position signal are supplied to the system control unit 11.

  In addition, a high frequency generator 27 is connected to the puncture needle 41. The high frequency generator 27 applies high frequency energy to the electrode attached to the distal end portion of the puncture needle 41 under the control of the ablation control unit 29. The electrode to which the high frequency energy is applied generates heat. The living tissue existing around the electrode is cauterized by the heat generated by the electrode.

  The ablation control unit 29 controls the high-frequency generation unit 27 so that ablation is performed according to predetermined ablation output conditions. The cautery output condition includes at least an output value item and an output time item. The output value is the intensity of the high frequency energy applied to the electrode. The output time is the duration of applying high frequency energy to the electrode, that is, the cauterization time.

  The puncture file storage unit 31 stores a plurality of puncture files. Each puncture file is a file in which various data relating to puncture actually performed in the past are managed for each puncture.

  FIG. 2 is a diagram schematically showing a puncture file stored in the puncture file storage unit 31. As shown in FIG. 2, the puncture file includes a past puncture needle position, a past puncture needle insertion path, a past ablation condition, a past ablation scheduled area, a past ablation implementation area, a past medical image data set, and past ultrasound image data. Contains items about sets. The past puncture needle position is a position coordinate of the tip portion of the puncture needle detected in the past puncture. The past puncture needle position is stored in association with the time or the like. The past puncture needle insertion path is a mark of the puncture needle insertion path displayed in the past puncture procedure. Hereinafter, the puncture path mark of the puncture needle will be referred to as a puncture guideline. The past puncture guideline is stored in association with the position coordinate in the real space of the puncture guideline. The past ablation condition is an ablation condition in the past puncture. The cauterization conditions specifically include items such as cauterization output conditions, cauterization sites, the number of puncture needles used, and the like. The ablation output condition includes items such as an output value of high frequency energy applied to the puncture needle and an output time (cauterization time). The past ablation scheduled area is image data of the ablation scheduled area set in the past puncture. The past ablation scheduled area is set so as to include the ablation target region in the past medical image and the past ultrasonic image. The past ablation scheduled area is stored in association with the position coordinates of the area in real space. The past cauterization execution area is image data of an area actually cauterized in the past puncture. The past cautery execution area is stored in association with the position coordinates of the area in real space. The past medical image data set is generated by a medical image diagnostic apparatus and used for reference in past punctures (hereinafter referred to as past medical image) and a spatial portion of a scan region of the past medical image. Position coordinates. In the past medical image, a puncture guideline, a past ablation planned area, and a past ablation execution area are superimposed. A medical image diagnostic apparatus that generates a past medical image data set may be any existing modality such as an X-ray diagnostic apparatus, an X-ray computed tomography apparatus, a magnetic resonance diagnostic apparatus, an ultrasonic diagnostic apparatus, or a nuclear medicine diagnostic apparatus. good. The past ultrasonic image data set is generated by an ultrasonic diagnostic apparatus, and is displayed in real time in the past puncture operation (hereinafter referred to as the past ultrasonic image) and the spatial portion of the scan portion of the past ultrasonic image. Position coordinates. In the past ultrasonic image, a puncture guideline, a past ablation planned area, and a past ablation execution area are superimposed.

  The puncture planning unit 33 generates a puncture file related to a puncture scheduled to be performed. For example, the puncture planning unit 33 has a cautery region setting function and a puncture route determination function. In the ablation area setting function, the puncture planning unit 33 sets the ablation scheduled area on the medical image in accordance with an instruction from the user. In the puncture route determination function, the puncture planner 33 determines the planned puncture routes of the puncture needles 41 for the number of use candidates in the planned puncture operation based on the set geometric characteristics of the planned ablation area. Details of the processing of the puncture planning unit 33 will be described later.

  The display control unit 35 controls the display unit 37 to display various information. For example, the display control unit 35 controls the display unit 37 so as to superimpose and display the scheduled insertion path determined by the puncture planning unit 33 on the medical image.

  The display unit 37 displays various information according to control by the display control unit 35. Examples of the display unit 37 include a CRT display, a liquid crystal display, an organic EL display, and a plasma display.

  The operation unit 39 receives various commands and information input from the user by the input device. As the input device, a keyboard, various switches, a touch panel, and the like can be used.

  The system control unit 11 supervises each unit of the ultrasonic diagnostic apparatus 1. The system control unit 11 has a central processing unit (CPU) and a random access memory (RAM). For example, the system control unit 11 reads out and develops an operation program of the program of the ultrasonic diagnostic apparatus 1, controls each unit according to an instruction expressed by the program, and executes the puncture support processing according to the present embodiment.

  Hereinafter, an operation example of the ultrasonic diagnostic apparatus 1 according to the present embodiment will be described. The ultrasonic diagnostic apparatus 1 according to the present embodiment determines and displays the planned insertion paths of the puncture needles 41 for the number of use candidates from the ablation planned area in the puncture operation using the plurality of puncture needles 41. The scheduled insertion path is displayed, for example, in the form of a puncture guideline that expresses the scheduled insertion path on a medical image. The method for determining the planned insertion route is roughly divided into two. The first method is a method for determining a planned insertion path using a past puncture file. The second method is a method of determining a scheduled insertion path by image processing without using a past puncture file. Hereinafter, an operation example using the first method will be described in the first embodiment, and an operation example using the second method will be described in the second embodiment.

Example 1
Hereinafter, an operation example of the ultrasonic diagnostic apparatus 1 according to the first embodiment will be described.

  FIG. 3 is a diagram illustrating a typical flow of the puncture support process performed under the control of the system control unit 11 according to the first embodiment. First, the system control unit 11 waits for a user to give an instruction to start puncture support processing via the operation unit 39. In response to the start instruction, the system control unit 11 causes the puncture planning unit 33 to perform setting processing (step SA1). In step SA1, the puncture planning unit 33 sets ablation planned area on the medical image in accordance with an instruction from the user via the operation unit 39.

  FIG. 4 is a diagram for explaining the setting process of the ablation scheduled area R1. As shown in FIG. 4, first, in step SA <b> 1, the past medical image I <b> 1 is displayed on the display unit 37 by the display control unit 35. The past medical image I1 is preferably a medical image generated by a medical image diagnostic apparatus prior to a puncture plan for a target patient to be punctured. As long as the past medical image I1 is an image that can be diagnosed satisfactorily, the type of modality that is the generation source is not limited. For example, as the past medical image I1, an image that clearly shows the form of the ablation site such as an image generated by an X-ray computed tomography apparatus or a magnetic resonance diagnostic apparatus may be used. The display control unit 35 reads the past medical image I1 designated by the user via the operation unit 39 from the puncture file storage unit 31 and displays it on the display unit 37. When the past medical image I1 is displayed, the user sets the cauterization condition via the operation unit 39. The expected ablation area R1 is set as one of the ablation conditions. The ablation scheduled region R1 is designated in the past medical image I1 so as to include the ablation target region such as a tumor. Other ablation conditions include ablation sites, the number of puncture needles to be used, output values, output times, and the like. The set ablation area R1 and the ablation condition are stored in the puncture file related to the puncture scheduled to be performed by the puncture file storage unit 31.

  When step SA1 is performed, the system control unit 11 causes the puncture planning unit 33 to perform selection processing (step SA2). In step SA2, the puncture planning unit 33 selects a puncture file to be used for the puncture plan from a plurality of puncture files stored in the puncture file, according to the ablation scheduled area set in step SA1. .

  FIG. 5 is a diagram for explaining a puncture file selection process. As shown in FIG. 5, the puncture planning unit 33 reads past cautery execution areas in all puncture files stored in the puncture file storage unit 31. In FIG. 5, a puncture file A, a puncture file B, and a puncture file C are illustrated. Puncture planning unit 33 calculates a geometric coincidence rate between the ablation area included in each puncture file and the ablation scheduled area set in step SA1. Specifically, first, puncture planning unit 33 aligns the ablation execution area included in each puncture file with the ablation scheduled area set in step SA1. Here, the alignment processing is desirably performed on a real space coordinate system using a magnetic sensor, an infrared ray, an optical camera, a GPS (global positioning system), or the like. Further, the alignment processing may be alignment in an image processing space such as pattern matching or a tag. The geometric coincidence rate is defined by, for example, the degree of coincidence between the shape and position of the ablation area included in each puncture file and the ablation scheduled area set in step SA1. The puncture planning unit 33 calculates the coincidence rate of the ablation execution area included in each puncture file with the ablation scheduled area set in step SA1. The puncture planning unit 33 identifies the highest match rate among the plurality of match rates, and selects a puncture file including the ablation area regarding the specified match rate as a reference puncture file.

  For example, as shown in FIG. 5, the coincidence rate between the ablation area R1A of the puncture file A and the ablation scheduled area R11 set in step SA1 is 70%, and the ablation area R1B of the puncture file B and the ablation area The coincidence rate with the scheduled region R11 is 60%, and the coincidence rate between the ablation execution region R1C of the puncture file C and the ablation scheduled region R11 is 95%. In this case, the puncture file C is selected as the reference puncture file.

  In the above description, the reference puncture file is automatically selected according to the degree of coincidence. However, this embodiment is not limited to this. For example, the puncture planning unit 33 automatically selects a use candidate puncture file in accordance with the degree of coincidence, and selects a use candidate puncture file as a reference puncture file from the use candidate puncture files. May be. Specifically, when the puncture planning unit 33 calculates a plurality of matching rates, each of the plurality of matching rates is compared with a predetermined threshold, and a puncture file having a matching rate equal to or higher than the predetermined threshold is used as a candidate for use. Select as puncture file. The use candidate puncture file is displayed on the display unit 37. The user designates a reference puncture file to be used in the scheduled puncture from among the use candidate puncture files. The puncture planning unit 33 selects the designated puncture file as a reference puncture file. As a result, the user's intention can be reflected in the selection of the reference puncture file. The puncture planning unit 33 may directly select a reference puncture file from a plurality of puncture files in accordance with an instruction from the user via the operation unit 39 without calculating the coincidence rate.

  In the above description, the reference puncture file is selected in accordance with the degree of coincidence between the ablation scheduled area and the ablation area stored in the puncture file. However, this embodiment is not limited to this. For example, a reference puncture file may be selected based on other ablation conditions set in step SA1 in addition to the above-mentioned degree of coincidence. For example, when the other ablation condition is the number of puncture needles scheduled to be used, the use candidate puncture file is limited to a file related to the number of puncture needles used that matches the planned number of puncture needles set in step SA1. good.

  When step SA2 is performed, the system control unit 11 causes the puncture planning unit 33 to perform determination processing (step SA3). In step SA3, the puncture planning unit 33 uses the puncture file selected in step SA2, and the planned puncture paths and cauterization possible areas of the puncture needles 41 for the number of puncture needles to be used from the ablation planned area set in step SA1. And decide.

  FIG. 6 is a diagram for explaining a process of determining the planned insertion paths and cauterization areas of the puncture needles 41 for the number of planned use. As shown in FIG. 6, in step SA3, the puncture planning unit 33 performs the puncture guideline expressing the geometric characteristics of the ablation scheduled region R1, the ablation execution region R1 ′ included in the reference puncture file, and the puncture route. Based on the geometrical characteristics with P1, the planned insertion paths and cauterization possible areas of the puncture needles 41 for the number of puncture needles to be used are determined. Specifically, the puncture planning unit 33 collectively coordinates the ablation execution region R1 ′ and the puncture guideline P1 ′ so that the ablation execution region R1 ′ is included in the ablation scheduled region R1. For example, the puncture planning unit 33 moves the ablation execution region R2 and the puncture guideline P1 ′ so that the reference points of the plurality of puncture guidelines P1 ′ are directed toward the reference point PR1 of the ablation scheduled region. Specifically, the ablation execution region R1 ′ and the puncture guideline P1 ′ are moved so that the centers of gravity of the tip portions PE1 ′ of the plurality of puncture guidelines P1 ′ coincide with the reference point PR1. Here, for example, the center of gravity is preferably used as the reference point PR1. And the puncture plan part 33 calculates provisional cauterization possible area | region R2 'based on several puncture guideline P1' after a movement. Specifically, the puncture planning unit 33 calculates the ablation possible region R2 ′ using the position coordinates of the distal end portions PE1 ′ of the plurality of puncture guidelines P1 ′ after movement and the ablation output conditions set in step SA1. To do.

  The puncture planner 33 moves the ablation area R2 and the puncture guideline P1 ′ until the temporary ablation area (cauterization area) R2 ′ is included in the ablation area R1, and the ablation area R2 ′. Repeat the calculation. When the temporary ablation capable region R2 ′ is included in the expected ablation region R1, the temporary ablation possible region R2 ′ is determined as the formal ablation possible region R2, and the puncture guideline P1 ′ becomes the official puncture guideline P1. It is determined. The position coordinates of the ablation capable region R2, the puncture guideline P1 (scheduled puncture route), and the tip portion PR of the puncture guideline P1 are stored by the puncture file storage unit 31 in a puncture file related to the puncture to be performed. .

  When there are a plurality of puncture guidelines, adjacent puncture guidelines may approach or separate to an extent that is not practically acceptable. In this case, the puncture planning unit 33 changes the number of puncture needles used in the puncture operation scheduled to be performed according to the interval between the plurality of puncture guidelines. For example, the puncture planning unit 33 calculates an interval between two puncture guidelines, and compares the interval for each of the lower threshold value and the upper threshold value. The lower threshold value and the upper threshold value are determined based on a range in which one puncture needle can be cauterized (hereinafter, referred to as a single puncture needle cauterization range). The puncture needle ablation possible range is determined according to the ablation output conditions of the puncture needle such as the output value and output time. The lower threshold is set to detect that the two puncture guidelines are approaching to an extent that is not practically acceptable. The lower threshold is set, for example, to a diameter within a range where one puncture needle can be cauterized. The upper threshold value is set in order to detect that the two puncture needles and the puncture needle cauterization range are separated to an extent that is practically unacceptable. The upper threshold value is set to, for example, twice the diameter of one puncture needle cauterization possible range. When the interval is smaller than the lower threshold, the puncture planning unit 33 deletes one of the two puncture guidelines. When the interval is larger than the upper threshold, the puncture planning unit 33 inserts a new puncture guideline between the two puncture guidelines. When the puncture guideline is deleted or inserted, the puncture planner 33 recalculates the ablation possible region as described above.

  The puncture planning unit 33 does not necessarily need to increase or decrease the number of puncture needles 41 according to the interval between puncture guidelines. When the situation where the distance between the puncture guidelines is approaching or moving away from the predetermined value is acceptable in the puncture operation, the number of puncture needles 41 may not be increased or decreased. In this case, the number of puncture needles used stored in the reference puncture file is defined as the number of puncture needles used for the puncture to be performed.

  If the ablation planned area does not deviate from the past ablation performing area in the reference puncture file, the puncture planning unit 33 performs the puncture performing the past ablation performing area in the reference puncture file. You may set to the cauterization execution area.

  The ablation scheduled area, the puncture needle scheduled insertion path, and the ablation possible area are stored in the puncture file storage unit 31 in association with the three-dimensional coordinates in the real space in the puncture file scheduled to be performed.

  In step SA3, the system control unit 11 causes the display control unit 35 to perform display processing (step SA4). In step SA4, as shown in FIG. 7, the display control unit 35 superimposes the ablation scheduled area R1, the puncture guideline P1, and the ablation possible area R2 on the past medical image I1 and displays them on the display unit 37. The user confirms the insertion path of the puncture needle in the puncture operation scheduled to be performed by observing the display image. At this time, the user can appropriately correct the path drawn by the puncture guideline via the operation unit 39. Along with the correction of the puncture guideline P1, the puncture planner 33 recalculates the cauterization possible region R2. The corrected puncture guideline and the cauterization possible region R2 are overwritten and saved by the puncture file storage unit 31.

  For example, when the puncture guideline overlaps in a major organ region such as the heart, if the puncture needle 41 is inserted along this path, the puncture needle 41 penetrates the organ. In this case, a serious risk is posed to the patient. Therefore, the puncture planning unit 33 allows manual correction of the puncture guideline by the user. Thereby, the user can correct the puncture guideline so that the puncture guideline does not overlap the organ or the like. Therefore, it is possible to improve the accuracy of support for puncture by the ultrasonic diagnostic apparatus 1.

  When step SA4 is performed, the system control unit 11 waits for an instruction to start an ultrasonic scan (step SA5). After confirming the planned insertion path of the puncture needle 41, the user inputs an instruction to start ultrasonic scanning via the operation unit 39 or the like. The system control unit 11 causes the transmission / reception control unit 17 to perform transmission / reception processing when the start instruction is input (step SA6). In the ultrasonic scan, the user abuts the ultrasonic probe 13 on the patient's body surface so that the ablation site is included in the scan region. In step SA6, the transmission / reception control unit 17 controls the transmission / reception unit 15 to repeatedly scan the scan area with ultrasonic waves. The signal processing unit 19 instantly generates a B mode signal based on the received signal from the transmission / reception unit 15, and the image generation unit 21 instantly generates an ultrasonic image based on the B mode signal from the signal processing unit 19. Occurs.

  When step SA6 is performed, the system control unit 11 causes the display control unit 35 to perform display processing (step SA7). In step SA7, the display control unit 35 immediately displays the ultrasonic image generated in step SA6 on the display unit 37. At this time, the display control unit 35 aligns the ultrasound image with the ablation scheduled region, the puncture guideline, and the ablation capable region, and superimposes the ablation scheduled region, the puncture guideline, and the ablation possible region on the ultrasound image. As in the above-described method, the alignment processing is desirably performed in real space using a magnetic sensor, infrared ray, optical camera, GPS (global positioning system), or the like. Further, the alignment processing may be alignment in an image processing space such as pattern matching or a tag. Note that the display control unit 35 may perform alignment processing with reference to the scan position by the ultrasound diagnostic apparatus 1. The scan position may be input by the user via the operation unit 39.

  FIG. 8 is a diagram showing an ultrasound image I2 on which the ablation scheduled region R1, the puncture guideline P1, and the ablation possible region R2 are superimposed. As shown in FIG. 8, the ultrasound image I2, the ablation scheduled region R1, the puncture guideline P1, and the ablation capable region R2 are displayed by the display control unit 35 in accordance with the three-dimensional coordinates in the real space. By observing the image I2, the user can immediately grasp the positions of the ablation scheduled region R1, the puncture guideline P1, and the ablation capable region R2 in real space immediately before the puncture.

  At this time, the display control unit 35 follows the instruction via the operation unit 39 by the user, and the image observation direction (line-of-sight direction) of the ultrasonic image on which the ablation planned area, the planned puncture needle insertion path, and the ablation possible area are superimposed. Can be changed. FIG. 9 is a diagram illustrating a change in the image observation direction of the ultrasound image I2 on which the ablation scheduled region R1, the puncture guideline P1, and the ablation capable region R2 are superimposed. As shown in FIG. 9, the ablation scheduled area R1, the puncture guideline P1, the ablation possible area R2, and the ultrasonic image I2 are defined in a three-dimensional image space. The display control unit 35 can change the image observation direction of the ultrasonic image I2 in accordance with an instruction from the user via the operation unit 39. Thus, by changing the image observation direction, the insertion path and the ablation area of the puncture needle can be examined from various directions.

  The display control unit 35 can correct the puncture guideline and the cauterization possible region in accordance with an instruction from the user via the operation unit 39. FIG. 10 is a diagram for explaining correction of puncture guideline P1 and cauterization possible region R2. As described above, it is not desirable when the puncture guideline P1 ′ overlaps with a major organ region such as the heart. Therefore, the user operates the operation unit 39 to correct the puncture guideline P1 ′ so as not to overlap with a major organ region such as the heart. For example, the puncture guideline P1 ′ is corrected to the puncture guideline P1 by the correction. Along with the correction of the puncture guideline P1 ′, the puncture planner 33 automatically corrects the cauterization possible region R2 ′ by image processing. For example, the corrected ablation capable region R2 is calculated by applying a coordinate conversion formula from the uncorrected puncture guideline P1 ′ to the corrected puncture guideline P1 to the uncorrectable ablation possible region R2 ′. The puncture planner 33 overwrites and saves the corrected puncture guideline P1 and the cauterization possible region R2.

  In this way, the user performs final confirmation of the insertion path and the ablation area of the puncture needle in the puncture while observing the ultrasound image on which the ablation scheduled area, the puncture guideline, and the ablation possible area are superimposed. When preparation for the puncture is completed, the user performs the puncture while observing an ultrasonic image on which the ablation scheduled area, the puncture guideline, and the ablation possible area are superimposed (step SA8). FIG. 11 is a diagram illustrating an example of a display screen during puncture. As shown in FIG. 11, in addition to the ultrasound image I2 on which the ablation scheduled region R1, the puncture guideline P1, and the ablation possible region R2 are superimposed, the display screen includes a pixel region (hereinafter referred to as puncture). P2, which is referred to as a needle area, is depicted.

  During the puncture, the display control unit 35 may superimpose the one puncture needle cauterization possible range R3 on the distal end portion PE of the puncture needle region P2 in the display screen as shown in FIG. For example, the display control unit 35 displays the range R3 so that the center of the range R3 is located at the tip portion PE2. In this way, the display control unit 35 causes the range R3 to follow the distal end portion PE2 of the puncture needle region P2. The display control unit 35 may detect the distal end portion PE2 of the puncture needle region P2 using an electrical signal from a position sensor provided at the distal end of the puncture needle, or the puncture needle region P2 depicted on the display screen. The leading edge PE2 of the image may be detected by image processing. By superimposing the range R3 on the distal end portion PE2, the user can immediately grasp the cauterization possible range by each puncture needle 41.

  In addition, when a plurality of one puncture needle ablation possible ranges derived from puncture needle areas related to a plurality of puncture needles overlap, the display control unit 35 provides a single ablation possible range based on the plurality of overlapping one puncture needle ablation possible ranges. Is calculated. FIG. 12 is a diagram for explaining a calculation process of a single ablation possible range R3 based on a plurality of overlapping one puncture needle ablation possible ranges R3. As shown in FIG. 12, when a puncture needle being punctured approaches a puncture needle that has already been punctured by a certain distance or more, a single puncture needle cauterization possible range R31 derived from the puncture needle region P21 related to the puncture needle that has already been punctured and puncture One puncture needle cauterization possible range R32 derived from the puncture needle region P22 related to the inner puncture needle overlaps. In this case, the display control unit 35 calculates a combined range R33 of the range R31 and the range R32. For example, the synthesis range R33 may be defined as a logical sum area of the range R31 and the range R32. Of course, the synthesis range R33 may be calculated by other methods based on the other ranges R31 and R32.

  In the puncture operation, the user inserts a puncture needle into the subject along the puncture guidelines while observing the display screen, and performs cauterization with reference to the ablation possible region. Thus, the user can perform puncture safely and without stress by performing the puncture operation while referring to the puncture needle schedule guideline and the cauterization possible region.

  When the puncture operation is completed, the user confirms the actually cauterized region while observing the ultrasonic image after cauterization. The puncture planning unit 33 recognizes an area (cauterization execution area) where the ultrasonic image after cauterization is subjected to image processing and is actually cauterized. The puncture file storage unit 31 stores the set image data of the ablation area and the three-dimensional coordinates in the real space of the ablation area in association with the ablation site. The ablation area is not limited to being automatically recognized by image processing. For example, the cautery execution area may be set by the puncture planning unit 33 in accordance with an instruction from the user via the operation unit 39.

  This is the end of the description of the operation example of the ultrasonic diagnostic apparatus according to the first embodiment.

(Example 2)
Hereinafter, an operation example of the ultrasonic diagnostic apparatus according to the second embodiment will be described. In the following description, components and processes having substantially the same functions as those in the first embodiment are denoted by the same reference numerals, and redundant description is provided only when necessary.

  FIG. 13 is a diagram illustrating a typical flow of a puncture support process performed under the control of the system control unit 11 according to the second embodiment. First, the system control unit 11 waits for a user to give an instruction to start puncture support processing via the operation unit 39. In response to the start instruction, the system control unit 11 causes the puncture planning unit 33 to perform setting processing (step SA1).

  When step SA1 is performed, the system control unit 11 causes the puncture planning unit 33 to perform determination processing (step SB2). In step SB2, the puncture planning unit 33 determines the planned insertion paths and cauterization possible areas of the puncture needles 41 corresponding to the number of use candidates from the ablation planned area set in step SA1 according to one puncture needle ablation possible range. . The one-puncture needle cauterization possible range can be calculated based on the cauterization output condition as described above.

  14, FIG. 15, FIG. 16, and FIG. 17 are diagrams for explaining the process of determining the planned insertion paths and cauterization areas of the puncture needles for the number of use candidates according to the second embodiment. 14 and 15, it is assumed that the past medical image I1 is an ultrasonic image. The puncture planning unit 33 fills the ablation scheduled area R1 with at least one puncture needle ablation possible range R3 under the restriction of a predetermined degree of overlap. Specifically, as shown in FIG. 14, the range R3 is swept from the end on the body surface side, and the first location where the range R3 is included in the planned ablation region R1 is specified. The identified location is determined as the position of the first puncture needle. Next, as shown in FIG. 15, the positions of the second and subsequent puncture needles are determined. Specifically, one puncture needle cauterization possible range R3 ′ relating to the second and subsequent puncture needles is swept from the position of the first puncture needle, and the range R3 is included in the ablation scheduled region R1 and other already arranged. A position that does not overlap the range R3 more than a predetermined overlap is provisionally specified. The degree of overlap is defined by the area of the pixel region or the number of pixels where two one puncture needle ablation possible ranges overlap. The predetermined overlap value can be arbitrarily set by the user via the operation unit 39.

  As shown in FIG. 16, the puncture planning unit 33 temporarily sets the ablation capable region R2 ′ based on the provisional one puncture needle ablation possible range R3 ′ and the already arranged one puncture needle ablation possible range R3. Calculate (recalculate). When the recalculated ablation capable region R2 ′ is included in the ablation scheduled region R1, a provisional one puncture needle ablation possible range R3 ′ is determined as the position of the second and subsequent puncture needles. When the ablation capable region R2 ′ is not included in the ablation scheduled region R1, that is, when the ablation possible region R2 ′ deviates from the ablation expected region R1, the range R3 ′ is changed to the ablation possible region R2 ′ as the ablation expected region R1. Move to included position. The position of the range R3 ′ after the movement is determined as the position of the second and subsequent puncture needles. The puncture planning unit 33 repeats this process until it becomes impossible to arrange one puncture needle cauterization range. In this way, the number of puncture needles scheduled to be used and the tip position of each puncture needle scheduled to be used are determined. The ablation capable region may be set to an elliptical region or a circular region that is inscribed in a plurality of puncture needle ablation possible ranges.

  As shown in FIG. 17, the puncture planning unit 33 determines a planned puncture route of the puncture needle according to the position of the center of one puncture needle cauterization possible range R3. Specifically, the puncture planning unit 33 first sets the center of the range R3 to the tip of the puncture guideline P1. Next, the puncture planning unit 33 determines a straight line extending in a predetermined direction from the distal end portion PE1 as the puncture guideline P1. The predetermined direction is typically defined as a direction extending perpendicularly to the body surface side. However, the predetermined direction is not limited to a direction extending perpendicularly to the body surface side, and may be any direction as long as it is a direction toward the body surface side.

  When step SB2 is performed, the system control unit 11 causes the display control unit 35 to perform display processing (step SA4). In step SA4, the display control unit 35 displays the expected ablation area R1, the puncture guideline P1, and the ablation possible area R2 on the display unit 37 so as to be superimposed on the past medical image I1. At this time, the puncture planning unit 33 can correct the puncture guideline according to the puncture guideline correction operation via the operation unit 39 by the user, as in the first embodiment.

  When step SA4 is performed, the system control unit 11 waits for an instruction to start an ultrasonic scan (step SA5). The user inputs an ultrasonic scan start instruction confirming the puncture guideline and the like via the operation unit 39 and the like. The system control unit 11 causes the transmission / reception control unit 17 to perform transmission / reception processing when the start instruction is input (step SA6).

  When step SA6 is performed, the system control unit 11 causes the display control unit 35 to perform display processing (step SA7). In step SA7, the display control unit 35 immediately displays the ultrasonic image generated in step SA6 on the display unit 37. At this time, the display control unit 35 aligns the ultrasound image with the ablation scheduled region, the puncture guideline, and the ablation capable region, and superimposes the ablation scheduled region, the puncture guideline, and the ablation possible region on the ultrasound image. At this time, the puncture planning unit 33 can correct the puncture guideline according to the puncture guideline correction operation via the operation unit 39 by the user, as in the first embodiment.

  When the preparation for the puncture is completed, the user performs the puncture while observing an ultrasonic image on which the ablation scheduled area, the puncture needle scheduled insertion path, and the ablation possible area are superimposed (step SA8).

  This is the end of the description of the operation example of the ultrasonic diagnostic apparatus according to the second embodiment.

(Modification 1)
In the above embodiment, the first and second embodiments have been described as independent puncture flows. However, this embodiment is not limited to this. That is, Example 1 and Example 2 may be integrated into a single puncture flow. For example, when an appropriate puncture file candidate is not selected in step SA2 of the first embodiment, the second embodiment may be performed.

(Modification 2)
The puncture file may be managed for each part by the puncture file storage unit 31. This management method facilitates reading of past puncture files. Therefore, in a new puncture, the display control unit 35 can display puncture plan information such as puncture guidelines stored in a puncture file related to a past puncture on a medical image generated in the new puncture. it can. Thus, according to the second modification, the puncture file can be easily used as reference information for effect determination and follow-up observation in puncture.

(Modification 3)
The above puncture file may be restored in another medical image diagnostic apparatus. Thereby, it can utilize for the plan at the time of performing a scan in order to perform the effect determination of puncture.

(Modification 4)
In step SA1 of the above-described embodiment, it is assumed that an ablation scheduled area smaller than a range that can be cauterized by one puncture needle (one puncture needle ablation possible range) is set. In this case, it is dangerous to perform puncture in the ablation planned area or ablation conditions. Therefore, the display control unit 35 warns about this. Specifically, when the ablation planned area is set, it is determined whether or not the size of the ablation scheduled area is larger than the size of one puncture needle ablation possible range. When it is determined that the size of the ablation scheduled area is larger than the size of the puncture needle ablation possible range, the display control unit 35 does not issue a warning. When it is determined that the size of the expected ablation area is not larger than the size of the puncture needle ablation possible range, the display control unit 35 issues a warning to that effect. For example, the display control unit 35 displays a message such as “the size of the designated ablation scheduled area is smaller than the size of the puncture needle ablation possible range”. Alternatively, the display control unit 35 may display a message such as “the puncture needle ablation range exceeds the designated ablation scheduled area”. In this case, the display control unit 35 may display a screen that prompts the user to reset the ablation schedule area or the ablation condition. As a result, it is possible to avoid a situation in which the size of the ablation planned area is smaller than the size of one puncture needle ablation possible range.

(Modification 5)
In the above-described embodiment, the configuration that does not participate in the ultrasound scan such as the puncture planning unit 33 and the high frequency generation unit 27 is incorporated in the ultrasound diagnostic apparatus 1. However, this embodiment is not limited to this. That is, the configuration that is not involved in the ultrasound scan, such as the puncture planning unit 33 and the high-frequency generation unit 27, may be incorporated in a device (puncture support device) that is separate from the ultrasound diagnostic device 1. Hereinafter, a puncture assisting apparatus according to Modification 5 will be described. In the following description, components and processes having substantially the same functions as those in the above embodiment are denoted by the same reference numerals, and redundant description is provided only when necessary.

  FIG. 18 is a diagram illustrating a configuration of a puncture support device 200 according to Modification 5. As shown in FIG. 18, the puncture support apparatus 200 is connected to the ultrasonic diagnostic apparatus 100. The ultrasonic diagnostic apparatus 100 is an existing ultrasonic diagnostic apparatus having an ultrasonic transmission / reception function, a signal processing function, an image generation function, and the like. For example, the ultrasound diagnostic apparatus 100 transmits and receives ultrasound through an ultrasound probe, generates ultrasound image data based on an echo signal from the ultrasound probe, and punctures the generated ultrasound image data. It transmits to the surgery support apparatus 200.

  The puncture support device 200 is centered on the system control 11, and includes an image storage unit 23, a puncture needle position detection unit 25, a high frequency generation unit 27, an ablation control unit 29, a puncture file storage unit 31, a puncture plan unit 33, and display control. A unit 35, a display unit 37, an operation unit 39, and a communication unit 201. The communication unit 201 transmits and receives various data to and from the ultrasonic diagnostic apparatus 100. For example, the communication unit 201 receives ultrasonic image data from the ultrasonic diagnostic apparatus 100. The received ultrasonic image data is stored in the image storage unit 23.

[effect]
As described above, the ultrasonic diagnostic apparatus 1 and the puncture support apparatus 200 according to the present embodiment include at least the puncture planning unit 33 and the display control unit 35. Puncture planning unit 33 has a setting function and a determination unit function. In the setting function, the puncture planning unit 33 sets a planned ablation area on the medical image in accordance with an instruction from the user. In the determination function, the puncture planning unit 33 performs scheduled insertion of puncture needles for the number of use candidates in the scheduled cauterization based on at least one geometric characteristic of the position, shape, and size of the planned ablation area. Determine the route. The display control unit 35 displays the scheduled insertion path superimposed on the medical image.

  With the above configuration, the ultrasonic diagnostic apparatus 1 and the puncture assisting apparatus 200 can present a user with an appropriate insertion path of a puncture needle corresponding to a planned ablation area in a puncture needle using a plurality of puncture needles. Therefore, the user can perform puncture and cauterization that can obtain a safe and reliable effect without stress.

  Thus, according to this embodiment, simplification and certainty of the puncture technique are improved.

  Although several embodiments of the present invention have been described, these embodiments are presented by way of example and are not intended to limit the scope of the invention. These novel embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the scope of the invention. These embodiments and modifications thereof are included in the scope and gist of the invention, and are included in the invention described in the claims and the equivalents thereof.

  DESCRIPTION OF SYMBOLS 1 ... Ultrasound diagnostic apparatus, 11 ... System control part, 13 ... Ultrasonic probe, 15 ... Transmission / reception part, 17 ... Transmission / reception control part, 19 ... Signal processing part, 21 ... Image generation part, 23 ... Image storage part, 25 ... Puncture needle position detection unit, 27 ... high frequency generation unit, 29 ... cauterization control unit, 31 ... puncture file storage unit, 33 ... puncture planning unit, 35 ... display control unit, 37 ... display unit, 39 ... operation unit, 41 ... Puncture needle, 100 ... ultrasonic diagnostic device, 200 ... puncture support device, 201 ... communication unit

Claims (12)

A puncture storage unit for storing an image data set in which insertion paths and ablation areas of a plurality of puncture needles generated in advance are depicted;
An image generator for generating medical image data relating to the subject;
A setting unit for setting a cauterization scheduled area on the medical image according to an instruction from the user;
Intervals between the insertion paths of the plurality of puncture needles included in the image data set based on geometric characteristics including the position of the planned ablation area and at least one of the shape and size of the expected ablation area and by adjusting at least one of the number, determining section for determining a plurality of expected insertion path for a plurality of candidates for usage number and the plurality of candidates for usage number portion of the puncture needle of the puncture needle in the ablation of execution scheduled When,
A display unit for displaying by superimposing the plurality of scheduled insertion path to said medical image,
A medical image diagnostic apparatus comprising: The paracentesis storage unit, as the image data set, to store a plurality of past puncture image data sets for a plurality of puncture that was performed in the past, the plurality of each of the past puncture image data set the puncture look including the actual image data sets and the actual ablation field and the actual insertion path using the number fraction of the puncture needle is rendered in,
The determination unit identifies a past puncture image data set including an actual ablation area that approximates the ablation area based on a geometric characteristic of the ablation area from the plurality of past puncture image data sets. Then, based on the identified past puncture image data set, determine the planned puncture routes of the puncture needles for the number of use candidates.
The medical image diagnostic apparatus according to claim 1. The determining unit performs image processing on the identified past puncture image data set to determine a planned insertion path of puncture needles for the number of use candidates and an ablation possible region by the puncture needles for the number of use candidates. ,
The display unit displays the planned insertion path and the cauterization possible region in a superimposed manner on the medical image;
The medical image diagnostic apparatus according to claim 2.   The medical image diagnostic apparatus according to claim 3, wherein the puncture storage unit stores an image data set including the scheduled insertion path and the cauterizing region as a past puncture image data set. The determination unit is configured to determine the plurality of use candidates, the predetermined tip positions of the puncture needles corresponding to the plurality of use candidates, and the plurality of use candidates based on the geometric characteristics of the planned ablation area and the ablation conditions related to the ablation technique to be performed. The medical image diagnostic apparatus according to claim 1, wherein a plurality of scheduled insertion paths are determined. The determining unit determines the ablation possible area by the puncture needles for the plurality of use candidates based on the ablation scheduled area, the ablation condition, the plurality of use candidates and the plurality of scheduled insertion paths, The medical image diagnostic apparatus according to claim 5.   The medical image diagnostic apparatus according to claim 5, wherein the planned insertion path is a straight line extending in a predetermined direction from the planned tip position toward the body surface. The medical image diagnostic apparatus according to claim 1, further comprising a changing unit that arbitrarily changes the plurality of scheduled insertion paths according to an instruction from a user. The paracentesis storage unit, as the image data set is stored in association with the ablation site image data set including the said planned insertion path wherein the ablation area, a medical image diagnostic apparatus according to claim 6, wherein. The medical image diagnostic apparatus according to claim 1, further comprising: an operation unit capable of arbitrarily correcting the plurality of scheduled insertion paths superimposed on the medical image according to an instruction from a user.   The medical image diagnostic apparatus according to claim 1, further comprising: a warning unit that issues a warning when the expected ablation area is smaller than a threshold value. A puncture storage unit for storing an image data set in which insertion paths and ablation areas of a plurality of puncture needles generated in advance are depicted;
An image storage unit for storing medical image data relating to the subject;
A setting unit for setting a cauterization scheduled area on the medical image according to an instruction from the user;
Intervals between the insertion paths of the plurality of puncture needles included in the image data set based on geometric characteristics including the position of the planned ablation area and at least one of the shape and size of the expected ablation area and by adjusting at least one of the number, determining section for determining a plurality of expected insertion path for a plurality of candidates for usage number and the plurality of candidates for usage number portion of the puncture needle of the puncture needle in the ablation of execution scheduled When,
A display unit for displaying by superimposing the plurality of scheduled insertion path to said medical image,
A puncture support device comprising:

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