JP6386384B2 - Ultrasonic therapy apparatus and ultrasonic therapy system - Google Patents

Description

  The present invention relates to an ultrasonic therapy apparatus and an ultrasonic therapy system, and an ultrasonic therapy apparatus that irradiates a target site set in a living body with high intensity focused ultrasound (HIFU) and treats it. The present invention relates to an ultrasonic therapy system.

  HIFU treatment is an embolus that has a high blood flow blocking effect by irradiating the focal point set on the treatment site with high-density focused ultrasound to locally heat the lesion and thermally coagulating the tissue of the lesion. It is known as a less invasive treatment for realizing the treatment. For example, it has been proposed to insert a treatment probe into the rectum of a living body and irradiate the lesion at the treatment target site with HIFU. In addition, the ultrasonic treatment apparatus using HIFU introduced in Patent Document 1 uses a plurality of treatment transducers (transducers) using ultrasonic electric signals (hereinafter referred to as ultrasonic signals) supplied from a multi-channel generator. ) Have been proposed. That is, by irradiating each channel generator with HIFU irradiation by independently controlling the amplitude, frequency and phase of the treatment ultrasound, it is possible to treat a wide range of treatment sites by moving the focal position. An MRI (magnetic resonance imaging) apparatus is used as a method for monitoring the HIFU treatment area. In addition, due to the energy generation multi-channel configuration of the assembly for heat treatment of the biological tissue, a moving means capable of changing the aiming direction on the aiming surface around the treatment target (target) region existing in the aiming surface. I have.

  On the other hand, Patent Document 2 reports a technique that allows an access start position, a target position, and a direction to be displayed in real space when a treatment tool such as a puncture needle is accessed into a living body.

Japanese Patent No. 4519905 Japanese Patent No. 4110457

  In the treatment method described in Patent Literature 1, the phase of therapeutic ultrasonic waves irradiated from each channel is controlled, and therapeutic ultrasonic waves are irradiated from all channels to enable a wide range of cauterization. However, since all the channels are used to periodically irradiate high-intensity therapeutic ultrasound pulses, burns on the surface of the living body (skin tissue on the body surface) on the HIFU irradiation path become a problem. That is, normally, HIFU is irradiated between the treatment probe and the living body surface, for example, with a water bag filled with deaerated water interposed. In this case, since the acoustic impedance of water and the living body surface (skin) is extremely different, the trigger ultrasonic waves are reflected at the boundary between the water and the living body surface, and the ultrasonic energy is accumulated. Occur. When heated ultrasonic waves are applied subsequent to the bubbles, the bubbles are destroyed, and the skin may be burned by the heat of destruction. When skin burns occur, propagation of therapeutic ultrasonic waves is hindered, and not only treatment ultrasonic waves are not irradiated to a deep treatment target site, but also damage to normal tissue becomes a problem.

  The problem to be solved by the present invention is to provide an ultrasonic treatment apparatus and an ultrasonic treatment system that can effectively avoid skin burns.

  In order to solve the problems of the present invention, an ultrasonic treatment apparatus of the present invention is held by facing a body surface of a living body, and a plurality of irradiations for irradiating therapeutic ultrasound to a focal point set in a treatment target site of the living body A treatment probe having a channel, a distance measuring unit that measures a distance from the focal point to the body surface in association with the irradiation channel, and the distance is determined based on a possibility of a burn on the body surface It is characterized by comprising a burn alarm unit that renders an alarm image color-coded so as to be able to identify a part that is equal to or greater than a set value.

  As described above, one of the causes of burns on the body surface (hereinafter referred to as skin burns) may be a case where the distance between the skin and the focus of HIFU (therapeutic ultrasound) is short. That is, since the HIFU beams irradiated from the plurality of irradiation channels are narrowed toward the focal point, the density of the HIFU increases as the focal point becomes closer. Therefore, when the distance between the skin and the focal point is shortened, the density of the HIFU that penetrates the skin increases and the possibility of burns increases. However, it is difficult for the surgeon to correctly or accurately recognize the distance between the skin and the focal point based on a navigation image displayed on a monitor or the like. Therefore, in the present invention, the distance measurement unit measures the distance from the focal point to the body surface in association with the irradiation channel, and is color-coded so that a part whose distance is equal to or more than a set value determined based on the possibility of skin burns can be identified. By providing a burn warning unit that renders the warning image, the surgeon can accurately perceive the possibility of skin burn by looking at the warning image.

  The alarm image displays the distance by an image of a color set in advance according to the distance between the skin and the focal point in association with the skin region through which the HIFU irradiated from the treatment probe passes. For example, an image of an area corresponding to a skin area with a high possibility of burns is displayed with a warning color such as red. An image of an area corresponding to a skin area where there is a possibility of burns is displayed in a warning color such as yellow. An image of an area with a low possibility of burn is displayed by a caution color such as blue. Thereby, the surgeon can determine the presence or absence or degree of the possibility of burn from the color image displayed on the burn alarm unit.

  Note that the burn alarm unit may be provided on the upper surface of the treatment probe or a graphic user interface. Furthermore, a plurality of laser light sources are provided in a ring shape on the outer peripheral edge of the treatment probe toward the body surface, and the laser light color-coded from the laser light source along the outer peripheral surface of the conical irradiation path of the treatment probe HIFU The alarm image may be drawn on the body surface. In this case, since a ring-shaped color display appears on the body surface, the operator can determine whether or not there is a possibility of a burn by operating the treatment probe manually and changing the focal position. In this case, the burn alarm unit controls the emission colors of the plurality of laser light sources according to the distance measured by the distance measuring unit.

  ADVANTAGE OF THE INVENTION According to this invention, the ultrasonic treatment apparatus and ultrasonic treatment system which can avoid skin burn effectively can be provided.

1 is a diagram illustrating an overall configuration of an ultrasonic therapy system according to an embodiment of the present invention. It is a block block diagram of the ultrasonic therapy apparatus of one Embodiment of this invention. It is a figure explaining the structure of the ultrasonic probe of one Embodiment of this invention. It is a figure which shows arrangement | positioning of the treatment ultrasonic beam and the some treatment vibrator | oscillator (channel) transmitted from the some treatment vibrator | oscillator of the treatment probe of one Embodiment of this invention. It is a figure explaining HIFU treatment. It is a figure explaining the navigation guide display function of the ultrasonic treatment system of one embodiment of the present invention. It is a flowchart which shows the treatment procedure of the ultrasonic treatment system of one Embodiment of this invention. It is a figure explaining the structure of the ultrasonic probe of the ultrasonic therapy apparatus provided with the burn warning part of one Example of this invention. It is a detailed flowchart of the burn warning part of one Example which concerns on the characteristic part of this invention. It is a figure explaining operation | movement of the burn warning part of one Example of this invention. It is a figure explaining the example which changes the position of a probe in order to avoid a skin burn. It is a figure explaining the example which changes the focus position of HIFU in order to avoid a skin burn. It is a figure which shows the example of a display of GUI of the ultrasonic treatment system of this invention.

  Hereinafter, the present invention will be described based on embodiments.

  FIG. 1 shows the overall configuration of the ultrasonic therapy system of the present invention. A magnetic resonance imaging (MRI) apparatus 1 which is one of medical imaging apparatuses is, for example, a vertical magnetic field permanent magnet type MRI apparatus. However, the MRI apparatus is not limited to the vertical magnetic field permanent magnet system, and other known medical imaging apparatuses such as an MRI apparatus, a CT apparatus, a PET apparatus, and an ultrasonic imaging apparatus can be applied.

  As shown in the drawing, the MRI apparatus 1 of the present embodiment includes an upper magnet 3 and a lower magnet 5 that generate a vertical static magnetic field, a support 7 that connects these magnets and supports the upper magnet 3, a position detection device 9, and an arm. 11, monitors 13 and 14, monitor support 15, reference tool 17, personal computer 19, bed 21, MRI controller 23, and the like. A gradient magnetic field generator (not shown) of the MRI apparatus 1 generates a territorial magnetic field. Further, the MRI apparatus 1 includes an RF transmitter (not shown) for generating nuclear magnetic resonance in the patient 24 in a static magnetic field and an RF receiver (not shown) for receiving a nuclear magnetic resonance signal from the patient 24.

  The position detection device 9 is a three-dimensional position detector that detects the three-dimensional position and posture of the ultrasonic probe 37 (hereinafter collectively referred to as a position). That is, the position detection device 9 includes two infrared cameras 25 and a light emitting diode (not shown) that emits infrared light, and detects the three-dimensional position of the pointer 27 attached to the ultrasonic probe 37. Thereby, the pointer 27 functions as an instruction device for an imaging tomographic plane of an ultrasonic image and an MR image, together with a function of detecting the position and inclination of the ultrasonic probe 37 (hereinafter collectively referred to as a position). Further, the position detection device 9 is connected to the upper magnet 3 so as to be movable by an arm 11 and is formed so that the arrangement with respect to the MRI apparatus 1 can be changed as appropriate. On the monitor 13, an ultrasonic image of the tomographic plane of the patient 24 indicated by the pointer 27 held by the operator 29 is displayed. The monitor 13 is connected to the upper magnet 3 by the monitor support unit 15 in the same manner as the infrared camera 25. The reference tool 17 links the coordinate system of the infrared camera 25 and the coordinate system of the MRI apparatus 1, includes three reflecting spheres 35, and is provided on the side surface of the upper magnet 3.

  The position information of the pointer 27 detected and calculated by the infrared camera 25 is transmitted to the personal computer 19 as position data of the ultrasonic probe 37 via, for example, the RS232C cable 33. The MRI control unit 23 is configured by a workstation and controls an RF transmitter, an RF receiver, and the like (not shown). Further, the MRI control unit 23 is connected to the personal computer 19. In the personal computer 19, the position data of the pointer 27 detected and calculated by the infrared camera 25 is converted into position data of the imaging range in the MRI apparatus 1 and transmitted to the MRI control unit 23. The position data is reflected in the control of the imaging section of the imaging sequence. The MR image acquired with the new imaging section is displayed on the monitor 13. MR images are simultaneously recorded in the video recording device 34.

  The ultrasonic therapy apparatus 40 projects an ultrasonic image obtained by the ultrasonic probe 37 to which the pointer 27 is attached on a dedicated monitor 38. The ultrasonic image is transferred to the personal computer 19 for image processing, and displayed on the operator monitors 13 and 14. The ultrasonic probe 37 is formed of a nonmagnetic material such as ceramic that can be operated even in the magnetic field of the MRI apparatus 1. Further, as will be described with reference to FIG. 3, the ultrasound probe 37 includes a treatment probe 37a for irradiating treatment ultrasound of HIFU and an imaging probe 37b for imaging an ultrasound image.

  The ultrasonic therapy apparatus 40 includes a HIFU controller 49 formed by a computer such as a personal computer and a power amplifier 50 that amplifies the HIFU ultrasonic signal output from the HIFU controller 49. The ultrasonic signal output from the power amplifier 50 is supplied to the treatment probe 37 a of the ultrasonic probe 37. As a result, HIFU treatment is performed by irradiating the patient 24 with HIFU (high density focused ultrasound) from the treatment probe 37a.

  FIG. 2 shows a block configuration of the main part of the ultrasonic therapy apparatus 40. The ultrasonic therapy apparatus 40 includes an ultrasonic transmission / reception unit 44 that transmits / receives an ultrasonic signal to / from the imaging probe 37b, and a two-dimensional ultrasonic image (for example, a B-mode image) including the focal point of the HIFU based on the received signal. An ultrasonic image composing unit 45 that constitutes a sound image, a monitor 38 that is a display unit that displays the ultrasonic image composed of the ultrasonic image composing unit 45, an ultrasonic control unit 47 that controls each component, The control panel 48 is configured to give an instruction to the sound wave control unit 47.

  The ultrasound image constructing unit 45 uses a reflected echo signal obtained by transmitting and receiving ultrasound from the imaging probe 37b into the patient 24 by the ultrasound transmitting and receiving unit 44, and uses a two-dimensional ultrasound image or a three-dimensional image including a treatment target region. An ultrasonic image is formed and displayed on the monitor 38.

  When operating the ultrasound therapy apparatus 40 as an ultrasound imaging apparatus, the HIFU controller 49 drives the imaging probe 37b via the ultrasound control unit 47 to irradiate the patient 24 with weak ultrasound for imaging. That is, the ultrasonic control unit 47 weakens the energy of the ultrasonic wave irradiated to the patient 24 when operating the ultrasonic therapy apparatus 40 as a diagnostic apparatus. On the other hand, when operating the ultrasonic treatment apparatus 40 as a treatment apparatus, the ultrasonic control unit 47 uses the HIFU controller 49 to increase the intensity of the ultrasonic wave to be irradiated so as to increase the energy of the ultrasonic wave irradiated to the patient 24. Control etc.

  That is, the HIFU controller 49 constitutes the treatment probe control unit of the present invention, and outputs an HIFU ultrasonic signal to the power amplifier 50 based on a command output from the ultrasonic control unit 47. The power amplifier 50 amplifies the HIFU ultrasonic signal and outputs the amplified signal to the treatment probe 37a. Thereby, a strong ultrasonic wave for treatment is irradiated from the treatment probe 37a to a predetermined part of the patient 24. That is, the HIFU controller 49 and the power amplifier 50 determine the intensity (energy) of the therapeutic ultrasound beam emitted from the treatment probe 37a including a plurality of treatment transducers 39 that constitute a channel for emitting the treatment ultrasound of the treatment probe 37a. Each is to be controlled. The ultrasonic frequency emitted from the treatment probe 37 a can be properly used as 2 MHz or 1 MHz as necessary, and is controlled by the HIFU controller 49.

  Moreover, the HIFU controller 49 is interlocked with the ultrasonic therapy apparatus 40 so that the state transition of the treatment target part before and after the HIFU irradiation can be understood. Before the HIFU irradiation, the image processing for rendering the skin as the body surface of the patient 24 using the diagnostic image inside the ultrasonic therapy apparatus 40 is also provided. Information generated by the ultrasonic therapy apparatus 40 can be shared with the HIFU controller 49.

  In addition, a distance measuring unit 51 and a burn alarm unit 52 that constitute one of the features of the present invention are incorporated in the ultrasonic therapy apparatus 40. The distance measuring unit 51 has a function of performing image processing for rendering the skin, which is the body surface of the patient 24, using a diagnostic image inside the ultrasonic therapy apparatus 40, and further from the HIFU focus set by the HIFU controller 49 to the body surface. Is provided with a function of measuring the distance up to the irradiation channel of the treatment probe 37a. The burn alarm unit 52 generates a color-coded alarm image so that a part having a distance from the focal point determined by the distance measuring unit 51 to a body surface that is greater than a set value determined based on the possibility of a burn on the body surface can be identified. It is configured with the function to draw.

  In the example of FIGS. 1 and 2, the ultrasonic diagnostic apparatus is incorporated into the ultrasonic therapeutic apparatus 40, but the ultrasonic diagnostic apparatus and the ultrasonic therapeutic apparatus may be configured as separate apparatuses. Moreover, although the ultrasonic therapy apparatus 40 and the HIFU controller 49 are separate apparatuses, they can be configured as an integrated apparatus.

  3 and 4 are configuration diagrams of an embodiment of the ultrasonic probe 37 according to the feature of the present invention. 3A is a cross-sectional view of a plane passing through the central axis of the ultrasonic probe 37, and FIG. 3B is a front view of the ultrasonic probe 37 viewed from the ultrasonic transmission surface side. As is clear from the figure, the ultrasonic probe 37 is formed with a treatment probe 37a formed on a concave spherical surface and an imaging probe 37b for imaging an ultrasonic image disposed on the central axis of the concave spherical surface. ing. The imaging probe 37b is an imaging ultrasound probe for capturing and drawing a tomographic image (ultrasonic image) of the illustrated fan-shaped region 601 including the focus of the treatment target region.

The treatment probe 37a is formed by arranging treatment ultrasound irradiation channels Cij (hereinafter simply referred to as channels) including a plurality of treatment transducers 39 on a two-dimensional plane or a three-dimensional curved surface. However, as shown in FIGS. 4A and 4B, the treatment probe 37a of the present embodiment divides the concave spherical surface into a plurality of concentric annular regions, and further divides the annular region in the radial direction. In each of the plurality of regions, the treatment transducers 39 are disposed and formed. Each treatment transducer 39 forms a channel Cij of a treatment ultrasonic beam. Here, i (1 to 5 in the illustrated example) is the order of the channels from the outermost channel to the center, and j (1 to 8 in the illustrated example) is the order of the channels in the circumferential direction. In other words, the treatment probe 37a is formed as a two-dimensional matrix array transducer having a plurality of treatment transducers 39 for transmitting a treatment ultrasonic beam. Here, the number of treatment transducers 39 is 40 in the illustrated example for simplification, but the number of treatment transducers 39 is generally 2 ⁿ . For example, 512 or 1024 pieces are used. The imaging probe 37b is an imaging ultrasonic probe for imaging and drawing the tomographic plane 601 including the focus of the treatment target region. What is common to them is that all channel areas are the same and the energy intensity is the same. However, an imaging probe 37b is attached to the central portion, and a cross section 404 including a therapeutic ultrasonic focus can be depicted.

  In FIG. 4B, the plurality of divided treatment transducers 39 will be described as treatment ultrasound irradiation channels (hereinafter simply referred to as channels). As shown in the drawing, the concave spherical surface is divided into a plurality of concentric annular regions i (i = 1 to 5 in the illustrated example), and the annular regions are further divided into a plurality of regions j (in the illustrated example in the illustrated example). , J = 1 to 8), a plurality of n (n = 1, 2,..., Arbitrary natural numbers) channels Cij are provided. The therapeutic ultrasound beam 404 a emitted from each channel Cij is focused on the focal point 403. In other words, by independently controlling the phase of the therapeutic ultrasonic wave transmitted from each channel Cij, the transmission angle of the plurality of therapeutic ultrasonic beams 404a can be controlled and focused on the focal point 403.

  With this configuration, the treatment ultrasound irradiated from each channel Cij of the treatment probe 37a becomes a treatment ultrasound beam 404a of a prescribed irradiation path (route) and is focused on the focal point 403. In other words, by independently controlling the phases of the therapeutic ultrasound waves of the plurality of channels Cij, the prescribed route and the focal point 403 are always passed. Further, the focus 403 can be moved in three dimensions (front and rear, left and right, depth direction) by phase control of therapeutic ultrasound.

Next, an outline of performing treatment by irradiating high-intensity focused ultrasound (HIFU) will be described with reference to FIG. As shown in FIG. 5A, the HIFU 404, which is a bundle of therapeutic ultrasonic beams 404a transmitted from the respective treatment transducers 39 of the treatment probe 37a, is focused on a focal point 403 and irradiated. Further, as shown in FIG. 5B, the range of treatment (cauterization) by irradiating one focal point 403 with HIFU is, for example, a diameter Φ of 5 to 10 mm. Therefore, when performing treatment with HIFU irradiation, as shown in FIG. 5C, the position of the focal point 403 that is the irradiation position of the HIFU 404 is sequentially moved to irradiate the entire treatment target region (target) 402 with the HIFU 404. To do. At that time, the state of treatment is monitored by an ultrasonic image picked up by the imaging probe 37b attached to the center of the ultrasonic probe 37. However, if treatment and monitoring are performed simultaneously, they will appear in the image as noise. Therefore, a clear diagnostic image free from noise is acquired by operating the treatment probe 37a and the imaging probe 37b alternately. In addition, by performing focus visualization by ARFI (Acoustic Radiation Force Impulse) as shown in Non-Patent Document 1 below, an actual affected area in a living tissue is calculated with respect to an ideal ablation area, and three-dimensional measurement is performed. Can be used to calculate a three-dimensional scheduled treatment area.
Palmeri ML, Wang MH, Dahl JJ, Frinkley KD, et al. Quantifyinghepatic shear modulus in vivo using acoustic radiation force.Ultrasound inMedicine & Biology 2008; 34: 546-58.

  Next, the navigation guide display function of this embodiment will be described with reference to FIG. The surgeon 29 adjusts the focus 403 of the treatment probe 37a connected to the HIFU controller 49 via the power amplifier 50 with respect to the patient 24 to one point of the treatment target site (target). That is, the position of the ultrasonic probe 37 is detected from the position of the pointer 27 with an infrared camera attached to the position detection device 9, and simulated images of the focal point 403 and the HIFU 404 of the treatment probe 37 a are displayed on the navigation screens 531 to 534, respectively. Is done. The operator 29 operates the position of the ultrasonic probe 37 while looking at the navigation screens 531 to 534 to adjust the focus 403 of the treatment probe 37a to the target. As the navigation screen configuration, for example, a three-dimensional volume rendering screen 534 can be used in addition to the navigation screens 531 to 533 having three-axis cross sections (Axial, Sagittal, and Coronal). In addition, the surgeon 29 previously sets a treatment planned area 536 that is a treatment target site, a warning area, a margin, and the like. Note that the navigation image can be configured using three-dimensional image volume data captured by a medical image apparatus such as an MRI apparatus in addition to an ultrasonic image apparatus.

  In addition to the simulated image of the ultrasonic probe 37, preoperative planning (surgical simulation) information 537 can be superimposed on the navigation image. Further, in the case of the volume rendering screen 534, the treatment scheduled area 536 can be displayed in three dimensions. Further, it is possible to provide a function of issuing a warning when entering the treatment scheduled area 536 or the warning area on the navigation screens 531 to 534. In addition, for example, when the treatment scheduled area 536 enters the warning area, a function of automatically changing an image on the navigation screen and a treatment parameter can be provided.

  When the above-described operation is performed inside the gantry of the MRI apparatus, the above-mentioned information is fed back continuously and in real time to the ultrasound treatment system, and the same MRI imaging including a simulated image of the ultrasound probe 37 in the treatment target region A cross-sectional image 508 and an ultrasonic image 509 can be displayed. That is, the surgeon 29 can use the two-dimensional real-time image obtained by the MRI apparatus 1 and the three-dimensional image information obtained by navigation for treatment as necessary. As one application of the high-speed imaging sequence of the MRI apparatus 1, a real-time dynamic imaging method called fluoroscopy (perspective imaging) is being clinically applied. In fluoroscopy, by repeating imaging and image reconstruction with a period of about 1 second or less, it can be used to extract the dynamics of internal tissues and to grasp the position of an instrument inserted from the outside like a fluoroscopic imaging. Generate and display dynamic images. This application is also applied to three-dimensional high-speed imaging.

  Next, a flowchart showing a treatment procedure of the ultrasonic treatment system of this embodiment shown in FIG. 7 will be described. A plurality of three-dimensional volume imaging and three-dimensional reconstruction of a three-dimensional image are performed using the MRI apparatus 1 (or an ultrasonic diagnostic apparatus) (S101), and from the three-dimensional image reconstructed three-dimensionally using this image. A specific area is rendered by image processing (treatment essential area: segmentation) (S102). A HIFU irradiable area and an impossible area are set in the rendering area (S103), and a treatment area and a margin area including them are set (S104). After inputting necessary parameters for HIFU irradiation (S105), the HIFU treatment plan is executed, and the position of the ultrasonic probe 37 is simulated (S106). After the treatment plan, the operation support guidance function such as navigation is activated (S107), and the operation is started (S108).

  At the time of surgery, as shown in FIG. 6, the simulated image of the ultrasonic probe 37 is superimposed and displayed on the navigation image, which is a guidance support image, following the position of the ultrasonic probe 37 (S109). Using the numerical information displayed on the graphic user interface (GUI) together with the simulated image, the ultrasonic probe 37 is guided to the treatment planned position (target position) by the operator's technique (S110). After the guidance, the position of the target is confirmed with an ultrasonic image or an MRI image (S111). Here, for example, the skin which is the body surface is drawn from the MRI image or the ultrasonic diagnostic image (S112), and the distance between the focal point 403 and the skin at the position of the ultrasonic probe 37 drawn in the image is calculated (S113). ). This step S113 is a process of the distance measuring unit 51 of the present invention. A method of calculating the distance Lij between the focal point 403 and the skin in this distance measuring unit will be described in detail later.

  The distance between the focal point 403 calculated by the distance measurement unit (S113) and the skin is compared with at least one set value Xn determined based on the presence / absence and degree of possibility of skin burn, and based on the comparison result Then, for example, color-coded irradiation is performed with laser light (S114). That is, an alarm image indicating whether or not the distance Lij between the focal point 403 and the skin is the distance X that may cause skin burn is drawn. This step S114 is the process of the burn alarm unit 52 for rendering the alarm image of the present invention. The process of the burn warning unit 52 will be described in detail with reference to the flowchart of FIG. The specific configuration of the burn warning unit 52 will be described later based on an embodiment.

  Based on the alarm image in step S114, the surgeon starts the HIFU treatment by his / her own judgment, and at the same time, monitors the MR image or ultrasonic diagnostic image and records the treatment progress as appropriate (S115). Then, after confirming the HIFU treatment effect of one treatment area (S116), it is confirmed whether or not the treatment area remains, or whether or not there is an additional treatment area (S117). Then, the processes in steps S109 to S116 are repeated, and the presence or absence of the necessity for additional treatment is confirmed, and the process is ended (S117).

  Next, the burn warning part 52 which is the characteristic part of this invention is demonstrated based on an Example.

  FIG. 8 shows a configuration of the treatment probe 37a including the burn alarm unit 52 according to the first embodiment of the present invention. In this embodiment, as shown in FIGS. 8A and 8B, a laser group 610 in which laser light sources R01 to R25 of a plurality of spot lasers are annularly arranged on the outer periphery of the channel Cij of the treatment probe 37a. Is provided. Further, four spot laser light sources R31 to R34 are provided at a 90 ° pitch on the outer peripheral edge of the treatment probe 37a. The laser light sources R01 to R25 and R31 to R34 are formed so that the laser light emission color of the laser light can be controlled by the laser control unit of the burn alarm unit 52. As shown in FIG. 8B, the laser group 610 is arranged so as to irradiate the body surface 501 with the laser light 611 along the outer peripheral surface of the treatment ultrasonic beam 404a.

  As a result, as shown in FIG. 8C, a ring-shaped alarm image 612 is drawn on the body surface 501. Further, from the four laser light sources R31 to R34, band-shaped light passing through the irradiation center of the HIFU is emitted, and in a ring-shaped alarm image 612 depicted on the body surface 501 as shown in FIG. 8C. , A cross mark 620 indicating the irradiation center of the HIFU is drawn. The display color of the cross mark 620 is drawn by the color of the distance L of the distance Cij distributed in the irradiation center region of the treatment probe 37a.

  In the second embodiment, instead of rendering the alarm image 612 on the body surface 501 of the first embodiment, a probe display unit 650 that displays the alarm image 612 on the outer surface on the back side of the channel surface of the treatment probe 37a is provided. It is different that it was provided. Since other points are the same as those of the first embodiment, the description thereof is omitted. The probe display unit 650 is formed using a display device such as a liquid crystal. In addition to the same alarm image as the ring-shaped alarm image 612, the distance L between the focal point 403 and the body surface 501, display color information, and the like Related information and the like are displayed as visual information.

  In addition, although the example which can draw the alarm image of both Example 1 and Example 2 was shown in FIG. 8, you may make it draw either one of Example 1 and the alarm image of Example 2. . Further, the alarm image may be drawn only on or in combination with a graphic user interface (GUI) such as the monitor 13, 14, or 38.

  FIG. 9 shows a detailed flowchart of step S114 in FIG. FIG. 9 shows a burn warning unit 52 that uses the treatment probe 37a shown in FIG. 8 and draws a warning image displaying whether or not the distance L between the focal point 403 and the skin is a distance that may cause skin burns. It is a flowchart of.

First, a plurality of (three in the illustrated example) set values X ₁ , X ₂ , X ₃ (X ₁ is compared with _<X 2 _{<X 3).} This set value is set by theoretically or experimentally determining the degree of possibility of skin burn according to the energy intensity of HIFU irradiated from each channel Cij, the skin penetration density, and the irradiation pattern of HIFU. In the present embodiment, the set values X ₁ , X ₂ , X ₃ and the display color of the alarm image are set as follows, for example.
L <X ₁ : The probability that skin burns are very likely (for example, red warning color).
X ₁ ≦ L <X ₂ : There is a possibility of skin burn (for example, yellow warning color).
X ₂ ≦ L <X ₃ : The possibility of skin burn is low (for example, blue caution color).
X ₃ ≦ L: There is almost no possibility of skin burn (for example, colorless).
However, the set value X and the display color are not limited to these. For example, the display color can be changed continuously or stepwise according to the distance L between the focal point 403 and the skin 501.

  Here, the processing of the distance measuring unit 51 that measures the distance L between the focal point 403 and the body surface 501 in step S113 in FIG. 7 will be described. Based on the position of the ultrasonic probe 37 detected by the position detection device 9, the distance measurement unit 51 converts a distance measurement image corresponding to a plurality of navigation images 531 around the central axis of the treatment probe 37 a into a three-dimensional volume image. The data is cut out and sequentially displayed on a display unit such as a monitor 38, for example. For example, it is assumed that the distance measurement image shown in FIG. As shown in the figure, the distance measurement image has an ultrasonic probe 37, a HIFU irradiation path 404a, a focal point 403, a laser beam 611, a simulated image of the body surface 501, and set values X1 to X3 from the focal point 403 as radii. A semicircle image is included. The distance measurement unit 51 measures the distance Lij from the focal point 403 to the body surface 501 for each channel Cij based on the distance measurement image. In order to depict the body surface with the distance measurement image, the biological surface and body surface information are registered in advance, and the boundary between regions where the information and brightness values are clearly different is depicted.

On the basis of the distance Lij of each channel Cij measured in step S121 in FIG. 9, when the distance Lij between focus 403 and the skin of the set value _{X 2} or more, the process proceeds from step S122 to step S123, described later As in this embodiment, a blue alarm image 612 that is predetermined as a safety color without fear of skin burns is drawn from the laser group 610 provided on the outer periphery of the channel Cij of the treatment probe 37a toward the skin surface. (S123). In other words, a blue ring is drawn on the skin surface 501 along the outer peripheral surface of the treatment ultrasound path of the treatment ultrasound irradiated from the treatment probe 37a. As a result, the operator is notified by color that the position of the ultrasonic probe 37 has a low possibility of skin burns.

Conversely, in the determination of step S121, if the distance Lij between focus 403 and the skin lower than the set value _{X 2,} the process proceeds from step S124 to step S125, the distance Lij is determines whether less than the set value _{X 1} (S125 ). When the distance Lij set value _{X 1} or more, i.e. _{X 1} ≦ Lij _{<X 2} is to render the alarm image 612 in color indicating that the likelihood of skin burns there (e.g. yellow) (S126). Thereby, since there is a possibility of skin burn, the surgeon can consider moving the ultrasonic probe 37 away from the body surface if possible. Further, when the distance Lij is less than the set value X _1, it renders the alarm image 612 in warning color likelihood of skin burns which means that very high (eg a red) (S127). As a result, the surgeon can recognize that the irradiation of the HIFU is impossible and can recognize it as a message that prompts the movement of the position of the ultrasonic probe 37, including the visualization of the treatment ultrasonic irradiation path by laser light and the possibility of burns. Both warnings are compatible (S128).

  Here, when the risk of skin burn is avoided without moving the position of the ultrasonic probe 37 (S129), the position of the focal point 403 can be changed to a deep position by controlling the phase of the HIFU (S130). . In other words, the surgeon can change the phase of the treatment ultrasound, which is one of the HIFU irradiation parameters, for each channel Cij as necessary to increase the depth of focus and increase the distance Lij. According to the change of the HIFU irradiation parameter, the operator recognizes that the position of the focal point 403 has been changed on the skin surface by, for example, increasing the thickness of the light of the ring-shaped alarm image 612, blinking it, or coloring it. Can be made. A similar alarm image is also displayed on the probe display unit 650 of the second embodiment. Further, the changed HIFU irradiation parameter is displayed on the probe display unit 650 to allow the operator to recognize it (S130), and the process returns to step S113. If the determination in steps S123 and S129 is negative, the operator is finally notified of the condition / various information to prompt the final decision on treatment (S131), and the process returns to step S115.

Next, a first processing method for avoiding the burn in step S129 of FIG. 9 will be described with reference to FIG. FIG. 11 shows a process for avoiding burns by changing the position of the ultrasonic probe 37 and increasing the distance L from the focal point 403 to the body surface 501, that is, by setting L> X ₂ . FIG. 11A shows a distance measurement image before changing the probe position, and FIG. 11B shows a distance measurement image after changing the probe position. As shown in FIG. 5A, there is a possibility of burns because the distance L from the focal point 403 to the body surface 501 is located within the range of the set values X _{1 to} X ₂ . In FIG. 6B, the ultrasonic probe 37 is moved to the body surface 501 side (for example, 100 mm) and held to reduce the energy density of the HIFU that passes through the body surface 501 and may cause skin burns. setting a distance to the set value _X 11 _{to X 31.} Thereby, since the distance L from the focal point 403 to the body surface 501 is in the range of X ₂₁ ≦ L <X ₃₁ , the possibility of burns can be eliminated.

  The burn avoiding process in FIG. 11 is performed by moving the position of the treatment probe 37a relative to the body surface 501 by a technique when the operator holds the treatment probe 37a and performs treatment. Further, when the treatment is performed by holding the entire ultrasound probe 37 with a manipulator, the position of the treatment probe 37a with respect to the body surface 501 is moved by the manipulator. That is, the treatment probe holding means of the present invention is a concept including an operator and a manipulator. The treatment probe holding means moves the focus position of the treatment probe 37b away from the body surface 501 when the warning color part is displayed in the alarm image, that is, moves the treatment probe 37b closer to the body surface 501. And avoid the possibility of skin burns.

  Since the position of the focal point 403 does not change even if the treatment probe position is changed, the HIFU controller 49 is based on the relationship between the changed position of the ultrasonic probe 37 and the focal point 403 position, that is, the focal point. It is natural to change the irradiation parameters such as the phase of the HIFU of the channel Cij in response to the shortening of the distance. Thereby, ultrasonic treatment can be performed without changing the treatment plan determined in step S106 of FIG.

  Further, by increasing the thickness of the laser beam of the alarm image 615a or blinking it, it is possible to recognize that the change of the treatment probe position has been performed by the operator. In the case of the second embodiment, the probe display unit 650 displays the focal length change value, the alarm image 615a, and the like, and notifies the operator of a message to that effect. Furthermore, during HIFU irradiation, the irradiation time and countdown value may be displayed.

In FIG. 12, the position of the focal point 403 that is the HIFU irradiation site is changed to the focal point 403a while maintaining the position of the treatment probe, and the distance L from the focal point 403a to the body surface 501 is increased, that is, L> X _2. This is the second processing method for avoiding burns. FIG. 12A shows a distance measurement image before changing the focal position, and FIG. 12B shows a distance measurement image after changing the focal position. As shown in FIG. 5A, there is a possibility of burns because the distance L from the focal point 403 to the body surface 501 is located within the range of the set values X _{1 to} X ₂ . Therefore, as shown in FIG. 5B, the position of the focal point 403 is moved in the depth direction with respect to the body surface 501 (for example, 100 mm) to set the changed focal point 403a. Thereby, the energy density of the HIFU that passes through the body surface 501 is reduced, and set values X _{11 to} X ₃₁ of distances that may cause skin burns are set. As a result, since the distance L from the focal point 403 to the body surface 501 is X ₃₁ ≦ L, the possibility of burns can be eliminated.

  That is, the HIFU controller 49, which is a treatment probe control unit, is formed to be able to move the position of the focal point 403 by controlling the phase of the HIFU irradiated from each channel of the treatment probe 37a. Therefore, the HIFU controller 49 avoids the possibility of skin burns by moving the position of the focal point 403 in the direction away from the body surface 501, that is, in the depth direction when a warning color part is displayed in the alarm image.

  Since the position of the focal point 403a is changed and the distance (focal length) from the channel Cij of the treatment probe 37a to the focal point 403a is changed, the HIFU controller 49 determines the positional relationship between the treatment probe 37a and the changed focal point 403a. It is natural to change the irradiation parameters such as the phase of the HIFU of the channel Cij based on the above, that is, in response to the increase in the focal length. Moreover, since the position where the HIFU is irradiated is different from the treatment plan, it is necessary to change the treatment plan determined in step S106 in FIG.

  Further, by increasing the thickness of the laser beam of the alarm image 615a or blinking it, it is possible to recognize that the change of the treatment probe position has been performed by the operator. In the case of the second embodiment, the probe display unit 650 displays the focal length change value, the alarm image 615a, and the like, and notifies the operator of a message to that effect. Furthermore, during HIFU irradiation, the irradiation time and countdown value may be displayed.

  As described above, according to the embodiments and examples of the present invention, the visibility of the alignment of the ultrasonic probe 37 and the prevention of skin burns can be performed at the same time. Can be improved.

  FIG. 13 shows a GUI display example at the time of surgery / treatment of the present invention. By pressing the 3D imaging button 1101, the Axial section 1131, the Sagittal section 1132, the Coronal section 1133, and the Volume Rendering screen 1134 are reconfigured, and when the segmentation button 1102 is pressed, segmentation / region extraction is performed automatically (or manually). Is done. Further, by depressing a HIFU irradiation enable / disable area setting button 1103, an ultrasonic access impossible area is identified in addition to the area 1119 to be treated with respect to the drawn segmentation information. In addition, by pressing the treatment plan / margin setting button 1104, the treatment route 1138 can be calculated in advance, and guidance can be provided along the treatment route. These pieces of information can be freely rotated on the Volume Rendering screen 1134 and can be viewed from another viewpoint / angle. Also, a tumor area (treatment area) 1139 and a margin area including them are set. Here, by pressing a treatment parameter setting button 1105, a treatment parameter for the region can be input. Specific input values include HIFU probe type, shape, output intensity, and unit output intensity for each channel. At the time of actual surgery, by pressing a navigation button 1106, a surgical support function such as a device necessary for treatment and a navigation image operates in conjunction with each other. The position of the ultrasonic probe 37 is detected, and a simulated image of the ultrasonic probe 37 is superimposed and displayed on the Axial cross section 1131, the sagittal cross section 1132, the coronal cross section 1133, and the Volume Rendering screen 1134. The surgeon guides the ultrasonic probe 37 with reference to the treatment path 1138 obtained in advance. In addition, the past path of the ultrasonic probe 37 can be displayed, and the information screen 1125 includes the difference between the tumor area and the treatment area as the log information in addition to the treatment progress / biological information, the number of treatments, the time, the ratio, and the number of remaining treatments. The schedule can also be displayed in real time as surgery information. When the position guide of the ultrasonic probe 37 is finished, the laser irradiation / path drawing button 1107 is pressed to measure the distance to the skin 501 at the HIFU focal point 403, and an alarm image is generated according to the flowchart of FIG. For example, it is drawn on the body surface. Information 1111 regarding the distance to the body surface and the display color of the alarm image is displayed on the probe display unit 650. The distance from the focal point 403 of the treatment probe 37a to the body surface 501 is measured, and an alarm image 1115 of a display color corresponding to the measured distance is displayed on the screen. Here, the relationship between the distance to the skin 501 with respect to the treatment probe 37a and the color information of the alarm image is set in advance. An alarm image is automatically drawn according to the measurement distance, and at the same time, an animation is displayed on the GUI. Further, when the measurement distance becomes an extremely small value, it has a function of issuing a warning that prompts a burn and prompting the operator to move the ultrasonic probe 37. By displaying these information on the navigation image immediately before the treatment, the information is visually transmitted to the user. The treatment is performed by pressing the HIFU irradiation / effect confirmation button 1108, and treatment ultrasonic waves and alternate MR imaging as necessary, and the treatment status are displayed on the dedicated screen 1117. Treatment information / ultrasound image is displayed in real time on the treatment area 1118 for the target 1119, and various information and warning information can be displayed on the treatment image. For example, the area 1118 treated in the past is displayed in a superimposed manner, and the function for issuing a warning is automatically turned on / off when the planned treatment area / margin 1120 is exceeded or an abnormality occurs in the patient. You can also. In addition to the target 1119, “remaining treatment area = target 1119−treated 1118” and a margin 1120 are also displayed, so that the surgeon can visually recognize the remaining treatment area and be under the MRI. For example, MR imaging and ultrasonic imaging are also provided with a function of imaging alternately. On the MR image, the specific region, the margin region, and the treatment planned region by ARFI are displayed in the same manner, and images having different tissue contrasts are displayed. The surgeon determines from the image information 1131 to 1134 before and after treatment and the operation information 1125 whether or not to perform retreatment, and retreats as necessary. Another advantage of MRI is that it can be imaged to the deep part of the body. As a result, the surgeon can move the surgical tool and perform additional treatment while viewing the previous treatment image. The information before and after the treatment can be linked with the surgical information 1125 in addition to the ultrasonic image 1117, the triaxial cross sections 1131 to 1133, the Volume Rendering image 1134, and the MR image.

  Further, by pressing the HIFU focal length correction button 1109 as necessary, the focal position 701 can be changed, and not only the display of the probe display unit 650 but also the focal length on the GUI is linked to the change. Position is corrected.

  As described above, the present invention has been described based on one embodiment and an example of the characteristic part, but the present invention is not limited to these, and is implemented in a form modified or changed within the scope of the gist of the present invention. It will be apparent to those skilled in the art that such modifications and variations are within the scope of the claims of the present application.

  For example, in the above-described embodiment and examples of the characteristic portion, the example is described in which the operator holds the ultrasonic probe 37 in the hand and is operated by a technique, but the ultrasonic probe 37 is held by a known manipulator, It is within the scope of the present invention to control the position of the ultrasonic probe 37. When the manipulator is used, the position of the ultrasonic probe 37 may be acquired using the coordinate system of the manipulator instead of the position detection device 9.

 DESCRIPTION OF SYMBOLS 1 ... MRI apparatus, 3 ... Upper magnet, 5 ... Lower magnet, 7 ... Support | pillar, 9 ... Position detection device, 11 ... Arm, 13, 14 ... Monitor, 15 ... Monitor support part, 17 ... Reference tool, 19 ... Personal computer , 21 ... Bed, 23 ... MRI control unit, 24 ... Patient, 25 ... Infrared camera (position detection device), 27 ... Pointer, 29 ... Surgeon, 33 ... RS232C cable, 34 ... Video recording device, 35 ... Reflecting sphere, 37 ... Ultrasonic probe, 37a ... Treatment probe, 37b ... Imaging probe, 38 ... Monitor, 40 ... Ultrasonic therapy device, 49 ... HIFU controller, 51 ... Distance measurement unit, 52 ... Burn alarm unit, 650 ... Probe display unit

Claims (12)

  A treatment probe having a plurality of irradiation channels that are held facing a body surface of a living body and irradiate a treatment ultrasonic wave to a focal point set at a treatment target site of the living body; and from the focal point to the body surface A distance measuring unit that measures the distance in association with the irradiation channel, and a burn alarm unit that renders a color-coded alarm image that can identify a region where the distance is less than a set value determined based on the possibility of skin burn An ultrasonic therapy device.   The ultrasonic treatment apparatus according to claim 1, wherein the burn warning unit is provided on an outer surface of the treatment probe or a graphic user interface. The burn alarm unit is provided with a plurality of laser light sources provided on the outer peripheral edge of the treatment probe, and a laser control unit which controls in accordance with the prior Symbol distance the emission color of the laser light sources corresponding to the illumination channel, The ultrasonic therapy apparatus according to claim 1, wherein the alarm image is drawn by irradiating the body surface with laser light emitted from the plurality of laser light sources.   The burn warning unit has a plurality of different set values, and draws a portion corresponding to the distance less than the set value with a high possibility of skin burn with a predetermined warning color. Item 4. The ultrasonic therapy apparatus according to any one of Items 1 to 3. The ultrasonic therapy apparatus according to claim 4 , wherein the burn warning unit warns an operator that there is a possibility of the skin burn when the warning image includes the warning color portion. Furthermore, a treatment probe control unit that controls the focus position of the treatment probe by controlling the phase of the treatment ultrasonic wave emitted from the irradiation channel of the treatment probe,
The treatment probe control unit moves the focal position in a direction away from the body surface to avoid the possibility of skin burn when the warning color part is displayed in the warning image. The ultrasonic therapy apparatus according to claim 4 or 5. Furthermore, it has a treatment probe holding means for holding the position of the treatment probe relative to the body surface in a movable manner,
The treatment probe holding means moves the focal position of the treatment probe in a direction away from the body surface to avoid the possibility of skin burn when the warning color portion is displayed in the alarm image. The ultrasonic therapy apparatus according to claim 4 or 5, characterized in that Further, the imaging probe is provided at the center of the treatment probe and has a plurality of imaging transducers for transmitting and receiving imaging ultrasound waves to and from the living body, and is generated from a reception signal of the imaging probe. An ultrasonic image construction unit that generates an ultrasonic tomographic image including the focal point, a display unit that displays the ultrasonic tomographic image, a three-dimensional position detector that detects the position of the treatment probe, and the treatment of the living body A memory in which three-dimensional volume image data including the target part is stored,
The distance measuring unit extracts a plurality of navigation images around the central axis of the treatment probe from the three-dimensional volume image data based on the position of the treatment probe detected by the three-dimensional position detector, and displays the display unit. The ultrasonic therapy apparatus according to claim 1, wherein a distance from the focal point to the body surface is measured for each irradiation channel based on the navigation image. The three-dimensional volume image data is imaged by a magnetic resonance imaging device or an ultrasonic diagnostic imaging device,
The ultrasonic therapy apparatus according to claim 8, wherein the position of the focus and the body surface detected from the three-dimensional volume image data are depicted in the navigation image.   10. The ultrasonic therapy apparatus according to claim 9, wherein the body surface is drawn in accordance with preset body surface information with a region where the brightness value of the navigation image is clearly different as a boundary.   The ultrasound treatment apparatus according to claim 9 or 10, wherein a simulated image of a treatment ultrasound path connecting each irradiation channel and the focal point is superimposed on the navigation image. A treatment probe having a plurality of irradiation channels for irradiating treatment ultrasound to a focal point which is held facing the body surface of the living body and set at a treatment target site of the living body, and provided at the center of the treatment probe, An imaging probe having a plurality of imaging transducers for transmitting and receiving ultrasound for imaging with the living body, and an ultrasound for generating an ultrasonic tomographic image including the focal point generated from a reception signal of the imaging probe Accumulation of three-dimensional volume image data including the ultrasonic image constructing unit, the display unit for displaying the ultrasonic tomogram, the three-dimensional position detector for detecting the position of the treatment probe, and the treatment target part of the living body A plurality of ultrasonic sounds around the central axis of the treatment probe from the three-dimensional volume image data based on the recorded memory and the position of the treatment probe detected by the three-dimensional position detector And a distance measuring image construction unit to be displayed on the display unit by cutting a tomographic image,
Based on the distance measurement image displayed on the display unit, a distance measurement unit that measures the distance from the focal point to the body surface for each irradiation channel;
An ultrasonic therapy system comprising a burn alarm unit that renders a color-coded alarm image in which the distance is greater than a set value determined based on the possibility of a burn on the body surface.

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