The present invention relates to an image processor for medical treatment support by which improvement in planning and efficacy can be achieved by monitoring an image of a target area upon treatment of the target area of an object to be examined.
The apparatuses such as X-ray CT or MRI are commonly known to be useful for image diagnosis, and are also widely applied as a guide for monitoring treatment of surgical operations or biopsy, not only as a mere diagnostic device for displaying images. The objective of using these apparatuses in the case of a biopsy is to figure out the positional relations between a puncture needle and a lesion, and the means in use are such as CT/MR fluoroscopy that enables grasping the positional relations in real time by contriving the reconstruction process and sequentially renewing the image. As for treatment, availability of various means and methods such as hyperthermia using a laser, RF (Radio Frequency) or cryosurgery using gas are under consideration. Also for a modality to use for monitoring, attempts are being made to use various types of image diagnostic apparatuses such as CT, MRI or US, each of which has its advantages and disadvantages. Descriptions relating to these methods of monitoring treatment are found in the following Patent Documents 1˜3.
Patent Document 1: JP-A-2003-10228
Patent Document 2: JP-A-2000-300591
Patent Document 3: JP-A-2003-88508
For example, treatment for disk herniation using a laser is performed by irradiating an interspinal disk with a laser and evaporating the moisture in the interspinal disk, by which the compression on the nerves caused by the herniation is reduced. CT apparatus can contribute in estimating the condition of the evaporation if the degree of the gas evaporation is acquired. Also for example, for treatment of diseases such as a tumor, a method of necrotization of the tissues of the tumor by heating or freezing the lesion is carried out. Cryosurgery being one example of the above method, takes a means to carry out the treatment to check if the lesion is covered sufficiently by the frozen region (Ice Ball).
MRI apparatus being high in tissue contrast is often used for monitoring, rather than ultrasound (US) apparatus that is not capable of observing the shadow of the ice ball. CT apparatus can also be used for monitoring. However, there are problems related to monitoring these complicated procedures as images need to be acquired sequentially during treatment, additionally in the case of using X-ray CT apparatus, that the dose of radiation exposure on the patient increases with the number of images acquired. Also, even though the region being treated needs to be somewhat larger than the lesion, there is a demand to reserve the normal tissues as much as possible, thus the need to depend on visual observation for determining the region for treatment is unavoidable at this point. However, it has been difficult to visually distinguish a freezing region from the lesion border as the treatment. Further, even though there is basic data in what degree of temperature is pathologically necessary for necrotization of tissues, it has been difficult to carry out reliable treatment procedure since there was no means to measure it quantitatively and check the relationship between the lesion and the temperature distribution.
The above-mentioned issues are taken into consideration by the present invention, and the objective of the invention is to provide an image processor for medical treatment support by which the time required to complete a treatment upon monitoring of the treatment can be estimated.
The present invention is also to provide an image processor for medical treatment support by which a lesion and the range of temperature for an effective treatment can be easily acquired upon monitoring of treatment, taking the above-mentioned issues into consideration.
The present invention provides an image processor for medical treatment support that obtains a tomographic image of the object to be examined, and monitors the treatment process, comprising:
Also, the total treatment time estimating means is for obtaining each of the distances from the reference point that is the starting point of the treatment to the border of the treatment-completed region with regard to the treatment-completed regions on a plurality of the monitoring images, and estimating the total treatment time based on the change of those distances.
Also, the total treatment time estimating means is for setting the straight lines extended radially with equiangular intervals from the reference point of the treatment target region as the reference lines, and estimating the total treatment time based on the degree of treatment progress on the reference lines.
Also, the total treatment time estimating means is for specifying at least one reference line that bisects the treatment target region from the reference point, obtaining the points of which a perpendicular line that divides the reference line into predetermined intervals intersects with the treatment target region, setting the lines that connect those points and the reference point as further reference lines, and estimating the total treatment time according to the degree of treatment progress on those reference lines.
Also, the total treatment time estimating means is for setting the lines that connect the pixels of predetermined intervals on the display means for displaying the outline of the treatment target region and the reference point as the reference lines, and estimating the total treatment time according to the degree of treatment progress on the reference lines.
Also, the treatment target region setting means is for setting a plurality of closed curves by synthesizing them and smoothing their crossed portion, and the total treatment time estimating means is for setting the reference line on every closed curve and estimating the total treatment time according to the degree of treatment progress on those plurality of reference lines.
The present invention provides an image processor for medical treatment support that obtains a tomographic image of an object to be examined and monitors treatment progress comprising:
Also, the display means is for displaying the treatment target region, the treatment-completed region and the estimated treatment region by allocating different hue information to each region.
Also, the display means is for displaying by allocating hue information on the treatment target region.
Also, the display means is for displaying the shifting of the region under treatment with color, as well as displaying by allocating the hue information on the treatment target region.
Also, the display means is for displaying by allocating different hue information to the treatment-completed regions at a plurality of time points.
Also, the display means is for displaying by allocating hue information to the estimated treatment-completed regions in incremental steps.
Also, the display means is for displaying the estimated treatment regions at a plurality of time points with desired color gradation.
Also, the display means is for displaying by superimposing one or both, the estimated treatment region, and the treatment-completed region with the treatment target region.
The present invention provides an image processor for medical treatment support that obtains a tomographic image of an object to be examined, and monitors the treatment progress, comprising;
Also, the measurement/temperature converting means is for setting a CT value as a measurement value, and converting CT value into a temperature by assuming the tissue of which the CT value of the vicinity of 25-degrees is 0 has −20 to −50 of CT value in below 0-degree.
Further, it also comprises:
It also comprises a difference image creating means for creating the difference image between the treatment progress image and one or both of the treatment target region and/or treatment-completed region, and the display means is for displaying the difference image and one or both of treatment target region and/or treatment-completed region.
Also, the display means is for displaying the treatment target region, the treatment-completed region, the treatment progress image and the difference image by allocating different hue information to each of them.
According to the present invention, by estimating the time needed for completing the treatment upon monitoring it, it is possible to improve remaining treatment planning and to reduce the number of images that must be obtained. Also, the lesion and the region of the temperature effective for the treatment can be easily calculated.
Hereinafter embodiment 1 of the present invention will be described referring to the attached drawings.
In step S40, the image processor for medical treatment support of the present embodiment determines a cross section for monitoring which is to be punctured prior to a treatment, and obtains it as a monitoring image IMG0.
In step S41, treatment target region setting unit 21 sets treatment target region 31 on monitoring image IMG0 using GUI (Graphical User Interface).
In step S42, a treatment is started, and the images of the treatment procedure are properly obtained for the purpose of observing them. Monitoring image IMG1 as a treatment procedure image after passing of time t1 since the starting of the treatment, and monitoring image IMG2 after passing of time t2 are respectively obtained.
In step S43, since the region frozen by the treatment is projected from the treatment process images, for example, as black low signals in MRI, treatment-completed region setting unit 23 extracts the frozen region from monitoring images IMG1 and IMG2, and sets coordinate of border thereof as treatment-completed regions B1 and B2 in respective monitoring images IMG1 and IMG2.
In step S44, reference point P is defined by reference point setting unit 22 based on monitoring image IMG1.
The processes of step S45˜S49 are executed by total treatment time estimating unit 24.
In step S45, straight line L1 (a reference line for calculating the treatment region) used for estimating the time, is defined from reference point P toward the direction where the treatment region is expanding. Reference line L1 to be defined first is reference line L1 as shown in
In step S46, intersection points C1 and C2 of reference line L1 being defined from reference point P and the respective monitoring images IMG1 and IMG2 are obtained.
In step S47, distance d1 and d2 from reference point P to the respective intersection points C1 and C2 are obtained.
In step S48, determination is conducted on whether the process of steps S46 and S47 are completed on at least 2 of the monitoring images IMG1 and IMG2 that are the intended images. When it is determined that the process is completed step S49 is carried out, and when not completed the process should return to step S46, and the same procedure is to be repeated.
In step S49, since it is already known that treatment time t1 and time t2 were required for reaching respective treatment-completed regions B1 and B2 which are the frozen regions of monitoring images IMG1 and IMG2 for indicating the treatment procedure, distance D from reference point P to intersection point C which is an intersection of treatment target region 31 being set in advance and reference line L1 is obtained, and time T which is the time required for the treatment is calculated from the relation between times t1 and t2 which are the time required to reach to distance d1 and d2 which are the distance from reference point P to the respective intersections C1 and C2.
In step S4A, the total treatment time being calculated by the estimation of treatment-time indicating unit 25 is displayed numerically to the observer. This treatment time indicating unit 25 may be set so that the treatment-completed region and the treatment regions after a minute and after two minutes are estimated, and the estimated treatment regions thereof can be displayed on the tomographic images by hue information in incremental steps. It may also be arranged so that the permeability can be set on the colors or gray scale to be displayed, and the shading information of the monitoring images may be superposed upon display. Hue information here means the color shade, thickness or pattern of the colors including white, black and gray. Also, in the case that it is easier to figure out the positional relation with the lesion by using the image before the treatment, the image before the treatment may be used to superpose with instead of the monitoring image.
Though the case of calculating the total treatment time based on two monitoring images IMG1 and IMG2 is mentioned in the above embodiment, it is possible to estimate the total treatment time more accurately by using plural n-pieces of monitoring images.
There are various sorts of methods for setting the reference line or closed region, and in one method the total treatment time is estimated by first obtaining the intersections from barycentric position G0 toward all directions with equal angles (15? intervals on the diagram) as seen in
Alternatively the intersection points can be obtained by setting the perpendicular lines to reference line L1 at regular (irregular is also accepted) intervals as seen in
Or, the total treatment time can be estimated by first setting the reference lines which connect the reference point and the pixels at predetermined intervals out of the pixels on the display unit for displaying the outline of the treatment target region, and estimate the time based on the treatment progress of those reference lines. In other words, this method is for estimating the total treatment time by using the reference lines being obtained by equally sampling the number of pixels on the border pixels of the closed curve and further drawing the additional reference lines toward these sample points. In this way, the reference lines can be drawn plurally by connecting the obtained intersections and reference point P, the treatment region after passing of predetermined time can be estimated as mentioned above, and the estimated treatment region can be projected with high accuracy.
Synthetic region 71 with a smoothing process can be determined by using information such as a continuity, angle or curvature of the borderline. As for concrete examples of the smoothing process, the degree of smoothing can be determined based on a quantitative value such as an angle oriented by a normal line of both closed regions, but the most simple and efficient means is to obtain a moving average with respect to the distance from the gravity point and to adopt the result of smoothing only to the region that the distance becomes larger. Total time required for the treatment can be estimated by using an arbitrary value such as the average value, maximal value or minimum value of the treatment progress on a plurality of reference lines.
Also, the total treatment time may be estimated by obtaining the treatment-completed regions at a plurality of time points, and implementing the functional approximation on them. For example, the relation between the treatment-time and the treatment-region may be obtained by first setting the outline of treatment-completed regions B1 and B2 of
The configuration or the process of the present embodiment is basically the same as embodiment 1, unless particularly mentioned otherwise. Also, the same reference number illustrates the same portion as in embodiment 1.
Measurement calculating means 82 is for calculating CT value based on the measurement data from image memory 81. Measurement/temperature converting means 83 as CT value/temperature converting table as seen in
In the case of an X-ray CT device, the reconstructed images are created based on the absolute value called “CT value”, and are high in reproducibility and quantifiable. It is assumed that there is actually a variance of around 20˜50 in the CT value from a frozen state to a room temperature state during cryosurgery. Monitoring mode switch 85 is for switching the monitoring mode. In
An operation example of the image processor in
Upon performing cryosurgery, it is preferable to execute the setting so that it displays in blue before the treatment, with the color changing to red when it is expected the temperature reaches the point of curative effect is expected, or to approach consecutively. Such color setting can be alternated without limitation to the above-mentioned example, but it is desirable that the operator can easily visibly identify when the temperature reaches the point that a curative effect can be expected in the course of treatment.
Image synthesizing unit 87 is for synthesizing the color information being converted in color table 84 based on temperature and the display color of the original CT image, and displaying it to display device 12. For example, using permeability parameter q, weighted sum of the respective RGB values is displayed as a new color. For example, when the original gradation is set as Cgray and the color corresponding with the temperature is set as Cred, Cblue and Cgreen, the new display color R,G, and B would be:
R=(1.0−q)×Cred+q×Cgray
G=(1.0−q)×Cgreen+q×Cgray
B=(1.0−q)×Cblue+q×Cgray.
The present invention is not limited to synthetic method of colors as mentioned above. Also, it is desirable that not only the cross-sections of axial, but also a point of view such as sagittal and coronal are displayed at the same time on the display unit. Cone beam CT that has a wide X-ray beam width is especially suitable for grasping the growth state of an ice ball in one-time imaging.
Additionally, a means for comparing the time-series images and evaluating the growth rate of the ice ball, and a function for estimating the time required for the ice ball to cover the lesion portion sufficiently may further be added.
Also, the evaluating means of the growth rate at the moment can be defined by the relationship between distance from the center of gas irradiation to the edge of the treatment region and time. An example of preferred display means is to change the color or permeability in phase from the current treatment region to the treatment region after a minute and then to after two minutes. In the display unit, the color being used is a synthesized one of originally set color and the colors of the image before or during the treatment, the image may include the reformatted image (MPR).
The above-mentioned embodiment 1 was about estimating and displaying the time up to the completion of the treatment. Instead of or additional to the time display, the images of treatment progress may be created and displayed. By this function, for example, the time or condition being required for the ice ball to cover the lesion portion sufficiently can be identified sequentially and instantly.
Embodiment 3 will now be described referring to
The above-mentioned display of the treatment progress image can be implemented, for example, by effecting a change on the function of total treatment-time estimating unit 94 being described in embodiment 1 to estimate the degree of progress by the minute, and by superimposing those images of completing the treatment at a plural time points onto the original tomographic image.
As illustrated in
In step 40˜step 49 of
In step 4B of
In the case of selecting the treatment progress image in a specified time or one of the above-mentioned difference images using the treatment progress image in a specified time, the time of the treatment progress image for display should be inputted and specified to time selecting and inputting unit 9H of display treatment progress image in
In step 4D, the treatment progress image in the inputted time in above-mentioned step 4C is created in treatment progress image creating unit 9I of
In step 4E, the difference image between the treatment progress image being created in above-mentioned step 4D and image IMG0 that is the image before the treatment is created indifference image creating unit 9J for creating the difference image between the current image and the monitoring image of the lesion portion. The image for creating the difference image here need not be limited to image IMG0 being the image before the treatment, but a previous treatment progress image may be used instead.
Instep 4F, according to the mode of the treatment support display being selected in step 4B, one out of total treatment time T, the treatment progress image at a specified time, and the difference image from the treatment progress image at a specified time, or any of the combination of these image displays are synthesized. The above-mentioned synthesis is executed in image creating unit 9K of
The treatment progress image or temperature distribution according to time can be displayed in various manners, making full use of the width or types of the lines for plotting the color coordinate or the regions.
Such display means will be valuable for determining the most suitable treatment time for the entire treatment region and the normal surrounding tissues.
The condition of treatment progress can easily be grasped by creating the difference image between the treatment progress image in step 4E and image before the treatment IMG0. The fact that the difference images are differential components contributes to more accurate evaluation of acceleration velocity of the treatment progress. For example, possible artifact components being produced in the difference images by using probe 30 or a probe can be removed conveniently. As a result of implementing a difference calculation on data, it advantageously displays only the region where the treatment is making progress.
The difference image can also be superposed on the image of, for example, IMG0 being used for the difference calculus when the difference image was created. Alternatively, by obtaining the area or volume (when three-dimensional) of the difference and displaying the area change and the volume change by a chart corresponding to the time axis, it will be easier to grasp the development of the treatment progress.
As for creating the difference images, the threshold processing or image denoising are necessary because at times the probe staggers during the treatment. As for image denoising, a well-known method can be used wherein the areas are obtained after labeling and only the noise of specific area would be the target of denoising.
Additionally, difference image creating unit 9J of the present embodiment in the case of monitoring the treatment progress by X-ray CT apparatus, is not only for using to display the estimated treatment process but also for using to extract the region where the heat transfer is being delayed due to the presence of organs such as blood vessels, by creating the treatment error-image of the treatment progress image and the treatment-completed region image being updated and obtained, and by using the error for the extraction. Different color information may be allocated to each of the following, treatment target region, treatment-completed region, treatment progress image, and the difference image. Also, the color information for allocating can be varied according to the temperature being obtained by the above-mentioned measurement/temperature converting means.
In this case, the difference region may be extracted by acknowledging the curvature or discontinuity on the images, but without limiting to this method any method can be used as long as executed by acknowledging the difference. Indications of the presence of a blood vessel in the portion where the treatment is being delayed can be given to the physician by executing such method. The physician can evaluate the result of this and change the treatment plan if necessary, in order to avoid the blockage of the blood vessel which is not the objective of the treatment.
In addition, the image used in any of the above-mentioned embodiment may be a reformated image (MPR). Also, it is preferable that the cross-sections of not only axial but a point of view such as sagittal or coronal, or three-dimensional image are displayed at the same time.
Particularly, in case of using a cone-beam CT with a wide X-ray beam width, further improves the treatment since a three-dimensional image and the growth condition of the ice ball from the point of view such as axial, sagittal or coronal can be grasped in one-time imaging.
As described above, according to the present invention, by enabling to monitor during the treatment and to estimate the time required up to the completion of the treatment, the accuracy of the remaining treatment plan can be improved. Further, by reducing the number of obtained the images in order to carry on the treatment according to the plan, rapid ablation therapy can take place. Especially in the case of using X-ray images, the amount of exposure to radiation can be reduced since the imaging takes place only the minimum number of times necessary for the treatment. Also, treatment conditions such as positioning of a lesion and a treatment target region, presence of the blood vessel in a target treatment region, or temperature can easily be understood at the time of monitoring during treatment, thus remarkably valuable support information for the treatment can be provided.
Number | Date | Country | Kind |
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2003-363921 | Oct 2003 | JP | national |
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/JP2004/015692 | 10/22/2004 | WO | 00 | 4/2/2007 |
Publishing Document | Publishing Date | Country | Kind |
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WO2005/039416 | 5/6/2005 | WO | A |
Number | Name | Date | Kind |
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5553618 | Suzuki et al. | Sep 1996 | A |
5590653 | Aida et al. | Jan 1997 | A |
6760402 | Ghelmansarai | Jul 2004 | B2 |
Number | Date | Country |
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2000-300591 | Oct 2000 | JP |
2003-10228 | Jan 2003 | JP |
Number | Date | Country | |
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20080027314 A1 | Jan 2008 | US |