The present invention relates to an ultrasonic diagnostic system, and in particular to an ultrasonic diagnostic system which measures visceral fat.
In the medical field, ultrasonic diagnostic systems are being utilized. An ultrasonic diagnostic system is generally formed from an ultrasonic diagnostic device or from a combination of an ultrasonic diagnostic device and a computer. The ultrasonic diagnostic device comprises an ultrasonic probe which transmits ultrasound to a living body and receives a reflected wave from the living body, and a device body which executes image formation and various measurements based on the received signal from the ultrasonic probe. With the ultrasonic diagnosis, it is possible to avoid a problem occurring in X-ray diagnosis such as radiation exposure, and the ultrasonic diagnosis does not require a large-scale device such as that required for X-ray diagnosis. Because of such convenience, it is desired to apply the ultrasonic diagnostic technique to medical examination of metabolic syndrome (that is, obesity due to visceral fat).
Currently, in medical examination of metabolic syndrome, in general, abdominal circumference is measured, because there is a certain degree of correlation between the abdominal circumference and the amount of visceral fat. However, abdominal circumference is merely length information including the subcutaneous fat (including muscle), and does not directly represent the amount of visceral fat in the abdominal cavity or the size of the range where the visceral fat exists. A method is proposed in which a weak current is applied to the abdominal region and the amount of visceral fat is estimated based on the electrical resistance thereof. However, for realization of such a method, a large-scale device would be required, and a result which sufficiently reflects the structure in the abdominal region cannot be obtained, and, thus, the reliability of measurement cannot be improved. In a method of measuring the amount of visceral fat using an X-ray CT device, measurement with high precision can be realized, but a very large-scale system must be constructed for this method, resulting in problems in scale and cost. In addition, a problem arises in relation to radiation exposure. In consideration of this, research has been carried out on application of ultrasonic diagnosis, which can non-invasively observe the in-body structure, to medical examination of metabolic syndrome; that is, visceral fat measurement.
Non-Patent Literature 1 is a paper describing a relationship between visceral fat and cardiovascular disease risk factors. Although the details are not clear, it can be deduced that the amount of visceral fat is measured using an ultrasonic image. More specifically, on a lateral cross section of the abdominal region (cross section vertically crossing the lumber vertebra) shown in
Patent Literature 1 discloses a visceral fat obesity examination device which calculates a ratio of a cross-sectional area of the subcutaneous fat and a cross-sectional area of preperitoneal fat by an image process on an ultrasonic image. However, this device is not targeted to measure a wide range within the abdominal region, and does not have a measurement condition and a measurement support device for realizing superior reproducibility.
Patent Literature 2 discloses a visceral fat measurement device which identifies a preperitoneal fat thickness near the liver and a preperitoneal fat thickness near the navel, and determines a visceral fact coefficient which depends on the amount of visceral fat based on these pieces of information. This device observes the visceral fat at two points distanced in the direction of extension of the spine, and does not take into consideration a shape and a structure in a cross section perpendicular to the spine.
Patent Literature 3 discloses an attachment for ultrasonic probe, which prevents a change of the fat thickness when the ultrasonic probe comes into contact with the patient. However, this attachment only has one probe-holding portion. Patent Literature 4 discloses a near-infrared light type body fat measurement device having a band-shaped string. On the string, a navel position matching portion is provided.
In the examination of metabolic syndrome; in particular, in a group medical examination of metabolic syndrome, easy, quick, and reliable measurement of the information corresponding to the amount of visceral fat is desired. However, with the techniques of the related art, such desire cannot necessarily be sufficiently satisfied.
In the case of examination by contacting the probe in a plurality of positions on a body surface in sequence, improvement of the positioning precision of the probe and realization of superior operability at the positioning of the probe are desired, but with the technique of related art, such desires cannot necessarily be sufficiently satisfied.
[Patent Literature 1] JP 2007-135980 A
[Patent Literature 2] JP 2008-194240 A
[Patent Literature 3] JP 2008-284136 A
[Patent Literature 4] JP 2006-296770 A
[Non-Patent Literature 1] Yu CHIBA et al., “Relationship between Visceral Fat and Cardiovascular Disease Risk Factors: The Tanno and Sobetsu Study”, Hypertens Res, Vol. 30, No. 3, 2007, pp. 229-236.
An advantage of the present invention lies in provision of an ultrasonic diagnostic system which can measure information corresponding to the amount of visceral fat with high precision using ultrasound.
Another advantage of the present invention lies in provision of an ultrasonic diagnostic system which can set a plurality of visceral fat measurement paths with superior reproducibility on a cross section of a living body.
Another advantage of the present invention lies in provision of an ultrasonic diagnostic system which can obtain a reliable measurement result with a simple structure and suited for group medical examination of metabolic syndrome.
Another advantage of the present invention lies in provision of an ultrasonic diagnostic system which can improve positioning precision and a positioning reproducibility of the probe on a surface of the living body.
Another advantage of the present invention lies provision of an ultrasonic diagnostic system which can improve operability during positioning of the probe on a surface of the living body.
Another advantage of the present inventions lies provision of an ultrasonic diagnostic system which can easily search a reference tissue which extends in a direction of a body axis and which can construct a superior measurement situation.
The invention described in each of the claims of the present application is directed to realizing one of the above-described advantages.
According to one aspect of the present invention, there is provided an ultrasonic diagnostic system comprising an ultrasonic probe which is brought into contact with a living body, which transmits and receives ultrasound, and which outputs a reception signal; an image formation unit which forms an ultrasonic image based on the reception signal; a distance measurement unit which uses a plurality of ultrasonic images including a plurality of measurement paths which are radially set on a cross section of the living body, to measure a distance between a reference site at a deep position and a predetermined boundary surface at a shallow position on each of the measurement paths; an index value calculation unit which calculates an index value having a correlation to an amount of visceral fat based on a relative positional relationship among the plurality of measurement paths and a plurality of distances measured on the plurality of measurement paths; and an output unit which outputs the index value.
According to the above-described structure, a range where there is a possibility that the visceral fat exists in the living body is identified as a plurality of distances along a plurality of measurement paths. Based on the relative positional relationship among the plurality of measurement paths (preferably, intersection angles) and the plurality of distances, an index value having a correlation to the amount of visceral fat is calculated. In the abdominal circumference measurement method which is the method of related art, the subcutaneous fat and the thickness of the muscle are also included as measurement targets, but with the above-described configuration, the range where the visceral fat may exist can be identified while removing the subcutaneous fat layer or the like, and use the range as a basis for the index value calculation. More specifically, according to the method disclosed in the present application, a plurality of distances are measured along a plurality of measurement paths, and, thus, a two-dimensional spreading or a size of the visceral fat can be considered. Because of this, the reliability of the index value can be improved. When the X-ray CT device is used for measurement of the visceral fat, a problem of radiation exposure occurs and a large-scale mechanism is required. However, with the above-described configuration, the index value can be measured quickly and non-invasively, and a high level of medical usability can be achieved. The predetermined boundary surface is a boundary surface surrounding an area where the visceral fat exists. Preferably, the predetermined boundary surface is an inner surface of a subcutaneous layer in which the visceral fat does not exist; more specifically, is an inner surface of a muscle layer or an inner surface of a subcutaneous fat layer.
The number of measurement paths is greater than or equal to two, and is preferably three. By setting three measurement paths, in addition to the spreading of the range where the visceral fat may exist, the approximate shape (or a difference between a form on a right side and a form on a left side) of the range can be considered. Alternatively, four or more measurement paths may be set. The distance measurement is executed automatically, manually, or semi-automatically. In the case of manual execution, in consideration of the user's burden, it is preferable to set three measurement paths. The plurality of measurement paths are preferably set such that the plurality of measurement paths intersect each other at a deep portion in the body. The shape of a range or a body cavity in which the visceral fat may exist is approximately elliptical, and, therefore, it is particularly preferable to set the reference site near the center of the ellipse and set a plurality of measurement paths which radially spread from the reference site. In order to realize the distance measurement on the plurality of measurement paths, the probe is stepwise or simultaneously brought into contact with a plurality of contact positions on the surface of the living body. Preferably, each of the plurality of ultrasonic images which are displayed includes a line representing the measurement path, and there is provided an input unit with which a user designates the reference site and the predetermined boundary surface on each line.
Preferably, the reference site is a blood vessel, each ultrasonic image corresponding to each of the measurement paths is displayed as a tomographic image, and a distance between the blood vessel and the predetermined boundary surface is measured on each of the tomographic images. Displaying the tomographic image facilitates visual identification of the predetermined boundary surface. In addition, the identification of the blood vessel is also facilitated. Alternatively, the identification of the blood vessel may be automatically executed using an ultrasonic Doppler method. Preferably, the blood vessel is a descending aorta which beats. Such a beating blood vessel can be very easily recognized on the tomographic image, and, by setting the measurement paths with reference to such a blood vessel, the reliability of measurement can be improved even for a manual measurement.
Preferably, the plurality of tomographic images correspond to a plurality of scanning planes which are perpendicular to the cross section and which cross each other on the descending aorta.
Preferably, the cross section of the living body is a lateral cross section on an abdominal region of the living body, and a central scanning plane among the plurality of scanning planes is formed at a position avoiding the navel existing in the abdominal region.
Preferably, the plurality of scanning planes include a central scanning plane, aright-side scanning plane, and a left-side scanning plane, and the right-side scanning plane and the left-side scanning plane are set on aright side and a left side of the central scanning plane with substantially the same inclination angle with respect to the central scanning plane. Preferably, the plurality of measurement paths include a central path, a right-side path, and a left-side path, and the index value calculation unit comprises a unit which calculates a right-side portion area of a right-side portion between the central path and the right-side path based on a distance along the central path, a distance along the right-side path, and a right-side angle between the central path and the right-side path; a unit which calculates a left-side portion area of a left-side portion between the central path and the left-side path based on the distance along the central path, a distance along the left-side path, and a left-side angle between the central path and the left-side path; and a unit which calculates the index value using at least the right-side portion area and the left-side portion area.
The calculated area value may be output as the index value without further processing, or a volume value may be determined by calculating area values at various positions of the living body and output as the index value. As the method of area calculation and volume calculation, various methods may be considered. In any case, it is preferable to calculate the plurality of distances along the plurality of radial measurement paths and to calculate the index value on the basis of the two-dimensional shape information in the living body.
Preferably, the ultrasonic diagnostic system further comprises probe-holding equipment. Preferably, the probe-holding equipment comprises a plurality of holding portions which store a probe to be brought into contact with the abdominal region, and a fixing unit which fixes the plurality of holding portions on the abdominal region, and the plurality of holding portions are provided aligned in a left-and-right direction of the abdominal region and with an angle to direct a transmission and reception surface of the probe toward the reference site during use.
With the above-described configuration, the plurality of holding portions are provided with a predetermined positional relationship, and a user can set the probe in the holding portions in order and execute the ultrasonic diagnosis at each position. With such a configuration, because the probe can be quickly and accurately positioned, the burden of the user can be reduced, and superior reproducibility of the measurement can be achieved. The reference site is, for example, a blood vessel positioned in a deep portion in the body, and an orientation of the probe is adjusted such that the scanning plane passes through the reference site. In particular, the inclination angle is adjusted. In the state where the probe is inserted in each of the plurality of holding portions, in general, the electronic scanning directions become parallel to each other, and only a rake angle of the scanning plane is adjusted. When the electronic scanning direction and the running direction of the blood vessel serving as the reference site are in a parallel relationship, the plurality of scanning planes may intersect on the central axis of the blood vessel. The number of the holding portions is determined according to the measurement objective, and, for the measurement of the visceral fat, for example, three holding portions are provided. Alternatively, two, or four or more holding portions may be provided. The fixing unit preferably surrounds the entirety of the abdominal region, but, alternatively, other structures may be used.
Preferably, each holding portion has a deformability to permit a rake movement of the probe stored therein. Each holding portion is preferably formed with an elastic, deformable material. A gap may be provided in the holding portion to permit the movement of the probe. The holding portion is preferably formed such that the probe is not dropped even when the user is not holding the probe with a hand. Preferably, the positioning of the scanning plane is executed by the user while viewing the ultrasonic image.
Preferably, the probe includes a one-dimensional array transducer, and each holding portion holds the probe such that an element arrangement direction of the one-dimensional array transducer is parallel to a body axis direction of the living body. Preferably, in each holding portion, there are formed an opening for exposing the transmission and reception surface of the probe to the living body side and a hollow structure which surrounds and holds the probe.
Preferably, the plurality of holding portions include a central holding portion, a right-side holding portion, and a left-side holding portion, the right-side holding portion and the left-side holding portion are inclined with respect to the central holding portion and the overall holding portions spread in a fan shape, and inclination angles of the right-side holding portion and the left-side holding portion with respect to the central holding portion during use are set between 30 degrees and 50 degrees. Preferably, the fixing unit is a belt-shaped member wound around the body section. Preferably, a marker which is used for position matching with respect to the navel is provided.
A preferred embodiment of the present invention will now be described with reference to the drawings.
In
In
For the measurement of the index value, in the present embodiment, 3 measurement paths 36A, 36B, and 36C are set. In
More specifically, a piece of holding equipment 26 is provided on the abdominal region surface 12, and a probe 32 is sequentially held at the three contact positions A, B, and C by the holding equipment 26. The holding equipment 26 has three holding portions 30A, 30B, and 30C, and the probe 32 may be selectively inserted and held in one of the holding portions 30A, 30B, and 30C. For example, in
In the present embodiment, in order to measure a value corresponding to the area of the visceral fat area 20 shown in
In
When, for example, reference is made to the central tomographic image Fa, the measurement path is shown with reference numeral La in this image. When the distance measurement is executed, a center O of the descending aorta is designated by the user, and a point 40A corresponding to a depth position of a boundary surface Ra is designated by the user. These two points O and 40A are designated on the measurement path La corresponding to a central line. Alternatively, there may be employed a configuration in which such a path can be freely inclined or deflected. The boundary surface Ra is in general a surface which can be easily visually identified, and the descending aorta can also be very easily identified on the image. Therefore, the distance can be identified with a high level of precision. Similarly, at the contact position B also, along the measurement path Lb, the center O of the descending aorta and a point 40B on a boundary surface Rb are designated by the user, and a distance b is automatically identified as a result . Similarly, at the contact position C also, along the measurement path Lc, the center point O and a point C on a boundary surface Rc are identified by the user, and a distance c is automatically calculated. With the above-describe process, the three distances a, b, and c are recognized.
As a method of obtaining such an index value, there exist a function calculation method and a table method. In the following, first, the function calculation method will be described. In this method, the area is calculated from the geometric viewpoint (that is, relative positional relationship among the three measurement paths and three distances). The details will now be described.
Areas Sb and Sc of the two triangles can be easily determined based on the distances a, b, and c which are already calculated, and the 2 angles θb and θc which are known. In the present embodiment, such a method is expanded to further calculate areas of four triangles . That is, partial areas Sb1, Sb2, Sc1, and Sc2 are calculated.
The area Sb1 is an area of a triangle surrounded by the points O, 40B, and R1, and can be calculated from the angle θb1 and lengths b and b1 of two sides. The angle θb1 is a known value, and the length b1 of the side is defined in the present embodiment as the same length as the side b or a length obtained by multiplying the length of side b by a predetermined coefficient. The area Sb2 is an area of a triangle surrounded by 3 points O, R1, and R2, and is calculated based on lengths b1 and b2 of the sides and an angle θb2. The angle θb2 is a known value, and the length b2 can be calculated, for example, using predetermined coefficients and based on b and c. With a similar method, the partial area Sc1 and the partial area Sc2 are determined. The partial area Sc1 is calculated from c, c1, and θc1, and the partial area Sc2 is calculated from c1, c2, and θc2. Because angles θc1 and θc2 are known, c1 and c2 may be estimated based on c or based on c and b. Finally, an area S in which the partial areas Sb, Sc, Sb1, Sb2, Sc1, and Sc2 are added is determined. The area S is output as an index value representing the amount of visceral fat, or an index value is determined by converting or correcting the area S. In either case, the size of the visceral fat area 20 is measured from a two-dimensional viewpoint, so that an index value can be obtained with higher reliability than the measurement of the abdominal circumference (that is, the method of the related art) .
As shown in
A probe 180 is connected to a body through a cable, and in the present embodiment, the probe 180 comprises a 1-D (one-dimensional) array transducer. The 1-D array transducer is formed from a plurality of transducer elements which are arranged in a linear shape or an arc shape. An ultrasonic beam is formed by the array transducer. The ultrasonic beam is electrically scanned. As such a scanning method, an electric linear scanning, electronic sector scanning, etc. are known. In the present embodiment, an arc-shaped array transducer is used, and a scanning method which is known as convex scanning is executed. A single probe 180 is used, and the same probe is sequentially brought into contact at the plurality of contact positions in multiple stages.
A transmission and reception unit 182 functions as a transmission beam former and a reception beam former. During transmission, the transmission and reception unit 182 supplies a plurality of transmission signals in parallel to the array transducer. With this process, a transmission beam is formed at the probe 180. A reflected wave from the inside of the living body is received by the probe 180, and a plurality of reception signals are output to the transmission and reception unit 182. During reception, the transmission and reception unit 182 executes a phase align and summing process on the plurality of reception signals to form a reception signal after the phase align and summing, and outputs beam data. The beam data is supplied to a signal-processing unit 184. The signal-processing unit 184 comprises a logarithmic converter, a wave detector, etc.
The beam data after the signal process are supplied to an image formation unit 186. The image formation unit 186 is formed from a digital scan converter, which includes a coordinate conversion function and an interpolation process function. A B-mode black-and-white tomographic image is formed by a plurality of sets of beam data. The image data are supplied to a display-processing unit 188. A tomographic image is displayed on a display unit 192.
A measurement unit 190 is a module which executes automatic distance measurement or a module which executes a distance calculation based on a position which is manually input. A control unit 194 executes operation control of the structures shown in
In a state where the living body lies on a bed facing upward, the holding equipment is placed on the abdominal region. Then, the probe is set at a position A in S101. The position A is, for example, the central position. In S102, on a tomographic image formed using the probe thus placed, a center point of the blood vessel and the boundary point are input by the user, and a distance therebetween is measured. Prior to this process, the orientation of the probe is adjusted by the user so that a desired cross section is drawn. This process corresponds to a process of setting the central measurement line. The holding equipment is formed with a soft material to permit such an inclining movement; that is, the raking movement.
When the distance measurement is completed at the central position, in S103, the probe is set at a position B, and, in S104, the orientation and position of the probe are adjusted and the center of the blood vessel and the boundary point are designated by the user on a B-mode tomographic image. With this process, a second distance is measured. Similarly, in S105, the probe is set at a position C, and, in S106, the position and the orientation of the probe are adjusted and the center point of the blood vessel and the boundary point are designated by the user on an ultrasonic image. With this process, a third distance is measured.
In S107, based on the three distances and two angles which are defined in advance, an index value having a high correlation to the amount of visceral fat is calculated. The calculation corresponds to estimation of the amount of visceral fat. In S108, the index value is displayed. In a group medical examination, by not simply measuring the abdominal circumference, but also estimating the visceral fat existing area in the abdominal cavity using the ultrasonic diagnosis and in a two-dimensional shape as described above, it becomes possible to obtain a more useful index value for diagnosing or evaluating metabolic syndrome. In order to further improve the correlation between the index value and the amount of visceral fat, in the diagnosis, it is desirable to apply correction based on the sex, physical constitution, and other information pertaining to the subject. A coefficient used for such a correction is determined based on experience or experimentally.
Next, with reference to
The body unit 100A is formed from a soft material such as, for example, rubber, and a belt section 110 connected to the body unit 100A is also formed from rubber or the like. However, when the belt section 110 is used to measure the abdominal circumference or the like, the belt section 110 is desirably formed from a material which is not stretchable. By providing the belt section 110, it becomes possible to fix the body unit 100A while the surroundings of the abdominal region are enwrapped by the belt section 110, and the probe can be easily held in a stable state. With such a configuration, an orthogonal coordinate system referencing the subject can be easily defined. In addition, with the use of such holding equipment 100, the probe can be followed and moved with the surface movement of the living body during respiration, a problem such as position deviation for measurement can be reduced, and reproducibility of the measurement can be improved.
Because three probe positions are defined in the measurement of the index value as described above, the body unit 100A shown in
Because the holding equipment shown in
In the present embodiment, the index value is measured in a state where the living body faces a lateral direction. Alternatively, the index value may be measured using similar holding equipment in a state where the living body is standing.
Number | Date | Country | Kind |
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2009-256886 | Nov 2009 | JP | national |
2009-256887 | Nov 2009 | JP | national |
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/JP2010/069976 | 11/10/2010 | WO | 00 | 4/30/2012 |