DE102009006188A1 - Imaging method for medical examination of breast to detect of tumor, involves pressing breast between support plate and pressing plate, and taking tomosynthetic three dimensional X-ray image and nuclear medical image from pressed breast - Google Patents

Abstract

In an imaging method for the medical examination of a breast (4) and an imaging medical device operating according to this method, an examiner is marked with a radionuclide (20) before the compression of the breast (4) to be examined in tumor tissue (22) Metabolite are administered, and then from the compressed breast (20) both an X-ray image (T) and a nuclear medicine image (G) are generated.

Description

The The invention relates to an imaging method for medical Examination of a breast as well as working on this procedure medical device.

to medical examination of the breast and for early detection Of tumors the so-called mammography is widespread, with the an X-ray is made of the breast. Through continuous improvement The mammography method is sought, X-ray images with high expressiveness to produce benign from malignant To distinguish changes and the number of erroneous findings, d. H. the number of suspicious findings not from malignant changes are caused, and to reduce the number of undetected malignant tumors. In the conventional mammography is doing in a single projection direction, a two - dimensional image of the generated compressed chest. Because with such a projection the in the direction of the X-ray beam one behind the other Tissue layers are superimposed, can be strong Absorbing benign structures superimpose a malignant tumor and make it more recognizable.

Around to avoid this are referred to as tomosynthesis mammography method known in which with a digital x-ray detector from the chest 2D projection images or 2D projection data in one Be included in a variety of different projection directions. From these recorded at different projection angles digital 2D projection images, d. H. from those to these 2D projection images associated image data, can then by image reconstruction method Three-dimensional image data set generated from a plurality consists of layer images, each one parallel to the receiving surface reflect the x-ray detector oriented layer of the breast. Such an image data set obtained by reconstruction is used in Hereafter referred to as tomosynthetic 3D X-ray image. By this measure, in the propagation direction X-ray seen deeper tissue structures be better recognized.

by virtue of the only available from a limited angular range Projections and the accompanying incomplete Scanning, however, is a reconstruction of a full 3D X-ray image limited possible, so the picture quality a tomosynthetic 3D X-ray image does not matter Computed tomography (CT) achieved known image quality. So z. B. the resolution in the direction of the central beam, the so-called "depth resolution", reduced opposite the resolution in the perpendicular Levels. Due to incomplete scanning can also no quantitative values of the attenuation coefficient μ reconstructed so that also the character or impression of the at Tomosynthesis won image of the character one with methods of Computed tomography gained image distinguishes. The focus The mapping task is therefore in the best possible Three-dimensional visualization of the object under investigation the given projection conditions and not in a quantitative Reconstruction of the local absorption coefficient μ.

Around to increase the safety of the diagnosis, it is basically known, in addition to the above described mammography method also use CT method. However, this is on the one hand with an increased radiation exposure of Investigator connected. In addition, you can the pictures of the breast produced with a CT procedure are not without further with the 2D X-ray images obtained in mammography or tomosynthetic 3D X-ray images, as opposed to conventional computerized tomography generated X-ray images obtained in compressed breast become.

Of the The invention is therefore based on the object of an imaging method to provide a medical examination of a breast with which it is possible, the diagnostic reliability over conventional Mammography method with the least possible additional Increase radiation exposure.

Furthermore the invention is based on the object, one by this method indicate the working medical imaging equipment.

Regarding of the method, the said object is achieved according to Invention solved by a method with the features of claim 1. In this method, a person to be examined first an enriching in tumor tissue, with a Radionuclide-labeled metabolite administered. Subsequently is the breast to be examined between a bearing plate and A compression plate compresses and compresses it from the compressed one Breast at least an x-ray and a nuclear medicine Image generated.

In the following, a nuclear medical image is understood to be an image obtained by nuclear medicine diagnostic methods in which the subject is injected with a metabolic preparation labeled with unstable nuclides, which accumulates in an organ with increased metabolic activity. Acting on these nuclides for example, gamma emitters that decay with the emission of a single gamma ray, or positron emitters, which in a subsequent annihilation process produce two gamma quanta that propagate in opposite directions. The nuclear medical image produced by gamma decay may be both an image as generated in conventional gamma-detector stationary gamma (stationary gamma) imaging and an image obtained in so-called SPECT in which The gamma detector (the gamma camera) is usually moved on a circular path either completely or similar to the tomosynthesis in a limited angular range around the subject.

When X-ray image in the sense of the present invention is both a two-dimensional X-ray image (two-dimensional projection data set) as also a three-dimensional tomosynthetic X-ray image to understand.

By the procedure according to the invention will be generated images of the breast to be examined, due to the different recording technique on different physical bases are based, namely the X-ray absorbing property of the tissue penetrated by the X-ray on the one hand and the metabolic properties of the tissue, on the other hand, and themselves Therefore, in terms of their information content supplement and complement the safety of the diagnosis. As is the chest in the generation of the X-ray image and in the generation of the nuclear medicine image in the same position and in the same compressed Condition is located between the bearing plate and the compression plate, X-ray image and gamma image can be directly related be compared. By such a direct comparison is the Diagnostic doctor provides an additional resource posed to benign lesions of malignant Distinguish lesions.

Regarding the imaging medical device is the task according to the Invention solved with the features of claim 10th

advantageous Embodiments of the method or the system are in the respective subordinate claims reproduced.

to Further explanation of the invention is based on the embodiment referred to the drawing, in whose only figure an imaging medical device according to the invention simplified is shown in a schematic diagram.

According to 1 The medical imaging system includes a mammography device with an X-ray tube 2 for generating X-rays 3 one between a compression plate 6 and a bearing plate 8th embedded breast 4 traverse. The breast 4 , the compression plate 6 and the bearing plate 8th traversing x-rays 3 be from a large area digital x-ray detector 10 received, which consists of a plurality of arranged in a matrix-shaped array of single detectors 12 constructed and below the bearing plate 8th is arranged.

The x-ray tube 2 is in a limited area to the chest 4 arranged in a variable position, and can be pivoted, for example, in a limited angular range φ ₁ , φ ₂ about an axis M perpendicular to the plane of the drawing in different angular positions j = 1 ... n, so that from the chest 4 with different projection angles α _j relative to the normal 13 the reception area 11 of the X-ray detector 10 2D X-ray images (projection _data P _αj ) can be generated. The angular range φ ₁ , φ ₂ does not have to be symmetrical to the normal 13 be arranged. The x-ray detector 10 is in the embodiment during the pivoting movement of the X-ray tube 2 stationary with its receiving surface 16 parallel to the bearing plate 8th arranged. In principle, however, it is also possible to use the X-ray detector 10 together with the x-ray tube 2 to pivot or the pivotal movement of the X-ray tube 2 following linear shift.

Instead of a panning is also a movement of the X-ray tube 2 possible on a limited linear path, so that the height difference between x-ray detector 10 and X-ray tube remains constant. Also, this linear path does not necessarily have to be symmetrical to the normal 13 run. In this linear movement, an alignment of the X-ray tube 2 on the chest 4 so that in this case too from the chest 4 Frames are taken at different projection angles α _j and in a limited angular range.

The control of the angular position j or in the case of a linear displacement of the linear position and the orientation of the x-ray tube 2 as well as their operating parameters are carried out by control signals S from a control and evaluation 14 to be generated.

In one in the chest 4 located tumor tissue 22 got one with a radionuclide 20 , in the example, a gamma emitter, enriched labeled metabolic preparation, which was administered to the subject before the mammographic examination by injection.

The radionuclide 20 emitted gamma radiation 23 traverses the X-ray detector 10 and is partially covered by this. When switched off or shielded X-ray tube therefore an X-ray blank image (empty data P ₀ ) is recorded. This can be done before or after the generation of the 2D X-ray images. The X-ray blank image or the blank data P ₀ give the X-ray detector 10 detected gamma radiation 23 again and are subtracted from the 2D X-ray images or projection _data P _αj . The 2D X-ray images or projection _data P _{αj, kor} corrected in this way are stored in the control and evaluation device containing an image _computer 14 assembled by reconstruction to a tomosynthetic 3D X-ray image T and displayed on a monitor.

Subsequently, the X-ray detector 10 from the area below the bearing plate 8th removed, for example, moved or swung away, as indicated by the arrow 24 is illustrated, and it is used instead of the X-ray detector 10 a gamma detector 26 , in the example a gamma camera 26 below the bearing plate 8th For example, also positioned by a pivoting movement, with the radionuclide 20 emitted gamma rays 23 be recorded.

The gamma detector 26 is preferably with a so-called multi-pinhole collimator 28 provided, for example, from the US 7,166,846 B2 is known, and in the figure by a plurality of pinhole 30 is illustrated schematically. With such a multi-pinhole collimator 28 it is possible to produce a nuclear medical image G, which consists of one of the number of pinhole corresponding number of staggered images of the breast 4 is composed. With a nuclear medicine image G produced in this way, it is possible the three-dimensional distribution of radionuclides 20 in the chest 4 That is, to reconstruct a nuclear medicine 3D image G _T without causing a gamma camera to pivot about the breast 4 is required. Because the compression of the breast 4 remains unchanged during the recording of the nuclear medical image G and in the recording of the 2D X-ray images, the visible in the tomosynthetic 3D X-ray image lesions and the tumor activity relative to each other in the correct position reproduced. The nuclear medicine 3D image G _T produced in this way can therefore be superimposed (fused) on the tomosynthetic 3D X-ray image T and displayed together with it on the monitor, so that the diagnosing physician can directly compare the image information from both imaging methods.

The Inclusion of the nuclear medical image G can be both before and after taking the 2D X-ray images.

in principle It is also possible that both for the recording of the X-ray images or a single energy-discriminating Detector comes with which it is possible, both to detect the gamma radiation as well as the X-radiation. Such a detector is then within the meaning of the present invention both X-ray and gamma detector.

In addition, it is also possible to make a nuclear-medical SPECT image with a gamma detector (a SPECT camera) arranged pivotably below the compression plate, such as by a gamma detector drawn in dashed lines 26 and an arrow also shown in dashed lines 32 is illustrated.

Instead of In the case of a gamma emitter, the person being examined can also use a positron emitter administered indirectly by positron killing two gamma quanta propagating in opposite directions be generated.

2

X-ray tube

3

X-rays

4

chest

6

compression plate

8th

bearing plate

10

X-ray detector

11

receiving surface

12

individual detectors

13

normal

14

Tax- and evaluation

16

receiving surface

20

radionuclide

22

tumor tissue

23

gamma radiation

24

arrow

26

gamma detector

28

multi-pinhole collimator

30

pinhole

32

arrow

G

image

G _T

3D image

M

axis

P ₀

dummy data

S

control signal

T

X-ray photograph

j

angular position

α

projection angle

φ

angle range

QUOTES INCLUDE IN THE DESCRIPTION

This list The documents listed by the applicant have been automated generated and is solely for better information recorded by the reader. The list is not part of the German Patent or utility model application. The DPMA takes over no liability for any errors or omissions.

Cited patent literature

• - US 7166846 B2 [0022]

Claims (14)

Imaging method for medical examination of a breast ( 4 ), comprising the following steps: a) An examination subject is identified in tumor tissue ( 22 ), with a radionuclide ( 20 b) subsequently administered to the breast to be examined ( 4 ) between a bearing plate ( 8th ) and a compression plate ( 6 ), c) from the compressed breast ( 20 ), at least one X-ray image (T) and one nuclear medicine image (G) are generated. The imaging method of claim 1, wherein the administered radionuclide ( 20 ) is a gamma emitter. An imaging method according to claim 1 or 2, wherein that of the compressed breast a tomosynthetic 3D X-ray image (T) is generated. Imaging method according to claim 2 or 3, in which the nuclear medicine image (G) is provided with a bearing plate below ( 8th ) arranged gamma detector ( 26 ) is produced. Imaging method according to one of the preceding claims, in which as gamma detector ( 26 ) for generating the nuclear medical image (G) a gamma camera with a multiple-pinhole collimator ( 30 ) and in which a nuclear medicine 3D image (G _T ) is reconstructed from the nuclear medicine image (G). Imaging process according to one of Claims 1 to 5, with one below the bearing plate ( 8th ) pivotally mounted gamma detector ( 26 ) for generating a SPECT image. Imaging method according to one of the preceding claims, wherein when the X-ray tube is switched off or shielded ( 3 ) an X-ray blank image is taken and in which the X-ray blank image is subtracted from the 2D X-ray image (s). Imaging method according to one of the preceding Claims in the X-ray and nuclear medicine Image are superimposed on each other in the right place. Imaging method according to one of the preceding claims, in which an x-ray detector provided for detecting the x-ray radiation ( 10 ) and a gamma detector provided for receiving the nuclear medicine image (G) ( 26 ) alternately below a bearing plate ( 8th ). Medical imaging system for medical examination of a breast ( 4 ), with a bearing plate ( 8th ) and a compression plate ( 6 ) for storing and compressing the breast ( 4 ), an x-ray tube ( 21 ) and at least one detector ( 26 . 10 ) for separately detecting X-ray and gamma radiation to produce an X-ray image and a nuclear medicine image. An imaging medical device according to claim 10, comprising an X-ray detector ( 10 ) and a gamma detector ( 26 ). Imaging medical device according to claim 11, with a gamma camera as gamma detector ( 26 ). Imaging medical device according to claim 12, whose X-ray detector ( 10 ) and gamma camera alternately below the compression plate ( 8th ) are arranged positionable. Imaging medical device according to one of claims 10 to 13, with a control and evaluation device ( 14 ) implemented software for performing the method according to one of the claims 1 to 9.