JP2014079441A - X-ray photographing condition setting system, image diagnostic device and x-ray photographing condition setting program - Google Patents

Abstract

An object of the present invention is to provide an X-ray imaging condition setting system capable of setting an appropriate X-ray imaging angle to prevent blood backflow in TAVR.
An X-ray imaging condition setting system according to an embodiment includes a backflow position designation unit and an imaging angle setting unit. The backflow position designating unit designates the backflow position of blood using, as reference data, ultrasonic image data in which the aorta of the subject in which the artificial valve is placed is depicted. The imaging angle setting unit sets an imaging angle in which a plane including the blood backflow position is an imaging plane of the X-ray image.
[Selection] Figure 2

Description

  Embodiments described herein relate generally to an X-ray imaging condition setting system, an image diagnosis apparatus, and an X-ray imaging condition setting program.

  Conventionally, replacement of an aortic valve is known as a technique for performing interventional treatment in real time while observing an image of the inside of a subject with an X-ray imaging apparatus. Aortic valve replacement is a treatment technique in which a prosthetic valve is placed in the aorta through a catheter inserted from a femoral blood vessel. Aortic valve replacement using a catheter is called TAVR (Trans-catheter Aortic Valve Implantation) or TAVI (Trans-catheter Aortic Valve Implantation).

  The placement of the artificial valve in TAVR is usually performed using an X-ray fluoroscopic image as an image guide. A physician who operates the device while referring to an X-ray image is called an Interventional Cardiologist. Therefore, the placement of the artificial valve is performed by an Interventional Cardiologist.

  After placement of the prosthetic valve, confirmation by an ultrasonic diagnostic apparatus is always performed. Specifically, a doctor observing an ultrasound echo image by transesophageal echocardiography (TEE) of the subject confirms the placement of the artificial valve. Particularly important as confirmation after the placement of the artificial valve is confirmation of the presence or absence of backflow (leakage) around the artificial valve.

  In many cases, the backflow is observed through two-dimensional (2D) or three-dimensional (3D) ultrasonic Doppler images. In the unlikely event that blood regurgitation is confirmed, additional intervention is taken by the Interventional Cardiologist. As the procedure to be added, a procedure in which the balloon is advanced to the inside of the artificial valve and expanded is typical. That is, the expansion of the balloon closes the gap between the artificial valve and the inner wall of the aorta.

  The expansion of the balloon is performed by an Interventional Cardiologist with reference to a fluoroscopic image. However, a small amount of contrast agent is administered to the subject. Thereby, the outline of the aortic valve is drawn on the X-ray image. Then, the Interventional Cardiologist expands the balloon so as to eliminate the gap between the artificial valve and the inner wall of the aorta while observing the edge of the artificial valve depicted in the X-ray image.

  When the balloon is inflated, it is confirmed again whether or not the backflow of blood is prevented by ultrasonic echo examination. When the backflow of the blood flow is confirmed here, the balloon is further expanded. When the backflow of blood stops, the treatment is terminated.

JP 2011-36433 A

  In TAVR, it is essential to reliably prevent the backflow of blood after placement of the artificial valve.

  Therefore, the present invention provides an X-ray imaging condition setting system, an image diagnostic apparatus, and an X-ray imaging condition setting program capable of setting an appropriate X-ray imaging angle in order to prevent blood backflow in TAVR. The purpose is to do.

An X-ray imaging condition setting system according to an embodiment of the present invention includes a backflow position designation unit and an imaging angle setting unit. The backflow position designating unit designates the backflow position of blood using, as reference data, ultrasonic image data in which the aorta of the subject in which the artificial valve is placed is depicted. The imaging angle setting unit sets an imaging angle in which a plane including the blood backflow position is an imaging plane of the X-ray image.
An image diagnostic apparatus according to an embodiment of the present invention includes the X-ray imaging condition setting system and an imaging system. The imaging system performs X-ray imaging at an imaging angle set by the X-ray imaging condition setting system.
An image diagnostic apparatus according to an embodiment of the present invention includes the X-ray imaging condition setting system and an ultrasonic image acquisition system. The ultrasonic image collection system collects the ultrasonic image data.
The X-ray imaging condition setting program according to the embodiment of the present invention causes a computer to function as a backflow position designation unit and an imaging angle setting unit. The backflow position designating unit designates the backflow position of blood using, as reference data, ultrasonic image data in which the aorta of the subject in which the artificial valve is placed is depicted. The imaging angle setting unit sets an imaging angle in which a plane including the blood backflow position is an imaging plane of the X-ray image.

1 is a functional block diagram showing a configuration of an X-ray imaging condition setting system and an image diagnostic apparatus according to an embodiment of the present invention. The flowchart which shows the flow at the time of performing TAVR using the X-ray imaging condition setting system, ultrasonic diagnostic apparatus, and X-ray imaging apparatus which are shown in FIG. The figure which shows typically the method of performing an X-ray imaging in the imaging angle set based on the ultrasonic diagnostic image in TAVR.

  An X-ray imaging condition setting system, an image diagnosis apparatus, and an X-ray imaging condition setting program according to an embodiment of the present invention will be described with reference to the accompanying drawings.

  FIG. 1 is a functional block diagram showing configurations of an X-ray imaging condition setting system and an image diagnostic apparatus according to an embodiment of the present invention.

  The X-ray imaging condition setting system 1 is connected to the ultrasonic diagnostic apparatus 2 and the X-ray imaging apparatus 3 via a network. However, part or all of the X-ray imaging condition setting system 1 may be incorporated in one or both of the ultrasonic diagnostic apparatus 2 and the X-ray imaging apparatus 3. The ultrasonic diagnostic apparatus 2 and the X-ray imaging apparatus 3 connected via the X-ray imaging condition setting system 1 are used as image diagnostic apparatuses for collecting TAVR image guides.

  The ultrasonic diagnostic apparatus 2 is an image diagnostic apparatus including an ultrasonic image collection system 4 that collects ultrasonic image data of the subject O. The ultrasonic image collection system 4 is configured by connecting an ultrasonic probe 5 to an ultrasonic data processing unit 6. The ultrasonic probe 5 is provided with a plurality of ultrasonic transducers 7 that collect ultrasonic reception signals by transmitting and receiving ultrasonic waves to and from the subject O. The ultrasonic data processing unit 6 is an apparatus that generates ultrasonic image data based on a reception signal converted into an electric signal in each ultrasonic transducer 7. The ultrasonic image generated in the ultrasonic data processing unit 6 can be displayed on the ultrasonic image display device 8 of the ultrasonic diagnostic apparatus 2.

  The ultrasound image data collected in the ultrasound diagnostic apparatus 2 is based on ultrasound morphological image data generated based on ultrasound reflected echo signals from the subject O and ultrasound Doppler signals from the subject O. There is ultrasonic Doppler image data to be generated. The ultrasonic Doppler image data can be superimposed on the ultrasonic morphological image data. For this reason, the ultrasonic diagnostic apparatus 2 can observe blood flow dynamics information such as blood flow velocity information flowing in the blood vessel of the aorta with the morphological image of the blood vessel cross-section as the background. In TAVR, TEE is mainly executed by the ultrasonic diagnostic apparatus 2.

  The X-ray imaging condition setting system 1 is a system for setting an appropriate imaging angle for the X-ray imaging apparatus 3 based on aortic ultrasound image data collected by the ultrasound diagnostic apparatus 2. Therefore, the X-ray imaging condition setting system 1 may be built in the ultrasonic diagnostic apparatus 2 so that the X-ray imaging angle set in the ultrasonic diagnostic apparatus 2 is output to the X-ray imaging apparatus 3.

  The X-ray imaging condition setting system 1 can be constructed by causing the computer 11 to read an X-ray imaging condition setting program. On the other hand, the X-ray imaging condition setting program can be recorded on an information recording medium and distributed as a program product so that a general-purpose computer can be used as the X-ray imaging condition setting system 1. Of course, the X-ray imaging condition setting program can be downloaded to the computer 11 via a network without using an information recording medium. However, a circuit may be used to configure the X-ray imaging condition setting system 1.

  The X-ray imaging condition setting system 1 includes a backflow position designation unit 12 and an imaging angle setting unit 13. Therefore, when the X-ray imaging condition setting system 1 is constructed by causing the computer 11 to read the X-ray imaging condition setting program, the X-ray imaging condition setting program causes the computer 11 to use the backflow position designation unit 12 and the imaging angle setting unit 13. To function as.

  The backflow position designating unit 12 has a function of acquiring ultrasonic image data in which the aorta of the subject O in which the artificial valve is placed is depicted from the ultrasound diagnostic apparatus 2 and the aorta of the subject O in which the artificial valve is placed. A function of designating the backflow position of blood using the rendered ultrasonic image data as reference data. The position of the blood reflux can be designated manually or automatically using ultrasonic Doppler image data in the cross section of the aorta as reference data.

  When the blood backflow position is automatically specified, the backflow position specifying unit 12 refers to the ultrasonic Doppler image data and automatically detects the blood backflow position based on the signal value indicating the blood backflow. Can be. On the other hand, the backflow position designation unit 12 displays a user interface for instructing the backflow position of blood by operating the input device 9 with reference to the ultrasonic Doppler image data so that the backflow position of blood can be manually designated. 10 is displayed.

  The imaging angle setting unit 13 has a function of setting an imaging angle in which the plane including the backflow position of blood is an imaging plane of the X-ray image, and a function of outputting the set imaging angle to the X-ray imaging apparatus 3. Preferably, the imaging angle setting unit 13 is configured to set an imaging angle in which a plane further including at least one of the central axis of the prosthetic valve and the core line of the aorta is used as an imaging plane of the X-ray image in addition to the blood backflow position Is done.

  Note that the shooting angle setting unit 13 can set a plurality of shooting angles in which not only a single plane but also a plurality of planes are set as shooting planes. In that case, priority or shooting order can be given to a plurality of shooting angles set as candidates. A method for determining the priority order and the photographing order is arbitrary. For example, with reference to ultrasonic Doppler image data, priorities corresponding to index values indicating the degree of blood backflow such as blood flow velocity on a plurality of surfaces can be set to a plurality of imaging angles. Alternatively, with reference to ultrasonic image data, the priority order corresponding to the length of each gap between the artificial valve and the inner wall of the aorta on a plurality of surfaces can be set to a plurality of imaging angles.

  The X-ray imaging apparatus 3 is an image diagnostic apparatus including an imaging system 14 that performs X-ray imaging of the subject O. The imaging system 14 is configured by providing an X-ray irradiation unit 16 including an X-ray tube and an X-ray detector 17 at both ends of a C-shaped arm 15. The C-type arm 15 is configured so that the X-ray irradiation unit 16 and the X-ray detector 17 can be opposed to each other with the bed 18 under the control of the control device 19.

  In particular, the imaging system 14 is configured to perform X-ray imaging at an imaging angle set by the X-ray imaging condition setting system 1. Specifically, when the imaging angle set by the X-ray imaging condition setting system 1 is output to the control device 19, the control device 19 drives the C-arm 15 and is set by the X-ray imaging condition setting system 1. X-ray imaging can be performed at different imaging angles. The output side of the imaging system 14 is connected to the X-ray image generation unit 20. The X-ray image generated in the X-ray image generation unit 20 can be displayed on the X-ray image display device 21 of the X-ray imaging apparatus 3.

  Next, the operation and action of the X-ray imaging condition setting system 1 will be described.

  FIG. 2 is a flowchart showing a flow when TAVR is performed using the X-ray imaging condition setting system 1, the ultrasonic diagnostic apparatus 2, and the X-ray imaging apparatus 3 shown in FIG. FIG. 3 is a diagram schematically illustrating a method of performing X-ray imaging at an imaging angle set based on an ultrasonic diagnostic image in TAVR.

  First, in step S1, the artificial valve is placed and expanded using an X-ray fluoroscopic image as a guide. For this purpose, a contrast medium is administered to the subject O in advance, and an X-ray contrast image is captured by the X-ray imaging apparatus 3. Thus, the doctor can observe the X-ray contrast image and grasp the structure near the aortic valve.

  Next, an X-ray fluoroscopic image of the subject O is taken by the X-ray imaging apparatus 3. The doctor advances the artificial valve attached to the catheter to the indwelling position by operating the catheter while observing the fluoroscopic image. Once the prosthetic valve is positioned in the indwelling position, the physician expands the prosthetic valve.

  Next, in step S2, collection and display of ultrasonic images by the ultrasonic diagnostic apparatus 2 are performed. In general, 2D or 3D ultrasonic morphological images and ultrasonic Doppler images in the vicinity of the artificial valve are collected. Then, a doctor observing the ultrasonic image observes the shape of the artificial valve and the blood flow. If there is a gap between the prosthetic valve and the aorta after dilation, blood backflow may occur. Therefore, doctors observe the presence or absence of blood backflow through ultrasound images.

  When blood is flowing backward, a procedure is required to close the gap between the prosthetic valve and the aorta by expanding the balloon. This balloon expansion is called post-dilation. The expansion of the balloon is executed while referring to the X-ray image in real time in a state where a small amount of contrast medium is administered to the subject O. That is, the balloon expansion degree and the gap between the artificial valve and the aorta are observed with reference to the X-ray image.

  Therefore, when the cross section of the aorta is not circular, such as an elliptical shape, it is difficult to observe the gap between the prosthetic valve and the aorta unless an X-ray image is taken at an appropriate imaging angle. For this reason, it is desirable to perform X-ray imaging at an imaging angle at which the gap between the artificial valve and the aorta can be observed so as to reliably prevent blood backflow. Therefore, an appropriate imaging angle is set for the post-expansion X-ray imaging.

  Therefore, in step S3, the backflow position designation unit 12 designates the blood backflow position. Designation of the backflow position of blood can be performed using an ultrasonic image as a reference image. For this purpose, the backflow position designation unit 12 causes the display device 10 to display a GUI (Graphical User Interface) for designating the backflow position of blood through an ultrasonic image.

  FIG. 3A shows an example of a GUI for designating the backflow position of blood. As shown in FIG. 3A, an ultrasonic Doppler image can be superimposed and displayed on a morphological image of a cross section of the aorta 30 as an ultrasonic image. When the cross section of the aorta 30 is displayed, the expanded artificial valve 31 is depicted in the aorta 30.

  The artificial valve 31 is normally expanded so as to have a circular cross section. Therefore, when the curvature of the aorta 30 is elliptic and the curvature is not constant, a gap is generated between the artificial valve 31 and the aorta 30 as shown in FIG. When a gap is generated between the artificial valve 31 and the aorta 30, a back flow of blood occurs.

  When a backflow occurs in the blood, the direction of the blood flow velocity is reversed from that of the other portions. Therefore, the backflow portion of the blood can be easily visually recognized by the color display of the ultrasonic Doppler image. For this reason, the doctor who is the user can set the landmark 32 at a position where the width of the gap is widest or a position where the backflow of blood is remarkable by operating the input device 9. Thereby, the backflow position of blood can be designated as the landmark 32.

  On the other hand, the backflow position of the blood can be automatically designated by the image analysis processing in the backflow position designation unit 12. In that case, the backflow position designation unit 12 refers to the ultrasonic Doppler image data in the cross section of the aorta 30 and extracts a region corresponding to the pixel value in which the sign of the blood flow velocity is in the reverse direction. That is, a color region indicating a blood backflow region is extracted. The extraction of the region can be performed by threshold processing for a signal representing blood flow dynamics. A representative position such as the center of gravity of the extracted backflow region can be obtained as the landmark 32 indicating the backflow position of blood.

  Next, in step S <b> 4, the imaging angle setting unit 13 sets an X-ray imaging angle corresponding to the backflow position. Therefore, the center position 33 of the cross section of the aorta 30 or the artificial valve 31 is specified as shown in FIG. The central position 33 of the aorta 30 or the artificial valve 31 can be specified automatically by known image processing, or can be specified manually by operating the input device 9.

  When the center position 33 is specified, as shown in FIG. 3A, a plane passing through the center position 33 and the landmark 32 and perpendicular to the cross section of the aorta 30 is set as an X-ray imaging plane 34. Can do. As a result, as shown in FIG. 3B, an imaging plane 34 is set that includes the central axis 35 of the aorta 30 and the artificial valve 31 and passes through the landmark 32 indicating the backflow position of blood.

  For this reason, when the cross section of the aorta 30 is an ellipse, a plane including the major axis of the cross section of the aorta 30 and the central axis 35 of the artificial valve 31 is set as an imaging plane 34 for X-ray imaging. .

  Note that a plurality of landmarks 32 indicating the backflow position of blood can be designated. In that case, a plurality of imaging planes 34 corresponding to a plurality of blood backflow positions are set. Further, the landmark 32 and the photographing surface 34 can be added or manually corrected through the GUI. When a plurality of imaging surfaces 34 are set, an ultrasonic image may be displayed for each imaging surface 34. Moreover, you may make it display the ultrasonic image in each imaging surface 34 for confirmation.

  You may make it give imaging | photography order and priority to the some imaging surface 34. FIG. For example, the intersecting line between the imaging surface 34 and the cross section of the aorta 30 measures the length across the gap between the aorta 30 and the artificial valve 31, and the priority of the imaging surface 34 corresponding to the longer intersecting line is measured. The ranking can be set higher.

  Alternatively, the priority order of the imaging surface 34 having a higher degree of blood backflow can be set higher. The degree of blood regurgitation can be quantified using as an index the product of the velocity signal value and the area of the regurgitated blood obtained as blood flow dynamic information in the ultrasonic diagnostic apparatus 2. For this reason, the imaging angle setting unit 13 can automatically calculate the degree of blood backflow.

  However, the imaging order and priority order of the imaging surface 34 may be determined manually with reference to the ultrasound image.

  Next, coordinate conversion of the imaging surface 34 set through the ultrasonic image is performed based on registration information indicating the positional relationship between the coordinate system in the X-ray imaging apparatus 3 and the coordinate system in the ultrasonic diagnostic apparatus 2. Is called. Thereby, the imaging surface 34 set in the coordinate system in the ultrasonic diagnostic apparatus 2 is converted into the coordinate system in the X-ray imaging apparatus 3.

  In addition, in order to acquire the alignment information between coordinate systems, the positional information of the ultrasonic probe 5 drawn on an X-ray image can be used. Thereby, it is possible to easily perform the alignment process between the coordinate system in the X-ray imaging apparatus 3 and the coordinate system in the ultrasonic diagnostic apparatus 2.

  When the coordinate conversion of the photographing surface 34 is completed, the photographing angle setting unit 13 obtains a direction perpendicular to the photographing surface 34 as the photographing angle. The obtained imaging angle is transmitted from the X-ray imaging condition setting system 1 to the control device 19 of the X-ray imaging apparatus 3. Therefore, in the control device 19 of the X-ray imaging apparatus 3, the imaging angle acquired from the X-ray imaging condition setting system 1 is stored as a control condition for the C-type arm 15. When a plurality of imaging angles are transmitted, a plurality of imaging angles are stored in the X-ray imaging apparatus 3 as control conditions for the C-arm 15 together with information indicating the priority order and imaging order.

  Next, in step S5, X-ray imaging and balloon expansion are executed at the set angle. That is, when the doctor presses the imaging start button, the control device 19 drives the C-arm 15 to automatically position the imaging system 14 so that X-ray imaging can be performed at the set imaging angle.

  When a plurality of shooting angles are set, the C-arm 15 is driven according to the shooting priority with the highest priority or the earliest shooting angle. It should be noted that an appropriate imaging angle can be selected from a plurality of imaging angle candidates and the imaging order can be set by operating the X-ray imaging apparatus 3.

  On the other hand, a contrast medium is administered into the aorta 30 from the contrast medium injection device through the catheter. A balloon is inserted through the catheter. X-ray images are collected and displayed. As a result, as shown in FIG. 3C, the X-ray image display device 21 includes a central plane 35 of the aorta 30 and the prosthetic valve 31, and an imaging plane 34 that passes through a landmark 32 that indicates the backflow position of blood. X-ray images are displayed. Further, the edge of the aorta 30 can be visually recognized by the contrast agent.

  For this reason, the doctor can observe the gap between the aorta 30 and the artificial valve 31 through the X-ray image. Then, the doctor can perform a procedure for expanding the balloon so that the gap between the aorta 30 and the artificial valve 31 disappears.

  In other words, the X-ray imaging condition setting system 1 as described above has an imaging angle in which, when blood backflow occurs after placement and expansion of the artificial valve in TAVR, the plane including the blood backflow position is taken as the X-ray imaging plane. Can be set. More specifically, the X-ray imaging condition setting system 1 refers to an ultrasonic image that has been previously aligned with the coordinate system in the X-ray imaging apparatus 3 to determine the blood backflow position after placement of the artificial valve. When designated, a direction perpendicular to the plane passing through the central axis of the aorta and the designated blood backflow position is output to the C-arm 15 as an imaging angle for X-ray imaging.

  Therefore, according to the X-ray imaging condition setting system 1, when a backflow of blood occurs around the artificial valve in TAVR, X-ray imaging can be performed at an imaging angle suitable for a technique for preventing backflow. .

  Although specific embodiments have been described above, the described embodiments are merely examples, and do not limit the scope of the invention. The novel methods and apparatus described herein can be implemented in a variety of other ways. Various omissions, substitutions, and changes can be made in the method and apparatus described herein without departing from the spirit of the invention. The appended claims and their equivalents include such various forms and modifications as are encompassed by the scope and spirit of the invention.

DESCRIPTION OF SYMBOLS 1 X-ray imaging condition setting system 2 Ultrasonic diagnostic apparatus 3 X-ray imaging apparatus 4 Ultrasonic image acquisition system 5 Ultrasonic probe 6 Ultrasonic data processing part 7 Ultrasonic transducer 8 Ultrasonic image display apparatus 9 Input apparatus 10 Display apparatus 11 Computer 12 Backflow position designation unit 13 Imaging angle setting unit 14 Imaging system 15 C-type arm 16 X-ray irradiation unit 17 X-ray detector 18 Bed 19 Control device 20 X-ray image generation unit 21 X-ray image display device 30 Aorta 31 Artificial Valve 32 Landmark 33 Center position 34 Imaging surface 35 Center axis O Subject

Claims (11)

A regurgitation position designating unit that designates a regurgitation position of blood with reference to ultrasonic image data in which the aorta of the subject in which the artificial valve is placed is depicted;
An imaging angle setting unit for setting an imaging angle with the surface including the backflow position of blood as the imaging surface of the X-ray image;
An X-ray imaging condition setting system comprising:   2. The X-ray imaging condition setting system according to claim 1, wherein the backflow position designation unit is configured to designate a backflow position of the blood using ultrasound Doppler image data in a cross section of the aorta as the reference data.   3. The X-back position according to claim 2, wherein the backflow position designation unit is configured to automatically detect the backflow position of the blood based on a signal value indicating the backflow of the blood with reference to the ultrasonic Doppler image data. Radiography condition setting system.   The said backflow position designation | designated part is comprised so that a user interface for instruct | indicating the backflow position of the said blood by operation of an input device with reference to the said ultrasonic Doppler image data may be displayed on a display apparatus. X-ray imaging condition setting system.   5. The imaging angle setting unit according to claim 1, wherein the imaging angle setting unit is configured to set an imaging angle in which a plane further including at least one of a central axis of the artificial valve and a core wire of the aorta is the imaging plane. The X-ray imaging condition setting system according to Item.   The X-ray imaging condition setting system according to any one of claims 1 to 5, wherein the imaging angle setting unit is configured to set a plurality of imaging angles each having a plurality of surfaces as the imaging surfaces.   The imaging angle setting unit is configured to set a priority order corresponding to each index value indicating the degree of backflow of the blood on the plurality of surfaces to the plurality of imaging angles with reference to ultrasonic Doppler image data. The X-ray imaging condition setting system according to claim 6.   The imaging angle setting unit refers to ultrasonic image data and sets a priority order corresponding to the length of each gap between the artificial valve and the inner wall of the aorta in the plurality of surfaces to the plurality of imaging angles. The X-ray imaging condition setting system according to claim 6, wherein the system is configured to do so. An X-ray imaging condition setting system according to any one of claims 1 to 8,
An imaging system for performing X-ray imaging at an imaging angle set by the X-ray imaging condition setting system;
An image diagnostic apparatus comprising: An X-ray imaging condition setting system according to any one of claims 1 to 8,
An ultrasound image collection system for collecting the ultrasound image data;
An image diagnostic apparatus comprising: Computer
A backflow position designating unit for designating the backflow position of blood using ultrasound image data in which the aorta of the subject in which the artificial valve is placed is depicted as reference data, and a plane including the backflow position of the blood as an imaging surface of the X-ray image A shooting angle setting section for setting a shooting angle,
X-ray imaging condition setting program to function as.

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