JP2014108110A - Puncture guide implement and treatment support device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To simultaneously puncture a target region with a plurality of different-diameter puncture needles.SOLUTION: A puncture guide implement includes a first partition group 9 and a second partition group 10 comprising a plurality of resin partitions 7 and 8 supported by a pair of frame members 3 and 4 orthogonal to each other of a resin rectangular frame 2, and extended toward frame members 5 and 6. Partition faces are arranged in parallel at even intervals in a state that the partition faces are orthogonal to a frame face of the rectangular frame, the respective partition groups are provided such that the respective partition groups are shifted to the frame face of the rectangular frame, and a plurality of rectangular holes through which puncture needles are inserted are formed in a lattice state. Further, the plurality of partitions each have a base part supported slidably in the longitude directions of the pair of frame members 3 and 4, and the pair of frame members 3 and 4 include a partition adjustment mechanism for sliding the respective base parts in an interlocking manner with each other, and adjusting size of the rectangular holes as keeping the intervals of the plurality of partitions even.

Description

  The present invention relates to a puncture guide tool and a treatment support apparatus, and more particularly to a puncture guide tool and a treatment support apparatus suitable for puncturing a target site of a living body with a plurality of puncture needles.

  A needle-like probe is punctured into a target site (lesion) of a living body and treated by heating, freezing, or the like, or a puncture needle is punctured into a target site of a living body to collect body fluid such as ascites, tissue, or cells. It has been broken. As described above, when puncturing a needle-like probe or a puncture needle (hereinafter collectively referred to as a puncture needle in this specification), an ultrasonic diagnostic apparatus, a magnetic resonance imaging apparatus (MRI apparatus), an X-ray CT apparatus, or the like is used. There has been proposed a puncture guide device that accurately guides puncture of a puncture needle to a target site using a medical imaging apparatus (Patent Document 1 and the like).

  The puncture guide described in Patent Document 1 has a puncture needle insertion hole at the center of a receiving coil for MRI, and is formed by attaching a pointer for detecting the three-dimensional position of the puncture needle. According to this, the puncture guide tool is brought into contact with the body surface of the living body placed in the imaging region of the MRI apparatus, and the pointer is detected by the three-dimensional position detection device to detect the position and posture of the puncture guide tool, while receiving By imaging using a coil, an MR image of an arbitrary slice surface including the puncture needle can be obtained. By adjusting the position and posture of the puncture guide tool while viewing the MR image, the puncture direction of the puncture needle can be easily guided to the target site. That is, since the receiving coil is integrated into the puncture guide device, the position and posture of the puncture guide device can be adjusted while viewing the MR image without performing special positioning imaging. Useful for treatment support.

JP 2009-125233 A

  By the way, for example, in the case of a puncture needle such as a needle probe for treatment, treatment may be performed in a short time by piercing a plurality of puncture needles according to the size of the target site. However, according to the puncture guide device described in Patent Document 1, there is a problem that the treatment time cannot be shortened because it is not considered to stab a plurality of puncture needles.

  Further, for example, in the case of a puncture needle such as a needle probe for treatment, it may be desirable to treat by changing the thickness (diameter) of the puncture needle according to the size of the target site. However, according to the puncture guide device described in Patent Document 1, it is necessary to prepare a dedicated puncture guide device according to the diameter of the puncture needle, so that the management of the puncture guide device is complicated. Furthermore, if a plurality of puncture needles having different diameters can be guided at the same time, the usability is improved.

An object of the present invention is to provide a puncture guide that can puncture a target site with a plurality of puncture needles at the same time.
Another object of the present invention is to provide a treatment support apparatus that can guide puncture of a plurality of puncture needles to a target site at the same time.

  In order to achieve the above object, the puncture guide device of the present invention is extended toward a frame member opposed to a rectangular frame made of a resin frame member and a pair of frame members orthogonal to each other of the rectangular frame. A plurality of partition walls, each of which is formed of a resin thin plate, and the plate surface is used as a frame surface of the rectangular frame. A plurality of rectangles that are orthogonally arranged in parallel at equal intervals, and the first partition wall group and the second partition wall group are provided with their positions shifted from each other with respect to the frame surface of the rectangular frame. The holes are formed in a lattice shape.

  Further, the medical imaging apparatus including at least a magnetic resonance imaging apparatus is provided, the position of the puncture needle and the posture of the puncture needle are displayed in real time on the target site of the patient, and the treatment with the puncture needle is performed using the puncture guide tool. A treatment support apparatus that uses and displays a guide for guiding the puncture needle is used.

  According to the present invention, it is possible to provide a puncture guide that can puncture a target site with a plurality of puncture needles at the same time.

It is a top view which shows the structure of the puncture guide tool of Example 1 of this invention. It is the upper side figure, side view, and perspective view which show the use condition of the puncture guide tool of Example 1. FIG. It is a figure which shows the state with the largest magnitude | size of a rectangular hole in the partition adjustment mechanism of the puncture guide tool of Example 1. FIG. It is a figure which shows the state which made the magnitude | size of the rectangular hole the minimum by the partition adjustment mechanism. It is a figure which shows the modification of the frame member of the rectangular frame of Example 1. FIG. It is a figure explaining the structure of the puncture guide implement of Example 2 of this invention. It is a figure explaining the usage method of the puncture guide tool of Example 2. FIG. It is a figure explaining the modification of the puncture guide tool of Example 2. FIG. It is a figure explaining the usage method of the puncture guide tool of the modification of FIG. It is a figure which shows the whole structure of one Embodiment of the treatment assistance apparatus comprised using the puncture guide tool of this invention. It is a figure explaining the treatment assistance image of one Embodiment of a treatment assistance apparatus. It is a whole block diagram of an example containing the puncture probe for treatment, and explanatory drawing of a treatment state. It is a flowchart which shows the treatment assistance procedure of one Embodiment of a treatment assistance apparatus. It is a figure explaining the treatment assistance operation | movement of an MRI apparatus using the puncture guide implement of Example 3 of this invention. An example in which the conductor coil of the puncture guide device of Example 3 is functioned as a magnetic field generating coil will be described. The block diagram of the ISC imaging cross section imaged using the puncture guide tool of Example 3 is demonstrated. It is a figure explaining the usage of the puncture guide implement of Example 3. FIG. It is a figure explaining the example of a display of GUI at the time of the treatment using the puncture guide implement of this invention.

  Hereinafter, the puncture guide device of the present invention will be described based on examples.

  FIG. 1 shows a top view of a puncture guide 1 according to a first embodiment of the present invention. 2A is a top view, FIG. 2B is a side view, and FIG. 2C is a perspective view of the puncture guide device 1 according to the first embodiment when in use. As shown in these drawings, the puncture guide 1 is formed with a rectangular frame 2 made of a resin frame member. A plurality of partition walls 7 and 8 that are supported by a pair of mutually orthogonal frame members 3 and 4 of the rectangular frame 2 and extended toward the opposing frame members 5 and 6 are provided. The plurality of partition walls 7 and 8 are formed of a resin thin plate, and are arranged in parallel at equal intervals with the plate surface orthogonal to the frame surface of the rectangular frame 2. The first partition group 9 formed of the plurality of partition walls 7 and the second partition group 10 formed of the plurality of partition walls 8 are shifted from each other with respect to the frame surface of the rectangular frame 2, that is, on the paper surface. It is provided in two stages with its position shifted in the vertical direction. A plurality of rectangular holes 12 through which the puncture needle 11 is inserted are formed in a lattice shape by the partition group 9 and the partition group 10. In addition, a grip 13 is provided at the center in the longitudinal direction of the frame member 3. Further, three position detection markers 14 a to 14 c that can be detected by a three-dimensional position detection device described later are attached in the vicinity of the corners of the rectangular frame 2. The rectangular frame 2 is, for example, 8 cm square, and the height (width in the direction perpendicular to the paper surface of the frame members 3 to 6) is about 15 mm.

  Because of this configuration, as shown in FIG. 2, puncture is performed according to a plurality of puncture positions planned before treatment among a plurality of rectangular holes 12 formed in a lattice pattern by the partition group 9 and the partition group 10. A plurality of rectangular holes 12 through which the needle 11 is inserted can be determined, and the puncture needles 11a and 11b can be punctured. That is, since a plurality of puncture needles 11a and 11b can be punctured at the target site at the same time, the treatment time can be shortened as compared with the case where treatment is performed by puncturing one by one.

  In the above description, the plurality of partition walls 7 and 8 have been described as being supported at intervals in the longitudinal direction of the frame members 3 and 4, respectively. However, in the first embodiment, the base portions of the plurality of partition walls 7 and 8 are supported so as to be slidable in the longitudinal direction of the frame members 3 and 4, respectively, and the interval between the plurality of partition walls 7 and 8 can be changed by the partition wall adjusting mechanism. Is formed.

  The partition wall adjusting mechanism 20 will be described with reference to FIGS. 3 and 4. FIG. 3 shows a state where the size of the rectangular hole 12 is maximized by the partition wall adjusting mechanism 20, and FIG. 4 shows a state where the size of the rectangular hole 12 is minimized. 3A is a top view of the puncture guide 1, and FIG. 3B is a view seen from the arrow AA in FIG. In (b), the partition adjustment mechanism 20 of the partition group 9 composed of the plurality of partition walls 7 is shown, but the partition adjustment mechanism of the partition group 10 composed of the plurality of partition walls 8 is also formed in the same manner. Therefore, hereinafter, the partition adjusting mechanism 20 of the partition group 9 including the plurality of partitions 7 will be described.

  The frame member 3 is formed in a rectangular tube shape having a hollow inside. The frame member 3 is formed with a slit (not shown) that supports the base portions 7 a of the plurality of partition walls 7 slidably along the longitudinal direction of the frame member 3. And the groove | channel which fits a slit is formed in the base part 7a of the some partition 7, and while making the base part 7a bite into a slit and supporting, it is formed so that a slide is possible. However, the structure in which the plurality of partition walls 7 are slidably supported on the frame member 3 is not limited thereto, and a through hole is provided in the base portion 7a of the partition wall 7 so that a guide bar is inserted, and the guide bar is inserted into the frame member 3. A structure provided along the longitudinal direction in the cylindrical space may be used.

  Further, the slider 21 is movably provided so as to extend in the longitudinal direction of the frame member 3. A linear rack gear 22 movably provided inside the frame member 3 is connected to the slider 21. The base portions 7a of the plurality of partition walls 7 mesh with the rack gear 22 via a pair of gears 23a and 23b, respectively. When the slider 21 is slid in the direction of the arrow 24 shown in the figure, the pair of gears 23a and 23b rotate according to the sliding amount of the rack gear 22, and the base portions 7a of the plurality of partition walls 7 are slid according to the amount of rotation. The intervals between the plurality of partition walls 7 are changed.

  In other words, the pair of gears 23 a and 23 b are provided in association with the plurality of partition walls 7. Further, the plurality of partition walls 7 are slid toward the center position in the longitudinal direction of the frame member 3 between the two positions in which the interval in FIG. 3 is widest and the interval in FIG. 4 is narrowest. . At this time, it slides symmetrically with respect to the center position of the partition wall group 9 composed of the plurality of partition walls 7, that is, the center position (reference position) in the longitudinal direction of the frame member 3, and the interval between the plurality of partition walls 7 is any position. Must be equally spaced. Therefore, the pair of gears 23a and 23b are set with different tooth ratios for each partition wall 7 that is symmetrical with respect to the reference position. That is, as shown in the figure, the tooth number ratio 23a / 23b of the gears 23a and 23b at both ends farthest from the reference position is larger than 1, and the tooth number ratio 23a / 23b of the gears 23a and b near the reference position is smaller than 1. The gear ratio 23a / 23b of the intermediate gears 23a, b is set to 1 or a value close to 1.

  By forming such a slide mechanism having a pair of gears 23a and 23b, the base portions 7a of the plurality of partition walls 7 are interlocked toward the center position in the longitudinal direction of the frame member 3 according to the operation amount of the slider 21. Slide. In particular, the partition adjusting mechanism 20 provided with the slide mechanism of the present embodiment changes the sliding amount of the partition 7 in conjunction with the distance from the center position in the longitudinal direction of the frame member 3, and so on. It is formed so as to adjust the interval between the plurality of partition walls 7 while maintaining the interval. The intervals between the plurality of partition walls 7 and 8 can be measured by the scales 24 provided on the frame members 3 and 4, respectively.

  According to the puncture guide device 1 of the first embodiment configured as described above, by installing the puncture guide device 1 on the body surface of the living body, a plurality of puncture needles 11 can be punctured at the target site at the same time. . As a result, even when the target site is large, treatment or treatment can be performed at a time, so that the treatment time can be shortened.

  Each of the plurality of partition walls 7 and 8 has base portions 7a and 8a supported so as to be slidable in the longitudinal direction of the pair of frame members 3 and 4, and the pair of frame members 3 and 4 have base portions 7a and 8a. Since the partition wall adjusting mechanism 20 that adjusts the size of the rectangular hole 12 is provided while keeping the intervals of the plurality of partition walls 7 and 8 at equal intervals by sliding in conjunction with each other, the thickness of the puncture needle 11 ( Even if the diameter changes, the size of the rectangular hole 12 can be changed by the partition wall adjusting mechanism 20, so that the puncture needle 11 having a different diameter can be handled, and therefore the management of the puncture guide 1 is easy.

  FIG. 5 shows a modification of the rectangular frame 2 according to the first embodiment. (A) of the figure shows a state where the size of the rectangular hole 12 is maximum. (B) shows a state where the size of the rectangular hole 12 is minimum. This modification is different from the embodiment of FIG. 1 in that a plurality of grooves 15 in which the ends of the partition walls 7 and 8 are locked are formed along the longitudinal direction of the frame inner surfaces of the frame members 5 and 6. That is, according to the embodiment of FIG. 1, the partition walls 7 and 8 are supported in a cantilevered manner so that the base portions can be slid on the frame members 3 and 4, respectively. The size changes. In this regard, according to the modification of FIG. 5, the ends of the partition walls 7 and 8 are locked to the groove 15, so that even when a force in the direction of expanding the rectangular hole 12 is applied when the puncture needle 11 is inserted, It can suppress that the magnitude | size of the hole 12 changes. The size of the rectangular holes 12 can be finely adjusted by making the pitch of the grooves 15 as fine as possible.

  The puncture guide 1 of the first embodiment described above can puncture guide a plurality of puncture needles 11 and can adjust the size of the rectangular hole 12 according to the diameter of the puncture needle 11. However, for example, when a puncture needle 11 having a diameter different from that of the puncture needle 11 is punctured after a single puncture needle 11 is punctured, the size of the rectangular hole 12 is reduced by the puncture needle 11 previously punctured. I can't change it.

  Therefore, as shown in FIGS. 6 to 8, the puncture guide device 30 of Example 2 of the present invention is configured to be able to guide a plurality of puncture needles having different diameters at the same time. As shown in FIG. 6, the puncture guide device 30 according to the second embodiment is characterized in that the joint portions 31 to 34 of the frame members 3 to 6 have a detachable connection structure. For example, as shown in the enlarged view of FIG. 6C, the joining portion 31 has a rectangular engagement hole 18 at the end of one frame member 3 and an engagement hole at the tip of the other frame member 4. A pair of columnar protrusions 16 that engage with the member 18 are formed. At the tips of the pair of columnar protrusions 16, wedge-shaped engaging protrusions 17 opposite to each other are formed. The open leg width of the columnar protrusion 16 is formed to be the same as the width of the engagement hole 18 in the same direction, and when the pair of engagement protrusions 17 are inserted into the engagement holes 18, the slope formed on the outer surface of the engagement protrusion 17 The surface comes into contact with the opening edge of the engagement hole 18 and is elastically deformed in a direction in which the distance between the pair of columnar protrusions 16 is reduced. When further pushed in, the inclined surface of the engagement protrusion 17 is disengaged from the opening edge of the engagement hole 18, and the bottom of the engagement protrusion 17 is locked to the opening edge of the engagement hole 18 to join the frame member 3 and the frame member 4. The part 31 is firmly connected. When releasing the joint between the frame member 3 and the frame member 4, the pair of engagement protrusions 17 are picked with fingers or the like, and the interval between the pair of engagement protrusions 17 is narrowed. Release the engagement.

  The other joint portions 32 to 34 are configured in the same manner as the joint portion 31. Thereby, as shown in FIG. 6B, the puncture guide device 30 includes a first part 35 composed of the frame member 3 and the partition wall group 9, and a second part 36 composed of the frame member 4 and the partition wall group 10. The frame member 5 and the frame member 6 can be divided into four parts. That is, the joint portions of all the frame members 3 to 6 constituting the rectangular frame 2 are detachably formed.

  According to the puncture guide device 30 of the second embodiment configured as described above, after puncturing the two puncture needles 11a and 11b, as shown in FIGS. The frame member 6, the second component 36, and the first component 35 can be disassembled and removed in this order. At this time, the pair of first parts 35 and second parts 36 on which the plurality of partition walls 7 and 8 are supported are pulled out along the extending direction of the partition walls 7 and 8. Thereby, after the puncture needles 11a and 11b are inserted into the target site, when the puncture guide device 30 becomes an obstacle to the treatment operation, the puncture guide device 30 can be removed, so that the treatment operation is facilitated. For example, if the treatment is performed without removing the puncture guide device 30, the puncture guide device 30 may move during the treatment and an external force may be applied to the puncture needles 11a and 11b.

  Although FIG. 7 shows an example in which the puncture guide 30 is divided into four parts, the present embodiment is not limited to this, and can be divided into two parts as shown in FIG. That is, as shown in FIG. 8A, the joint portion 34 between the frame member 3 and the frame member 6 and the joint portion 32 between the frame member 4 and the frame member 5 are fixed structures, and the frame member 3 and the frame member 4 are fixed. The joint portion 31 and the joint portion 33 between the frame member 5 and the frame member 6 have a detachable connection structure. In other words, the joint part 31 of the pair of frame members 3 and 4 and the joint part 33 of the other pair of frame members 5 and 6 at the diagonal positions of the joint part 31 are formed detachably. Thus, as shown in FIG. 8B, the size of the rectangular hole 12 can be changed by operating the slider 21 and adjusting the intervals 7c and 8c of the plurality of partition walls 7 and 8 to arbitrary dimensions. . Then, by connecting the first part 35 and the second part 36 adjusted as shown in FIG. 8B and connecting the frame member 5 and the frame member 6, the size of the rectangular hole 12 as shown in FIG. Can be adjusted to a minimum.

  According to the second embodiment, as shown in FIG. 9, a plurality of puncture needles 11 a to 11 h having different diameters can be punctured and guided by one puncture guide tool 30. That is, as shown in FIG. 7A, first, the thick puncture needles 11a and 11b are punctured. After puncturing, as shown in FIG. 9 (a), the puncture guide 30 is removed, and as shown in FIG. 9 (b), the size of the rectangular hole 12 is adjusted according to the thin puncture needles 11c to 1h, For example, the first part 35 is installed while being aligned with the body surface. Then, as shown in FIG. 9 (c), the puncture guide device 30 is assembled by installing the second component 36 while aligning it with the body surface. Thereafter, as shown in FIG. 9 (d), thin puncture needles 11 c to 11 e are punctured using a fine rectangular hole 12. Then, as shown in FIG. 9 (e), the puncture guide device 30 is removed again, and at the position shown in FIG. 9 (f), the puncture guide device 30 is assembled and the thin puncture needles 11f to 11h are punctured.

  According to Example 2 of FIG. 8, the joint part 31 of a pair of frame members 3 and 4 with which the some partition walls 7 and 8 were supported, and the junction part of the other pair of frame members 5 and 6 located diagonally By detaching 33, the pair of frame members 3, 4 supporting the plurality of partition walls 7, 8 are pulled out along the extending direction of the partition walls 7, 8 even when the puncture needle 11 is inserted into the rectangular hole 12. Thus, the puncture guide 30 can be disassembled and removed. Then, as shown in FIG. 9, a plurality of puncture needles 11 having different diameters can be punctured and guided by adjusting the size of the rectangular hole 12 as necessary, shifting the position, and reassembling. As a result, a plurality of puncture needles having different diameters can be guided at the same time, and the usability of the puncture guide device 30 can be improved and the treatment time can be shortened.

  When the puncture operation shown in FIG. 9 is performed, the diameter and puncture position of the puncture needle 11 are planned in advance, and a fine adjustment of the position of the puncture guide tool 30 and the slider 21 are performed together with a navigation image described later. Adjustments can be made. In addition, treatment can be performed by performing puncture according to a treatment plan in combination with image monitoring.

  According to the second embodiment, the size of the rectangular hole 12 can be adjusted according to the diameter of the puncture needle 11 to be used, and a plurality of large and small puncture needles 12 can be used at a time using the plurality of rectangular holes 12. Can puncture. Furthermore, after puncturing, the puncture guide 30 can be divided into a plurality of parts and removed without interfering with the puncture needle 11. As a result, it is possible to simultaneously reduce the treatment time and improve the treatment accuracy, and also reduce the burden on the operator and the patient.

  The puncture guide device 40 according to the third embodiment of the present invention is not particularly illustrated, but a rectangular MRI receiving coil or magnetic field generating coil is added to the rectangular frame 2 of the puncture guide device 1 or 30 shown in the first and second embodiments. The only difference is that the coil conductor is embedded and formed. The other points are the same as in the first and second embodiments. In addition, in the puncture guide device 1 or 30 of the first and second embodiments, in the case where the joint portions 31 to 34 of the frame members 3 to 6 are detachably formed, the coil conductor embedded in the rectangular frame 2 is connected to the joint portions 31 to 31. Needless to say, it is formed so as to be able to come into contact with and separate from the surface 34.

[Embodiment of Treatment Support Device]
With reference to FIGS. 10-13, one Embodiment of the treatment assistance apparatus which treats the target site | part of a biological body using the puncture guide tool of Example 1 is described. FIG. 10 shows the overall configuration of the interventional-MRI apparatus. The MRI apparatus of this embodiment is configured to include a treatment support apparatus. The MRI apparatus 101 is, for example, a vertical magnetic field type permanent magnet MRI apparatus, and includes an upper magnet 103 and a lower magnet 105 that generate a vertical static magnetic field, a column 107 that connects these magnets and supports the upper magnet 103, and a position detection device. 109, an arm 111, a monitor 113, a monitor support unit 115, a reference tool 117, a personal computer 119, a bed 121, a control unit 123, and the like. In addition, the MRI apparatus 101 includes a gradient magnetic field generator (not shown) that generates a gradient magnetic field in a pulsed manner and an RF transmission (not shown) that causes nuclear magnetic resonance to occur in a patient 124 placed in a static magnetic field that is an imaging region. And an RF receiver (not shown) for receiving a nuclear magnetic resonance signal from the patient 124.

  The position detection device 109 that detects a three-dimensional position includes two infrared cameras 125 and a light emitting diode (not shown) that emits infrared light, and detects the position and posture of a pointer 127 that is a tomographic plane indicating device. Is. Further, the position detection device 109 is connected to the upper magnet 103 so as to be movable by an arm 111, and appropriately changes the arrangement relative to the MRI apparatus 101. The monitor 113 displays an image of the tomographic plane of the patient 124 indicated by the pointer 127 held by the operator 129. The monitor 113 is connected to the upper magnet 103 by the monitor support unit 115 in the same manner as the infrared camera 125. The reference tool 117 links the coordinate system of the infrared camera 125 and the coordinate system of the MRI apparatus 101. That is, the reference tool 117 includes three reflecting spheres 135 and is provided on the side surface of the upper magnet 103. The information of the pointer 127 detected and calculated by the infrared camera 125 is transmitted to the personal computer 119 via the cable 133, for example, as surgical instrument position data.

  The control unit 123 includes a workstation and controls an RF transmitter, an RF receiver, and the like (not shown). The control unit 123 is connected to a personal computer 119. In the personal computer 119, the position of the pointer 127 detected by the infrared camera 125 is converted into position data of the imaging area of the MRI apparatus 101 and transmitted to the control unit 123. The position data is reflected on the imaging section of the imaging sequence. The MR image acquired with the new imaging section is displayed on the monitor 113. MR images are simultaneously recorded in the video recording device 134.

  In the present embodiment, the pointer 127 is attached to the puncture needle 11, and the position where the puncture needle 11 is located is always set as the imaging section. Thereby, the cross section including the puncture needle 11 is always displayed on the monitor 113. In addition, the infrared camera 125 detects the position and posture of the puncture guide 1 for guiding the puncture needle 11. That is, as described in the first embodiment, the position detection markers 14a to 14c attached to the rectangular frame 2 of the puncture guide device 1 are detected by the infrared camera 125, and the position and posture of the puncture guide device 1 are detected. It has become. And the position and attitude | position of both the pointer 127 and the puncture guide tool 1 can be displayed on a navigation image. In addition, as described in the first embodiment, the puncture guide 1 can adjust the rectangular hole 12 through which the puncture needle 11 is inserted according to the thickness of the puncture needle 11. Moreover, since the puncture guide device 1 includes a plurality of rectangular holes 12, a plurality of puncture needles 11 can be punctured.

  In this embodiment, the cryotherapy apparatus 140 is connected to the personal computer 119, and the freezing gas hose is connected to the puncture needle 11 that is a cryotherapy probe. As a result, the frozen gas is filled simultaneously with the start of treatment, and a treatment start signal is transmitted to the personal computer 119, so that MRI synchronous imaging is started simultaneously with the treatment. However, MRI imaging conditions are registered in advance. During the cryotherapy, the treatment information and the frozen equipment status are displayed on the dedicated monitor 138, and the treatment is performed according to a preset treatment protocol.

  With reference to FIG. 12, the structure of the needle-like probe used for the cryotherapy which is an example of the puncture needle 11 is demonstrated. FIG. 12 shows the overall configuration of the cryotherapy apparatus 140, which mainly includes a control unit 401 and a probe 402. The cryotherapy apparatus utilizes 140 “Joule-Thomsos effect”, and can perform MR compatible cryotherapy that can be frozen and thawed. In this example, argon gas 403 is used for freezing and helium gas 404 is used for thawing, and these are controlled by valves 408 and 409, respectively. The probe 402 is cooled by the Joule-Thomson effect by jetting high-pressure refrigeration gas from the tip of the thin tube inside the heat exchanger 405 into the small chamber 406 at the tip of the probe. While the cooled gas passes through the heat exchanger 405, the frozen gas in the narrow tube is further cooled and released into the atmosphere through the hose 407.

  Thus, when the high pressure (24 to 27 Mpa) argon gas 403 is ejected into the small chamber 406 at the probe tip at atmospheric pressure, the probe tip is at an extremely low temperature of −185 ° C. Conversely, when high-pressure helium gas (17 to 27 MPa) 404 is injected, the temperature of the small chamber 406 at the tip of the probe rises and thawing becomes possible. For example, the range of biological tissue that can be frozen by the probe 402 is a 2 cm region at the tip of the probe. Therefore, since the frozen regions 411 and 412 shown in the lower part of FIG. 12 can be increased as the number of probes 402 increases, it is desirable to increase or decrease the number of probes 402 according to the size of the lesioned part 410 that is the target site.

  Further, in order to measure the temperature of the probe 402, a small thermometer 415 can be built in the small chamber 406 at the tip. For example, by providing thermometers at least at one point on the tip of the probe 402, the distribution of the frozen region at that point can be grasped. In addition, by providing a sound field measuring device in the probe 402, it is possible to immediately detect an abnormality such as cracking caused by freezing of a diseased tissue.

  Next, an example of the processing procedure of the treatment support apparatus that performs treatment monitoring using the MRI apparatus 101 of the present embodiment will be described with reference to the flowchart shown in FIG. For example, a plurality of three-dimensional volume imaging and three-dimensional reconstruction of a three-dimensional image are performed using an MRI apparatus, CT apparatus, or ultrasonic diagnostic (US) apparatus (S101).

  A target region that is a treatment target region is depicted by image processing from the three-dimensionally reconstructed three-dimensional image (S102). After the treatment plan is executed, parameters necessary for the treatment device are input, a treatment support guidance function such as navigation is activated (S103), and a treatment operation is started (S104). At the time of surgery, position adjustment is performed by bringing any one of puncture guide tools 1, 30, and 40 (here, puncture guide tool 40 will be described as a representative) close to the region of interest (S105). At that time, the position detection device 109, which is a three-dimensional position detection device, detects the puncture guide 40 in real time, so that the positional relationship between the actual patient, the target site, and the puncture guide 40 is always displayed on a separate monitor. It can be grasped (S106). Further, the conductor coil built in the puncture guide 40 is automatically tuned for image acquisition according to the moved position (S107), and acquires MR images in real time according to the operator's instructions. (S108).

  The MR image can freely capture a cross section including the puncture route, and can perform three-section switching and offset imaging as necessary. Further, the position of the puncture guide tool 40 whose position has been detected is three-dimensionally displayed in real time on the image information captured before the operation (S109). If necessary, the surgical parameter is changed (S110), and an approach to the target site to be punctured is performed (S111). Further, if necessary, a magnetic field is generated from the conductor coil for detecting the position of the puncture guide tool 40, and the position information of the ultrasonic probe and other surgical tools is acquired to perform guidance (S112). After the puncture, the puncture guide device 40 is disassembled and removed at the operator's discretion (S113), and additional puncture or treatment is started (S114). At the time of treatment, monitoring is performed by a medical diagnostic apparatus such as an MRI apparatus, an X-ray CT apparatus, or an ultrasonic diagnostic apparatus (S115), a residual lesion (tumor) is confirmed, and determination of additional treatment / end is performed ( S116).

  The navigation guide display function will be described with reference to FIG. The operator 129 approaches the target site using the puncture needle 11 with respect to the patient 124. The MR image information is displayed on the monitor 311. The puncture needle 11 is attached with a pointer 127 for detecting the position, and follows the position of the target site using a position detection device 109 which is a three-dimensional position detection device. The position of the puncture needle 11 is detected from the position of the pointer 127 by the infrared camera 125 attached to the position detection device 109 and displayed on the navigation screens 313 to 316, respectively. The navigation screens 313 to 316 are a triaxial section (Axial, Sagittal, Coronal) image and a volume rendering image 316, respectively. These images can be freely customized, and the operator 129 sets the target site 320 and the warning area / margin 321 before the operation. In addition to the simulated image 317 of the puncture needle 11, preoperative planning (surgery simulation) information 322 can be superimposed on the navigation image. In addition, the volume rendering image 316 can display the target portion 320 corresponding to the surgical tool in a three-dimensional manner. Furthermore, it has a function of issuing a warning when the puncture needle 11 enters the target part 320 or the warning area / margin 321 on the navigation screens 313 to 316 that are guidance support images. Furthermore, the treatment conditions can be changed according to the surgical environment. For example, when the target part 320 enters the warning area / margin 321, the navigation image and the treatment parameter are automatically changed.

  By feeding back such information continuously and in real time to the MRI apparatus 101, it becomes possible to obtain the same MR image including the puncture needle 11 at the target site 320. That is, the operator 129 can apply the two-dimensional real-time image obtained by the MRI apparatus 101 and the three-dimensional image information obtained by navigation to the surgery as necessary. As one application of the high-speed imaging sequence of the MRI apparatus 101, a real-time dynamic imaging method called fluoroscopy (fluoroscopic imaging) is being clinically applied. In fluoroscopy, by repeating imaging and image reconstruction with a period of about 1 second or less, it can be used to extract the dynamics of internal tissues and to grasp the position of an instrument inserted from the outside like a fluoroscopic imaging. Generate and display dynamic images. This application is also applied to three-dimensional high-speed imaging.

[Application Example of Puncture Guide Tool 40 of Example 3]
With reference to FIG. 14, the treatment support operation of the MRI apparatus 101 using the puncture guide tool 40 according to the third embodiment of the present invention will be described. A conductor coil capable of receiving an MRI signal is built in the rectangular frame 42 of the puncture guide 40. When puncturing the patient 124, the puncture guide by the puncture guide 40 and the MR image can be displayed simultaneously. In addition, a function of intensively imaging regions 1123 to 1126 including the target parts registered in advance is provided in conjunction with the navigation image. The state when the surgeon 129 translates the puncture guide tool 40 along the side with respect to the patient 124 placed in the imaging region of the MRI apparatus 101 is shown. The MRI apparatus 101 captures MR images 1111 to 1114 of slice sections including the puncture guide 40 and the puncture needle 11 detected by the position detection device 109.

  With reference to FIG. 15, the example which made the conductor coil of the puncture guide tool 40 function as a magnetic field generation coil is demonstrated. For example, using an ultrasonic diagnostic apparatus 1204 that can capture and display a B-mode image, an anatomical image is obtained by an X-ray CT apparatus, an MRI apparatus, or the like that is imaged about the same region as the currently captured B-mode image 1210. Patent Document 3 (Japanese Patent No. 3871747) introduces a technique for automatically performing alignment with an image 1211 and performing position confirmation of an arbitrary part easily, quickly and accurately. Using this technique, the position of the ultrasonic probe 1203 detected by the puncture guide tool 40 is specified, and an MR image or CT image 1211 having the same cross section as the ultrasonic image 1210 is displayed on the monitor 1205. Thereby, not only the target part 320 and the puncture needle 11 on the ultrasonic image but also the position of the target part 320 and the puncture needle 11 on the MR image or the CT image 1211 can be seen to double check the treatment area.

  With reference to FIG. 16, a configuration diagram of an ISC (Interactive Scan Control) imaging cross section will be described using the puncture guide 40 of Example 3 in which a conductor coil is embedded in a rectangular frame. An example of a cross section obtained by capturing an MR image using the puncture guide 40 as an MRI receiving coil will be described. As an operation before surgery, it is assumed that a normal imaging section 1301, a first orthogonal section 1302, and a second orthogonal section 1303 are defined for the puncture guide device 40 to which the marks 14a to 14c are attached. However, each section can be adjusted according to the operator's request. The technical scope related to ISC is described in detail in Patent Document 4 (Japanese Patent No. 3980406).

  With reference to FIG. 17, the usage of the puncture guide tool 40 of Example 3 based on Example 2 is demonstrated. After the first puncture needle is punctured with the puncture guide tool 40 as shown in FIG. 5A, the puncture guide tool 40 is separated and detached as shown in FIG. It can be performed. Further, as shown in FIG. 4D, the puncture guide device 40 can be used as a puncture needle fixing device during treatment. In this case, in the treatment within the MRI imaging region, the conductor coil of the puncture guide device 40 is used as a reception coil. MR images can be taken. On the other hand, when performing a puncture needle guide using an ultrasonic diagnostic apparatus, the position and posture of the puncture needle 11 are determined using a conductor coil as a magnetic field generating coil in cooperation with a three-dimensional magnetic field space formed in the space surrounding the living body. It is also possible to detect and display the puncture needle 11 on the navigation image. Then, after the treatment with the puncture needle 11, it is determined whether or not additional treatment is necessary. If unnecessary, the treatment is terminated. If additional treatment is necessary, a puncture route simulation is performed, and the process returns to FIG. Do the therapeutic operation.

  With reference to FIG. 18, a display example of a GUI (graphic user interface) at the time of treatment using the puncture guide device of the present invention will be described. When the ISC: On / Off button 1501 is pressed, a real-time MR image 1511 including the puncture needle 11 is displayed in the screen. The actual position of the simulated image 317 of the puncture needle 11 and the target part 320 are displayed in different colors. There is also a screen 1522 showing the state of the puncture guide 40. For example, the position 1523 of the first puncture needle 11a and the puncture position 1524 of the second puncture needle 11b which is the cross-sectional image 1525 currently being punctured are color-coded. It is displayed. In another screen 1515, patient information and treatment information necessary for treatment are displayed, and the situation can be visually grasped. The screen 1515 also displays information details such as patient information and treatment devices, and various parameters such as the depth of the puncture needle 11 are displayed. Furthermore, treatment parameters set in advance can be displayed in the same screen, and parameters necessary for treatment such as a preset threshold value are also displayed. These values can be changed during treatment, and can be freely changed at any time by pressing a parameter change / treatment device change button 1503.

  On the other hand, when the conductor coil of the puncture guide 40 is used as a magnetic field generating coil, guiding can be performed in combination with an ultrasonic image or the like. That is, when the ultrasonic button 1504 is turned ON, an ultrasonic B-mode image 1517 is displayed. In the image, a state in which the puncture needle 11 approaches the target region 320 and the treated region 1537 calculated in advance via the skin 1520 on the body surface is displayed. On the other hand, when the navigation image button 1502 is pressed, the volume rendering image 1534 is displayed in addition to the three-axis cross sections 1531 to 1533, and the position of the simulated image 317 of the puncture needle 11 can be superimposed on the image. In addition, the target site 320 corresponding to the surgical instrument can also be displayed. Further, by setting the target part 320 and the warning area / margin area 321 respectively, it is possible to superimpose and display on the volume rendering image 1534 in addition to the three-axis cross sections 1531 to 1533, and use real space and image information. Can be treated. Although the center of the three-axis cross section is generally set in the treatment planned area, the puncture needle 11 and the target site 320 can always be displayed. The three-dimensional image can be changed in real time by pressing an image information change button 1505, and can be freely displayed according to the operator's request. As these images, MR images, CT images, and US images that have been captured in advance can be used, but real-time images captured on the spot can also be used. The treated region 1537 can be displayed superimposed on the image obtained by the course of treatment, so that the remaining treatment region can be seen at a glance. Further, by pressing the monitoring button 1506, the temperature and sound field information at the time of treatment can be measured, and each monitoring information 1515 is continuously updated until a stop instruction is given. At that time, by pressing the automatic warning button 1507 for automatically issuing a warning, when the value exceeds the threshold value, various warnings with sounds and colors that can be understood by the surgeon are given. Can do. A final treatment start instruction is given according to the operator's will by pressing a treatment start button 1508.

  The cryotherapy in which the tissue is locally necrotized by freezing described in the embodiment of the treatment support apparatus of the present invention is a treatment method that has been known for a long time, and is used for advanced cancer such as breast, cervix, head and neck, etc. Perfusion, reduced size, and remission of pain and drainage. In conjunction with the Joule-Thompson effect, MRI-compatible medical cryotherapy devices (sophisticated cryoablation systems for internal surgery) using argon gas for freezing with high-pressure gas and helium gas for thawing have been developed. It is used to treat kidney cancer and uterine fibroids. The temperature measurement range of the apparatus is −190 ° C. to + 80 ° C., freezing and thawing conversion is easy, and temperature changes of −165 ° C. and + 54 ° C. can be obtained in 10 seconds. The range in which the cryogenic temperature can be obtained is 2 cm at the tip of the probe, and the other parts are kept at room temperature. Also, there are probes that are MRI compatible and bent at a right angle. This apparatus is proposed in, for example, Patent Document 2 (USP-5522870).

  In addition, there are medical imaging devices such as X-rays, CT, US, and MRI for drawing the heat / frozen region. In particular, the MRI device provides a sharp surface line in cryotherapy, and has an excellent ability to draw ice. Because it is preferred. A means for visualizing the position of a lesion and a heat / frozen region by performing image diagnosis during treatment has been proposed in Patent Document 5 (Japanese Patent Laid-Open No. 2005-160553), and a clinically effective result has been obtained.

DESCRIPTION OF SYMBOLS 1 Puncture guide tool 2 Rectangular frame 3-6 Frame member 7, 8 Partition 9 First partition group 10 Second partition group 11, 11a, 11b Puncture needle 12 Rectangular hole 13 Grasping part 14a-14c Position detection marker 20 Partition Adjustment mechanism 21 Slider 22 Rack gear 23a, b Gear 24 Scale 31-34 Joint 35 First part 36 Second part

Claims (10)

A first partition group consisting of a rectangular frame made of a resin frame member and a plurality of partition walls supported by a pair of frame members orthogonal to each other and extending toward the opposing frame member And a second partition wall group,
The plurality of partition walls are each formed of a resin thin plate, and are arranged in parallel at equal intervals with the plate surface orthogonal to the frame surface of the rectangular frame,
The first partition group and the second partition group are provided with their positions shifted from each other with respect to the frame surface of the rectangular frame, and a puncture guide formed by forming a plurality of rectangular holes through which a puncture needle is inserted in a lattice shape Ingredients. The plurality of partition walls each have a base portion slidably supported in the longitudinal direction of the pair of frame members,
The pair of frame members includes a partition wall adjusting mechanism that adjusts the size of the rectangular hole while keeping the intervals of the plurality of partition walls equal to each other by sliding the base portions in conjunction with each other. The puncture guide device according to claim 1.   The partition adjusting mechanism includes a slider provided on each of the pair of frame members, and a slide that slides bases of the plurality of partitions toward the longitudinal center of the pair of frame members according to an operation amount of the slider. And a sliding mechanism is formed to adjust the interval between the plurality of partition walls by changing the sliding amount of the partition walls according to the distance from the center to maintain equal intervals between the plurality of partition walls. The puncture guide device according to claim 2, wherein the puncture guide device is provided.   The puncture guide device according to claim 3, wherein a scale for measuring the size of the rectangular hole is provided along a longitudinal direction of the pair of frame members.   5. The connecting portion of at least the pair of frame members and the connecting portion of another pair of frame members at diagonal positions of the joint portions are detachably formed. The puncture guide device according to claim 1.   The puncture guide device according to any one of claims 2 to 4, wherein joint portions of all the frame members constituting the rectangular frame are detachably formed.   The puncture guide device according to any one of claims 1 to 4, wherein position detection markers are provided in the vicinity of three corners of the rectangular frame.   The puncture guide device according to any one of claims 1 to 4, wherein the rectangular frame is embedded with a receiving coil for MRI. The rectangular frame is embedded with a receiving coil for MRI,
The puncture guide device according to claim 5 or 6, wherein the joint portion is formed so that an end portion of the receiving coil embedded in the adjacent frame member can be contacted and separated.   10. A medical imaging apparatus including at least a magnetic resonance imaging apparatus, wherein the position of the puncture needle and the posture of the puncture needle are displayed in real time on the target site of the patient, and treatment with the puncture needle is performed. A treatment support apparatus that performs display for guiding the puncture of the puncture needle using the puncture guide device according to claim 1.

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