JPH01299545A - Shock wave medical treating device - Google Patents

Abstract

PURPOSE:To prevent execution of useless irradiation with a shock wove, by a method wherein an overlapping state between a substance to be crushed and a focus area is automatically determined and it is automatically decided whether the substance to be crushed is effectively contained in the focus area of a shock wave, and based on its result, a pulse is generated. CONSTITUTION:Based on information on displacement in a direction B of an ultrasonic transducer 16 from a transducer support drive part 36, a focus area marker generating means 22a calculates the position on a screen of a present focus marker 26a at a real time, and by updating data of a focus area marker memory 28b for displaying a focus area marker one by one according to the calculating result, the focus area marker 26a is displayed on a monitor 27. A degree-of-overlap discriminating circuit 33 receives information from a CPU 22, counts the number of substances contained in the focus marker 26a, and computes the degree of overlap as a value obtained by dividing the number of picture elements by the number of picture elements of the substance to be crushed extracted by a substance-to-be-crushed extracting circuit 31. When it is decided through watching of a display picture on the monitor 27 that a kidney calculus image 39a coincides with the focus area marker 26a, a pulse generating switch 29 is depressed to demand the generation of a pulse.

Description

[Detailed Description of the Invention] [Object of the Invention] (Industrial Application Field) The present invention provides shock wave therapy for treating objects to be crushed, such as cancer cells, stones, etc., within a subject by crushing them with the focused energy of shock waves. Regarding equipment.

(Prior Art) Conventionally, shock wave treatment devices include a shock wave transducer that forms and covers a shock wave focal region (hereinafter referred to as focal region) for crushing objects to be crushed, and a shock wave transducer that forms and covers a shock wave focal region (hereinafter referred to as focal region) for crushing objects to be crushed, and a shock wave transducer that generates and covers tomographic image information of the specimen. An ultrasonic transducer that collects images and a tomographic image display unit is used.

FIG. 2 shows the configurations of the shock wave transducer and the ultrasonic transducer, and the positional relationship between them and the focal region.

The figure shows an embodiment of the present invention, which includes a shock wave transducer 15, an ultrasonic transducer 16, etc. of conventionally known structure, and forms a focal region 26.

Further, the display section displays a sound field image in a so-called B mode based on the image information collected by the ultrasonic transducer.

In the shock wave therapy device having such a configuration, the object to be crushed, such as a stone, is set to fit within the focal region, and the shock wave transducer 15 generates a shock wave to focus the high sound pressure shock wave within the focal region 26. In this case, shock waves are reflected at the boundary between the object to be crushed and the biological tissue due to the difference in acoustic impedance between the object to be crushed and the biological tissue, and the resulting internal stress of the object causes the object to be crushed. It is.

In this way, it is necessary for the object to be crushed to be within the focal zone for crushing, but even if the setting is correct so that the object to be crushed is within the focal zone at a certain point, it is difficult to actually generate a shock wave after that. At the time when the application is about to be applied, the object to be crushed moves due to the subject's movement or breathing, and a situation arises in which it is no longer correctly within the focal region.

In such a case, even if a shock wave is generated, not only will the target object to be crushed not be crushed, but biological tissue is usually uniform in a microscopic area such as the focal region and does not produce a large reflection. Although it is thought that there are no permanent side effects, they should be avoided, and in fact, bleeding due to capillary damage frequently occurs. Furthermore, if a portion with large acoustic impedance, such as a bone, is included in the focal region, such a portion may be damaged.

In order to avoid wasteful irradiation of such dangerous shock waves, conventional shock wave therapy devices emit shock waves by estimating the positional change of the object to be crushed, such as a stone, in synchronization with heartbeat or breathing. Ta.

Alternatively, in order to confirm that the object to be crushed is within the focal region, a focus marker indicating the apex position of the focal region is displayed on the sound field image.

(Problems to be Solved by the Invention) However, such conventional techniques are based on mere speculation, and are not reliable methods for avoiding unnecessary shock wave irradiation.

That is, the subject may make unexpected movements.

Furthermore, by simply displaying the focus marker, it is difficult for the operator to quickly determine how much the focus area and the object to be crushed actually overlap.

The present invention has been made in consideration of such circumstances, and an object of the present invention is to provide a shock wave treatment device that can reliably avoid unnecessary shock wave irradiation and safely perform treatment.

"Structure of the Invention" (Means for Solving the Problems) In order to solve the above-mentioned problems, the shock wave treatment device of the present invention has a focal zone marker display means, and/or has a shock wave focal zone and an object to be crushed. overlap degree determination means for calculating the degree of overlap with the overlap degree I obtained by the overlap degree determination means;
and/or an overlap degree variation information display means for displaying the mode of temporal variation of the overlap degree on a display section using the 1st-order result, and/or an overlap for calculating the overlap degree between the shock wave focal area and the object to be crushed. Wi-Fi controls the generation of shock waves using a degree determination means and an overlap degree calculation result obtained by the overlap degree determination means so that the shock wave is not generated if the overlap degree calculation result is less than a predetermined value. It has a firing shot generation control means.

(Function) The shock wave therapy device of the present invention having such a configuration displays a focal region marker and/or a sound field region image on the display unit so that the overlapping state of the object to be crushed and the focal region can be easily determined. Displays the temporal variation of the degree of overlap.

Also,! It is automatically determined whether the object to be crushed is effectively included in the focal region of the LI bombardment wave, and based on the result, the execution of the pulse generation request is controlled. If the object to be crushed is not effectively included in the focal region, the shock wave is not irradiated.

(Example) Examples of the present invention will be described below with reference to the drawings.

FIG. 1 is a block diagram of a shock wave treatment device according to a first embodiment.

In the figure, the shock wave treatment device includes a shock wave transducer 15 that forms a focal region of a VFI shock wave for crushing the object to be examined, which will be described in detail later, transmits and receives ultrasonic waves, and collects ultrasonic tomographic image information. A shock wave applicator 17 including an ultrasonic transducer 16, and a balsa 18 that sends a pulse signal to the shock wave transducer 15.
Then, under the control of the controller 23, a pulse is sent to the ultrasonic transducer 16, and the ultrasonic transducer 16 is excited to perform, for example, a four-stage focused sector scan, and each sector scan is A transmitter/receiver circuit 19 receives an echo signal from an ultrasonic transducer 16 based on the ultrasonic transducer 16, and the output signal of this transmitter/receiver circuit 19 is inputted, subjected to amplitude detection, and sent to a signal conversion system 21 as a digital video signal. signal processing circuit 20
and a central information processing unit (CPU) that controls each part of the device.
22, and the transmitting/receiving circuit 19 controlled by this CPU 22.
, a signal processing circuit 20, a controller 23 that controls the transmission/reception timing, amplitude, frequency, etc. of pulse signals in the balsa 18, a frame memory and a line that are controlled by the CPU 22 and perform signal conversion processing, etc. on the output signal of the signal processing circuit 20. A signal conversion system 21 comprising a memory etc. and a sector-shaped sound field area image 2 by an ultrasonic transducer 16 based on the output signal of this signal conversion system 21.
5a, a TV monitor 2 that displays a focal region marker 26a indicating the focal region of the crushing shock wave transmitted from the shock wave transducer 15, along with a kidney image of the subject, a kidney stone image 39a, etc.;
7, image memory 28, and WE'! from the balsa 18.
two pulse generation switches connected to the CPU 22 to set the generation timing of the pulse signal of the j1-wave transducer 15 and instructing the start of pulse transmission;
It is configured to include a position controller 30 that adjusts the relative positional relationship of the ultrasonic transducer 16 to the shock wave transducer 15, an object extraction circuit 31, an overlap degree determination circuit 33, and the like. The image memory 28 includes a B-mode image memory 28a, a focal zone marker memory 28b, an object area marker memory 28c, and the like.

Further, within the CPU 22, a focal region marker generating section 22a having a predetermined program for displaying a focal region marker 26a at a position corresponding to the focal region on the sound field image, and a shape degree determining circuit 33 are provided. A balsa control means 22b is included which has a predetermined program for comparing the sent overlap degree and a set value and controls the operation of the shock wave balsa 18 via the controller 23.

In this embodiment, the crushed object extraction circuit 31 and the overlap degree determination circuit 33 constitute the overlap degree determination means described in the claims, and the balsa control means 22b corresponds to the shock wave generation control means. do.

Next, the shock wave applicator 17 will be described in detail with reference to FIGS. 2 to 4.

First, in FIG. 2, the shock wave applicator 17 transmits a focal region 2 of a crushing shock wave (for example, an ultrasonic pulse with strong energy) for crushing an object to be crushed, such as a kidney stone 39, into a subject 32.
a water tank 43 provided on the side of the ultrasonic wave transmitting surface 15a of the shock wave transducer 15 forming the shock wave transducer 15; and the object surface 3
2S, and an ultrasound transducer 16 that forms a sound field region 25 including the focal region 26 with the ultrasound transmission/reception wave surface 16a in contact with the ultrasound transducer 16 and collects tomographic image information of the subject 32. ing.

The shock wave transducer 15 includes a concave vibrator having a constant curvature and a backing material (none of which is shown) uniformly adhered to the back surface of the concave vibrator.

An ultrasonic transducer 16 is attached to the center of the shock wave transducer 15 so as to be movable in the direction of arrow B via a transducer support drive section 36.

This transducer support drive unit 36 has a mechanism that can move and stop arbitrarily in the direction of arrow B based on the control signal from the position controller 30 described above, and its drive source.
It is equipped with a position sensor that detects the position of the ultrasonic transducer 16 in the B direction.

Incidentally, on the ultrasonic wave transmission surface 15a side of the shock wave transducer 15, as described above, a water tank 43 filled with water as a shock wave transmission liquid is provided.

The illustrated water tank 43 has a substantially cylindrical shape or a cylindrical shape with a bottom that is approximately equal to the outer diameter of the shock wave transducer 15 . A bellows 43a that can expand and contract in the direction of arrow B or within a predetermined angle with that direction is formed on its side surface, and its bottom portion 47 is made of a thin film having an impedance of 11 approximately equal to that of water. Aquarium 43 like this
The details are shown in Figure 3.

As shown in the figure, a notch 47a is formed in the center of the bottom 47, and is formed to correspond to the side surface shape of the ultrasonic wave transmitting/receiving surface 16a of the ultrasonic transducer 16. The notch 47a and the side surface of the ultrasonic wave transmitting/receiving surface 16a of the ultrasonic transducer 16 are fixed by welding or bonding. Further, due to this configuration, the ultrasonic wave transmitting/receiving surface 16aG is brought into direct contact with the subject surface 328 together with the thin film. In this embodiment, the bellows 43a is formed so that it can maintain its position when no force is applied from the outside. This can be done, for example, by appropriately setting the material of the bellows 43a or the auxiliary tool.

Incidentally, FIG. 4 is an external perspective view of the shock wave applicator 17 shown in FIG. 2.

The operation and effect of the shock wave treatment device configured as described above will be explained assuming that a kidney stone 39 in the kidney shown at 38 in FIG. 2 is subjected to crushing treatment.

First, the water tank 4 provided in the W1 shock wave applicator 17
3 is placed on the surface 328 of the subject 32, and in this state, the transmitting/receiving circuit 19, signal processing circuit 20, and signal conversion system 21 are controlled to drive the ultrasound transducer 16, and the monitor 2 is placed on the surface 328 of the subject 32.
A tomographic image of the subject is displayed on the screen of 7.

In this case, a focal region marker generating means 22a is displayed on the monitor 27.
calculates the current position of the focal zone marker 26a on the screen in real time based on the B direction displacement information of the ultrasonic transducer and user 16 from the transducer support drive unit 36, and displays the focal zone marker based on this result. The focal area marker 26a is displayed by sequentially updating the data in the focal area marker memory 28b.

Furthermore, the sound field area image (B-mode image) 25a obtained by the signal conversion system 21 displays an image of the object to be crushed, but since the object to be crushed has a high acoustic impedance, it is strongly Even if the sound waves are reflected and not passed through the crushing object extraction circuit 31, the sound field area image @
25a, it is displayed relatively white compared to the surrounding living tissue.

In this embodiment, this sound field region image information is input to the object extraction circuit 31, the object region to be crushed is extracted and clarified, and the result is used in the subsequent overlap degree determination.

That is, J3 in the object extraction circuit 31 extracts only pixels having brightness information of a certain value or more, and the CPU 22 extracts only pixels having brightness information of a certain value or more. Shredded object area marker memory 2
Update data in 8c.

The crushed object extraction circuit 31 has a digital comparator, and the extraction of the pixels is performed using this digital comparator.

Further, the overlap degree determination circuit 33 receives information from the CPU 22, counts the number of pixels that are also included in the focal zone marker 26a among the pixels extracted in this way, and calculates the number of pixels to be crushed by the object extraction circuit. The degree of overlap is calculated as a value divided by the number of pixels of the object to be crushed extracted in step 31.

An image is displayed on the monitor 27 based on the image information in the image memory created as described above.

The display portion of the tomographic image of the subject 32 displayed in real time changes as the shock wave applicator 17 moves.

Then, when the kidney stone image 39a is depicted in the tomographic image, the shock wave applicator 17 is further finely adjusted to set the focus area marker 26a to match the kidney stone @39a, and in this state, the shock wave applicator 17 is set to match the kidney stone @39a. Fix the applicator 17.

Then, when the operator looks at the image displayed on the monitor 27 and determines that the kidney stone image 39a and the focal zone marker 26a match and that the kidney stone 39 is within the focal zone 26,
Press the pulse generation switch 29 to request pulse generation.

However, there is a time gap between the operator's judgment and the operation of the pulse generation switch 29, and the subject moves during that time, and the judgment is incorrect. It may not exist within the area 26 or the overlap may not be sufficient.

In such a case, the following measures are taken to avoid unnecessary shock wave irradiation.

That is, the degree of shape at the time when the pulse generation request is made is compared with a predetermined reference value, 10% in this embodiment, in the CPtJ 22 internal balsa control means 22b, and if it is determined to be less than the reference value, This balsa control means 22b controls the pulser 18 so that it does not generate pulses.

On the other hand, if the balsa control means 22b determines that the degree of overlap is greater than or equal to the reference value, the pulse generation is possible, the pulse generation request is executed, and a pulse signal is transmitted from the balsa 18 to the shock wave transducer 15. In fact, the object 39 to be crushed within the focal region 26 receives a strong shock wave and is crushed.

In this way, in this embodiment, it is determined in real time whether or not the object to be crushed is effectively included in the focal region, and control for the pulse generation request is performed based on the result, so that a reliable shock wave can be generated. This makes it possible to avoid unnecessary and harmful shock wave irradiation.

In this embodiment, a circuit for extracting objects to be crushed, a circuit for determining the degree of overlap, a balsa control means, etc. are provided, and the shock wave is not irradiated when the degree of formability is less than a set value. Even if the circuit or means is omitted, a certain effect can be obtained by configuring the focal area marker generating section to display the focal area marker. That is, even in that case,
This is because the operator or observer can easily determine the actual positional relationship between the object to be crushed and the focal area from the overlapping state of the image of the object to be crushed and the focal area marker.

Next, a shock wave treatment device according to a second embodiment of the present invention will be described.

FIG. 5 shows an example of the display displayed on the display section in the shock wave therapy device of this embodiment. The shock wave therapy device of this embodiment has almost the same basic groove bottom as the first shock wave therapy device, but is further provided with an overlap degree variation graph in the CPU 22 for displaying a predetermined program for displaying the overlap degree variation graph. The image memory 28 has an overlapping degree variation memory 29d instead of the object region marker memory 28c, and the object extraction circuit 3
The difference is that it does not have 1. Further, the controller 23 includes trigger pulse generating means. In the description of this embodiment, the same elements as in the first embodiment will be referred to with the same reference numerals.

The overlap degree variation graph generating section 22c, the overlap degree variation memory 28d, etc. correspond to the overlap degree variation information display means described in the claims.

In the endoscope apparatus of this embodiment, the overlapping degree determination circuit 33 calculates the overlapping degree as an integral value of the brightness of the pixels of the B mode image included in the focal zone marker 26a.

That is, the displacement in the B direction in FIG. 2 is obtained from the history information of the control performed by the position controller 30, and based on that
The position of the focal zone marker 26a on the mode image is calculated.

Based on the position of the focal region marker 26a obtained in this way,
The brightness of the pixels of the B-mode image that overlap with the pixels of the focal zone marker 26a are read out from the B-mode image memory 28a, their sum is determined, and the value is taken as the degree of shape.

In this way, in this embodiment, the degree of overlap is easily determined with a simple configuration, and high-speed signal processing is possible.

The overlap degree variation graph generating section 22C is the overlap degree determination circuit 3.
The current value of the degree of overlap that is continuously sent from 3 to the CPU 22 is displayed on the display section 27 as an overlap degree variation graph 3, typically up to 5 seconds ago. This display is performed by the pattern degree variation graph generating section 22c sequentially updating the data in the overlap degree variation memory 28d.

FIG. 6(a) shows a case where the degree of overlap changes approximately periodically above and below the reference value α mainly due to the patient's suction action. Note that in this embodiment as well, the reference value for the degree of overlap is set to 10%.

In this way, the temporal changes in the degree of overlap are displayed on the screen, allowing the operator to accurately judge the state of overlap between the stone and the focal area, and also predict changes in the degree of overlap from this point onward. This is also possible. These things are extremely difficult to do when only the focus marker is displayed on the B-mode image, and can only be done easily by displaying an overlap degree variation graph as in this example. It is something.

When the operator turns on the pulse generation switch 29, the CPU
The internal balsa control means 22b determines whether the degree of overlap at that time exceeds the reference value α. Only when it is determined that the threshold is exceeded, the balsa control means 22b controls the balsa 1B so that pulse irradiation is performed when the trigger pulse is input from the controller 23 to the pulsar 18 via the controller 23.

FIG. 6(b) shows a case where the trigger pulse generating means generates five trigger pulses per second. This frequency can be variably set to about 2 to 10 pieces per second.

When the degree of overlap changes as shown in (a) of Figure 6, (
A shock wave is generated in response to the trigger pulse in C).

When the operator confirms by looking at the screen that the stone has been destroyed by the series of pulse irradiations and turns off the pulse generation switch 29, the pulse irradiation is immediately stopped.

Further, in this embodiment, a shock wave generation control means is provided so that shock waves are not irradiated when the degree of overlap does not exceed a standard value, but the structure is configured without the shock wave generation control means. However, a corresponding effect can be obtained by providing an overlapping degree determining circuit, an overlapping degree variation information display means, etc., and arranging to display a graph of temporal changes in the overlapping degree. That is, even in that case, the operator can easily and accurately judge or predict the degree of overlap between the object to be crushed and the focal region from the display of the temporal variation of the degree of overlap.

[Effects of the Invention] As is clear from the above description, the shock wave treatment device of the present invention has the following effects.

That is, since the focal region marker is displayed on the sound field region image and/or the manner of variation in the degree of overlap is displayed, it is possible to easily determine the overlapping state or positional relationship between the object to be crushed and the focal region, It is possible to avoid unnecessary shock wave irradiation and perform reliable and safe treatment.

In addition, it is determined whether the object to be crushed is effectively included in the focal region of the shock wave, and based on the result, the execution of the plow pulse generation request is controlled to ensure that the object to be crushed is not effectively included in the focal region. In such cases, since the configuration is such that shock waves are not irradiated, wasteful Vf1 shock wave irradiation can be avoided, and reliable and safe treatment can be performed, thereby shortening the treatment time.

[Brief explanation of the drawing]

Fig. 1 is a block diagram of the structure of the shock wave therapy device according to the first embodiment of the present invention, Fig. 2 is an explanatory diagram showing a cross section of the ultrasonic applicator shown in Fig. 1 and its usage state, and Fig. 3 is a water tank. 4 is an external perspective view of the ultrasonic applicator shown in FIG. 1, FIG. 5 is a diagram showing the display mode in the second embodiment, and FIG. FIG. 6 is a diagram showing the timing of shock wave generation in the second embodiment. 15... Shock wave transducer 16... Ultrasonic transducer 17... Shock wave applicator 22a... Focal area marker generation section 25... Sound field area 26... Focal area 28a... B-mode image memory 28b...focal area marker memory 28c...object area marker memory 22b...bulke control means 27...display section 31...object extraction circuit 33...degree of overlap Discrimination circuit 36...Transducer support drive unit 41...Shock wave travel wave crest

Claims (3)

[Claims] (1) A shock wave having a shock wave transducer that forms a focal region of the shock wave for crushing the object to be examined, an ultrasonic transducer that collects tomographic image information of the object, and a display unit that displays the tomographic image. What is claimed is: 1. A shock wave therapy device, comprising: a focal region marker display means for displaying a focal region marker on the display section. (2) A shock wave having a shock wave transducer that forms a focal region of the shock wave for crushing the object to be examined, an ultrasonic transducer that collects tomographic image information of the object, and a display unit that displays the tomographic image. The treatment device includes an overlapping degree determining means for calculating the overlapping degree between the shock wave focal region and the object to be crushed, and an overlapping degree calculation result obtained by the overlapping degree determining means, and displays temporal changes in the overlapping degree on a display section. 1. A shock wave therapy device comprising: an overlap degree variation information display means for displaying an aspect of the above. (3) Shock wave having a shock wave transducer that forms a focal zone of the shock wave for crushing the object to be examined, an ultrasonic transducer that collects tomographic image information of the object, and a display unit that displays the tomographic image. The treatment device comprises an overlap degree determining means for calculating the degree of overlap between a shock wave focal region and an object to be crushed, and an overlap degree calculation result obtained by the overlap degree determination means, and the method includes: A shock wave treatment device comprising: shock wave generation control means for controlling shock wave generation so that shock waves are not generated.