WO2018221509A1 - 経路選択支援システム、経路選択支援プログラムを記録した記録媒体、経路選択支援方法および診断方法 - Google Patents
経路選択支援システム、経路選択支援プログラムを記録した記録媒体、経路選択支援方法および診断方法 Download PDFInfo
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Definitions
- the present invention relates to a path selection support system that supports selection of a path of a biological lumen for delivering a medical device to a site in the living body via the body lumen, a recording medium recording the path selection support program, and path selection support
- the present invention relates to a method and a diagnostic method.
- a medical device is introduced into a blood vessel from the outside of a living body via a site serving as an access point to the blood vessel (hereinafter referred to as an introduction site), and is delivered to the target site as a target of the procedure via a plurality of sites of the blood vessel.
- an introduction site a site serving as an access point to the blood vessel
- the medical device is introduced into the blood vessel from the radial artery or the like, and the lower limb via the aortic arch, the aorta (the descending aorta), the iliac artery or the like. Delivered to the target site.
- TRI is a technique that has been actively performed in recent years because the burden on the patient is small compared to TFI (Trans Mechanical Intervention) in which a medical instrument is introduced from the femoral artery or the like.
- the ease of delivery of the medical device varies depending on, for example, the size of the bend or curvature of the blood vessel portion constituting the path.
- the size of the bending or bending of the blood vessel site varies depending on the target patient.
- the surgeon visually confirms the in-vivo image of the target patient, confirms the bending or bending size of the blood vessel region, and selects an appropriate blood vessel route. Need to do. This work largely depends on the experience of the surgeon over many years, and is a heavy burden on the surgeon.
- the number of blood vessel sites that pass through is increased compared to TFI.
- the femoral artery, iliac artery to aortic branch To the opposite iliac or femoral artery.
- the right radial artery, right upper arm artery, right axillary artery, right subclavian artery, brachiocephalic artery is passed through the aortic arch .
- the left radial artery, left brachial artery, left axillary artery, right subclavian artery brachiocephalic artery is generally passed through the aortic arch. After reaching the aortic arch, it reaches the aortic branch via the thoracic aorta and the abdominal aorta (descending aorta).
- either the left or right common iliac artery, external iliac artery, internal iliac artery, common femoral artery, superficial femoral artery, deep femoral artery, and optionally popliteal artery It reaches the lower limb arteries such as the anterior tibial artery, the posterior tibial artery, the radial artery, the dorsal artery, the plantar artery, and peripheral blood vessels connected to them.
- the present invention has been made in view of the above problems, and route selection support capable of easily selecting a route of a biological lumen for delivering a medical instrument to a site in the living body via the biological lumen. It is an object to provide a system, a recording medium on which a route selection support program is recorded, a route selection support method, and a diagnosis method.
- a route selection support system of the present invention is a route selection support system that supports selection of a route of the living body lumen for delivering a medical instrument to a site in the living body through the living body lumen.
- a receiving unit that receives input of site information specifying a target site in the living body to which the medical device is to be delivered, and image information in the living body of a target patient to be delivered to the medical device.
- a route score calculation unit for calculating a route score determined according to ease of delivery of the medical device when delivering the medical device via the route, and a large burden on the target patient And a patient score calculation unit that calculates a patient score determined according to the ranking, and a rank assignment unit that ranks the plurality of routes extracted by the route extraction unit using the route score and the patient score.
- an output unit that outputs the plurality of routes extracted by the route extraction unit and the ranks assigned by the rank assigning unit, and the image information includes an imaging image of the biological lumen.
- the path score calculation unit calculates the path score using the imaging image.
- a computer-readable recording medium on which a route selection support program of the present invention is recorded is a path of the path of the living body lumen for delivering a medical instrument to a site in the body via the living body lumen.
- a route selection support program for supporting selection wherein input of site information for specifying a target site in the living body to which the medical device is to be delivered is received, and the target patient to which the medical device is to be delivered is received.
- In vivo image information is acquired, and based on the acquired image information, a plurality of the routes of the biological lumen capable of delivering the medical instrument to the target site are extracted, and the route is passed through the route.
- a path score determined according to the ease of delivery of the medical device when the medical device is delivered, and a patient score determined according to the amount of burden on the target patient Calculating, using the calculated route score and the calculated patient score, assigning ranks to the plurality of extracted routes, outputting the extracted plurality of routes, and the assigned ranks, and
- the image information includes an imaging image of the living body lumen, and when calculating the path score, a path selection support program for causing the computer to calculate the path score using the imaging image of the living body lumen Is a computer-readable recording medium on which is recorded.
- a route selection support method of the present invention for achieving the above object is a method for supporting selection of a route of the living body lumen for delivering a medical device to a site in the living body via the living body lumen,
- the input of the part information specifying the target part in the living body to be the target for delivering the medical instrument is received, the in-vivo image information of the target patient to be the target for delivering the medical instrument is acquired, and the acquired Based on the image information, a plurality of the routes of the biological lumen capable of delivering the medical device to the target site are extracted, and the medical device is delivered when the medical device is delivered through the route.
- a rank is assigned to the plurality of extracted paths, and the plurality of extracted Route ,
- the image information includes an imaging image of the biological lumen, and when calculating the path score, the path score is calculated using the imaging image of the biological lumen. calculate.
- a diagnostic method of the present invention is a method for diagnosing a path of the biological lumen for delivering the medical device to a site in the living body via the biological lumen, the medical device comprising: Based on the acquired image information, the input of the part information specifying the target part in the living body to be delivered is received, the in-vivo image information of the target patient to be delivered the medical instrument is obtained.
- the medical device it is easy to deliver the medical device when extracting the plurality of routes of the biological lumen capable of delivering the medical device to the target site and delivering the medical device through the route.
- a rank is assigned to the plurality of extracted routes by using a route score determined according to the size of the patient and a patient score determined according to the magnitude of the burden given to the target patient, and the plurality of the extracted routes Before A path is diagnosed from the rank, and the image information includes an imaging image of the biological lumen, and the path score is calculated using the imaging image of the biological lumen when calculating the path score.
- the rank assigning unit facilitates delivery of the medical device when the medical device is delivered.
- a rank is assigned to the plurality of routes extracted by the route extraction unit, using a route score determined according to the size of the patient and a patient score determined according to the magnitude of the burden given to the target patient.
- the output unit outputs the plurality of routes extracted by the route extraction unit and the ranks assigned by the rank assigning unit.
- the medical device is delivered to the site in the living body through the living body lumen. It is possible to easily select the path of the biological lumen.
- FIG. 6A is a diagram schematically illustrating an image of a living body of a target patient
- FIG. 6B is an enlarged view of a region surrounded by a broken line portion 6B in FIG. 6A.
- FIG. 7A is a schematic diagram illustrating a display screen of the route selection support system according to the first embodiment
- FIG. 7B is a schematic diagram illustrating a route display region of the screen
- FIG. 8A is a diagram schematically illustrating the data structure of image information
- FIG. 8B is a diagram schematically illustrating the data structure of incidental information. It is a block diagram which shows the function structure of the route extraction part of the route selection assistance system which concerns on Embodiment 1.
- FIG. 3 is a flowchart for explaining a route selection support method according to the first embodiment.
- FIG. 13 (A) is a diagram schematically showing the data structure of the medical device list
- FIG. 13 (B) is a diagram schematically showing the data structure of the device list
- FIG. 13 (C) is It is a figure which shows typically the data structure of a device information list.
- FIG. 13 (C) is the schematic which shows typically the data structure of the device information list.
- FIG. It is the schematic which shows the screen of the display of the route selection assistance system which concerns on Embodiment 2.
- FIG. It is a figure which shows typically the data structure of the device information list used in the route selection assistance system which concerns on the modification 1 of Embodiment 2.
- FIG. 13 (A) is a diagram schematically showing the data structure of the medical device list
- FIG. 13 (B) is a diagram schematically showing the data structure of the device list
- FIG. 13 (C) is It is a figure which shows typically the data structure of a device information list.
- FIG. It is a figure which shows typically the data structure of the device information list used
- FIG. 19A is a diagram for explaining the function of the deformation prediction unit of the route selection support system according to Modification Example 1, and FIG.
- FIG. 19A is a schematic diagram illustrating the shape of a blood vessel before deformation is predicted by the deformation prediction unit;
- FIG. 19B is a schematic diagram showing the shape of the blood vessel after deformation predicted by the deformation prediction unit.
- FIG. 21A is a diagram for explaining the function of the output unit of the route selection support system according to the modified example 2, and
- FIG. 21A is a schematic diagram showing a display displaying ground information about the aortic arch, and
- FIG. 21B is a schematic diagram showing a display displaying ground information about the descending aorta, and
- FIG. 21C is a schematic diagram showing a display displaying ground information about the iliac artery.
- FIG. 22A is a schematic diagram for explaining a calculation method of the degree of bending in the route selection support system according to the modification example 3, and FIG. 22B is a bending in the route selection support system according to the modification example 3. It is the schematic for demonstrating another calculation method of a degree.
- the route selection support system 1 supports route selection support that supports selection of the route RT of the blood vessel BV for delivering a medical instrument to a site in the living body BD via the blood vessel BV (corresponding to a living body lumen). System.
- FIG. 1 is a schematic diagram for explaining the device configuration of the route selection support system 1
- FIG. 2 is a block diagram for explaining the functional configuration of the route selection support system 1
- FIGS. It is a figure for demonstrating the various functions of the route selection assistance system 1.
- the device configuration of the route selection support system 1 will be described.
- the route selection support system 1 includes a computer main body 10 and a display 20.
- the computer main body 10 is connected to the external server 30.
- the computer main body 10 includes an arithmetic device 50, a storage device 60, and a reading device 70.
- the computing device 50 performs computation based on the program and data stored in the storage device 60.
- the arithmetic device 50 is configured using a known CPU (Central Processing Unit).
- the storage device 60 includes a memory circuit 61 and a hard disk drive 65.
- the memory circuit 61 includes a ROM (Read Only Memory) and a RAM (Random Access Memory).
- the storage device 60 stores a basic program such as an operating system, a route selection support program PR for causing the arithmetic device 50 to perform the function of the route selection support system 1, and data processed by the route selection support program PR.
- a basic program such as an operating system
- a route selection support program PR for causing the arithmetic device 50 to perform the function of the route selection support system 1, and data processed by the route selection support program PR.
- the reading device 70 reads information recorded on the computer-readable recording medium MD.
- the computer-readable recording medium MD is, for example, an optical disc such as a CD-ROM or DVD-ROM, a USB memory, an SD memory card, or the like.
- the reading device 70 is, for example, a CD-ROM drive, a DVD-ROM drive, or the like.
- the route selection support program PR is provided in a state of being recorded on a computer-readable recording medium MD.
- the reading device 70 reads the route selection support program PR recorded on the computer-readable recording medium MD.
- the route selection support program PR read by the reading device 70 is stored in the hard disk drive 65.
- the display 20 is connected to the computer main body 10.
- the display 20 transmits and receives information to and from the computer main body 10.
- the display 20 includes a screen 21 for inputting and outputting information.
- the display 20 outputs information received from the computer main body 10 to the screen 21.
- the display 20 transmits information input via the screen 21 to the computer main body 10.
- the display 20 is configured using a known touch panel display.
- the computer main body 10 transmits and receives information to and from the external server 30.
- the computer main body 10 and the external server 30 are connected via a network.
- the type of network is not particularly limited, and may be a wired network using a LAN cable or the like, or a wireless network using Wi-Fi or the like.
- the route selection support system 1 includes a reception unit 110, an image acquisition unit 120, a route extraction unit 130, a rank assignment unit 140, and an output unit 150.
- Calculations relating to the processing of the reception unit 110, the image acquisition unit 120, the route extraction unit 130, the rank assignment unit 140, and the output unit 150 are performed in the calculation device 50.
- Data processed by the reception unit 110, the image acquisition unit 120, the route extraction unit 130, the rank assignment unit 140, and the output unit 150 is stored in the storage device 60.
- reception unit 110 receives input of site information specifying target site RG that is a target of a procedure performed by delivering a medical instrument.
- the accepting unit 110 accepts input of part information via the display 20.
- the target site RG is not particularly limited.
- the left and right common iliac arteries, external iliac arteries, internal iliac arteries, common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, anterior tibial artery, posterior tibia These are arteries of the lower limbs such as arteries, radial arteries, dorsal arteries, plantar arteries, collateral circulations, peripheral blood vessels connected to them, and the like.
- the image acquisition unit 120 acquires the image information DT1 in the living body BD of the target patient that is the target of the procedure performed by delivering the medical instrument.
- the image information DT1 includes image data DT2 in the living body BD of the target patient photographed by the medical image photographing device.
- the image data DT2 of the living body BD is three-dimensional image data.
- the data format of the image information DT1 is not particularly limited, but is, for example, DICOM (Digital Imaging and Communication in Medicine).
- the image information DT1 is stored in the external server 30.
- the image acquisition unit 120 acquires the image information DT1 from the external server 30 via the network.
- the route extraction unit 130 extracts a plurality of routes RT of the blood vessel BV that can deliver the medical instrument to the target site RG based on the image information DT1 acquired by the image acquisition unit 120.
- the number of routes RT of the blood vessel BV extracted by the route extraction unit 130 is not particularly limited, but is six, for example.
- the path extraction unit 130 creates a blood vessel BV from the target site RG to the introduction site RS for each candidate site (hereinafter referred to as an introduction site RS) that serves as an access point when a medical instrument is introduced into the blood vessel BV from outside the living body BD.
- a route RT is extracted.
- Candidates for the introduction site RS are not particularly limited.
- Candidates for introduction site RS may be ankle blood vessels such as popliteal artery, anterior tibial artery, posterior tibial artery, radial artery, dorsal artery, plantar artery.
- the radial artery may be a distal radial artery or a radial artery located in a snuff box.
- the route extraction unit 130 extracts the route RT of the blood vessel BV from the target site RG to the introduction site RS using the introduction site list LS1 in which the introduction site RS candidates are recorded.
- the introduction site list LS1 is stored in the external server 30.
- the route extraction unit 130 acquires the introduction site list LS1 from the external server 30 via the network. Details of processing in the route extraction unit 130 will be described later.
- the rank assigning unit 140 is determined according to a route score calculating unit 141 that calculates a route score SR that is determined according to the ease of delivery of the medical device, and a burden applied to the target patient.
- a patient score calculation unit 145 that calculates a patient score SP.
- the rank assigning unit 140 uses the route score SR calculated by the route score calculating unit 141 and the patient score SP calculated by the patient score calculating unit 145 to give a rank to a plurality of routes RT extracted by the route extracting unit 130. .
- the rank assigning unit 140 includes a plurality of routes RT extracted by the route extracting unit 130 in ascending order of the product SR ⁇ SP of the route score SR calculated by the route score calculating unit 141 and the patient score SP calculated by the patient score calculating unit 145. Is given a ranking.
- the route score calculation unit 141 calculates a route score SR based on the length L of the route RT and the bending degree P of the route RT.
- the route score calculation unit 141 calculates a product L ⁇ P of the length L of the route RT and the bending degree P of the route RT as the route score SR.
- the route score calculating unit 141 includes a center line deriving unit 142 that calculates the center line CL of the route RT extracted by the route extracting unit 130, and a route length calculating unit that calculates the length L of the route RT. 143, and a bending degree calculation unit 144 that calculates the bending degree P of the route RT.
- the image data DT2 includes an imaging image of the blood vessel BV.
- the imaging image of the blood vessel BV is an image taken for the blood vessel BV.
- the imaging image of the blood vessel BV is, for example, an image of the inner region BVal of the blood vessel BV acquired by using an intravascular ultrasonic diagnostic method (IVUS: IntraVascular UltraSound) or an optical coherence tomography method (OCT: Optical Coherence Tomography). Contrast X-ray CT (Computed Tomography) images, non-contrast MRA (Magnetic Resonance Angiography) images, and the like.
- the imaging image of the blood vessel BV may be an angiographic image using a contrast agent. Further, the imaging image of the blood vessel BV may be a cine image.
- the center line deriving unit 142 calculates the center CP of the blood vessel BV based on the imaging image of the blood vessel BV, and connects the center CP of the blood vessel BV from the target site RG to the introduction site RS, thereby connecting the center of the blood vessel BV.
- a line CL is derived.
- Center CP of blood vessel BV means the center of the region surrounded by the blood vessel wall in the cross section of blood vessel BV.
- the centerline deriving unit 142 discretely calculates the center CP of the blood vessel BV for each predetermined interval D, and derives the centerline CL by interpolating between the calculated centers CP.
- the interval D may be a fixed value or a variable value.
- interval D is not specifically limited.
- the interpolation method between the center CPs is not particularly limited, and may be linear interpolation, polynomial interpolation, or spline interpolation.
- the route length calculation unit 143 calculates the length of the center line CL calculated by the center line deriving unit 142 as the length L of the route RT.
- the path length calculation unit 143 calculates the sum of the distances between the center CPs discretely calculated by the center line deriving unit 142 as the length of the center line CL.
- the bending degree calculation unit 144 calculates the bending degree of the center line CL derived by the center line deriving unit 142 as the bending degree P of the route RT.
- the “degree of bending” is the total sum of the magnitudes of bending or bending calculated for each portion bent or bent in the center line CL of the blood vessel BV.
- the “bending or bending magnitude” may be expressed using curvature.
- the “flexion degree” is not limited to a continuous numerical value, and may be a discrete value such as “large”, “medium”, and “small”.
- the bending degree calculation unit 144 calculates the curvature of the center line CL at the vertex PP for each vertex PP of the center line CL of the blood vessel BV, and the sum of the curvatures calculated for each vertex PP. Is calculated as the bending degree P. In addition, the bending degree calculation unit 144 may use the maximum value of the curvature calculated for each vertex PP as the bending degree P.
- the “vertex PP of the center line CL” is a point where the curvature becomes maximum or minimum on the center line CL.
- the patient score calculation unit 145 calculates the patient score SP using the invasiveness of the route RT extracted by the route extraction unit 130.
- the degree of invasiveness is determined according to the amount of bleeding when the medical device is introduced into the blood vessel BV via the introduction site RS, the time from the end of the procedure to the time when the bleeding stops. For example, the invasiveness of the route RT in which the introduction site RS is the radial artery is smaller than the invasiveness of the route RT in which the introduction site RS is the femoral artery.
- the introduction site list LS1 records the degree of invasion when a medical device is introduced into the blood vessel BV via the corresponding introduction site RS for each introduction site RS candidate.
- the patient score calculation unit 145 calculates the invasiveness of the route RT extracted by the route extraction unit 130 using the invasiveness recorded in the introduction site list LS1.
- the patient score calculation unit 145 acquires the introduction site list LS1 from the external server 30 via the network.
- the output unit 150 includes a plurality of routes RT extracted by the route extracting unit 130, the ranks given by the rank assigning unit 140, a route score SR, and a patient.
- the score SP is output to the display 20.
- the output unit 150 outputs a plurality of routes RT extracted by the route extraction unit 130 to the display 20 together with the image GR of the living body BD of the target patient.
- the output unit 150 displays the plurality of routes RT extracted by the route extraction unit 130 in the route display area AR1 of the display 20.
- the output unit 150 displays the enlarged images of the plurality of routes RT extracted by the route extraction unit 130 in the detailed display area AR2.
- the output unit 150 includes information (for example, the name of the site of the blood vessel BV) that identifies a site where the degree of flexion P, which is expected to be difficult to pass due to kinking or the like in the device (hereinafter, the maximum bend site), A numerical value indicating the degree of bending such as a curvature and an angle (an angle ⁇ described later with reference to FIG. 22) or the like may be displayed.
- the output unit 150 can perform processing for displaying these based on the bending degree P calculated by the bending degree calculation unit 144.
- the output unit 150 may display not only the maximum bending portion but also information for specifying the portion and the degree of bending in the order of the bending degree P.
- the accepting unit 110 accepts selection of a route RT that the output unit 150 outputs to the display 20.
- the output unit 150 selects one route RT among the plurality of routes RT extracted by the route extraction unit 130 according to the selection of the route RT accepted by the accepting unit 110, and the rank and route corresponding to the one route RT.
- the score SR and the patient score SP are displayed on the display 20.
- the output unit 150 includes a navigation unit 151 that guides the route RT extracted by the route extraction unit 130.
- the accepting unit 110 accepts an operation for starting guidance for the route RT extracted by the route extracting unit 130. And the navigation part 151 will start guidance of route RT, if the reception part 110 receives operation which starts guidance of route RT.
- the navigation unit 151 estimates the position of the tip of the medical device delivered to the site in the living body BD via the blood vessel BV, and displays an icon IC indicating the estimated position of the medical device on the route RT.
- the navigation unit 151 displays the route RT extracted by the route extraction unit 130 and the icon IC indicating the position of the tip of the medical device on the display 20 together with the image data DT2 of the blood vessel BV.
- the method for estimating the position of the tip of the medical device is not particularly limited.
- the position may be estimated based on an average moving speed of the medical device in the blood vessel BV, or the length of the medical device introduced into the blood vessel BV may be calculated. You may estimate by measuring on the base end side of a medical device. Further, when the contrast marker is provided at the distal end portion of the medical instrument, the position estimation unit may correct the estimated position of the distal end of the medical instrument by imaging the contrast marker.
- image information DT1 includes divided image data DT3 obtained by dividing image data DT2 into a plurality of pieces and auxiliary information DT4 in which information related to divided image data DT3 is recorded. Have.
- the divided image data DT3 is data generated by dividing the image data DT2 according to the site of the blood vessel BV.
- the divided image data DT3 includes image data DT2 for each region such as the right subclavian artery, brachiocephalic artery, aortic arch, thoracic aorta, abdominal aorta, left common iliac artery, left external iliac artery, left femoral artery, and the like. This data is generated by dividing.
- the divided image is identified by a unique identifier (hereinafter referred to as ID).
- the incidental information DT4 includes, for each divided image data DT3, site information for specifying the site of the blood vessel BV included in the corresponding divided image data DT3, and link information for bidirectionally linking adjacent divided image data DT3. , Record.
- the path extraction unit 130 includes a target part image specifying unit 131 that specifies the ID of the divided image data DT3 including the target part RG among the plurality of divided image data DT3 included in the image information DT1.
- the introduction part image specifying unit 132 for specifying the ID of the divided image data DT3 including the candidate for the introduction part RS among the plurality of pieces of divided image data DT3 included in the image information DT1, and the target part RG to the introduction part RS
- a route search unit 133 that searches for a route RT of the blood vessel BV.
- the target part image specifying unit 131 specifies the ID of the divided image data DT3 including the target part RG using the part information received by the receiving unit 110 and the part information included in the incidental information DT4.
- the introduction site image specifying unit 132 specifies the ID of the divided image data DT3 including the introduction site RS candidate using the introduction site list LS1 and the site information included in the incidental information DT4.
- the route search unit 133 uses the ID of the divided image specified by the target part image specifying unit 131, the ID of the divided image specified by the introduction part image specifying unit 132, and the link information included in the incidental information DT4.
- the route RT of the blood vessel BV from the target site RG to the introduction site RS is searched.
- a method for supporting the selection of the path RT of the living body lumen for delivering the medical instrument to the site in the living body via the living body lumen (hereinafter referred to as a path selection support method) will be described.
- step S1 for accepting input of part information
- step S2 for obtaining image information DT1
- step S3 for extracting route RT of blood vessel BV (corresponding to a biological lumen).
- step S4 for calculating the route score SR
- Step S5 for calculating the patient score SP
- Step S6 for assigning a rank to the extracted route RT
- Step S7 for outputting the extracted route RT and rank Have.
- step S1 for receiving the input of the part information the input of the part information specifying the target part RG that is the target of the procedure performed by delivering the medical instrument is received.
- Step S ⁇ b> 1 for receiving the input of the part information is performed by the receiving unit 110.
- step S2 of acquiring the image information DT1 the image information DT1 of the living body BD of the target patient that is the target of the procedure performed by delivering the medical instrument is acquired.
- Step S2 for acquiring the image information DT1 is performed by the image acquisition unit 120.
- step S3 of extracting the blood vessel BV route RT a plurality of biological lumen routes RT capable of delivering the medical device to the target site RG are extracted based on the acquired image information DT1.
- Step S3 for extracting the route RT of the blood vessel BV is performed by the route extraction unit 130.
- step S4 for calculating the route score SR the route score SR determined according to the ease of delivery of the medical device when the medical device is delivered via the route RT is calculated.
- Step S4 for calculating the route score SR is performed by the route score calculation unit 141.
- step S5 for calculating the patient score SP the patient score SP determined according to the magnitude of the burden given to the target patient is calculated.
- the step S5 for calculating the patient score SP is performed by the patient score calculation unit 145.
- step S6 for assigning ranks ranks are assigned to the plurality of extracted routes RT based on the calculated route score SR and the calculated patient score SP.
- Step S6 for assigning a rank is performed by the rank assigning unit 140.
- step S7 the plurality of routes RT extracted in step S3 for extracting the route RT of the blood vessel BV, the order given in step S6 for giving the ranking, and the route score calculated in step S4 for calculating the route score SR.
- the SR and the patient score SP calculated in step S5 for calculating the patient score SP are output to the display 20.
- step S7 of outputting in order to support the selection of the route RT of the blood vessel BV for delivering the medical instrument to the target site RG in the living body BD via the blood vessel BV by an operator such as a doctor, the route RT and the rank And the route score SR and the patient score SP are output to the display 20.
- a plurality of routes RT extracted by the route extraction unit 130 are output to the display 20 together with the image GR of the target patient's living body BD.
- the output unit 150 performs the output step S7.
- a method for diagnosing the route RT of the blood vessel BV for delivering a medical instrument to a site in the living body BD via the blood vessel BV (corresponding to a living body lumen) (hereinafter referred to as a diagnostic method) will be described.
- the diagnosis method according to the present embodiment includes a plurality of routes RT extracted in step S3 for extracting the route RT of the blood vessel BV, and a step S6 for assigning ranks.
- the medical device for delivering the medical device via the route RT by comparing the route RT having a higher ranking given in the step S6 of assigning the ranking with the route RT having the lower ranking. From the standpoint of ease of delivery and the burden on the subject patient, it is diagnosed that the route RT is more appropriate.
- the surgeon operates the display 20 to input “left superficial femoral artery” as part information for specifying a target part RG to be a target of a procedure performed by delivering a medical instrument.
- the image acquisition unit 120 acquires, from the external server 30 (see FIG. 1), the image information DT1 in the living body BD of the target patient that is the target of the procedure performed by delivering the medical instrument via the network.
- the route extraction unit 130 is a candidate for six introduction sites RS of the right radial artery, right upper arm artery, right femoral artery, left radial artery, left brachial artery, and left femoral artery recorded in the introduction site list LS1 (see FIG. 4). Six routes RT of the blood vessel BV corresponding to are extracted.
- the route score calculation unit 141 calculates a route score SR for each of the six routes RT extracted by the route extraction unit 130 based on the length L of the route RT and the bending degree P of the route RT.
- the patient score calculation unit 145 calculates the patient score SP for each of the six routes RT extracted by the route extraction unit 130 using the degree of invasiveness.
- the route score SR is that the introduction site RS is the route RT of the right radial artery (left radial artery), the introduction site RS is the route RT of the right upper arm artery (left brachial artery), and the introduction site RS is the right femoral artery ( The left femoral artery) becomes smaller in order of the route RT.
- the introduction site RS is the route RT of the right femoral artery (left femoral artery)
- the introduction site RS is the route RT of the right upper arm artery (left brachial artery)
- the introduction site RS is the right radial artery. It becomes smaller in order of the route RT of the (left radial artery).
- the product SR ⁇ SP of the route score SR and the patient score SP is that the introduction site RS is the route RT of the right femoral artery (left femoral artery) and the introduction site RS is the route of the right upper arm artery (left radial artery). RT and introduction site RS become smaller in order of the route RT of the right radial artery (left radial artery).
- the rank assigning unit 140 includes a plurality of routes RT extracted by the route extracting unit 130 in ascending order of the product SR ⁇ SP of the route score SR calculated by the route score calculating unit 141 and the patient score SP calculated by the patient score calculating unit 145. Is given a ranking.
- the output unit 150 outputs the plurality of routes RT extracted by the route extraction unit 130, the ranks given by the rank assigning unit 140, the route score SR, and the patient score SP to the display 20 (FIGS. 7A and 7B). )reference).
- An operator such as a doctor refers to the route RT, rank, route score SR, and patient score SP of the blood vessel BV output on the display 20, and facilitates the delivery of the medical device and the target.
- An appropriate route RT is selected in consideration of the burden imposed on the patient.
- the rank assigning unit 140 provides a medical device when delivering the medical device. Using the route score SR determined according to the ease of delivery and the patient score SP determined according to the burden applied to the target patient, a rank is assigned to the plurality of routes RT extracted by the route extraction unit 130. Then, the output unit 150 outputs the plurality of routes RT extracted by the route extracting unit 130 and the ranks given by the rank assigning unit 140.
- an operator such as a doctor places the medical instrument on the target site RG that is the target of the procedure in consideration of the ease of delivery of the medical instrument and the burden on the target patient when delivering the medical instrument.
- An appropriate route RT can be easily selected from a plurality of routes RT of the blood vessel BV that can be delivered. Therefore, according to the route selection support system 1, the recording medium MD in which the route selection support program PR is recorded, and the route selection support method according to the present invention, the medical instrument is delivered to the site in the living body BD via the blood vessel BV.
- the route RT of the blood vessel BV can be easily selected. This effect is particularly noticeable when the number of sites of blood vessels BV that pass therethrough is increased, such as when treating blood vessels BV in the lower limbs using TRI.
- the route score calculation unit 141 uses an imaging image of the blood vessel BV. To calculate a route score SR. Thereby, the route score calculation unit 141 can calculate the route score SR with higher accuracy. Therefore, the surgeon considers the ease of delivery of the medical instrument when delivering the medical instrument from among the plurality of routes RT of the blood vessel BV that can deliver the medical instrument to the target site RG. A more appropriate route RT can be easily selected.
- the output unit 150 outputs the route RT extracted by the route extraction unit 130.
- a navigation unit 151 for guiding the user Accordingly, the surgeon can easily deliver the medical instrument to the target site RG via the blood vessel BV according to the guidance of the route RT by the navigation unit 151.
- the rank assigning unit 140 may adjust the rank using patient information related to a target patient to which a medical instrument is to be delivered.
- the route selection support system includes a patient information acquisition unit (not shown) that acquires patient information related to a target patient to which a medical instrument is to be delivered to a site in the living body BD via the blood vessel BV.
- the patient information includes, for example, worker identification information for identifying whether or not the target patient is a worker.
- the rank assigning unit 140 gives a rank to the route RT by giving priority to the degree of invasiveness over the length L of the route RT and the bending degree P of the route RT.
- the route RT having a higher degree of invasiveness is adjusted to the lower order. Therefore, when a target patient is a worker, an operator such as a doctor can easily select a route RT having a lower invasive degree than a route RT having a higher invasive degree.
- the degree of invasiveness is low, the number of days until the target patient is discharged after the procedure for delivering the medical device to the target site RG via the blood vessel BV is shortened. Therefore, when the target patient is a worker, the QOL (Quality Of Life) of the target patient is improved when the medical instrument is delivered to the target site RG using the route RT having a low invasiveness.
- the rank assigning unit 140 adjusts the rank of the route RT having a high degree of invasiveness to the lower side when the target patient is a worker, the surgeon such as a doctor can In this case, it is easier to select a route RT having a lower invasiveness than a route RT having a higher invasiveness. Therefore, an operator such as a doctor can easily select a more appropriate route RT depending on whether the target patient is a worker.
- the patient information is not limited to the worker identification information described above, but may be information on the gender, height, weight, age, personality, occupation, blood vessel BV status, etc. of the target patient.
- Information regarding the state of the blood vessel BV can record the presence or absence of calcification or chronic total occlusion (CTO) for each site of the blood vessel BV.
- CTO chronic total occlusion
- the rank assigning unit 140 determines the route than the degree of invasiveness.
- the order of the route RT with a small burden on the blood vessel BV may be adjusted to the higher side by giving priority to the bending degree P of the RT and the state of the blood vessel BV (presence or absence of calcification or CTO). This makes it easier for an operator such as a doctor to select a route RT with a smaller burden on the blood vessel BV than the degree of invasiveness when the target patient is older. Therefore, according to the route selection support system according to this modification, an operator such as a doctor can easily select an appropriate route RT in consideration of the burden on the target patient according to the age of the target patient. it can.
- the route selection support system the recording medium in which the route selection support program is recorded, the route selection support method, and the diagnosis method according to this modification, an operator such as a doctor can select a more appropriate route RT according to the target patient. Easy to select.
- the bending degree calculation unit 144 calculates the bending degree P for one or a plurality of selected parts selected in advance based on the size of bending or bending among the parts of the blood vessel BV, and calculates the sum of the calculated bending degrees P.
- the bending degree P of the route RT may be calculated. Thereby, the amount of calculation can be reduced as compared with the case where the degree of bending is calculated for all the portions of the blood vessel BV constituting the route RT extracted by the route extraction unit 130.
- the bending degree calculation unit 144 may use the maximum value of the bending degree P calculated for each selected region as the bending degree P of the route RT.
- the selected part is predicted to have a significant difference in, for example, a part that is predicted to have a large amount of bending or bending among the parts of the blood vessel BV that constitutes the route RT, or a size of bending or bending for each target patient.
- the selected site may be the aortic arch, the aorta (descending aorta), the iliac artery, or the like.
- the route selection support system 200 extracts a type of medical device used for the procedure in addition to the functional configuration of the route selection support system 1 according to the embodiment described above. It has the extraction part 160 and the device extraction part 170 which extracts the candidate of the device which can be used according to the kind of medical instrument which the medical instrument extraction part 160 extracted.
- the device configuration of the route selection support system 200 according to the present embodiment is the same as the device configuration of the route selection support system 1 according to the above-described embodiment.
- the functional configuration is the same.
- the same devices and functional blocks as those in the route selection support system 1 according to the embodiment described above are denoted by the same reference numerals, and description thereof is omitted.
- the accepting unit 110 accepts input of procedure information specifying the type of procedure to be performed by delivering a medical instrument to the target site RG via a blood vessel BV (corresponding to a biological lumen).
- the types of procedures include, for example, expansion of the stenosis of the blood vessel BV, excavation of the stenosis of the blood vessel BV, imaging of the inner region BVa1 of the blood vessel BV, release of a drug in the blood vessel BV, and the like.
- the function of the reception unit 110 is the same as the function of the reception unit 110 of the route support system according to the above-described embodiment except that it receives input of procedure information.
- the medical instrument extraction unit 160 extracts one or more types of medical instruments used for the type of procedure specified by the procedure information.
- Types of medical devices include, for example, introducer sheaths, guide wires, contrast catheters, microcatheters, angiographic catheters, guide wire support catheters, guiding catheters, balloon catheters, balloon expandable stents, self-expandable stents, drug release types Examples include stents, drug release balloons, DCA catheters (Directional Coronary Therapy), microdissection catheters, laser ablation catheters, and imaging diagnostic catheters.
- DCA catheters Directional Coronary Therapy
- the catheter for image diagnosis is a catheter that acquires an image using, for example, intravascular ultrasonic diagnosis (IVUS) or optical coherence tomography (OCT).
- IVUS intravascular ultrasonic diagnosis
- OCT optical coherence tomography
- the device extraction unit 170 extracts usable device candidates for each type of medical instrument extracted by the medical instrument extraction unit 160.
- the device extraction unit 170 extracts usable device candidates based on whether or not the device is in stock.
- the device extraction unit 170 extracts a plurality of device candidates within a range not exceeding the upper limit number.
- the upper limit number is not particularly limited, but is about 10, for example.
- the number of device candidates extracted by the device extraction unit 170 is zero.
- the external server 30 stores a medical device list LS2 in which the types of medical devices used for each type of procedure are recorded, and device candidates for each type of medical devices.
- a recorded device list LS3 and a device information list LS4 in which the presence / absence of device inventory is recorded for each device candidate are stored.
- Device list LS3 records commercially available devices for each type of medical instrument.
- a device is identified by a unique device identifier.
- the unique device identifier is, for example, a manufacturer name or model name of a manufacturer that sells the device, a regulatory approval number, a product code, barcode data, a product name, a lot number, or the like.
- the device information list LS4 records the presence / absence of device inventory in the facility where the route selection support system 200 is used.
- the device information list LS4 is updated so that the recorded information is maintained at the latest information.
- the medical instrument extraction unit 160 extracts the type of medical instrument using the medical instrument list LS2.
- the device extraction unit 170 extracts usable device candidates using the device list LS3 and the device information list LS4.
- the rank assigning unit 140 adjusts the order to be given to the plurality of routes RT extracted by the route extracting unit 130 based on the device extraction result by the device extracting unit 170.
- the rank assigning unit 140 lowers the rank of the route RT for which no usable device was extracted by the device extracting unit 170.
- the output unit 150 outputs the device candidates extracted by the device extraction unit 170 to the display 20 in addition to the information output by the output unit 150 of the route selection support system 1 according to the above-described embodiment. To do.
- the output unit 150 includes information (for example, the name of the site of the blood vessel BV) that identifies a site where the degree of flexion P, which is expected to be difficult to pass due to kinking or the like in the device (hereinafter, the maximum flex site)
- a numerical value indicating the degree of bending such as a curvature and an angle (an angle ⁇ described later with reference to FIG. 22) or the like may be displayed.
- the output unit 150 can perform processing for displaying these based on the bending degree P calculated by the bending degree calculation unit 144.
- the output unit 150 may display not only the maximum bending portion but also information for specifying the portion and the degree of bending in the order of the bending degree P.
- the output unit 150 uses a route RT, a rank, and an order in order to support selection by a surgeon such as a doctor of a device used for a procedure performed by delivering a medical instrument to the target site RG in the living body BD via the blood vessel BV.
- the route score SR and the patient score SP are output to the display 20.
- the reception unit 110 determines the type of procedure to be performed by delivering a medical instrument via the blood vessel BV. Accepts input of specific procedure information.
- the route selection support system 200 includes a medical instrument extraction unit 160 that extracts a type of medical instrument used for a procedure specified by the procedure information, and a type of medical instrument that the medical instrument extraction unit 160 extracts.
- a device extraction unit 170 that extracts usable device candidates.
- the output unit 150 outputs the device candidate extraction result by the device extraction unit 170.
- the device extraction unit 170 extracts usable device candidates based on the presence or absence of device inventory.
- the device extraction unit 170 may extract usable device candidates using the device characteristics.
- the device extraction unit 170 includes a device feature information acquisition unit (not shown) that acquires device feature information in which device features are recorded.
- the device information list LS4 records device characteristic information for each device.
- the device feature information acquisition unit acquires the device information list LS4 stored in the external server 30 via the network.
- the device feature information acquisition unit acquires device feature information from the device information list LS4.
- the device extraction unit 170 includes a device ranking assigning unit (not shown) that assigns ranks to devices based on the device feature information obtained by the device feature information obtaining unit, and the rank assigned by the device ranking assigning unit is a predetermined threshold value.
- the above devices are extracted as usable device candidates.
- the threshold value is not particularly limited, but is 10, for example.
- the device feature information includes a device score that indexes the dynamic performance of the device.
- the mechanical performance of the device includes, for example, stiffness, pushability, followability, slidability, and kink resistance.
- the mechanical performance of the device may vary depending on the type of medical instrument. For example, in the case of a guide wire, indexing may be performed using rigidity, and in the case of a guiding catheter, indexing may be performed using pushability and followability or kink resistance.
- the device ranking assigning unit gives the device ranking in descending order of device score.
- the output unit 150 outputs the order given by the device extraction unit 170.
- the device extraction unit 170 acquires device feature information that records device feature information. Part. Then, the device extraction unit 170 extracts usable device candidates using the device feature information. Thus, the surgeon can more easily select a device in consideration of the characteristics of the device.
- the device extraction unit 170 uses a device score that indexes the dynamic performance of the device. To extract usable device candidates. Thereby, the surgeon can more easily select a device in consideration of the mechanical performance of the device.
- the device extraction unit 170 may extract a usable device candidate using the feature of the target region RG.
- the route extraction unit 130 includes a target part analysis unit (not shown) that analyzes the characteristics of the target part RG using the imaging image of the blood vessel BV.
- the target site analysis unit specifies a lesion site N in the target site RG and measures the length of the specified lesion site N.
- the target site analysis unit identifies, as a lesion site N, a location where the distance H between the inner wall Vw1 of the blood vessel BV and the outer wall Vw2 of the blood vessel BV is greater than a predetermined threshold using the imaging image of the blood vessel BV.
- the target site analysis unit measures the length of the identified lesion site N using the imaging image of the blood vessel BV.
- the device characteristic information according to this modification records the length of the treatment part M that performs treatment on the lesion site N in the device.
- the length of the treatment portion M is the length of the balloon.
- the device extraction unit 170 extracts a device having a length of the treatment unit M larger than the length of the lesion site N measured by the target site analysis unit as a usable device.
- the route extraction unit 130 analyzes the characteristics of the target region RG using the imaging image of the blood vessel BV.
- the target part analysis part to perform is provided.
- the device extraction unit 170 extracts usable device candidates using the analysis result of the target part analysis unit and the device feature information. Thereby, the surgeon can more easily select an appropriate device according to the characteristics of the target region RG.
- the target site analysis unit determines whether the stenosis has a degree of stenosis (the degree of clogging of the blood vessel BV in the stenosis), whether it is chronic complete occlusion (CTO), The hardness may be calculated.
- the device extraction unit 170 may extract a usable device using the degree of stenosis calculated by the target region analysis unit.
- the device characteristic information records information for identifying whether the balloon has an expanded diameter, nominal pressure (NP), maximum expanded pressure (RBP), semi-compliant or non-compliant, and the like. It may be.
- the target site analysis unit uses the blood flow rate and blood pressure in the vicinity of the lesion site N, and the length of the lesion site N and the lesion site N are narrowed by a known numerical analysis method such as computational fluid dynamics (CFD).
- CFD computational fluid dynamics
- the degree of stenosis of the stenosis may be identified.
- the modeling of the blood vessel BV when applying computational fluid dynamics can be performed using an imaging image of the blood vessel BV.
- the device extraction unit 170 may output, through the output unit 150, non-extraction reason information that records a reason why the device was not extracted as a usable device candidate.
- the non-extraction reason information records the reason why it was not extracted as a usable device candidate for each device.
- Reasons that were not extracted as candidates for usable devices include, for example, “not in stock”, “sold only overseas (overseas)”, “drug application” “Waiting for approval”, “Insufficient rigidity”, “Insufficient length of treatment area relative to the length of the lesion”, “May be kinked against the maximum bend”, etc. is there.
- the device manufacturer can more appropriately adjust the shipment amount of the device, improve the dynamic performance of the device, improve the shape of the treatment section M of the device, etc. Can do.
- the route selection support system 300 analyzes medical data used in the medical field.
- An analysis unit 180 is included.
- the rank assigning unit 140 adjusts the rank using the analysis result of the medical data analysis unit 180.
- the device configuration of the route selection support system 300 according to the present embodiment is the same as the device configuration of the route selection support system 1 according to the above-described embodiment.
- the functional configuration of the route selection support system 300 according to the present embodiment is the same as the functional configuration of the route selection support system 1 according to the above-described embodiment except that the route selection support system 300 further includes a medical data analysis unit 180.
- the same devices and functional blocks as those in the route selection support system according to the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.
- the medical data analysis unit 180 includes a medical data acquisition unit 181 that acquires medical data used in the medical field.
- the medical data includes procedure history information in which the features of the route RT selected and the features of the route RT not selected in the procedure of delivering the medical device to the site in the living body BD via the blood vessel BV are recorded for each procedure.
- the characteristics of the route RT recorded in the procedure history information may be recorded as structured data such as the length of the route RT and the degree of bending of the route RT, or the structure of image data or the like. It may be recorded as non-converted data.
- the medical data may include presentation data from academic societies and the like.
- the medical data analysis unit 180 is highly likely to select the route RT by an operator who delivers a medical instrument to a site in the living body BD via the blood vessel BV for each of the plurality of routes RT extracted by the route extraction unit 130. Is calculated.
- the medical data analysis unit 180 calculates the high possibility that the route RT is selected by analyzing the procedure history information.
- the technique history information analysis method is not particularly limited, for example, a machine learning method using an artificial neural network ANN (Artificial Neural Network) can be applied.
- ANN Artificial Neural Network
- characteristics of route RT of blood vessel BV are input to input layer LY1.
- the output layer LY2 outputs a probability that the operator selects the route RT of the blood vessel BV having the input characteristics.
- the output probability may be a continuous numerical value or a discrete value such as “large”, “medium”, and “small”.
- the medical data analysis unit 180 inputs the characteristics of the route RT extracted by the route extraction unit 130 to the learned artificial neural network ANN learned using the procedure history information, so that the route RT is selected by the operator. To get the probability.
- the rank assigning unit 140 adjusts the ranks assigned to the plurality of routes RT extracted by the route extracting unit 130 based on the possibility that the route RT calculated by the medical data analyzing unit 180 is selected.
- the rank assigning unit 140 calculates an operator score SD that is determined according to the possibility that the route RT is selected.
- the rank assigning unit 140 assigns ranks to the plurality of routes RT extracted by the route extracting unit 130 in ascending order of the value SR ⁇ SP / SD obtained by dividing the product of the route score SR and the patient score SP by the operator score SD. .
- the ranking assignment unit 140 in the present embodiment, the ranking of the first route RT is adjusted to the higher side as compared with the case of the first embodiment in which the ranking is given using only the route score SR and the patient score SP.
- the order of the second route RT is adjusted to the lower side.
- the route selection support system 300 includes the medical data analysis unit 180 that analyzes medical data.
- the medical data analysis unit 180 responds to the possibility that the route RT is selected by the operator who delivers the medical instrument to the site in the living body BD via the blood vessel BV for each of the plurality of routes RT extracted by the route extraction unit 130.
- the operator score SD determined is calculated.
- the rank assigning unit 140 adjusts the ranks assigned to the plurality of routes RT extracted by the route extracting unit 130 based on the operator score SD calculated by the medical data analyzing unit 180.
- the surgeon can further easily select the route RT according to the characteristics of the route RT of the blood vessel BV.
- the medical data is not particularly limited as long as it is data used in the medical field.
- the medical data includes information on a procedure performed in the past at a facility where the route selection support system 300 is used and / or information on a procedure performed in a past at a facility other than the facility where the route selection support system 300 is used. Can be included.
- the medical data is stored in a management system (for example, PACS (Medical Image Management System), RIS (Radiology Information System), HIS (Hospital Information System), etc.) installed in a facility where the route selection support system 300 is used. Can be some or all of the data.
- the medical data analysis unit 180 can acquire medical data from the management system.
- the medical data can include information recorded in an electronic medical record (EMR).
- EMR electronic medical record
- the medical data analysis method may be a deep learning method using an artificial neural network or a statistical analysis technique.
- the medical data analysis unit 180 may cause the external server to execute a part of the function and acquire the execution result from the external server.
- the rank assigning unit 140 may cause the medical data analysis unit 180 to analyze the medical data, and may use the analysis result of the medical data analysis unit 180 to calculate the size of the burden on the patient.
- the probability calculated by the medical data analysis unit 180 in the third embodiment described above is a high possibility that the route RT is selected by a general surgeon.
- the medical data analysis unit 180 may calculate the high possibility that the route RT is selected by a specific operator.
- the route selection support system includes an operator mode that outputs route RT candidates suitable for a specific operator who receives route selection support. Then, the medical data analysis unit 180 calculates the high possibility that the route RT is selected by the specific operator in the operator mode.
- the accepting unit 110 accepts operator identification information for identifying an operator who uses the route selection support system.
- the medical data includes features of the route RT selected by the operator identified by the operator identification information and features of the route RT not selected in the procedure of delivering the medical device to the site in the living body BD via the blood vessel BV. Specific history information recorded for each procedure.
- the medical data analysis unit 180 uses the specific history information to increase the possibility that the route RT is selected by a specific operator identified by the operator identification information as the possibility that the route RT is selected. Is calculated.
- the route selection support system, the recording medium storing the route selection support program, and the route selection support method according to this modification output route RT candidates suitable for a specific operator who receives route selection support.
- the surgeon can more easily select an appropriate route RT from among the plurality of routes RT of the blood vessel BV that can deliver the medical device to the target site RG.
- the specific history information is not particularly limited as long as it is information about the surgeon identified by the surgeon identification information.
- the specific history information may include the type of case handled by the surgeon identified by the surgeon identification information and the number of procedures.
- the route selection support system may hold the operator identification information received by the receiving unit 110.
- the operator can receive the candidate route RT suitable for the operator without inputting the operator identification information.
- the specific operator in the operator mode is not limited to the operator who actually receives the route selection support, but may be a prominent operator in a procedure such as TRI, for example.
- the surgeon who uses the route selection support system according to the present modification can trace the thought of route selection of the prominent surgeon and more easily select a more appropriate route.
- the path extraction unit 130 obtains deformation of the blood vessel BV when the medical instrument is delivered to the blood vessel BV, and a biological lumen feature information acquisition unit 135 that acquires information on the mechanical characteristics of the blood vessel BV.
- a deformation prediction unit 136 that performs prediction. Then, the route score calculation unit 141 may adjust the calculated route score SR using the prediction result of the deformation prediction unit 136.
- the biological lumen feature information acquisition unit 135 acquires information related to the mechanical features of the blood vessel BV.
- the information on the mechanical characteristics of the blood vessel BV includes information on the hardness of the blood vessel BV.
- the information regarding the hardness of the blood vessel BV is information in which the hardness of the blood vessel BV is recorded for each region of the blood vessel BV.
- the hardness of the blood vessel BV can be measured for each site of the blood vessel BV by a known measurement method such as a pulse wave velocity (PWV) measurement method.
- the hardness of the blood vessel BV is represented by a value indexed based on the pulse wave velocity when measured using the pulse wave velocity (PWV) measurement method.
- the hardness of the blood vessel BV may be identified from the blood pressure or the blood flow rate / flow velocity using a known numerical analysis method such as computational fluid dynamics.
- the medical data analysis unit analyzes the medical data in which the blood vessel BV hardness, blood pressure, blood flow rate / flow velocity, and the like are recorded, thereby determining the blood vessel BV hardness of the target patient.
- a well-known machine learning (deep learning) method or a statistical method can be used as an analysis method of the medical data analysis unit.
- the deformation prediction unit 136 uses the biological lumen feature information acquired by the biological lumen feature information acquisition unit 135 to deliver a medical instrument to the blood vessel BV.
- the deformation of the blood vessel BV is predicted.
- the deformation prediction unit 136 predicts the deformation of the blood vessel BV when the representative device DV having the typical mechanical performance of the medical instrument is delivered to the blood vessel BV.
- a method for predicting the deformation of the blood vessel BV is not particularly limited, and a known dynamic numerical simulation method or the like can be used.
- the path length calculation unit 143 corrects the length of the path RT according to the prediction result of the deformation of the blood vessel BV predicted by the deformation prediction unit 136.
- the bending degree calculation unit 144 corrects the bending degree P of the route RT according to the prediction result of the deformation of the blood vessel BV predicted by the deformation prediction unit 136.
- the route score calculation unit 141 can calculate the route score SR with higher accuracy. Therefore, the surgeon considers the ease of delivery of the medical instrument when delivering the medical instrument from among the plurality of routes RT of the blood vessel BV that can deliver the medical instrument to the target site RG. Furthermore, an appropriate route RT can be easily selected.
- the deformation prediction unit 136 may predict the deformation of the blood vessel BV using the experimental data of the model experiment regarding the deformation of the blood vessel BV using the existing device.
- the experimental data may record the experimental result (the deformation result of the blood vessel BV) for each of one or more devices that may be used as a device that is delivered to the target site RG via the blood vessel BV.
- the deformation prediction unit 136 predicts the deformation of the blood vessel BV using the experimental data of the device with the highest rank assigned by the device rank assigning unit among the devices extracted by the device extraction unit 170. Good.
- the experimental data may record the length and diameter of the device, the bending rigidity and the elastic modulus for each part constituting the device.
- the device experiment is similar in the length and diameter of the device, the bending rigidity and the elastic modulus of each part constituting the device, etc.
- Data may be used to predict the deformation of blood vessel BV.
- a representative device may be selected in advance, and the deformation of the blood vessel BV may be predicted using experimental data of the representative device.
- the deformation prediction unit 136 determines whether or not the deformation of the blood vessel BV can be predicted based on the experimental data of the model experiment, and can the output unit 150 predict the deformation of the blood vessel BV of the deformation prediction unit 136? A determination result of whether or not may be output.
- the ranking assignment unit 140 may output the basis information FR that records the basis for the ranking assignment via the output unit 150.
- the basis information FR may include route score basis information recording a basis for calculating the route score SR.
- the path score basis information is corrected for each part of the blood vessel BV constituting the path RT and the degree of bending P before the correction according to the prediction result of the deformation of the blood vessel BV predicted by the deformation prediction unit 136. And the degree of flexion P after the recording.
- output unit 150 displays basis information FR in detail display area AR2 of display 20 for each site of blood vessel BV that constitutes route RT. Also good.
- the surgeon refers to the basis information FR output by the output unit 150, and one route RT selected from the plurality of routes RT of the blood vessel BV that can deliver the medical device to the target site RG is appropriate. It is possible to more easily verify whether the route RT is correct.
- Another route RT different from the one route RT can be selected.
- the ground information FR is not limited to information related to the correction of the bending degree P.
- the priority was given to the burden on the blood vessel BV over the degree of invasiveness, and the ranking was lowered because there was no available device inventory. It may be information that the rank of the route RT having a high probability of being made is increased.
- the surgeon more accurately verifies whether the selected route RT is an appropriate route RT in consideration of the ground information FR, the route selection results by other surgeons, the conference presentation data, and the like. Can be done.
- the bending degree calculation unit 144 calculates the curvature of the center line CL at the vertex PP for each vertex PP of the center line CL of the blood vessel BV, and the sum of the curvatures calculated for each vertex PP. was calculated as the degree of bending P.
- the calculation method of the bending degree P in the bending degree calculation part 144 is not specifically limited.
- the bending degree calculation unit 144 includes a point PT0 on the center line CL derived by the center line deriving unit 142 and a center line CL adjacent to the one point PT0.
- the sum of the angles ⁇ between the straight lines LN1 and LN2 connecting the two arbitrary points PT1 and PT2 may be calculated as the bending degree P.
- the point PT1 is separated from the point PT0 by a predetermined distance D1 in one direction along the center line CL
- the point PT2 is separated from the point PT0 by a predetermined distance D2 along the center line CL in the other direction.
- the distance D1 and the distance D2 may be the same or different.
- the magnitudes of the distance D1 and the distance D2 are not particularly limited.
- the bending degree calculation unit 144 includes one center CP0 of the blood vessel BV discretely calculated by the centerline deriving unit 142 and two centers adjacent to the one center CP0.
- the sum of the angles ⁇ between the straight lines LN1 and LN2 connecting CP1 and CP2 may be calculated as the degree of bending P.
- angle ⁇ means an inferior angle out of the two angles (the inferior angle and the dominant angle) formed by the straight line LN1 and the straight line LN2.
- the route selection support system As described above, the route selection support system, the recording medium on which the route selection support program is recorded, and the route selection support method have been described through the embodiment and its modifications.
- the present invention is not limited to the configuration described in the embodiment. Further, it can be appropriately changed based on the description of the scope of claims.
- the blood vessel of the lower limb is exemplified as the target site, but the target site is not particularly limited.
- the target site may be a blood vessel in the brain or heart.
- the biological lumen is a blood vessel has been described as an example.
- the biological lumen is not limited to a blood vessel, and a vascular tube, bile duct, oviduct, hepatic tube, trachea, It may be the esophagus or urethra.
- the output unit outputs the plurality of routes extracted by the route extraction unit, the ranks given by the rank assigning unit, the route score, and the patient score to the display.
- the output unit may output the plurality of routes extracted by the route extraction unit, the rank given by the rank assigning unit, the route score, and the patient score as data to an external server.
- the path of the biological lumen can be expressed as a set of coordinates with the target site as the origin.
- the rank assigning unit 140 assigns ranks to the plurality of routes RT extracted by the route extracting unit 130 in ascending order of the product SR ⁇ SP of the route score SR and the patient score SP. did.
- the method of assigning ranks using the route score SR and the patient score SP is not particularly limited.
- the rank assigning unit 140 may assign ranks to a plurality of routes RT extracted by the route extracting unit 130 in descending order of SR / SP obtained by dividing the route score SR by the patient score SP.
- the ranks assigned by the rank assigning unit 140 are in descending order when viewed with respect to the route score SR, and in ascending order with respect to the patient score SP.
- the route score calculation unit calculates the route score using the length of the route and the degree of curvature of the route.
- the route score calculation unit may calculate the route score using the length of the route, the degree of bending of the route, and / or the size of the lumen of the living body lumen constituting the route.
- the route score calculation unit may classify the blood vessel parts constituting the route based on the form, and calculate the route score using the classification result. For example, the route score calculation unit classifies each part constituting the route into “difficult”, “normal”, and “easy” from the viewpoint of the difficulty of delivery of the medical device based on the form of the part. A route score may be calculated using the classification result.
- the route score calculation unit may include a path prediction unit that predicts a path through which the device passes in the blood vessel.
- the route score calculation unit may correct the calculated route length and the degree of curvature of the route based on the path predicted by the path prediction unit.
- the output unit displays one route among the plurality of routes extracted by the route extraction unit in accordance with the selection of the route received by the reception unit.
- the output unit may simultaneously display a plurality of routes extracted by the route extraction unit on the display. In this case, the output unit may display the plurality of routes extracted by the route extraction unit in different colors on the display.
- the image information includes image data and incidental information.
- the image information only needs to include at least image data of the target patient's biological lumen,
- the incidental information is not an essential requirement.
- the image data does not necessarily have to be divided for each part of the body lumen. Even if the image data is not divided for each part of the biological lumen, the path extraction unit uses a known image processing technique or the like to determine the path of the biological lumen that can deliver the medical instrument to the target part. It is possible to extract based on image data.
- the route selection support system functions by reading a route selection support program recorded on a computer-readable recording medium by a reading device and storing it in a storage device.
- the route selection support system may be provided in a state where the route selection support program is stored in advance in the storage device.
- part or all of the functions of the route selection support system may be realized by a programmable circuit structure such as an FPGA (Field Programmable Gate Array). In this case, part or all of the route selection support program is described in a hardware description language such as Verilog.
- the computer main body and the display are configured separately, but the computer main body and the display may be configured integrally, and the display is provided inside the computer main body. It may be incorporated.
- the image acquisition unit acquires image information from an external server.
- the image acquisition unit may be configured using a medical imaging apparatus such as an X-ray CT apparatus or an MRI apparatus.
- the medical data used in the above-described third embodiment may be so-called big data including a large amount of structured data and / or unstructured data.
- the medical instrument extraction unit and the device extraction unit may extract the type and device of the medical instrument using medical data.
- the route selection support system includes a route extraction unit, a medical device extraction unit, and a device extraction unit that causes the medical data analysis unit to analyze the medical data, and uses the analysis result of the medical data analysis unit to analyze the route and the medical device.
- Types and devices may be extracted. For example, when there is no inventory of devices belonging to the type of medical instrument, the device extraction unit may extract a device that can be used as an alternative using the analysis result of the medical data analysis unit.
- Route selection support system 10 computer body, 20 display, 30 External server, 50 arithmetic unit, 60 storage devices, 70 reader, 110 reception desk, 120 image acquisition unit, 130 route extraction unit, 135 feature information acquisition unit, 136 deformation prediction unit, 140 ranking assignment unit, 141 route score calculation unit, 145 patient score calculator, 150 output section, 151 Navigation part, 160 medical device extraction unit, 170 device extractor, 180 Medical Data Analysis Department, BD living body, BV blood vessels (biological lumen), DT1 image information, MD recording medium, PR route selection support program, RG target site, RS introduction site, RT route, SD surgeon score, SP patient score, SR path score, L path length, P Path bending degree.
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Abstract
Description
本実施形態に係る経路選択支援システム1は、血管BV(生体管腔に相当)を介して生体BD内の部位に医療器具を送達させるための血管BVの経路RTの選択を支援する経路選択支援システムである。
順位付与部140は、医療器具を送達させる対象となる対象患者に関する患者情報を用いて順位を調整してもよい。
屈曲度算出部144は、血管BVの部位のうち、屈曲または湾曲の大きさに基づいて予め選択された一または複数の選択部位について屈曲度Pを算出し、算出された屈曲度Pの和を、経路RTの屈曲度Pとして算出してもよい。これにより、経路抽出部130が抽出した経路RTを構成する血管BVの部位の全てについて屈曲度を算出する場合と比較して、計算量を削減できる。なお、屈曲度算出部144は、選択部位ごとに算出された屈曲度Pの最大値を、経路RTの屈曲度Pとしてもよい。
図11を参照して、本実施形態に係る経路選択支援システム200は、上述した実施形態に係る経路選択支援システム1の機能構成に加えて、手技に使用する医療器具の種類を抽出する医療器具抽出部160と、医療器具抽出部160が抽出した医療器具の種類に応じて使用可能なデバイスの候補を抽出するデバイス抽出部170と、を有する。
上述した実施形態2では、デバイス抽出部170は、デバイスの在庫の有無に基づいて、使用可能なデバイスの候補を抽出した。しかしながら、デバイス抽出部170は、デバイスの特徴を用いて、使用可能なデバイスの候補を抽出してもよい。
さらに、デバイス抽出部170は、対象部位RGの特徴を用いて、使用可能なデバイスの候補を抽出してもよい。
デバイス抽出部170は、出力部150を介して、使用可能なデバイスの候補として抽出されなかった事由を記録した非抽出事由情報を出力してもよい。
図17を参照して、本実施形態に係る経路選択支援システム300は、上述した実施形態1に係る経路選択支援システム1の機能構成に加えて、医療分野において用いられる医療データを分析する医療データ分析部180を有する。そして、順位付与部140は、医療データ分析部180の分析結果を用いて順位を調整する。
上述した実施形態3において医療データ分析部180が算出した確率は、一般の術者によって経路RTが選択される可能性の高さである。しかしながら、医療データ分析部180は、特定の術者によって経路RTが選択される可能性の高さを算出してもよい。
図19を参照して、経路抽出部130は、血管BVの力学的な特徴に関する情報を取得する生体管腔特徴情報取得部135と、血管BVに医療器具を送達した際の血管BVの変形を予測する変形予測部136と、を有してもよい。そして、経路スコア算出部141は、変形予測部136の予測結果を用いて、算出した経路スコアSRを調整してもよい。
さらに、順位付与部140は、出力部150を介して、順位付与の根拠を記録した根拠情報FRを出力してもよい。根拠情報FRは、経路スコアSRの算出根拠を記録した経路スコア根拠情報を含み得る。
上述した実施形態およびその改変例では、屈曲度算出部144は、血管BVの中心線CLの頂点PPごとに、頂点PPにおける中心線CLの曲率を算出し、頂点PPごとに算出した曲率の和を屈曲度Pとして算出した。しかしながら、屈曲度算出部144における屈曲度Pの算出方法は特に限定されない。
10 コンピュータ本体、
20 ディスプレイ、
30 外部サーバ、
50 演算装置、
60 記憶装置、
70 読み取り装置、
110 受付部、
120 画像取得部、
130 経路抽出部、
135 特徴情報取得部、
136 変形予測部、
140 順位付与部、
141 経路スコア算出部、
145 患者スコア算出部、
150 出力部、
151 ナビゲーション部、
160 医療器具抽出部、
170 デバイス抽出部、
180 医療データ分析部、
BD 生体、
BV 血管(生体管腔)、
DT1 画像情報、
MD 記録媒体、
PR 経路選択支援プログラム、
RG 対象部位、
RS 導入部位、
RT 経路、
SD 術者スコア、
SP 患者スコア、
SR 経路スコア、
L 経路の長さ、
P 経路の屈曲度。
Claims (10)
- 生体管腔を介して生体内の部位に医療器具を送達させるための前記生体管腔の経路の選択を支援する経路選択支援システムであって、
前記医療器具を送達させる対象となる前記生体内の対象部位を特定する部位情報の入力を受け付ける受付部と、
前記医療器具を送達させる対象となる対象患者の前記生体内の画像情報を取得する画像取得部と、
前記画像取得部が取得した前記画像情報に基づいて、前記対象部位に前記医療器具を送達させることが可能な前記生体管腔の前記経路を複数抽出する経路抽出部と、
前記画像取得部が取得した前記画像情報を用いて、前記経路を介して前記医療器具を送達する際の前記医療器具の送達のし易さに応じて定まる経路スコアを算出する経路スコア算出部と、前記画像取得部が取得した前記画像情報を用いて、前記対象患者に与える負担の大きさに応じて定まる患者スコアを算出する患者スコア算出部と、を有し、前記経路スコアと前記患者スコアとを用いて、前記経路抽出部が抽出した複数の前記経路に順位を付与する順位付与部と、
前記経路抽出部が抽出した複数の前記経路と、前記順位付与部が付与した前記順位と、を出力する出力部と、を有し、
前記画像情報は、前記生体管腔のイメージング画像を含み、
前記経路スコア算出部は、前記イメージング画像を用いて前記経路スコアを算出する、経路選択支援システム。 - 前記受付部は、前記生体管腔を介して前記医療器具を前記対象部位に送達させて行う手技の種類を特定する手技情報の入力を受け付け、
前記手技情報によって特定される前記手技に使用する前記医療器具の種類を抽出する医療器具抽出部と、
前記医療器具抽出部が抽出した前記医療器具の種類ごとに、使用可能なデバイスの候補を抽出するデバイス抽出部と、をさらに有し、
前記順位付与部は、前記経路抽出部が抽出した複数の前記経路に対して付与する前記順位を、前記デバイス抽出部による前記デバイスの候補の抽出結果に基づいて調整し、
前記出力部は、前記デバイス抽出部による前記デバイスの候補の抽出結果を出力する、請求項1に記載の経路選択支援システム。 - 前記デバイス抽出部は、前記デバイスの特徴を記録したデバイス特徴情報を取得するデバイス特徴情報取得部を有し、前記デバイス特徴情報を用いて、使用可能な前記デバイスの候補を抽出する、請求項2に記載の経路選択支援システム。
- 医療分野において用いられる医療データを取得する医療データ取得部を備え、前記医療データ取得部が取得した前記医療データを分析する医療データ分析部をさらに有し、
前記医療データ分析部は、前記経路抽出部が抽出した複数の前記経路ごとに、前記生体管腔を介して前記生体内の部位に前記医療器具を送達させる術者によって前記経路が選択される可能性の高さを算出し、
前記順位付与部は、前記経路抽出部が抽出した複数の前記経路に対して付与する前記順位を、前記医療データ分析部が算出した前記可能性の高さに基づいて調整する、請求項1~3のいずれか1項に記載の経路選択支援システム。 - 前記生体管腔の力学的な特徴を記録した特徴情報を取得する特徴情報取得部と、
前記特徴情報取得部が取得した前記特徴情報を用いて、前記生体管腔に前記医療器具を送達した際の前記生体管腔の変形を予測する変形予測部と、をさらに有し、
前記経路スコア算出部は、前記変形予測部の予測結果を用いて、算出した前記経路スコアを調整する、請求項1~4のいずれか1項に記載の経路選択支援システム。 - 前記対象患者に関する患者情報を取得する患者情報取得部をさらに有し、
前記患者スコア算出部は、前記患者情報取得部が取得した前記患者情報を用いて前記患者スコアを算出する、請求項1~5のいずれか1項に記載の経路選択支援システム。 - 前記出力部は、前記経路抽出部が抽出した前記経路を案内するナビゲーション部を有する、請求項1~6のいずれか1項に記載の経路選択支援システム。
- 生体管腔を介して生体内の部位に医療器具を送達させるための前記生体管腔の経路の選択を支援する経路選択支援プログラムであって、
前記医療器具を送達させる対象となる前記生体内の対象部位を特定する部位情報の入力を受け付け、
前記医療器具を送達させる対象となる対象患者の前記生体内の画像情報を取得し、
取得した前記画像情報に基づいて、前記対象部位に前記医療器具を送達させることが可能な前記生体管腔の前記経路を複数抽出し、
前記経路を介して前記医療器具を送達する際の前記医療器具の送達のし易さに応じて定まる経路スコアを算出し、前記対象患者に与える負担の大きさに応じて定まる患者スコアを算出し、算出した前記経路スコアと算出した前記患者スコアとを用いて、抽出した複数の前記経路に順位を付与し、
抽出した複数の前記経路と、付与した前記順位と、を出力し、
前記画像情報は、前記生体管腔のイメージング画像を含み、
前記経路スコアを算出する際には、前記生体管腔のイメージング画像を用いて前記経路スコアを算出することをコンピュータに実行させる経路選択支援プログラムを記録したコンピュータ読み取り可能な記録媒体。 - 生体管腔を介して生体内の部位に医療器具を送達させるための前記生体管腔の経路の選択を支援する経路選択支援方法であって、
前記医療器具を送達させる対象となる前記生体内の対象部位を特定する部位情報の入力を受け付け、
前記医療器具を送達させる対象となる対象患者の前記生体内の画像情報を取得し、
取得した前記画像情報に基づいて、前記対象部位に前記医療器具を送達させることが可能な前記生体管腔の前記経路を複数抽出し、
前記経路を介して前記医療器具を送達する際の前記医療器具の送達のし易さに応じて定まる経路スコアを算出し、前記対象患者に与える負担の大きさに応じて定まる患者スコアを算出し、算出した前記経路スコアと算出した前記患者スコアとを用いて、抽出した複数の前記経路に順位を付与し、
抽出した複数の前記経路と、付与した前記順位と、を出力し、
前記画像情報は、前記生体管腔のイメージング画像を含み、
前記経路スコアを算出する際には、前記生体管腔のイメージング画像を用いて前記経路スコアを算出する、経路選択支援方法。 - 生体管腔を介して生体内の部位に医療器具を送達させるための前記生体管腔の経路を診断する診断方法であって、
前記医療器具を送達させる対象となる前記生体内の対象部位を特定する部位情報の入力を受け付け、
前記医療器具を送達させる対象となる対象患者の前記生体内の画像情報を取得し、
取得した前記画像情報に基づいて、前記対象部位に前記医療器具を送達させることが可能な前記生体管腔の前記経路を複数抽出し、
前記経路を介して前記医療器具を送達する際の前記医療器具の送達のし易さに応じて定まる経路スコアと、前記対象患者に与える負担の大きさに応じて定まる患者スコアと、を用いて、抽出した複数の前記経路に順位を付与し、
抽出した複数の前記経路と、付与した前記順位とから前記経路を診断し、
前記画像情報は、前記生体管腔のイメージング画像を含み、
前記経路スコアを算出する際には、前記生体管腔の前記イメージング画像を用いて前記経路スコアを算出する、診断方法。
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