PUNCH SUPPORT DEVICE AND PUNCH SUPPORT PROGRAM

Abstract

An operator is provided with a recommended puncture route, which is a route extending from a subject's body surface to a puncture target, while avoiding any tissue that should be avoided by a puncture needle and through which the puncture needle should be passed. A volume data acquisition unit captures volume data that includes a puncture target and an alternative tissue. A modeling unit creates a subject model, a three-dimensional model containing a puncture target model and an alternative tissue model, based on the volume data. A puncture route specification unit specifies a recommended puncture route on the subject model. This route extends from a subject's body surface position E to the puncture target model, avoiding the alternative tissue model, and through which a puncture needle should be passed. A display control unit notifies an operator of the specified recommended puncture route.

Description

BACKGROUND OF THE INVENTION 1. Field of the invention

[0001] The present description discloses improvements to a puncture support device and a puncture support program. 2. Description of the state of the art

[0002] An ultrasound diagnostic device is known which transmits ultrasound from an ultrasound probe to a subject, receives a reflected wave from the subject in the ultrasound probe, and performs various types of processing, such as forming an ultrasound tomography image representing a cross-section in the subject, based on a received signal formed from the reflected wave.

[0003] Furthermore, in the prior art, a puncture cannula is inserted (punctured) into the tissue of a subject for the purpose of collecting tissue (for example, a tumor). An ultrasound probe incorporating a puncture cannula has also been proposed. With such an ultrasound probe, it is possible to perform a puncture on a subject while ultrasound is transmitted to the subject to generate and display an ultrasound tomography image.

[0004] JP1998-005223A (JP-H10-005223A) discloses a puncture support system comprising: a puncture cannula; a probe guide that holds the puncture cannula so that a deflection angle of the puncture cannula can be set and that has a built-in ultrasonic sensor capable of performing sector scanning around an axis of the puncture cannula; a CCD camera that captures a marker attached to the puncture cannula and a marker attached to the probe guide; an ultrasonic diagnostic device that generates an ultrasonic tomography image based on a signal from the ultrasonic sensor built into the probe guide;and a monitor image construction unit that calculates and displays on a display unit a relationship between a puncture depth of the puncture cannula, obtained on the basis of the marking attached to the puncture cannula in an image captured by the CCD camera, and a deflection angle of the puncture cannula, obtained on the basis of the marking attached to the probe guide in the image captured by the CCD camera, and a position of an internal target site (for example, a tumor) obtained from the ultrasound tomography image. SUMMARY OF THE INVENTION

[0005] In a case involving the puncture of a target tissue in a patient, it may be necessary to puncture the target tissue while avoiding puncture of surrounding tissue (referred to in this description as "avoidance tissue"). Avoidance tissue is, for example, tissue that would affect the patient's prognosis if the avoidance tissue were punctured. Examples of avoidance tissue include a blood vessel and a nerve.

[0006] As described above, although in the state of the art puncture was performed while the ultrasound tomography image showing the cross-section in the subject was displayed, it is still necessary for an operator, such as a doctor, to have experience and manual skills to perform puncture on the target object while avoiding the escape tissue.

[0007] One function of the puncture support device disclosed in the present description is to provide an operator with a recommended puncture route, which is a route extending from a body surface of an examinee to a puncture target object, while avoiding tissue that is to be avoided by a puncture cannula and through which the puncture cannula is to be passed.

[0008] A puncture support device disclosed in the present description comprises: a probe information acquisition unit that acquires probe information indicating the position and orientation of an ultrasound probe; a volume data acquisition unit that acquires volume data based on a received signal obtained by transmitting and receiving ultrasound from the ultrasound probe to an examinee;a modeling unit comprising a subject model, a puncture target model (a three-dimensional model representing a puncture target), and an avoidance tissue model (a three-dimensional model representing avoidance tissue to be avoided by a puncture cannula while the puncture target is being punctured), based on volume data, wherein the subject model includes position information specifying each position of the subject model based on the position and orientation of the ultrasound probe in a case where the received signal is acquired;a puncture route specification unit that specifies a recommended puncture route, which is a route extending from a body surface position of the subject to the puncture target model while avoiding the alternative tissue model in the subject model, and through which the puncture cannula should be passed; and a notification processing unit that notifies an operator of the recommended puncture route.

[0009] The puncture route specification unit can specify the recommended puncture route such that a shortest distance between the recommended puncture route and the alternative tissue model is equal to or greater than a first threshold distance.

[0010] In a case where the puncture route specification unit specifies multiple candidate puncture routes extending from the subject's body surface position to the puncture target model while avoiding the alternative tissue model, the recommended puncture route may specify a candidate puncture route with the shortest length among the multiple candidate puncture routes.

[0011] The puncture target can be a tumor, the puncture cannula can be an ablation puncture cannula for removing the tumor, and the puncture route specification unit can specify the recommended puncture route such that one end portion of the recommended puncture route is located on one side of a tumor model as the puncture target model at a distance of at least one threshold distance from a tissue model other than the tumor model.

[0012] The ultrasound diagnostic device may further include: a recommended position and orientation specification unit that specifies a recommended probe position and orientation corresponding to the position and orientation of the ultrasound probe, such that a scanning plane of the ultrasound probe contains the recommended puncture route and is parallel to the recommended puncture route, based on the recommended puncture route, wherein the notification processing unit notifies the operator of the recommended probe position and orientation.

[0013] The notification processing unit can notify the operator of guidance information to transfer the position and orientation of the ultrasound probe from a current position and orientation to the recommended probe position and orientation based on a difference between the current position and orientation of the ultrasound probe and the recommended probe position and orientation.

[0014] The ultrasound diagnostic device may further include: a consistency index calculation unit that calculates a consistency index, which is an index indicating a degree of agreement between a reconstructed ultrasound image cut from the subject model in a cross-section containing the recommended puncture route and parallel to the recommended puncture route, and a real-time image, which is an ultrasound tomography image generated at the current position and orientation of the ultrasound probe, wherein the notification processing unit notifies the operator of the consistency index.

[0015] The ultrasound diagnostic device may further comprise: a puncture cannula information acquisition unit that acquires information about the puncture cannula, indicating its current position and orientation; and a puncture cannula deviation determination unit that determines that the puncture cannula has deviated from the recommended puncture route in a case where the distance between the puncture cannula at its current position and the recommended puncture route becomes equal to or greater than a distance threshold, or in a case where the angular difference between a current extension direction of the puncture cannula and an extension direction of the recommended puncture route becomes equal to or greater than an angular threshold, wherein the notification processing unit notifies the operator in a case where it is determined that the puncture cannula has deviated from the recommended puncture route.

[0016] The probe information acquisition unit can detect the position and orientation of the ultrasound probe relative to the body surface of the subject based on a captured image obtained by imaging a probe detection marker attached to the ultrasound probe and a body surface detection marker attached to the subject's body surface via a camera.

[0017] The probe information acquisition unit can detect the position and orientation of the ultrasound probe relative to the body surface of the subject based on a captured image obtained by imaging a probe detection marker attached to the ultrasound probe and a body surface detection marker attached to the subject's body surface via a camera; and the puncture cannula information acquisition unit can detect the position and orientation of the puncture cannula relative to the body surface of the subject based on a captured image obtained by imaging a puncture cannula detection marker attached to the puncture cannula and the body surface detection marker via the camera.

[0018] Furthermore, a puncture support program disclosed in this description causes a computer to function as: a probe information acquisition unit, which acquires probe information specifying the position and orientation of an ultrasound probe; a volume data acquisition unit, which acquires volume data based on a received signal obtained by transmitting and receiving ultrasound from the ultrasound probe to an examinee;a modeling unit comprising a subject model, a puncture target model (a three-dimensional model representing a puncture target), and an avoidance tissue model (a three-dimensional model representing avoidance tissue to be avoided by a puncture cannula while the puncture target is being punctured), based on volume data, wherein the subject model includes position information specifying each position of the subject model based on the position and orientation of the ultrasound probe in a case where the received signal is acquired;a puncture route specification unit that specifies a recommended puncture route, which is a route extending from a body surface position of the subject to the puncture target model while avoiding the alternative tissue model in the subject model, and through which the puncture cannula should be passed.

[0019] With the puncture support device disclosed in the present description, it is possible to provide an operator with a recommended puncture route, which is a route extending from a body surface of an examinee to a puncture target object, while avoiding tissue that is to be avoided by a puncture cannula and through which the puncture cannula is to be passed. BRIEF DESCRIPTION OF THE DRAWINGS Fig. Figure 1 is a schematic diagram of a configuration of a puncture support system according to the present embodiment. Fig. Figure 2 is a diagram showing an example of an image taken by a camera. Fig. Figure 3 is a schematic diagram of a configuration of an ultrasound diagnostic device according to the present embodiment. Fig. Figure 4 is a conceptual diagram that illustrates a concept of processing the formation of volume data. Fig. Figure 5 is a concept diagram that illustrates a concept of processing the formation of a subject model. Fig. Figure 6 is a diagram showing an example of the subject model. Fig. Figure 7 is a diagram showing an example of a recommended puncture route. Fig. Figure 8 is a diagram showing a display example of a reconstructed ultrasound image and a recommended puncture route image. Fig. Figure 9 is a first diagram showing a notification example of a recommended probe position and orientation. Fig. Figure 10 is a second diagram showing the notification example of the recommended probe position and orientation. Fig. Figure 11 is a diagram showing a display example of a real-time image that has the same cross-section as the reconstructed ultrasound image. Fig. Figure 12 is a diagram showing a current puncture cannula and a recommended puncture route in a model coordinate system. Fig. Figure 13 is a diagram showing an example of notification that a puncture needle has migrated. Fig. Figure 14 is a diagram showing an example of notification that the puncture cannula has not deviated. DESCRIPTION OF PREFERRED EXECUTION FORMS

[0020] Fig. Figure 1 is a schematic diagram of a configuration of a puncture support system 10 according to the present embodiment. The puncture support system 10 is configured to include a camera 12, an ultrasound diagnostic device 16 (which serves as a puncture support device and contains an ultrasound probe 14), and a puncture cannula 18. In the present embodiment, the ultrasound probe 14 and the puncture cannula 18 are separate bodies, but the ultrasound probe 14 can also function as a puncture probe; that is, the puncture cannula 18 can be integrated into the ultrasound probe 14. The camera 12 and the ultrasound diagnostic device 16 are communicatively connected.

[0021] In the present embodiment, a probe detection marker 20 is attached to the ultrasound probe 14. The probe detection marker 20 is a marker for detecting the position and orientation of the ultrasound probe 14. Furthermore, a puncture cannula detection marker 22 is attached to the puncture cannula 18. The puncture cannula detection marker 22 has a pattern different from the probe detection marker 20 and is a marker for detecting the position and orientation of the puncture cannula 18. Additionally, a body surface detection marker 24 is attached to a body surface of a subject E.The body surface detection marker 24 has a different pattern than the probe detection marker 20 and the puncture cannula detection marker 22 and is a marker for detecting a position and orientation of the body surface of the subject E. An example of the probe detection marker 20, the puncture cannula detection marker 22, and the body surface detection marker 24 is a marker for augmented reality (AR).

[0022] The camera 12 is configured to include, in addition to a lens and an image sensor, a processor containing a central processing unit (CPU) and the like, a communication interface containing a network adapter and the like. The camera 12 images the ultrasound probe 14 (in particular the probe detection marker 20), the puncture cannula 18 (in particular the puncture cannula detection marker 22), and the examinee E (in particular the body surface detection marker 24). An image is captured by the image sensor of the camera 12, and the captured image is transmitted to the ultrasound diagnostic device 16 via the communication interface of the camera 12.

[0023] Fig. Figure 2 is a diagram showing an example of a captured image 26 from camera 12. As described above, the captured image 26 contains the images of the probe detection marker 20, the puncture cannula detection marker 22, and the body surface detection marker 24. The ultrasound diagnostic device 16 can detect the position and orientation of the ultrasound probe 14 by analyzing the image of the probe detection marker 20 shown in the captured image 26. Furthermore, the ultrasound diagnostic device 16 can detect the position and orientation of the puncture cannula 18 by analyzing the image of the puncture cannula detection marker 22 shown in the captured image 26.Furthermore, the ultrasound diagnostic device 16 can detect the position and orientation of the body surface of the subject E by analyzing the image of the body surface detection marker 24 shown in the captured image 26. Details of the processing for detecting the positions and orientations of the ultrasound probe 14, the puncture cannula 18, and the subject E are described below.

[0024] Fig. Figure 3 is a schematic diagram of a configuration of the ultrasound diagnostic device 16. The ultrasound diagnostic device 16 is a medical device that is installed in medical facilities, such as a hospital.

[0025] The ultrasound probe 14 is a device that transmits ultrasound to and receives it from the subject E. The ultrasound probe 14 has a transducer element arrangement comprising several transducer elements. In the present embodiment, the transducer element arrangement consists of the several transducer elements arranged in one direction (arrangement direction). In a case where a transmission signal from a transmission / receiving unit 30, which will be described later, is supplied to each transducer element, each transducer element generates ultrasound. In particular, the ultrasound probe 14 scans an ultrasound beam on a plane (scanning plane) that is parallel to the arrangement direction.

[0026] As described above, the probe detection marker 20 is attached to the ultrasound probe 14.

[0027] The transmit / receive unit 30 transmits a transmission signal to the ultrasound probe 14 (specifically, each transducer element of the transducer element assembly) under the control of a controller 48, which will be described later. As a result, the ultrasound beam is sampled at the scanning plane. Furthermore, the transmit / receive unit 30 receives a receive signal from each transducer element that has received a reflected wave from the target tissue. The transmit / receive unit 30 comprises an adder and several delay devices corresponding to the respective transducer elements and performs phase alignment and addition processing of the received signals from the transducer elements using the adder and the multiple delay devices.As a result, a received beam signal is formed in which information indicating a signal intensity of the reflected wave from the target tissue is arranged in a depth direction of the target tissue.

[0028] A signal processing unit 32 performs various types of signal processing, including filter processing by applying a bandpass filter, detection processing and the like, on the received beam signal from the transmit / receive unit 30.

[0029] An image generation unit 34 generates an ultrasound tomography image (B-mode image) representing a cross-section (in particular a scanning plane of the ultrasound beam) of the subject E, based on the received beam signal which was subjected to signal processing in the signal processing unit 32.

[0030] A display control unit 36 ​​performs control to display various images, including the ultrasound tomography image generated by the image generation unit 34, on a display 38.

[0031] The display 38 as a display unit is, for example, a display device configured using a liquid crystal display, organic electroluminescence (EL) or the like.

[0032] The transmission / receiving unit 30, the signal processing unit 32, the image generation unit 34, and the display control unit 36, which are contained in the ultrasound diagnostic device 16, are configured by a processor. The processor is configured to include at least one general-purpose processing device (for example, a CPU or the like) and one dedicated processing device (for example, a graphics processing unit (GPU), an application-specific integrated circuit (ASIC), a field-programmable gate array (FPGA), or a programmable logic device).The processor need not be configured using a single processing device, but can instead be configured through the cooperation of multiple processing devices located at physically separate locations. Furthermore, each of the units described above can be implemented through the cooperation of hardware, such as a processor, and software.

[0033] A communication interface 40 is configured, for example, using a network adapter. The communication interface 40 has the function of communicating with another device (in particular, the camera 12). In particular, the communication interface 40 receives the captured image 26 from the camera 12.

[0034] An input interface 42 is configured using, for example, a button, a trackball, or a touch panel. The input interface 42 is used to input an instruction from an operator, such as a physician using the ultrasound diagnostic device 16, to the ultrasound diagnostic device 16.

[0035] Memory 44 is configured to contain a hard disk drive (HDD), a solid-state drive (SSD), an embedded MultiMediaCard (eMMC), read-only memory (ROM), random-access memory (RAM), or the like. A puncture support program for operating each unit of the ultrasound diagnostic device 16 is stored in memory 44. Alternatively, the puncture support program can also be stored on a non-volatile, computer-readable storage medium, such as a Universal Serial Bus (USB) drive or a CD-ROM. The ultrasound diagnostic device 16 can read and execute the puncture support program from such a storage medium.Since the ultrasound diagnostic device 16 reads the puncture support program in order to have the functions described below, it can be said that the ultrasound diagnostic device 16 is a computer program product.

[0036] As in Fig. As shown in Figure 3, volume data 46 are stored in the memory 44. In the present embodiment, the volume data 46 are generated based on several ultrasound tomography images and on the received signals acquired by the operator when moving the ultrasound probe 14 in a direction perpendicular to the scanning plane. Details of the volume data 46 are described later.

[0037] A controller 48 comprises at least one general-purpose processor (such as a CPU) and one dedicated processor (such as a GPU, ASIC, FPGA, or programmable logic circuit). The controller 48 need not be configured using a single processing device but can instead be configured through the cooperation of multiple processing devices located at physically separate positions. The controller 48 controls each unit of the ultrasonic diagnostic device 16. Furthermore, as shown in Fig. Figure 3 shows the control 48 functions as a probe information acquisition unit 50, a volume data acquisition unit 52, a modeling unit 54, a puncture route specification unit 56, a specification unit 58 for recommended position and orientation, a consistency index calculation unit 60, a puncture cannula information acquisition unit 62 and a puncture cannula deviation determination unit 64 in accordance with the puncture support program stored in the memory 44.

[0038] The probe information acquisition unit 50 acquires probe information that specifies the position and orientation of the ultrasound probe 14.

[0039] In the present embodiment, the probe information acquisition unit 50 acquires the probe information by analyzing the captured image 26 taken by the camera 12 in order to detect the position and orientation of the ultrasound probe 14. As described above, the captured image 26 contains the image of the probe detection marker 20 for detecting the position and orientation of the ultrasound probe 14 (see Fig. 2) The probe information acquisition unit 50 acquires the probe information by analyzing the image of the probe detection marker 20 in the captured image 26. The probe information includes position information, which specifies the position of the ultrasound probe 14, and orientation information, which specifies the orientation of the ultrasound probe 14. The position information can be, for example, three-dimensional coordinates in a camera coordinate system. The orientation information can be an angle of rotation with respect to a predetermined axis (for example, an X-axis, a Y-axis, or a Z-axis) in the camera coordinate system. Since a known method can be used to detect the position and orientation of the ultrasound probe 14 in the camera coordinate system from the image of the probe detection marker 20 contained in the captured image 26, detailed descriptions of this method are omitted.

[0040] The probe information acquisition unit 50 can perform calibration before detecting the position and orientation of the ultrasound probe 14 based on the captured image 26. Specifically, the operator sets the position and orientation of the ultrasound probe 14 to a predetermined position and orientation and, in this state, enters a calibration instruction to the ultrasound diagnostic device 16. The probe information acquisition unit 50 detects the position and orientation of the ultrasound probe 14, based on the probe detection marker 20 contained in the captured image 26, and stores the position and orientation as a reference position and orientation.As a result, it is possible to obtain a relationship between the information (for example, the position and orientation in the camera coordinate system) that specifies the position and orientation of the ultrasound probe 14 detected by the probe information acquisition unit 50, and a coordinate system for real space.

[0041] As described above, the recorded image 26 also contains the image of the body surface detection marker 24 for detecting the position and orientation of the body surface of the subject E (see Fig. 2) The probe information acquisition unit 50 can detect the position and orientation of the body surface of the subject E by analyzing the image of the body surface detection marker 24 in the acquired image 26. Furthermore, the probe information acquisition unit 50 can detect the position and orientation of the ultrasound probe 14 relative to the position and orientation of the body surface of the subject E. Consequently, the position and orientation of the ultrasound probe 14 relative to the subject E can be obtained, taking into account any variation in the position or orientation of the subject E.

[0042] The probe information acquisition unit 50 can detect the position and orientation of the ultrasound probe 14 by a method other than analyzing the recorded image 26. For example, a position and orientation sensor, such as a magnetic sensor, can be provided in the ultrasound probe 14, and the position and orientation of the ultrasound probe 14 can be detected based on a detection value from the position and orientation sensor.

[0043] The scanning plane, which is the plane in which the ultrasound beam is scanned by the ultrasound probe 14, is determined by the position and orientation of the ultrasound probe 14. Therefore, it can be said that the probe information acquired by the probe information acquisition unit 50 specifies a position and orientation of the scanning plane.

[0044] The volume data acquisition unit 52 acquires the volume data 46 based on the received signal obtained by transmitting and receiving ultrasound from the ultrasound probe 14 to the subject E. In the present embodiment, the volume data acquisition unit 52 generates the volume data 46 based on the received signals corresponding to several of the scanning planes acquired by the operator as he moves the ultrasound probe 14 in a direction perpendicular to the scanning plane.

[0045] Fig. Figure 4 is a conceptual diagram illustrating a concept for processing the imaging of volume data 46. In the present embodiment, the operator first transmits and receives ultrasound signals to and from the subject E while moving the ultrasound probe 14 in a direction perpendicular to the scanning plane. Here, it is assumed that a puncture target is located within the subject E, and that avoidance tissue surrounding the puncture target is contained within a movement path of the scanning plane. Consequently, the transmit / receive unit 30 acquires several of the received signals for the multiple scanning planes, arranged in the direction perpendicular to the scanning plane. Then, the image generation unit 34 constructs multiple ultrasound tomography images 46a corresponding to the multiple scanning planes based on the multiple received signals.At least some of the multiple ultrasound tomography images 46a contain an image of the puncture target or an image of the alternative tissue.

[0046] The probe information acquisition unit 50 detects the position and orientation of the ultrasound probe 14 in a case where each received signal corresponding to each ultrasound tomography image 46a is acquired, and assigns the probe information indicating the position and orientation of the ultrasound probe 14 detected by the probe information acquisition unit 50 to each ultrasound tomography image 46a. As described above, the probe information can specify the position and orientation of the ultrasound probe 14 relative to the subject E. Each position (coordinate) on the ultrasound tomography image 46a can be specified based on the position and orientation of the ultrasound probe 14 in a case where the received signal corresponding to the ultrasound tomography image 46a is acquired.This means that each ultrasound tomography image 46a contains position information specifying each position (coordinate) of the ultrasound tomography image 46a, based on the position and orientation of the ultrasound probe 14 in a case where the received signal corresponding to the ultrasound tomography image 46a is captured.

[0047] The volume data acquisition unit 52 generates the volume data 46 based on the multiple ultrasound tomography images 46a as the received signals. Since a known method can be used to generate the volume data 46 from the multiple ultrasound tomography images 46a, detailed descriptions of this method are omitted here. As described above, since the puncture target and the alternative tissue are contained within the motion path of the scanning plane, and the image of the puncture target or the image of the alternative tissue is contained in at least some of the multiple ultrasound tomography images 46a, the volume data 46 are data that contain the puncture target and the alternative tissue.Furthermore, as described above, since each ultrasound tomography image 46a contains coordinate information specifying each position of the ultrasound tomography image 46a based on the position and orientation of the ultrasound probe 14 in a case where the received signal corresponding to the ultrasound tomography image 46a is acquired, the volume data 46 constructed from the multiple ultrasound tomography images 46a also contain coordinate information specifying each position of the volume data 46 based on the position and orientation of the ultrasound probe 14 in a case where the received signal corresponding to each ultrasound tomography image 46a is acquired (referred to in the present description as a model coordinate system).

[0048] In the present embodiment, the volume data 46 consist of the multiple ultrasound tomography images 46a. However, in a case where a 2D array probe, in which the transducer elements are arranged two-dimensionally, is used as the ultrasound probe 14, the volume data acquisition unit 52 can directly generate the volume data 46, which includes the puncture target and the avoidance tissue, based on two-dimensional received signals from the ultrasound probe 14. Even in this case, the volume data 46 can be specified based on the position and orientation of the ultrasound probe 14. That is, even in this case, the volume data 46 have coordinate information that specifies each position of the volume data 46 in the model coordinate system.

[0049] The modeling unit 54 forms a subject model, which is a three-dimensional model, including a puncture target model, which is a three-dimensional model representing the puncture target, and a substitute tissue model, which is a three-dimensional model representing the substitute tissue, based on volume data 46.

[0050] Fig. Figure 5 is a concept diagram illustrating the concept of processing the formation of a subject model 70. Since a known procedure can be used as a method for forming the subject model 70 based on the volume data 46, detailed descriptions of it are omitted here, but the modeling unit 54 forms the subject model 70 using a technology such as volume rendering or surface rendering.

[0051] Fig. Figure 6 is a diagram showing an example of the participant model 70. In the example of Fig. 6. Subject model 70 is a model representing the liver of subject E and its periphery. Subject model 70 is configured to contain multiple tissue models. In the example of Fig. 6. The subject model 70 contains a liver model LV, a vein model VE, an artery model AR, a bile duct model BD, and a tumor model TM. In the present embodiment, since a tumor in the liver is the puncture target, the tumor model TM is the puncture target model, and since a vein, an artery, and a bile duct in the liver are the alternative tissues, the vein model VE, the artery model AR, and the bile duct model BD are the alternative tissue models. It should be noted that the subject model 70, which represents the periphery of the liver, also technically contains models of an inferior vena cava, a portal vein, vascular regions, and other tissues; however, these are omitted in Fig. 6 not shown.

[0052] Since the volume data 46 contain the positional information in the model coordinate system, and the subject model 70 is formed from the volume data 46, the subject model 70 also contains the positional information that specifies each position of the subject model 70 based on the position and orientation of the ultrasound probe 14 in a case where the received signals forming the volume data 46 are acquired (in the model coordinate system). Since the position of the ultrasound probe 14 in a case where the received signal is acquired represents a body surface position of the subject E, the body surface position of the subject E is also known in the subject model 70.

[0053] Fig. Figure 6 shows three axis directions (X-axis, Y-axis, and Z-axis) of the model coordinate system, which specifies the position of the subject model 70. In a case where the position and orientation of the ultrasound probe 14 are determined by analyzing the recorded image 26 captured by the camera 12, and the position and orientation of the camera 12 are fixed, the model coordinate system can be the same as the camera coordinate system of the camera 12. Furthermore, a relationship between the model coordinate system and the coordinate system for real space can be obtained through the calibration described above.

[0054] The puncture route specification unit 56 specifies a recommended puncture route, which is a route that the puncture cannula 18 should pass through in the subject model 70. Fig. Figure 7 is a diagram showing an example of a recommended puncture route 72. In particular, the puncture route specification unit 56 specifies a recommended puncture route 72 that extends from the body surface position of the subject E to the puncture target model (in the example of Fig. 7 the tumor model TM) extends, while they extend the alternative tissue models (in the example of Fig. 7 avoids the vein model VE, the artery model AR and the bile duct model BD).

[0055] In particular, the puncture route specification unit 56 searches for a straight line in the subject model 70 that extends from the puncture target model to the subject's body surface position E (the body surface position is not restricted to a single point) and that does not pass through the alternative tissue models. If such a straight line is found, the straight line is specified as a candidate for the recommended puncture route 72 (referred to in this description as a "candidate puncture route"). In particular, the puncture route specification unit 56 can specify the candidate puncture route such that a shortest distance between the candidate puncture route and the alternative tissue model is equal to or greater than a predetermined first threshold distance.This is intended to reduce the probability that the puncture cannula 18 will puncture the alternative tissue model in a case where the operator later actually performs a puncture along the recommended puncture route 72.

[0056] In a case where only one candidate puncture route is found, the puncture route specification unit 56 can specify the candidate puncture route as the recommended puncture route 72. However, typically several candidate puncture routes 72a to 72c are specified, as in Fig. Figure 7 shows that in this case, the puncture route specification unit 56 specifies the recommended puncture route 72 as the shortest candidate puncture route (for example, candidate puncture route 72a) among the several candidate puncture routes 72a to 72c. This is because, in a case where the operator actually performs puncture later along the recommended puncture route 72, a shorter puncture route is less likely to result in an unexpected event (such as operator error).

[0057] Furthermore, in a case where the target object is a tumor, the puncture cannula 18 can be an ablation cannula for tumor removal. The ablation cannula ablates the tumor by delivering a high-frequency radio wave current to the tumor from its tip. In this case, if there is tissue other than the tumor near the tip of the puncture cannula 18, the surrounding tissue may be affected during tumor ablation.Taking this into account, in a case where the puncture target is a tumor and the puncture cannula 18 is an ablation puncture cannula, the puncture route specification unit 56 can specify the recommended puncture route 72 such that an end part of the recommended puncture route 72 is located on one side of tumor model TM as the puncture target model at a distance of at least one predetermined second threshold distance from the other tissue model as tumor model TM.

[0058] The display control unit 36, acting as a notification processing unit, notifies the operator of the recommended puncture route 72 specified by the puncture route specification unit 56. In the present embodiment, the display control unit 36 ​​notifies the operator of the recommended puncture route 72 by a method described below.

[0059] First, the image generation unit 34 specifies a cross-section within the volume data 46 that contains the recommended puncture route 72 and is parallel to the recommended puncture route 72. As described above, since the volume data 46 and the subject model 70 have the positional information in the same model coordinate system, the image generation unit 34 can specify the cross-section containing the recommended puncture route 72 and that is parallel to the recommended puncture route 72 within the volume data 46, based on the recommended puncture route 72 specified in the subject model 70.

[0060] The image generation unit 34 extracts the volume data 46 in the specified cross-section and reconstructs it to form a reconstructed ultrasound image. The display control unit 36 ​​then displays a recommended puncture route image on the display 38, indicating the recommended puncture route 72 superimposed on the reconstructed ultrasound image. Consequently, the display control unit 36 ​​informs the operator of the recommended puncture route 72.

[0061] Fig. Figure 8 is a diagram showing a display example of a reconstructed ultrasound image 80 and a recommended puncture route image 82. In the example of Fig. The recommended puncture route image 82 is indicated by a dashed line.

[0062] A method of notification of the recommended puncture route 72 by the display control unit 36 ​​is not limited to the method described above. For example, the display control unit 36 ​​can notify the operator of the recommended puncture route 72 by displaying the three-dimensional subject model 70, in which the recommended puncture route 72 is shown, on the display 38.

[0063] As described above, according to the present embodiment, the puncture route specification unit 56 specifies the recommended puncture route 72, which extends from the body surface position of the subject E to the puncture target while avoiding the alternative tissue, and the operator is notified of the recommended puncture route 72. As a result, the operator can easily determine the puncture route for puncturing the puncture target while avoiding the alternative tissue.

[0064] As in Fig. As shown in Figure 8, the display control unit 36 ​​can display a real-time image 84, which is an ultrasound tomography image generated at the current position and orientation of the ultrasound probe 14, together with the reconstructed ultrasound image 80 and the recommended puncture route image 82. In a case where the puncture cannula 18 is inserted into the subject E and the puncture cannula 18 passes through the scanning plane of the ultrasound probe 14 (especially in a case where the puncture cannula 18 and the scanning plane are parallel to each other), an image of the puncture cannula 18 appears in the real-time image 84.Therefore, in a case where the operator views a cross-section of the real-time image 84 as being the same cross-section as that of the reconstructed ultrasound image 80, the operator can perform puncture along the recommended puncture route 72 while comparing the recommended puncture route image 82 on the reconstructed ultrasound image 80 with the image of the puncture cannula 18 appearing in the real-time image 84.

[0065] The specification unit 58 for recommended position and orientation specifies a recommended probe position and orientation that corresponds to the position and orientation of the ultrasound probe 14 for generating the real-time image 84 of the same cross-section as that of the reconstructed ultrasound image 80. As described above, the reconstructed ultrasound image 80 represents a cross-section that contains the recommended puncture route 72 and is parallel to the recommended puncture route 72 within the volume data 46. Therefore, the specification unit 58 for recommended position and orientation also initially specifies a cross-section that contains the recommended puncture route 72 and is parallel to the recommended puncture route 72 within the volume data 46, based on the recommended puncture route 72.Then, the body surface position contained in the specified cross-section is the position of the ultrasound probe 14 for generating the real-time image 84 of the same cross-section as that of the reconstructed ultrasound image 80 in the model coordinate system, and the orientation in which the specified cross-section is parallel to the scanning plane is the orientation of the ultrasound probe 14 for generating the real-time image 84 of the same cross-section as that of the reconstructed ultrasound image 80 in the model coordinate system. Furthermore, the specification unit 58 for recommended position and orientation converts the recommended probe position and orientation specified in the model coordinate system into a recommended probe position and orientation in real space based on the relationship between the model coordinate system and the real-space coordinate system.The recommended probe position and orientation obtained in this way corresponds to a position and orientation in which the scanning plane of the ultrasound probe 14 contains the recommended puncture route 72 (in real space) and is parallel to the recommended puncture route 72.

[0066] The display control unit 36, as the notification processing unit, notifies the operator of the recommended probe position and orientation specified by the recommended position and orientation specification unit 58.

[0067] Fig. Figure 9 is a first diagram showing a notification example of the recommended probe position and orientation. For example, it shows how in Fig. As shown in Figure 9, the display control unit 36 ​​displays a body marker 86, which indicates an outline of the subject E, on the display 38 and indicates the recommended probe position and orientation on the body marker 86 to notify the operator of the recommended probe position and orientation.

[0068] In addition, the probe information acquisition unit 50 can detect the current position and orientation of the ultrasound probe 14, and the display control unit 36 ​​can notify the operator of guidance information to transfer the position and orientation of the ultrasound probe 14 from the current position and orientation of the ultrasound probe 14 to the recommended probe position and orientation based on a difference between the current position and orientation of the ultrasound probe 14 and the recommended probe position and orientation.

[0069] Fig. Figure 10 is a second diagram showing the notification example of the recommended probe position and orientation. For example, as shown in Fig. As shown in Figure 10, the display control unit 36 ​​can display the body marker 86, which indicates the outline of the subject E, on the display 38 and can show the current position and orientation of the ultrasound probe 14 and the recommended probe position and orientation as guidance information on the body marker 86. Such guidance information can be a moving image showing the transition from the current position and orientation of the ultrasound probe 14 to the recommended probe position and orientation.

[0070] The notification aspect of the recommended probe position and orientation is not limited to the above.

[0071] The operator adjusts the position and orientation of the ultrasound probe 14 so that the cross-sections of the reconstructed ultrasound image 80 and the real-time image 84 are the same based on the recommended probe position and orientation that was communicated.

[0072] The consistency index calculation unit 60 calculates a consistency index, which is an index indicating a degree of agreement between the reconstructed ultrasound image 80 and the real-time image 84. In the present embodiment, the consistency index calculation unit 60 calculates the consistency index by comprehensively evaluating a similarity between the reconstructed ultrasound image 80 and the real-time image 84, a difference between the position specified by the recommended probe position and orientation and the actual position of the ultrasound probe 14, and a difference between the orientation specified by the recommended probe position and orientation and the actual orientation of the ultrasound probe 14. For example, the consistency index calculation unit 60 calculates the consistency index according to Equation 1. (Consistency index) = (Similarity between reconstructed ultrasound image 80 and real-time image 84) × α1 + (Difference between position specified by recommended probe position and orientation and current position of ultrasound probe 14) × α2 + (Difference between orientation specified by recommended probe position and orientation and current orientation of ultrasound probe 14) × α3

[0073] In equation 1, α1, α2 and α3 are coefficients (weights) and can be appropriately set in advance.

[0074] The display control unit 36, as the notification processing unit, notifies the operator of the consistency index calculated by the consistency index calculation unit 60.

[0075] For example, it shows how in Fig. As shown in Figure 10, the display control unit 36 ​​displays a consistency index image 88, representing the calculated consistency index, on the display 38 together with the reconstructed ultrasound image 80 and the real-time image 84. It should be noted that the notification method for the consistency index is not limited to this. For example, an audio output unit, acting as the notification processing unit, can notify the operator of the consistency index by voice.

[0076] Fig. Figure 11 is a diagram showing a display example of the real-time image 84, which has the same cross-section as that of the reconstructed ultrasound image 80. The operator can bring the cross-section of the real-time image 84 closer to the cross-section of the reconstructed ultrasound image 80 by appropriately adjusting the position and orientation of the ultrasound probe 14. In the example of Fig. 11. The consistency index reaches a fairly high value of 95%. The display control unit 36 ​​can notify the operator that the consistency index is equal to or greater than a predetermined index threshold. For example, if the consistency index is equal to or greater than the predetermined index threshold, the display control unit 36 ​​can notify the operator by highlighting the consistency index image 88.

[0077] In a case where the real-time image 84 of the same cross-section as that of the reconstructed ultrasound image 80 can be visualized, the operator begins the puncture of the target object, referring to the recommended puncture route 72 and the real-time image 84. Here, the ultrasound diagnostic device 16, according to the present embodiment, assists in performing a puncture along the recommended puncture route 72.

[0078] The puncture cannula information acquisition unit 62 acquires puncture cannula information that specifies the current position and orientation of the puncture cannula 18 in the model coordinate system.

[0079] In the present embodiment, the puncture cannula information acquisition unit 62 acquires the puncture cannula information by analyzing the recorded image 26 (see Fig. 2), which is captured by the camera 12 to detect the position and orientation of the puncture cannula 18. As described above, the captured image 26 contains the image of the puncture cannula detection marker 22 for detecting the position and orientation of the puncture cannula 18. The puncture cannula information acquisition unit 62 acquires the puncture cannula information by analyzing the image of the puncture cannula detection marker 22 in the captured image 26. The puncture cannula information includes position information, which specifies the position of the puncture cannula 18, and orientation information, which specifies the orientation of the puncture cannula 18.

[0080] The positional information can, for example, be three-dimensional coordinates in a camera coordinate system. The position of the puncture cannula 18 is determined by detecting the position of the base of the cannula 18 (that is, a section not yet inserted into the subject E). However, since the shape (for example, length) of the cannula 18 is known, the position of the section (for example, the tip of the cannula 18) inserted into the subject E can be detected based on the positional information and the shape of the cannula 18.

[0081] Furthermore, the orientation information can be a rotation angle relative to a predetermined axis (for example, the X-axis, the Y-axis, or the Z-axis) in the camera coordinate system. In other words, the orientation of the puncture cannula 18 is a direction of extension of the puncture cannula 18.

[0082] Since a known method can be used as a method of detecting the position and orientation of the puncture cannula 18 in the camera coordinate system from the image of the puncture cannula detection marker 22 contained in the recorded image 26, detailed descriptions of it are omitted.

[0083] The puncture cannula information acquisition unit 62 can perform calibration prior to detecting the position and orientation of the puncture cannula 18 based on the captured image 26. Specifically, the operator sets the position and orientation of the puncture cannula 18 to a predetermined position and orientation and, in this state, inputs a calibration instruction to the ultrasound diagnostic device 16. In this case, the puncture cannula information acquisition unit 62 detects the position and orientation of the puncture cannula 18 based on the puncture cannula detection marker 22 contained in the captured image 26 and sets the position and orientation as a reference position and orientation.As a result, it is possible to obtain a relationship between the information (for example, the position and orientation in the camera coordinate system) that specifies the position and orientation of the puncture cannula 18 detected by the puncture cannula information acquisition unit 62, and the coordinate system for real space.

[0084] As described above, the recorded image 26 also contains the image of the body surface detection marker 24 for detecting the position and orientation of the body surface of the subject E (see Fig. 2) The puncture cannula information acquisition unit 62 can detect the position and orientation of the subject's body surface E by analyzing the image of the body surface detection marker 24 in the captured image 26. Furthermore, the puncture cannula information acquisition unit 62 can detect the position and orientation of the puncture cannula 18 relative to the position and orientation of the subject's body surface E. Consequently, the position and orientation of the puncture cannula 18 relative to the subject E can be maintained, even if any variation in the subject's position or orientation is observed.

[0085] The puncture cannula information acquisition unit 62 can detect the position and orientation of the puncture cannula 18 by a method other than analyzing the captured image 26. For example, a position and orientation sensor, such as a magnetic sensor, can be provided in the puncture cannula 18, and the position and orientation of the puncture cannula 18 can be detected based on a detection value from the position and orientation sensor.

[0086] The puncture cannula information acquisition unit 62 converts the puncture cannula information in the real space coordinate system (or the camera coordinate system) into the puncture cannula information in the model coordinate system based on the relationship between the real space coordinate system and the model coordinate system.

[0087] The puncture cannula deviation determination unit 64 determines that the puncture cannula 18 has deviated from the recommended puncture route 72 in a case where a distance between the puncture cannula 18 at the current position and the recommended puncture route 72 in the model coordinate system is equal to or greater than a predetermined distance threshold, based on the puncture cannula information acquired by the puncture cannula information acquisition unit 62.

[0088] Fig. Figure 12 is a diagram showing the actual puncture cannula 18 and the recommended puncture route 72 in the model coordinate system. Since both the puncture cannula 18 and the recommended puncture route 72 have an extending shape, the puncture cannula deviation determination unit 64 can, for example, determine a maximum distance between the puncture cannula 18 and the recommended puncture route 72 (in the example of Fig. 12, a length of a vertical line drawn from a tip 18a of the puncture cannula 18 to the recommended puncture route 72) as the distance between the current position of the puncture cannula 18 and the recommended puncture route 72.

[0089] Furthermore, in a case where there is a difference between an angle θ (see Fig. 12) if the angle between the current orientation (extension direction) of the puncture cannula 18 and the extension direction of the recommended puncture route 72 is equal to or greater than a predetermined angle limit, the puncture cannula deviation determination unit 64 indicates that the puncture cannula 18 has deviated from the recommended puncture route 72.

[0090] In the present embodiment, the puncture cannula deviation determination unit 64 calculates the distance between the puncture cannula 18 at the current position and the recommended puncture route 72 or the difference in angle from the extension direction in the model coordinate system, but the puncture cannula deviation determination unit 64 can perform the calculation in the coordinate system for real space.

[0091] Furthermore, as in Fig. Figure 11 shows that in a case where the cross-section of the real-time image 84 and the cross-section of the reconstructed ultrasound image 80 are the same cross-section, the puncture cannula deviation determination unit 64 determines, taking into account the comparison result between an image 90 of the puncture cannula 18 contained in the real-time image 84 and the recommended puncture route image 82 of the recommended puncture route 72, that the puncture cannula 18 has deviated.

[0092] The display control unit 36, as the notification processing unit, notifies the operator in a case where the puncture cannula deviation determination unit 64 determines that the puncture cannula 18 has deviated from the recommended puncture route 72.

[0093] Fig. Figure 13 is a diagram showing an example of notification that the puncture cannula 18 has deviated from the recommended puncture route 72. In a case where it is determined that the puncture cannula 18 has deviated from the recommended puncture route 72, the display control unit 36 ​​notifies the operator that the puncture cannula 18 has deviated from the recommended puncture route 72 by, for example, displaying a symbol 92a, as shown in Figure 13. Fig. The display control unit 36 ​​can change the symbol 92a displayed according to the amount of deviation of the puncture cannula 18 from the recommended puncture route 72. For example, the display control unit 36 ​​can display a Δ mark as symbol 92a in a case where the puncture cannula 18 has deviated from the recommended puncture route 72, but the amount of deviation is relatively small, and can display an × mark as symbol 92a in a case where the amount of deviation is relatively large.

[0094] Fig. Figure 14 is a diagram showing an example of notification that the puncture cannula 18 has not deviated. Even in a case where the puncture cannula 18 has not deviated from the recommended puncture route 72, the display control unit 36 ​​can notify the operator that the puncture cannula 18 has not deviated from the recommended puncture route 72, for example by displaying a message that differs from the one shown in Figure 14. Fig. The symbol shown in 14, 92a, indicates a different symbol, 92b.

[0095] Although the puncture support device according to the present disclosure has been described above, the puncture support device according to the present disclosure is not limited to the embodiment described above, and various modifications can be made without deviating from its core.

[0096] For example, in each of the embodiments described above, the puncture support device is the ultrasound diagnostic device 16, and each of the functions of the image generation unit 34, the display control unit 36, the probe information acquisition unit 50, the volume data acquisition unit 52, the modeling unit 54, the puncture route specification unit 56, the recommended position and orientation specification unit 58, the consistency index calculation unit 60, the puncture cannula information acquisition unit 62, and the puncture cannula deviation determination unit 64 is included in the ultrasound diagnostic device 16. However, it is not absolutely necessary for each of these functions to be demonstrated by the ultrasound diagnostic device 16. For example, these functions can be provided by a server computer or the like that is communicatively connected to the ultrasound diagnostic device 16.Furthermore, it is possible that not all of the functions described above are provided by a single device, and the functions described above can be provided through the cooperation of several devices. Reference symbol list 10 Puncture support system 12 Camera 14 ultrasound probe 16 Ultrasound diagnostic device 18 puncture cannula 20 Probe detection marking 22 Puncture needle detection markings 24 Body surface detection marking 26 recorded images 30 Transmitting / Receiving Unit 32 Signal processing unit 34 Image generation unit 36 Display control unit 38 ads 40 Communication interface 42 Input interface 44 storage 46 volume data 48 Control 50 probe information acquisition unit 52 Volume data acquisition unit 54 Model building unit 56 Puncture Route Specification Unit 58 Specification unit for recommended position and orientation 60 Consistency index calculation unit 62 Puncture cannula information acquisition unit 64 Puncture cannula deviation determination unit 70 test subject model 72 recommended puncture routes 80 reconstructed ultrasound image 82 Image of recommended puncture route 84 Real-time image 86 Body marking 88 Consistency index image 90 images 92a, 92b Symbol QUOTES INCLUDED IN THE DESCRIPTION

[0000] This list of documents cited by the applicant was automatically generated and is included solely for the reader's convenience. The list is not part of the German patent or utility model application. The DPMA accepts no liability for any errors or omissions. Cited patent literature

[0000] JP 1998-005223A

[0004] JP-H10-005223A

[0004]

Claims

[1] Puncture support device comprising: a probe information acquisition unit that acquires probe information specifying the position and orientation of an ultrasound probe; a volume data acquisition unit that acquires volume data based on a received signal obtained by transmitting and receiving ultrasound from the ultrasound probe to a subject under examination; a modeling unit comprising a subject model, a puncture target model (a three-dimensional model representing a puncture target), and an avoidance tissue model (a three-dimensional model representing avoidance tissue to be avoided by a puncture cannula while the puncture target is being punctured), based on volume data, wherein the subject model includes position information specifying each position of the subject model based on the position and orientation of the ultrasound probe in a case where the received signal is acquired; a puncture route specification unit that specifies a recommended puncture route, which is a route extending from a body surface position of the subject to the puncture target model while avoiding the alternative tissue model in the subject model, and through which the puncture cannula should be passed; and a notification processing unit that notifies an operator of the recommended puncture route. [2] Puncture support device according to claim 1, wherein the puncture route specification unit specifies the recommended puncture route such that a shortest distance between the recommended puncture route and the alternative tissue model is equal to or greater than a first threshold distance. [3] Puncture support device according to claim 1 or 2, wherein in a case where the puncture route specification unit specifies several candidate puncture routes extending from the body surface position of the subject to the puncture target model while avoiding the alternative tissue model, the puncture route specification unit specifies as the recommended puncture route a candidate puncture route with the shortest length among the several candidate puncture routes. [4] Puncture support device according to any one of claims 1 to 3, where the target object for the puncture is a tumor, The puncture cannula is an ablation puncture cannula used to remove the tumor, and The puncture route specification unit specifies the recommended puncture route such that one end portion of the recommended puncture route is located on one side of a tumor model as the puncture target model at a distance of at least one threshold distance from any tissue model other than a tumor model. [5] Puncture support device according to any one of claims 1 to 4, further comprising: a specification unit for recommended position and orientation which, based on the recommended puncture route, specifies a recommended probe position and orientation corresponding to the position and orientation of the ultrasound probe, such that a scanning plane of the ultrasound probe contains the recommended puncture route and is parallel to the recommended puncture route. the notification processing unit informs the operator of the recommended probe position and orientation. [6] Puncture support device according to claim 5, wherein the notification processing unit notifies the operator of guidance information to transfer the position and orientation of the ultrasound probe from a current position and orientation of the ultrasound probe to the recommended probe position and orientation based on a difference between the current position and orientation of the ultrasound probe and the recommended probe position and orientation. [7] Puncture support device according to claim 6, further comprising: a consistency index calculation unit that calculates a consistency index which is an index indicating a degree of agreement between a reconstructed ultrasound image cut from the subject model in a cross-section containing the recommended puncture route and parallel to the recommended puncture route, and a real-time image which is an ultrasound tomography image generated at the current position and orientation of the ultrasound probe, the notification processing unit notifies the operator about the consistency index. [8] Puncture support device according to any one of claims 1 to 7, further comprising: a puncture cannula information acquisition unit that acquires puncture cannula information indicating the current position and orientation of the puncture cannula; and a puncture cannula deviation determination unit that determines that the puncture cannula has deviated from the recommended puncture route in a case where a distance between the puncture cannula at its current position and the recommended puncture route becomes equal to or greater than a distance threshold, or in a case where an angular difference between a current extension direction of the puncture cannula and an extension direction of the recommended puncture route becomes equal to or greater than an angular threshold. wherein the notification processing unit notifies the operator in a case where it is determined that the puncture cannula has deviated from the recommended puncture route. [9] Puncture support device according to one of claims 1 to 8, wherein the probe information acquisition unit detects a position and orientation of the ultrasound probe relative to a body surface of the subject on the basis of a captured image, which is captured by imaging a probe detection marker attached to the ultrasound probe and a body surface detection marker attached to the body surface of the subject via a camera. [10] Puncture support device according to claim 8, wherein the probe information acquisition unit detects a position and orientation of the ultrasound probe relative to a body surface of the subject based on a captured image obtained by imaging a probe detection marker attached to the ultrasound probe and a body surface detection marker attached to the subject's body surface via a camera, and The puncture cannula information acquisition unit detects the position and orientation of the puncture cannula relative to the body surface of the subject based on a captured image obtained by imaging a puncture cannula detection marker attached to the puncture cannula and the body surface detection marker via the camera. [11] Puncture support program that causes a computer to act as: a probe information acquisition unit that acquires probe information specifying the position and orientation of an ultrasound probe; a volume data acquisition unit that acquires volume data based on a received signal obtained by transmitting and receiving ultrasound from the ultrasound probe to a subject under examination; a modeling unit comprising a subject model, a puncture target model (a three-dimensional model representing a puncture target), and an avoidance tissue model (a three-dimensional model representing avoidance tissue to be avoided by a puncture cannula while the puncture target is being punctured), based on volume data, wherein the subject model includes positional information specifying each position of the subject model based on the position and orientation of the ultrasound probe in a case where the received signal is acquired; and a puncture route specification unit that specifies a recommended puncture route, which is a route extending from a body surface position of the subject to the puncture target model while avoiding the alternative tissue model in the subject model, and through which the puncture cannula should be passed.

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