X-ray diagnostic apparatus, medical image processing apparatus, and control method for an X-ray diagnostic apparatus

Abstract

It accurately recognizes areas of interest on the subject, including regions containing medical devices. [Solution] An X-ray diagnostic apparatus according to one embodiment comprises an X-ray tube, an X-ray diaphragm, an X-ray detector, a recognition unit, and an output control unit. The X-ray tube generates X-rays. The X-ray diaphragm forms an aperture in which the transmission of X-rays is higher than in other areas by means of at least one of a diaphragm vane that shields the X-rays and an X-ray filter that attenuates the X-rays. The X-ray detector detects the X-rays that have passed through the subject. The recognition unit recognizes at least one of the subject's area of ​​interest and a medical device inserted into the subject by image recognition based on the detection signal detected in the detection area of ​​the X-ray detector corresponding to the area of ​​the aperture. The output control unit causes the recognition result recognized by the recognition unit to be output to the output unit.

Description

[Technical Field]

[0001] The embodiments disclosed in the present specification and drawings relate to an X-ray diagnostic apparatus, a medical image processing apparatus, and a control method for an X-ray diagnostic apparatus. [Background Art]

[0002] In an X-ray diagnostic apparatus such as an X-ray angiography apparatus, an X-ray generated from an X-ray tube is irradiated onto a subject (e.g., a patient), and X-rays transmitted through the subject are detected by an X-ray detector, thereby acquiring an X-ray image of the subject.

[0003] X-rays generated by the X-ray tube pass through a component called an X-ray collimator before being irradiated onto the subject. Inside the X-ray collimator, an X-ray aperture that forms an aperture opening allowing X-ray transmission by aperture blades that block X-rays is disposed. Further, inside the X-ray collimator, an X-ray filter that forms a filter opening allowing X-ray transmission by a filter that attenuates X-rays in regions other than the region of interest (ROI) is also disposed as needed. The X-ray filter is sometimes called an ROI filter.

[0004] The X-ray aperture almost completely blocks X-rays in regions other than the aperture opening. In contrast, the X-ray filter allows X-rays attenuated by a predetermined amount to pass through even in regions other than the filter opening.

[0005] A treatment method called IVR (Interventional Radiology) is widely performed using an X-ray diagnostic apparatus such as an X-ray angiography apparatus. In Japanese, IVR is translated as "image-guided therapy", and literally, while viewing the inside of the body through the use of an X-ray diagnostic apparatus, a thin medical device is inserted into a blood vessel to diagnose and treat a target disease. Examples of medical devices inserted into blood vessels include thin tubes called catheters, balloons and stents attached to the distal end of catheters for dilating stenotic sites in blood vessels, and coils for filling aneurysms and the like.

[0006] In interventional radiology (IVR), it is extremely important to continuously observe the area of ​​interest (i.e., the anatomical site to be treated or examined, such as narrowed or aneurysmal areas of blood vessels) and medical devices such as stents and coils with high precision.

[0007] On the other hand, areas other than the area of ​​interest or medical devices do not necessarily need to be observed with high precision at all times. In fact, from the viewpoint of reducing X-ray exposure to the subject, it may be preferable to shield or attenuate X-rays from these areas. The aforementioned X-ray diaphragms and X-ray filters are provided for the purpose of reducing X-ray exposure to the subject.

[0008] Therefore, if the aperture of the X-ray diaphragm and the filter aperture of the X-ray filter can be precisely matched to the area of ​​interest on the subject and the size and position of the medical device, X-ray exposure to the subject can be effectively reduced without hindering the efficiency of treatment in interventional radiology (IVR). To achieve this, it is first necessary to accurately recognize the area of ​​interest. [Prior art documents] [Patent Documents]

[0009] [Patent Document 1] Japanese Patent Publication No. 2007-143982 [Overview of the project] [Problems that the invention aims to solve]

[0010] One of the problems that the embodiments disclosed herein and in the drawings aim to solve is to accurately recognize areas of interest on a subject or areas including medical devices. However, the problems that the embodiments disclosed herein and in the drawings aim to solve are not limited to the above problem. Problems corresponding to the effects of each configuration shown in the embodiments described later can also be positioned as other problems. [Means for solving the problem]

[0011] One embodiment of the X-ray diagnostic apparatus comprises an X-ray tube, an X-ray diaphragm, an X-ray detector, a recognition unit, and an output control unit. The X-ray tube generates X-rays. The X-ray diaphragm forms an aperture in which the transmission of X-rays is higher than in other areas, by means of at least one of aperture blades that shield the X-rays and an X-ray filter that attenuates the X-rays. The X-ray detector detects the X-rays that have passed through the subject. The recognition unit recognizes at least one of the subject's area of ​​interest and a medical device inserted into the subject by image recognition, based on the detection signal detected in the detection area of ​​the X-ray detector corresponding to the area of ​​the aperture. The output control unit causes the recognition result recognized by the recognition unit to be output to the output unit. [Brief explanation of the drawing]

[0012] [Figure 1] A diagram showing an example configuration of an X-ray diagnostic apparatus according to the first embodiment. [Figure 2] A functional block diagram showing specific configuration examples of the X-ray irradiation device and X-ray detection device in the X-ray diagnostic apparatus of the first embodiment, as well as configuration examples related to the control of the X-ray irradiation device. [Figure 3] (a) is a schematic diagram showing an example of the configuration of aperture blades and the aperture opening formed by the aperture blades; (b) is a diagram showing the relationship between the aperture opening and the detection area corresponding to the aperture opening; (c) is a schematic diagram showing an example of the configuration of an X-ray filter and the filter opening formed by the filter plate; (d) is a diagram showing the relationship between the filter opening and the detection area corresponding to the filter opening. [Figure 4] A flowchart illustrating an example of operation in the X-ray diagnostic apparatus of the first embodiment. [Figure 5] An explanatory diagram of the operation of the X-ray diagnostic apparatus according to the first embodiment. [Figure 6] A flowchart illustrating an example of operation in the X-ray diagnostic apparatus of the second embodiment. [Figure 7] An explanatory diagram of the operation of the X-ray diagnostic apparatus according to the second embodiment. [Figure 8] A flowchart illustrating an example of operation in the X-ray diagnostic apparatus of the third embodiment. [Figure 9]Operation explanatory diagram of the X-ray diagnostic apparatus according to the third embodiment. [Figure 10] Flowchart illustrating an example of operation in the X-ray diagnostic apparatus according to the fourth embodiment. [Figure 11] Operation explanatory diagram of the X-ray diagnostic apparatus according to the fourth embodiment. [Figure 12] Flowchart illustrating an example of operation in the X-ray diagnostic apparatus according to the fifth embodiment. [Figure 13] Operation explanatory diagram of the X-ray diagnostic apparatus according to the fifth embodiment. MODE FOR CARRYING OUT THE INVENTION

[0013] Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings.

[0014] (First Embodiment) Figure 1 is a diagram showing a configuration example of an X-ray diagnostic apparatus 1 according to the first embodiment. As shown in Figure 1, the X-ray diagnostic apparatus 1 includes an imaging apparatus 100 and a medical image processing apparatus 110.

[0015] As shown in Figure 1, the imaging apparatus 100 is generally configured of a gantry device 2, a couch 3, and a controller 4. The gantry device 2, the couch 3, and the controller 4 are generally installed in a procedure room (examination and treatment room), while the medical image processing apparatus 110 is installed, for example, in a control room adjacent to the procedure room.

[0016] The gantry device 2 includes an X-ray irradiation device 21, an X-ray detection device 22, a C-arm driving mechanism 23, and a C-arm 24.

[0017] The X-ray irradiation device 21 is provided at one end of the C-arm 24. The X-ray irradiation device 21 is provided so as to be movable back and forth under the control of the controller 4. A detailed configuration of the X-ray irradiation device 21 will be described later.

[0018] The X-ray detection device 22 is mounted at the other end of the C-arm 24, facing the X-ray irradiation device 21. The X-ray detection device 22 is mounted so that it can move back and forth under the control of the controller 4. The X-ray detection device 22 includes, for example, an X-ray detector 221 composed of an FPD (Flat Panel Detector) and an ADC (Analog to Digital Converter) 222 (see Figure 2).

[0019] The X-ray detector 221 has multiple detection elements arranged in two dimensions. The detection elements of the X-ray detector 221 are arranged so that the scan lines and signal lines are orthogonal to each other. A grid may be provided in front of the X-ray detector 221. The grid is made of grid plates formed from materials that absorb X-rays well, such as lead, and materials that transmit X-rays well, such as aluminum or wood, arranged alternately to absorb scattered radiation incident on the X-ray detector 221 and improve the contrast of the X-ray image.

[0020] The ADC222 converts the projection data of the time-series analog signal (video signal) output from the X-ray detector 221 into a digital signal and outputs it to the medical image processing device 110.

[0021] The X-ray detection device 22 may also be an Image Intensifier (II)-TV system. In an II-TV system, X-rays transmitted through the subject and directly incident X-rays are converted into visible light, and the brightness is doubled during the photo-electron-photo conversion process to form highly sensitive projection data, and the optical projection data is converted into an electrical signal using a Charge Coupled Device (CCD) image sensor.

[0022] The C-arm 24 positions the X-ray irradiation device 21 and the X-ray detection device 22 opposite each other with respect to the patient. Under the control of the controller 4, the C-arm drive mechanism 23 moves the X-ray irradiation device 21 and the X-ray detection device 22 together in an arc direction of the C-arm 24. In Figure 1, the X-ray diagnostic device 1 is described using a configuration in which the C-arm 24 is equipped with a C-arm 24 and the C-arm 24 operates the X-ray irradiation device 21 and the X-ray detection device 22 together, but the device is not limited to this case. For example, the X-ray diagnostic device 1 may not be equipped with a C-arm 24, and the X-ray irradiation device 21 and the X-ray detection device 22 may be operated independently.

[0023] Figure 1 shows an example configuration of a single-plane type X-ray diagnostic device 1 having only one C-arm, but the X-ray diagnostic device 1 may also be a biplane type X-ray diagnostic device 1 that allows simultaneous fluoroscopy from two directions using two arms.

[0024] The bed 3 is supported by the floor and supports the tabletop (catheter table) 31. The bed 3 can be controlled by the controller 4 to slide (in the X and Z axis directions), move up and down (in the Y axis direction), and roll the tabletop 31. In Figure 1, the case where the X-ray irradiation device 21 is an under-tube type located below the tabletop 31 is explained, but it may also be an over-tube type where the X-ray irradiation device 21 is located above the tabletop 31.

[0025] Controller 4 includes a CPU (Central Processing unit) and memory (not shown). Controller 4 controls the driving of the X-ray irradiation device 21, X-ray detection device 22, and C-arm 24 of the pedestal device 2, as well as the driving of the patient bed 3, in accordance with the control of the medical image processing device 110. Controller 4 also controls the operation of the X-ray irradiation device 21, X-ray detection device 22, and C-arm drive mechanism 23, etc., for surgical X-ray imaging and X-ray fluoroscopy, in accordance with the control of the image processing device 5.

[0026] Figure 1 also illustrates the medical device 60 and device operating unit 61 used in the procedure. In this specification, the term "medical device 60" mainly refers to thin medical instruments inserted into tubular tissues such as blood vessels to diagnose or treat a subject. Examples of medical devices inserted into blood vessels include thin tubes called catheters, balloons or stents attached to the tip of catheters, guidewires for guiding catheters to diagnostic or treatment sites within blood vessels, and coils for treating aneurysms.

[0027] The device operation unit 61 is a device used by a physician or other technician to manually insert a medical device 60, such as a guidewire or catheter, into a blood vessel and to advance the medical device 60 to a predetermined target site.

[0028] The medical image processing device 110 is configured based on a computer such as a workstation or personal computer. The medical image processing device 110 includes a display 10, a memory circuit 20, a user interface 30, and a processing circuit 40.

[0029] Display 10 displays X-ray fluoroscopic images generated by the image generation function F10 of the processing circuit 40, as well as various support images and information generated by the processing circuit 40 to assist in the procedure. Display 50 is a large display device positioned in a location easily visible to the surgeon during the procedure. Display 50 also displays various support images and information, in addition to X-ray fluoroscopic images (video) and X-ray radiographic images (still images). X-ray fluoroscopic images and X-ray radiographic images are examples of X-ray images.

[0030] The memory circuit 20 is composed of semiconductor memory elements such as RAM (Random Access Memory) and flash memory, as well as a hard disk, optical disc, etc. The memory circuit 20 stores various processing programs used in the processing circuit 40 (including application programs as well as the OS (Operating System)), and data necessary for program execution.

[0031] The user interface 30 includes an input device that can be operated by the operator and an input circuit that receives signals from the input device. The input device can be a mouse, keyboard, trackball, switch, button, joystick, touchpad that allows input by touching the operating surface, touchscreen that integrates a display screen and a touchpad, a non-contact input circuit using an optical sensor, an audio input circuit, etc. When the input device receives an input operation from the operator, the input circuit generates an electrical signal corresponding to the input operation and outputs it to the processing circuit 40.

[0032] The processing circuit 40 has a dedicated or general-purpose processor and implements various functions described later through software processing by executing a program stored in the memory circuit 20. The processing circuit 40 may also be configured with hardware such as an ASIC (Application Specific Integration Circuit) or a programmable logic device such as an FPGA (Field Programmable Gate Array). Various functions described later can also be implemented through hardware processing using these devices. Furthermore, the processing circuit 40 may implement various functions described later by combining software processing and hardware processing.

[0033] The processing circuit 40 implements the control function F30, output control function F40, and image processing function F50, which are higher-level functions of the image generation function F10, image recognition function F20, filter control function F301, and aperture control function F302.

[0034] The image generation function F10 generates X-ray fluoroscopic images as video and still X-ray radiographic images from X-ray detection signals acquired in real time from the X-ray detection device 22 during procedures using medical devices 60 such as Tetel.

[0035] The image recognition function F20 uses machine learning and pattern matching techniques to perform image recognition on X-ray fluoroscopic images generated by the image generation function F10, identifying at least one of the subject's area of ​​interest and any medical devices inserted within the subject.

[0036] The filter control function F301 and aperture control function F302 within the control function F30 control the aperture of the X-ray diaphragm 200 (see Figure 2) located in the X-ray irradiation device 21, respectively, based on the image-recognized area of ​​interest of the subject and at least one of the medical devices inserted into the subject.

[0037] The output control function F40 outputs various data to the display 10, which acts as an output unit. The image processing function F50 performs image processing on a region that includes at least one of the recognized area of ​​interest and the medical device, based on the results of image recognition. This image processing includes segmentation processing, image processing with a processing time exceeding a threshold, and image processing with a number of processing steps exceeding a threshold. Furthermore, this image processing may involve transferring image data to an image processing server connected via a network and receiving the processing results from the image processing server. In addition, this image processing may be AI (Artificial Intelligence) processing, or it may be processing to determine, for example, the state in which the coil is inserted into the tumor site.

[0038] The specific operation of the image recognition function F20 and the control function F30 will be described later. Prior to describing the specific operation of the image recognition function F20 and the control function F30 in the X-ray diagnostic apparatus 1 of the first embodiment, the configuration of the X-ray diaphragm device 200 provided in the X-ray diagnostic apparatus 1, and the relationship between the aperture (the area through which X-rays are transmitted, or the area where the transmittance of X-rays is higher than in other parts) and the detection area of ​​the X-ray detector in the X-ray diaphragm device 200 will be described.

[0039] Figure 2 is a functional block diagram showing specific configuration examples of the X-ray irradiation device 21 and X-ray detection device 22 in the X-ray diagnostic apparatus 1 of the first embodiment, as well as configuration examples related to the control of the X-ray irradiation device 21.

[0040] As shown in Figure 2, the X-ray irradiation device 21 includes an X-ray diaphragm 200 and an X-ray tube 500. The X-ray tube 500 generates X-rays by receiving a high voltage from a high-voltage device (not shown). The X-rays generated in the X-ray tube 500 pass from the X-ray focal point F through the aperture blades 400 of the X-ray diaphragm 200 and at least one of the apertures of the X-ray filter 300, and then pass through the subject P before being detected by the X-ray detector 221.

[0041] As mentioned above, the X-ray detector 221 is configured, for example, as an FPD (Flat Panel Detector). The detection signals, which are analog signals detected by each detection element of the FPD, are converted into digital detection signals by the ADC (Automatic Diode) 222. Based on these detection signals, an X-ray fluoroscopic image or X-ray radiographic image is generated by the image generation function F10 of the processing circuit 40 in the medical image processing device 110.

[0042] Figure 3(a) schematically shows an example of the configuration of the aperture blades 400 of the X-ray diaphragm device 200 and the aperture opening 420 formed by the aperture blades 400. The aperture blades 400 are made of a plate member that shields X-rays, for example, a lead plate. The aperture blades 400 are composed of, for example, four shielding blades 410, and each shielding blade 410 is driven independently in the opening and closing directions, as shown by the black arrows in Figure 3(a). By driving the four shielding blades 410 independently, the size, shape (aspect ratio of the rectangle), and position of the aperture opening 420 can be changed arbitrarily.

[0043] As shown in Figure 2, the size, shape, and position of the aperture opening 420 can be set or changed by independently driving each of the shielding blades 410 of the aperture opening 420 by the aperture blade drive device 401 in accordance with the control of the aperture control function F302.

[0044] X-rays that pass through the aperture 420 and then through the subject P are detected in the detection region 410A, which corresponds to the aperture 420, within the entire area of ​​the X-ray detector 221, as shown in Figure 3(b). In the detection region 410A, either the area of ​​interest of the subject or the medical device is visualized.

[0045] As mentioned earlier, the site of interest refers to an anatomical area that is the target of treatment or examination, such as a narrowed blood vessel or an aneurysm. Medical devices are devices used to treat or examine diseased areas of blood vessels, and include thin tubes called catheters, balloons or stents attached to the tip of the catheter, guidewires to guide the catheter to the diagnostic or treatment site within the blood vessel, and coils used to treat aneurysms.

[0046] On the other hand, Figure 3(c) schematically shows an example of the configuration of an X-ray filter 300 provided by the X-ray diaphragm 200 and the filter aperture 320 formed by the X-ray filter 300. The X-ray filter 300 is made of a plate member that transmits X-rays while attenuating them, for example, a plate member made of copper or aluminum. The X-ray filter 300 is composed of, for example, one filter plate 310, and the filter plate 310 is driven in a direction perpendicular to the plane of the paper in Figure 3(c) (i.e., in the depth direction). By driving one filter plate 310, the position of the filter aperture 320 can be changed arbitrarily.

[0047] As shown in Figure 2, the position of the filter aperture 320 can be set or changed by driving the filter plate 310 of the X-ray filter 300 with the X-ray filter drive device 301 according to the control of the filter control function F301.

[0048] The X-ray diaphragm device 200 can be configured with only aperture blades 400 without an X-ray filter 300, or, as shown in Figure 2, it can be configured with an X-ray filter 300 in addition to the aperture blades 400. When both aperture blades 400 and an X-ray filter 300 are provided in the X-ray diaphragm device 200, the size and position of the filter aperture 320 are usually controlled so that the detection area 320A corresponding to the filter aperture 320 is located inside the detection area 420A corresponding to the aperture aperture 420, as shown in Figure 3(d).

[0049] As mentioned above, the X-ray filter 300, also known as an ROI filter, attenuates X-rays from areas other than the region of interest (ROI), while the filter aperture 320 allows X-rays to pass through without attenuation. In interventional radiology (IVR), it is extremely important to observe the area of ​​interest (i.e., anatomical sites targeted for treatment or examination, such as vascular stenosis or aneurysms) and medical devices such as stents and coils with high precision and continuous operation. For this reason, the filter aperture 320 needs to allow X-rays to pass through a relatively narrow area where the area of ​​interest or medical device is located without attenuation. On the other hand, from the viewpoint of reducing X-ray exposure to the patient, it may be preferable to shield or attenuate X-rays from areas other than the area of ​​interest or medical device.

[0050] On the other hand, while areas other than the area of ​​interest or medical device do not necessarily need to be observed with high precision at all times, there is a demand for some information on a wider area outside the area of ​​interest or medical device when performing a procedure. From this perspective, the X-ray diaphragm 200 is equipped with an X-ray filter 300 in addition to the diaphragm blades 400.

[0051] As a result of the effect of the X-ray filter 300, as shown in Figure 3(d), a clear and highly visible X-ray fluoroscopic image is generated in the detection region 320A corresponding to the filter aperture 320, while in the region outside the filter aperture 320, although visibility is somewhat reduced, exposure to the subject can be suppressed due to the attenuation of X-rays.

[0052] In the X-ray diagnostic apparatus 1 of each embodiment described below, the area of ​​interest and / or at least one of the medical device is recognized by image recognition based on the detection signal detected in the detection area 320A corresponding to the filter aperture 320. Then, the filter aperture 320 is controlled based on the recognized area of ​​interest and / or at least one of the medical device.

[0053] The operation of each embodiment will be specifically explained below using the flowcharts and operation diagrams shown in Figures 4 to 13.

[0054] Figure 4 is a flowchart illustrating an example of operation in the X-ray diagnostic apparatus 1 of the first embodiment. Figure 5 is an explanatory diagram of the operation of the X-ray diagnostic apparatus 1 of the first embodiment.

[0055] First, in step ST100, the X-ray filter 300 is set. Here, setting the X-ray filter 300 means that although the aperture blades 400 are always set in the X-ray diaphragm device 200, the X-ray filter 300 is an optional setting in the X-ray diaphragm device 200, and therefore both the aperture blades 400 and the X-ray filter 300 are set.

[0056] In the next step, ST101, the subject is irradiated with X-rays, and an X-ray fluoroscopic image is acquired.

[0057] In step ST102, a user such as a physician observes the fluoroscopic image and manually sets the initial detection region 320A via the user interface 30 for the area of ​​interest or medical device depicted in the fluoroscopic image. Thereafter, the processing circuit 40 continues to search for the area of ​​interest from the initial detection region 320A.

[0058] In step ST103, the filter aperture 320 is set to correspond to the initial detection region 320A according to this manual setting. The setting of the filter aperture 320 is performed by the X-ray filter drive unit 301 driving the filter plate 310 according to the control of the filter control function F301 of the processing circuit 40.

[0059] Figure 5(a) is an explanatory diagram of the operations corresponding to steps ST102 and ST103. In Figure 5(a), a coil that is implanted (or being implanted) in an aneurysm is shown as an example of a medical device, and the user manually sets the initial detection area 320A to include this coil.

[0060] Next, in step ST104, the image recognition function F20 of the processing circuit 40 performs image recognition processing based on pattern matching and machine learning on the X-ray fluoroscopy image within the initial detection area 320A to recognize the area of ​​interest or medical device. In other words, the image recognition function F20 calculates the detection area based on the user's operation of at least one of the aperture blades 400 and the X-ray filter 300, and recognizes at least one of the area of ​​interest and medical device in the detection area of ​​the X-ray fluoroscopy image acquired in step ST101. The image recognition function F20 may recognize both an aneurysm and a stent as the area of ​​interest and medical device, for example.

[0061] Then, in step ST105, the output control function F40 displays the image recognition results on the display 10. Subsequently, the filter control function F301 may transition to a first mode in which it changes the size and / or position of the filter aperture 320 in accordance with changes in the size and / or position of the area of ​​interest or medical device based on the image recognition results. Alternatively, the image processing function F50 may transition to a second mode in which it performs image processing on the region including at least one of the recognized area of ​​interest and medical device based on the image recognition results. The processing circuit 40 may execute both the first mode and the second mode in parallel, or it may execute only one of them.

[0062] Figures 5(b) to 5(d) are explanatory diagrams of the operations corresponding to the processing in steps ST104 and ST105. Figure 5(b) shows how the size and position of the filter aperture 320 change based on the image recognition results, even though the size and position of the medical device coil do not change, so as to include the entire coil while minimizing the exclusion of areas other than the coil. This change reduces exposure to areas of the subject other than the coil, while allowing for the acquisition of clear and highly visible X-ray fluoroscopic images in the area containing the coil. As a result, a good treatment environment can be provided to users such as physicians, and at the same time, highly reliable image recognition processing is possible.

[0063] Figure 5(c) shows an example of operation in which the position of the filter opening 320 changes in accordance with the movement of the coil, even when the angle and position of the C-arm 24 and the top plate 31 change according to the treatment or diagnosis situation, and the position of the coil within the aperture opening 420 changes accordingly.

[0064] On the other hand, Figure 5(d) shows an example of operation in which the size of the filter aperture 320 changes in accordance with the change in coil size, even when the size of the coil depicted in the X-ray fluoroscopy image changes, for example, by changing the SID (Source to Image Distance) or changing the magnification of the X-ray detector 221, depending on the treatment or diagnostic situation.

[0065] According to the operation of the first embodiment described above, even if the position and size of medical devices such as coils change according to the treatment or diagnostic situation, it is possible to reduce exposure to areas of the subject other than the coil as a medical device, while obtaining clear and highly visible X-ray fluoroscopic images in the area containing the coil. As a result, a good treatment environment can be provided to users such as physicians, and at the same time, image recognition processing with high reliability can be achieved.

[0066] In the above example, we demonstrated how to use image recognition to identify medical devices such as coils and how to make the filter aperture 320 track changes in the size and position of these medical devices. However, the objects to be tracked are not limited to medical devices. For example, it is also possible to use image recognition to identify specific branching points of blood vessels after contrast agent injection, as well as areas of interest such as aneurysms and varicose veins. The size and position of the filter aperture 320 can then be changed to track changes in their relative position and size within the X-ray fluoroscopic image.

[0067] Figure 6 is a flowchart illustrating an example of operation in the X-ray diagnostic apparatus 1 of the second embodiment. Figure 7 is an explanatory diagram of the operation of the X-ray diagnostic apparatus 1 of the second embodiment.

[0068] In Figure 6, the difference from the first embodiment lies in the processing of steps ST200 and ST201.

[0069] In step ST200, the detection area corresponding to the initial state of the filter aperture 320 is defined as the initial detection area 320A, and the area of ​​interest or medical device is image-recognized in the initial detection area 320A. Figure 7(a) is an explanatory diagram of the operation corresponding to the process in step ST200.

[0070] In step ST201, the size and / or position of the filter aperture 320 are changed based on the image recognition results. Figure 7(b) is an explanatory diagram of the operation corresponding to the process in step ST201.

[0071] In the second embodiment, although it is assumed that the site of interest or medical device (in the example of Figure 7, a coil as a medical device) is located within the initial detection area 320A, the user does not need to manually set the initial detection area as in steps ST102 and ST103 of the first embodiment.

[0072] Figure 8 is a flowchart illustrating an example of operation in the X-ray diagnostic apparatus 1 of the third embodiment. Figure 9 is an explanatory diagram of the operation of the X-ray diagnostic apparatus 1 of the third embodiment.

[0073] In the third embodiment, the system learns in advance that multiple different medical devices will enter the detection area in a predetermined order, and controls the position of the opening in the detection area based on the learned results so that each of the multiple medical devices entering the detection area sequentially is located in the center of the detection area.

[0074] For example, in a treatment method that involves placing coils in an aneurysm, depending on the size and shape of the aneurysm's opening, the coils may not remain stably inside the aneurysm. To address this problem, a treatment method called stent-assisted coil embolization is known, in which a stent is placed at the opening of the aneurysm before placing coils inside the aneurysm.

[0075] In step ST300 of Figure 8, the user selects an imaging protocol corresponding to such a treatment method via the user interface 30.

[0076] The processes from step ST100 to step ST103 are the same as in the first embodiment, and therefore will not be explained. Figure 9(a) is an operation diagram corresponding to the processes from step ST100 to step ST103.

[0077] In step ST301, the first medical device (a stent in this example) is image-recognized in the detection region 320A, which corresponds to the area of ​​the filter aperture 320, based on learning from the imaging protocol. Then, in step ST302, the size and / or position of the filter aperture 320 are adjusted to follow and match the stent (the first medical device) so that it is positioned in the center of the detection region 320A.

[0078] Figure 9(b) is an explanatory diagram of the operations corresponding to the processes in steps ST301 and ST302.

[0079] In step ST303, the system continues to perform image recognition of the second medical device (a coil in this example) in the detection region 320A, which corresponds to the area of ​​the filter aperture 320, based on learning from the imaging protocol. Then, in step ST304, the size and / or position of the filter aperture 320 are adjusted to follow and match the coil (the second medical device) so that the coil is located in the center of the detection region 320A, and so that the area outside the coil is not included too much within the detection region 320A.

[0080] Figure 9(c) is an explanatory diagram of the operations corresponding to the processes in steps ST301 and ST302.

[0081] According to the third embodiment, even in procedures in which multiple medical devices are sequentially inserted into the area near the site of interest (e.g., an aneurysm), the size and / or position of the filter aperture 320 can be adjusted to follow and match the coil, based on the imaging protocol and machine learning, so that the multiple medical devices are sequentially positioned in the center of the filter aperture 320, without requiring any user intervention.

[0082] Figure 10 is a flowchart illustrating an example of operation in the X-ray diagnostic apparatus 1 of the fourth embodiment. Figure 11 is an explanatory diagram of the operation of the X-ray diagnostic apparatus 1 of the fourth embodiment.

[0083] For example, in patients with chronic total occlusion (CTO), a procedure that involves approaching the narrowed area from multiple directions with a catheter is considered effective.

[0084] In this case, the fluoroscopic image of the stenosis will show the tips of multiple catheters (for example, two) entering the stenosis from different directions. Typically, the physician using the catheter will not be manipulating two catheters simultaneously, so they will focus on the position and movement of one of the catheter tips.

[0085] Therefore, in the fourth embodiment, when multiple medical devices (e.g., the tip of a catheter) are detected in the detection region 320A, the position of the filter opening 320 is controlled so that one of these medical devices, as instructed by the user, is located at the center of the detection region 320A.

[0086] The processes from step ST100 to step ST103 are the same as in the first embodiment, and therefore their explanation is omitted. Figure 11(a) is an operation diagram corresponding to the processes from step ST100 to step ST104.

[0087] In step ST400, image recognition is used to determine whether or not multiple medical devices are present within the detection area 320A. If multiple medical devices are present, the process proceeds to step ST401.

[0088] In step ST401, the medical device specified by the user is selected as the medical device to be tracked.

[0089] Then, in the next step ST105, the size and / or position of the filter aperture 320 is changed to follow changes in the size and / or position of the area of ​​interest or the medical device, based on the results of image recognition of the medical device as instructed by the user.

[0090] Figures 11(a) and 11(b) show an example in which two medical devices, the tip of catheter A and the tip of catheter B, are present within the detection region 320A, and when the user directs catheter A, the tip of catheter A is set to the center of the filter opening 320, and the device follows the tip of catheter A.

[0091] The process from step ST104 to step ST105 is repeated until the process is complete. At step ST401, when the medical device instructed by the user is changed from the tip of catheter A to the tip of catheter B, the tip of catheter B is then set to the center of the filter opening 320, as shown in Figure 11(c), and the filter follows the tip of catheter B.

[0092] Figure 12 is a flowchart illustrating an example of operation in the X-ray diagnostic apparatus 1 of the fifth embodiment. Figure 13 is an explanatory diagram of the operation of the X-ray diagnostic apparatus 1 of the fifth embodiment. The only difference between the flowchart in Figure 12 (fifth embodiment) and the flowchart in Figure 10 (fourth embodiment) is the difference in processing between step ST500 and step ST401.

[0093] In the fourth embodiment, when multiple medical devices were present in the detection region 320A, the selection of which medical device to set as the center of the filter aperture 320 and track was left to the user's instructions.

[0094] In contrast, in the fifth embodiment, when multiple medical devices are present in the detection region 320A, the medical device with the highest moving speed among the multiple medical devices is set to the center of the filter opening 320 and followed. For example, as shown in Figures 13(a) and 13(b), when the tip of catheter A and the tip of catheter B are present in the detection region 320A, in the case of the medical device with the higher moving speed (Figure 13(b)), the tip of catheter A is selected as the medical device to be followed (step ST500). Then, the selected tip of catheter A is set to the center of the filter opening 320, and the tip of catheter A is followed (step ST105).

[0095] When the user is operating catheter A, one of two catheters A and B, the movement speed of the tip of catheter A is considered to be greater than the movement speed of the tip of catheter B. In this case, the tip of catheter A, which the user is operating, is automatically selected as the target to follow, thus reducing the user's operational burden compared to the fourth embodiment.

[0096] The process from step ST104 to step ST105 is repeated until the process is complete. If the user's operation then shifts from catheter A to catheter B, it is assumed that the movement speed of the tip of catheter B will be greater than that of the tip of catheter A. In this case, as shown in Figure 13(c), the target being tracked automatically switches to the tip of catheter B, which the user is operating, thus reducing the user's operational burden compared to the fourth embodiment.

[0097] Up to this point, we have described embodiments in which the size and position of the filter aperture 320 of the X-ray filter (i.e., ROI filter) 300 are adjusted to follow changes in the size and position of the area of ​​interest or medical device. However, we are not limited to this, and the size and position of the aperture aperture 420 of the aperture blades 400 may also be adjusted to follow changes in the size and position of the area of ​​interest or medical device. In this case, the filter aperture 320 in the description of each embodiment above can be replaced with the aperture aperture 420, and the same technical effects as in each embodiment described above can be obtained.

[0098] In the sixth embodiment, the search range is expanded when the angle of the C-arm 24 is changed, in which case the medical device cannot be found in the X-ray image. If a medical device is not visible in the region of interest in the X-ray fluoroscopy image, it is assumed that the medical device is located outside the region of interest, and the area surrounding the region of interest is searched. To this end, the search range is expanded to a wider area based on the information from the C-arm 24 and the position of the patient bed 3.

[0099] For example, if the image recognition function F20 has previously recognized a medical device in a past fluoroscopic image at the position of the C-arm 24, the processing circuit 40 stores prior information, including the position of the C-arm 24, in the memory circuit 20. If the image recognition function F20 cannot recognize the medical device in the fluoroscopic image, the processing circuit 40 starts searching for the medical device from the position of the C-arm 24 included in the prior information in the memory circuit 20 and expands the search range. That is, the processing circuit 40 searches the vicinity of the region of interest identified by the prior information, i.e., it searches in an area slightly larger than the region of interest. For example, since cerebral aneurysms are small, the processing circuit 40 temporarily expands the search range to the normal field of view (wide field of view) and searches again. If it still cannot be found, the processing circuit 40 may extend the SID (X-ray Source to Image receptor Distance). SID is the distance between the focal point F of the X-ray tube 500 and the surface of the X-ray detector 221, i.e., the imaging distance. If it still cannot be found, the output control function F40 may display a message on the display 10 indicating that the medical device could not be found.

[0100] Furthermore, the image generation function and image recognition function in each embodiment are examples of the recognition unit as described in the claims. Also, the filter control function and aperture control function in each embodiment are examples of the control unit as described in the claims. Also, the output control function in each embodiment is an example of the output control unit as described in the claims. Also, the image processing function in each embodiment is an example of the image processing unit as described in the claims. Also, the aperture opening and filter opening in each embodiment are examples of the openings as described in the claims.

[0101] As described above, the X-ray diagnostic apparatus of each embodiment can accurately recognize the area of ​​interest of the subject and the area including medical devices.

[0102] While several embodiments of the present invention have been described, these embodiments are presented as examples only and are not intended to limit the scope of the invention. These embodiments can be carried out in a variety of other forms, and various omissions, substitutions, and modifications can be made without departing from the spirit of the invention. These embodiments and their variations are included in the scope and spirit of the invention, as well as in the claims and their equivalents. [Explanation of Symbols]

[0103] 1. X-ray diagnostic equipment 40 Processing Circuits 100 Imaging device 110 Medical Image Processing Equipment 200 X-ray diaphragm 300 X-ray filters 400 aperture blades F20 Image Recognition Function F30 Control Function F301 Filter control function F302 Aperture control function F40 Output Control Function F50 Image Processing Function

Claims

1. An X-ray tube that generates X-rays, An X-ray diaphragm device that forms an aperture in which the transmission of X-rays is higher than in other parts by using at least one of the diaphragm blades that shield the X-rays and the X-ray filter that attenuates the X-rays, An X-ray detector for detecting the X-rays that have passed through the subject, A recognition unit that recognizes, by image recognition, at least one of the subject's area of ​​interest and a medical device inserted into the subject, based on the detection signal detected in the detection area of ​​the X-ray detector corresponding to the aperture region, An output control unit that causes the recognition result recognized by the recognition unit to output to the output unit, An X-ray diagnostic device equipped with [specific features / features].

2. The recognition unit calculates the detection area based on user operation relating to at least one of the aperture blades and the X-ray filter, and recognizes at least one of the area of ​​interest and the medical device in the detection area in the acquired X-ray image. The X-ray diagnostic apparatus according to claim 1.

3. The system further includes an image processing unit that performs image processing on a region including at least one of the recognized area of ​​interest and the medical device based on the recognition result. The X-ray diagnostic apparatus according to claim 2.

4. The X-ray aperture apparatus further comprises a control unit that controls the aperture of the X-ray aperture apparatus based on at least one of the region of interest and the medical device recognized by the recognition unit, The X-ray diaphragm device changes the size or position of the aperture by driving at least one of the diaphragm blades and the X-ray filter based on a control signal from the control unit. The X-ray diagnostic apparatus according to claim 1.

5. The control unit controls the opening such that the size or position of the detection area matches the size or position of at least one of the region of interest and the medical device. The X-ray diagnostic apparatus according to claim 4.

6. The recognition unit recognizes the movement of at least one of the area of ​​interest and the medical device. When the position of at least one of the region of interest and the medical device changes, the control unit controls the position of the opening so that the detection region follows the region of interest and the medical device. The X-ray diagnostic apparatus according to claim 4.

7. The recognition unit recognizes the movement of at least one of the area of ​​interest and the medical device. When the position of at least one of the region of interest and the medical device changes, the control unit controls the position of the opening so that the detection region follows the region of interest and the medical device. The X-ray diagnostic apparatus according to claim 5.

8. The control unit, When multiple medical devices are detected in the detection area, the position of the opening is controlled so that the medical device instructed by the user is located in the center of the detection area. The X-ray diagnostic apparatus according to claim 4.

9. The control unit, The system learns in advance that multiple different medical devices will enter the detection area in a predetermined order. The position of the opening in the detection area is controlled based on the learning results so that each of the multiple medical devices that sequentially enter the detection area is positioned at the center of the detection area. The X-ray diagnostic apparatus according to claim 4.

10. The control unit, When multiple medical devices with different movement speeds are detected in the detection area, the position of the opening is controlled so that the medical device with the higher movement speed is located at the center of the detection area. The X-ray diagnostic apparatus according to claim 4.

11. An acquisition unit that acquires a detection signal detected in a detection region of an X-ray detector corresponding to an aperture region where the transmittance of the X-rays is higher than in other regions, by at least one of an aperture blade that shields the X-rays and an X-ray filter that attenuates the X-rays, Based on the acquired detection signal, a recognition unit recognizes at least one of the subject's area of ​​interest and a medical device inserted into the subject by image recognition. An output control unit that causes the recognition result recognized by the recognition unit to output to the output unit, A medical image processing device equipped with [a specific feature].

12. A detection signal is obtained in the detection region of the X-ray detector corresponding to the region of the aperture where the X-ray transmittance is higher than in other regions, by using at least one of the aperture blades that shield the X-rays and the X-ray filter that attenuates the X-rays. Based on the acquired detection signal, at least one of the subject's area of ​​interest and a medical device inserted into the subject is recognized by image recognition. The recognized results are output to the output unit. A control method for an X-ray diagnostic device.

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