Respiratory training systems, respiratory training methods, and respiratory training programs

Abstract

To provide a respiration training technology to visualize the motion in the body on the basis of a respiration state and perform respiration training effectively in the respiration training for reproducing a respiration state when formulating a treatment plan at the time of treatment.SOLUTION: A respiration training system 1 includes: a terminal 5 for training and a respiration information processing device 3. The respiration information processing device 3 calculates a feature amount of a respiration state at each time point, and generates information for training in which each of an image 70 for training is associated with a feature amount of a corresponding respiration state. The terminal 5 for training acquires the information for training from the respiration information processing device 3, acquires a respiration state of a patient P using a device 6 for training, calculates a feature amount of the respiration state acquired by the device 6 for training, and displays, on a screen, an image 70 for training associated with the feature amount calculated by itself.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] Embodiments of the present invention relate to respiratory training techniques.

Background Art

[0002] There is a treatment device that irradiates a patient with a radiation treatment beam such as a heavy particle beam. In this treatment device, a technique is used to accurately irradiate a cancer target, which is the treatment target, with a treatment beam. However, the cancer target may move due to breathing, heartbeat, organ movement, etc. This is sometimes called a mobile target. When irradiating a treatment beam to this mobile target, it is necessary to irradiate in synchronization with the patient's respiratory phase. In particular, since the movement of the mobile target caused by breathing is large, special techniques have been developed to irradiate the cancer target with a treatment beam. As the technique, there are external respiration synchronization in which an external sensor is arranged on the patient and the respiratory phase is acquired based on the output value of this external sensor, and internal respiration synchronization in which a fluoroscopic image inside the patient is acquired with X-rays or the like and the respiratory phase is grasped.

[0003] In any technique, a fluoroscopic image of the patient is taken a plurality of times before treatment, and the range of irradiation of the treatment beam, the direction of irradiation of the treatment beam, the timing of irradiation of the treatment beam, and the irradiation dose are set from the image pattern of the cancer target of the patient. This is called treatment planning. Here, when performing external respiration synchronization, at the time of formulating a treatment plan, the relationship between the fluoroscopic image of the patient and the output value of the external sensor is grasped, and a threshold value is set for the output value of the external sensor. Then, at the time of treatment, the treatment beam is irradiated when the output value of the external sensor arranged on the patient falls within the threshold value. On the other hand, when performing internal respiration synchronization, the position of the cancer target is specified from the fluoroscopic image of the patient taken during treatment, and when the cancer target moves within a predetermined range, the treatment beam is irradiated.

[0004] Both methods require several days to develop a treatment plan. Therefore, the first time the treatment beam is applied to a patient is several days after the fluoroscopic images are taken to develop the treatment plan. The treatment beam is then applied in several sessions (over several days) with a predetermined radiation dose depending on the type of cancer. For example, in the treatment of prostate cancer, it is applied in about 12 sessions (over 12 days). For this reason, it is common for patients to visit the hospital regularly for treatment, from the development of the treatment plan to the completion of treatment.

[0005] Recreating the respiratory state during treatment planning is crucial for accurately irradiating mobile targets with the treatment beam. However, several days to several months can pass between planning and the start of treatment, and from the start of treatment to its completion. Therefore, it can be difficult to recreate the respiratory state during treatment planning. Furthermore, a method for recreating the respiratory state during treatment planning is needed. In addition, it is important for patients to understand the importance of breathing, to be aware of how to breathe properly, and to actively cooperate with treatment in particle beam cancer therapy.

[0006] In particular, it is effective to conduct training that reproduces the respiratory state during treatment planning in remote locations other than treatment facilities such as hospitals, for example, at the patient's home. Here, it is required that the patient perform respiratory training at home using a designated training device. During this training, it is conceivable that the patient's vision or hearing will be used to help them recognize the target respiratory waveform and practice reproducing their breathing. However, in actual treatment, the treatment beam is irradiated in a way that fills in the cross-section of the cancer target that appears on an image called a slice plane, which is a two-dimensional plane onto which parts of the cancer target at each depth are projected. In other words, the respiratory waveform is only complementary information, and it is most effective for radiation therapy to help the patient recognize how the actual cancer target is moving based on the respiratory waveform and to actively obtain the patient's cooperation. [Prior art documents] [Patent Documents]

[0007] [Patent Document 1] Japanese Patent Publication No. 2017-18570 [Overview of the Initiative] [Problems that the invention aims to solve]

[0008] The problem that this invention aims to solve is to provide a respiratory training technique that enables effective respiratory training by visualizing internal bodily movements based on the respiratory state, in order to reproduce the respiratory state at the time of formulating a treatment plan during treatment. [Means for solving the problem]

[0009] An embodiment of the present invention provides a respiratory training system comprising a training terminal for training a patient's respiration at a location other than a treatment facility where radiation therapy is performed, and a respiratory information processing device that generates training information when formulating a treatment plan, wherein the respiratory information processing device determines the patient's respiratory state The first respiratory state Simultaneously with obtaining the above, a plurality of training images including at least one of tomographic images or X-ray images showing the inside of the patient's body, 1 The training images are acquired at each point in time, which change in chronological order according to the respiratory state, and the respiratory information processing device then processes the images at each point in time. 1 Respiratory status features The first feature is The respiratory information processing device calculates the corresponding training image. 1 The respiratory state 1 The training terminal generates training information linked to the features, the training terminal acquires the training information from the respiratory information processing device, and the training terminal uses the training device to train the patient The call Inhalation state This is the second respiratory state. The training terminal acquires the training device 2nd Respiratory status special Significant The second feature is The training terminal calculates the above that it has calculated. 2nd Features The first feature that matches the above The system is configured to display the training images associated with the system on the screen. [Effects of the Invention]

[0010] According to an embodiment of the present invention, in respiratory training for reproducing a respiratory state at the time of formulating a treatment plan during treatment, a respiratory training technique is provided that can effectively perform respiratory training by visualizing the movement inside the body based on the respiratory state.

Brief Description of the Drawings

[0011] [Figure 1] Fig. showing the respiratory training system of the first embodiment. [Figure 2] Block diagram showing the management server. [Figure 3] Block diagram showing the training terminal. [Figure 4] Graph showing the relationship between the respiratory waveform and the feature amount. [Figure 5] Fig. showing a CT image depicting the inside of a patient in the state of maximum exhalation. [Figure 6] Fig. showing a CT image depicting the inside of a patient in the state of maximum inhalation. [Figure 7] Screen diagram showing the display mode of the display of the training terminal. <00000,8,0>Flowchart showing the training information generation process executed by the management server. [Figure 9] Flowchart showing the respiratory training process executed by the training terminal. [Figure 10] Block diagram showing the management server of the second embodiment. [Figure 11] Screen diagram showing the display mode of the display of the training terminal.

Modes for Carrying Out the Invention

[0012] (First Embodiment)<, Hereinafter, embodiments of a respiratory training system, a respiratory training method, and a respiratory training program will be described in detail with reference to the drawings. First, the first embodiment will be described using FIGS. 1 to 6.

[0013] Reference numeral 1 in FIG. 1 is the breathing training system of the present embodiment. This breathing training system 1 is for a patient P undergoing treatment with a particle beam therapy apparatus 2 to perform breathing training. In particular, it enables the patient P to perform breathing training at a location other than a treatment facility such as a hospital, for example, at home or in a hotel serving as a residence during recuperation. Note that training may also be performed at an inpatient facility provided near the treatment facility. In the following description, a form of performing training at the home of the patient P will be exemplified.

[0014] <---0000099--->The breathing training system 1 includes a management server 3, a management terminal 4, a training terminal 5, and a training device 6. Note that the breathing information processing apparatus of the present embodiment is configured by the management server 3. Further, the management terminal 4 may be included in the breathing information processing apparatus together with the management server 3.

[0015] The management server 3, the management terminal 4, and the training terminal 5 have hardware resources such as a CPU, a ROM, a RAM, and an HDD, and are configured by computers in which information processing by software is realized using the hardware resources by the CPU executing various programs. Further, the breathing training method of the present embodiment is realized by causing a computer to execute various programs.

[0016] At the treatment facility, a particle beam therapy apparatus 2, a management server 3, and a management terminal 4 are provided. The management server 3 and the management terminal 4 are connected to each other by a local area network 7, enabling transmission and reception of information. Further, the management server 3 and the management terminal <---4---> are connected to the Internet 8 via the local area network 7.

[0017] <00001 --->08<---At home, a training terminal 5 is provided. The training terminal 5 is connected to the Internet 8. The management server 3 and the management terminal 4 can transmit and receive information to and from the training terminal 5 via the Internet 8. [[ID=!7]]

[0018] The management terminal 4 is operated by instructor C, who is located at the treatment facility. Instructor C is responsible for guiding patient P through respiratory training. For example, a doctor or technician may serve as instructor C. The training terminal 5 is operated by patient P, who is at home.

[0019] First, let me explain particle beam therapy device 2. Particle beam therapy device 2 treats patients P by irradiating them with a particle beam (therapeutic radiation), such as carbon ions, onto the cancerous lesion (tumor).

[0020] The radiation therapy technique using particle beam therapy device 2 is also known as heavy ion beam cancer therapy. This technique allows carbon ions to precisely target cancerous lesions, damaging them while minimizing damage to normal cells. Particle beams are defined as radiation heavier than electrons, and include proton beams and heavy ion beams. Of these, heavy ion beams are defined as those heavier than helium atoms.

[0021] In cancer treatment using heavy ion beams, the ability to kill cancerous lesions is higher compared to conventional cancer treatments using X-rays, gamma rays, and proton beams. Furthermore, the radiation dose is weaker on the surface of the patient's body, and peaks at the cancerous lesion. Therefore, the number of irradiation sessions and side effects can be reduced, and the treatment period can be shortened.

[0022] Although detailed illustrations are omitted, the particle beam therapy apparatus 2 comprises an ion generator, a circular accelerator, and a beam transport line. Here, the ion generator has an ion source of charged particles, which are carbon ions, and generates a particle beam using these carbon ions. The circular accelerator is ring-shaped in plan view and accelerates the particle beam generated by the beam generator. The beam transport line transports the particle beam accelerated by the circular accelerator.

[0023] A particle beam guided by the beam transport line is irradiated onto patient P. The particle beam therapy device 2 may be equipped with a rotating gantry. The rotating gantry supports the beam transport line in a rotatable manner. Patient P is positioned inside this rotating gantry. By rotating the rotating gantry circumferentially, the direction of irradiation of the particle beam onto patient P can be changed.

[0024] As the particle beam passes through patient P's body, it loses kinetic energy and its velocity decreases. At the same time, it encounters resistance that is approximately inversely proportional to the square of its velocity, and once it reaches a certain velocity, it stops abruptly. This stopping point of the particle beam is called the Bragg peak, and high energy is released there. By aligning this Bragg peak with the location of the cancerous lesion in patient P, the particle beam therapy device 2 can destroy only the diseased tissue while minimizing damage to normal tissue.

[0025] As shown in Figure 1, the particle beam therapy apparatus 2 comprises an imaging unit 10 and a respiratory monitoring unit 11. These imaging unit 10 and respiratory monitoring unit 11 are used when formulating the treatment plan and during treatment.

[0026] The imaging unit 10 acquires at least one of either computed tomography (CT) images or X-ray images of patient P, who is the subject of the examination. The CT images capture patient P's body in sliced ​​form. The X-ray images capture the inside of patient P's body in a fluoroscopic view. These images are acquired to determine the location of the tumor that is the target of treatment. The following description illustrates a configuration in which the imaging unit 10 uses CT images.

[0027] The respiratory monitoring unit 11 acquires the respiratory status of patient P while the imaging unit 10 is taking CT images. The location of the tumor inside patient P's body moves due to respiratory movements. The particle beam therapy device 2 can determine the location of the tumor by understanding the respiratory cycle of patient P. The sensor used by the respiratory monitoring unit 11 to acquire the respiratory status may be a position sensor placed on the surface of patient P's body, or a measuring device that measures the actual respiratory volume of patient P. In other words, any sensor capable of acquiring information related to patient P's respiration is acceptable.

[0028] CT images taken by the imaging unit 10 and respiratory status information acquired by the respiratory monitoring unit 11 are stored in the management server 3. For example, instructor C can display the CT images and respiratory status information stored in the management server 3 on the display 12 connected to the management terminal 4, and formulate a treatment plan.

[0029] When patient P receives treatment, they first go to the treatment facility and undergo various tests necessary for formulating a treatment plan. A CT scan of patient P is taken at this time. Based on the tumor pattern in the image, the irradiation area, direction of irradiation, and irradiation dose are determined. Formulating this treatment plan takes several days. Therefore, the start date of particle beam irradiation for patient P will be several days after the CT scan is taken during the treatment planning stage.

[0030] When a CT image of patient P is taken during the development of a treatment plan, respiratory status is also acquired simultaneously. For example, under the guidance of an instructor C, such as a doctor or technician, respiratory status is acquired when patient P performs breathing actions such as deep breathing or breath-holding. Here, instructor C provides guidance on how to breathe so that patient P's respiratory status becomes ideal. Based on this respiratory data, instructor C sets beam parameters, including the identification of the tumor type, the dose to be irradiated to the tumor, at what respiratory state the particle beam should be irradiated to the mobile target (tumor), the threshold for determining whether irradiation is permissible, and the direction of irradiation.

[0031] From the formulation of the treatment plan to the actual start of treatment, and from the start of treatment to its completion, several days to several months may pass. If a significant amount of time has passed since patient P first received breathing instruction, patient P may forget the breathing techniques taught by instructor C. Therefore, patient P performs breathing training at home using training terminal 5 and training device 6.

[0032] As an example of a training device 5, a smartphone that is easy for patient P to carry around can be used. Alternatively, training device 5 could be a tablet computer that is easy to use at home, a mobile computer, or a desktop or notebook computer.

[0033] When performing breathing exercises, patient P downloads an application containing the breathing exercise program from the management server 3 beforehand. This application is then installed on the training terminal 5. The training terminal 5 may be patient P's personal device or one provided by the medical institution operating the treatment facility. During the exercises, a target breathing waveform is set, and the patient uses visual and auditory information to adjust their breathing to match the target waveform.

[0034] The training device 6 is used to obtain the respiratory status of patient P at home. This training device 6 is loaned by the medical institution. For example, patient P wears the training device 6 and performs breathing exercises while lying supine in bed.

[0035] The training device 6 comprises at least one strain sensor 13 (respiratory sensor) and a mounting device 14 for attaching the strain sensor 13 to at least one of the patient P's chest or abdomen. In this way, the strain sensor 13 can detect movement of the patient P's chest or abdomen and acquire the respiratory state during training. Furthermore, the training device 6 can be provided at a low cost. Moreover, the training device 6 can be made small and light enough for the patient P to carry.

[0036] The strain sensor 13 measures the strain of an object by utilizing the fact that a metal (resistor) expands and contracts in proportion to the expansion and contraction of the object being measured, and its resistance changes. It is a so-called electrical resistance strain gauge. This strain sensor 13 can measure the movement of the patient P's chest or abdomen. For example, when patient P inhales, the chest and abdomen expand. Conversely, when patient P exhales, the chest and abdomen contract. This movement is captured by the strain sensor 13. This movement allows for the estimation of the lung ventilation volume generated by respiration. The relationship between the movement of the chest or abdomen and the lung ventilation volume is obtained in advance during examinations when formulating a treatment plan.

[0037] Furthermore, the attachment device 14 is exemplified by a belly band worn by patient P. It could also be a belt wrapped around the chest or abdomen. It could also be a suction cup that adheres to patient P's skin. For example, the strain sensor 13 is attached to the side of patient P's torso. In addition, multiple strain sensors 13 may be attached to patient P's body. For example, multiple strain sensors 13 may be provided on a single attachment device 14.

[0038] Next, the system configuration of the management server 3, training terminal 5, and training device 6 will be explained with reference to the block diagrams shown in Figures 2 and 3.

[0039] As shown in Figure 2, the management server 3, which is a respiratory information processing device, comprises a communication unit 20, a control unit 21, and a storage unit 22.

[0040] The memory unit 22 stores various information necessary for treatment planning and respiratory training. The communication unit 20 communicates with other computers via communication lines such as the local area network 7 and the internet 8.

[0041] The control unit 21 includes a training information generation unit 60, a guidance information reception unit 61, a training image acquisition unit 63, a feature calculation unit 64, an image processing unit 65, and an irradiation area setting unit 66. These are realized by the CPU executing a program stored in memory or on the HDD.

[0042] The training information generation unit 60 generates training information, including information indicating the respiratory state, which is the training target generated when the treatment plan was formulated. This training information is transmitted to the training terminal 5. The training terminal 5 then outputs the training information.

[0043] The instruction information receiving unit 61 receives instruction from instructor C regarding respiratory training for patient P. Instructor C inputs the instruction information using the management terminal 4. The management server 3 receives the instruction information via the management terminal 4. The instruction information includes text created by instructor C, instructor C's voice, images created by instructor C, images related to the treatment plan, and other data. The management server 3 then transmits the instruction information, including the instruction information received from instructor C, to the training terminal 5. The training terminal 5 then outputs the instruction information from instructor C. In this way, patient P can receive instruction from instructor C at a location other than the treatment facility.

[0044] The memory unit 22 stores, for example, training information. Furthermore, the memory unit 22 stores current information, including information indicating the respiratory status of patient P acquired by the training terminal 5. The memory unit 22 may also store instructional information.

[0045] Each component of the management server 3, which functions as a respiratory information processing device, does not necessarily have to be located on a single computer. For example, a single respiratory information processing device may be implemented using multiple computers connected to each other via a network.

[0046] As shown in Figure 3, the training terminal 5 includes a device connection unit 30, an input unit 31, a display 32, a speaker 33, a communication unit 34, a control unit 35, and a storage unit 36.

[0047] The control unit 35 includes a waveform display unit 39, a memory information erasure unit 40, a feature quantity calculation unit 48, and a current video generation unit 49. These are realized by the CPU executing a program stored in memory or HDD. The memory unit 36 ​​stores various information necessary when patient P performs breathing exercises.

[0048] A training device 6 is connected to the device connection unit 30. The detection signal output from the strain sensor 13 is input to the device connection unit 30. This allows the control unit 35 to acquire the measurement value from the strain sensor 13.

[0049] The input unit 31 receives predetermined information in response to the patient P (user)'s operation. If the training terminal 5 is a smartphone or tablet computer, the touch panel integrated with the display 32 serves as the input unit 31. The input unit 31 also includes input devices such as a mouse, keyboard, or stylus. Predetermined information is input to the input unit 31 in response to the operation of these input devices.

[0050] The display 32 displays images. The speaker 33 outputs sound. These devices constitute an output unit that outputs predetermined information. Note that if the training terminal 5 is a desktop computer, the display 32 and speaker 33 may be separate from the computer body. Furthermore, predetermined information may be output from the training terminal 5 to the display 32 and speaker 33 of another computer connected via the network.

[0051] The communication unit 34 communicates with other computers via a communication line such as the Internet 8. For example, the communication unit 34 communicates with the management server 3. In this embodiment, the training terminal 5 and the management server 3 are connected to each other via the Internet 8, but other configurations are also possible. For example, the training terminal 5 and the management server 3 may be connected to each other via a LAN (Local Area Network), WAN (Wide Area Network), or mobile communication network.

[0052] As shown in Figure 7, the respiratory state of patient P, obtained under the guidance of instructor C during the formulation of the treatment plan, represents the target respiratory waveform 50, which is the target respiratory state for the training. This target respiratory waveform 50 is the ideal respiratory state set during the formulation of the treatment plan. Then, during treatment with the particle beam therapy device 2, patient P needs to reproduce this target respiratory waveform 50.

[0053] On the other hand, when patient P performs breathing exercises at home, the respiratory state acquired by the training device 6 is represented as the current respiratory waveform 51. This current respiratory waveform 51 represents patient P's current (during training) respiratory state. The current respiratory waveform 51 is information included in the current information and is transmitted from the training terminal 5 to the management server 3.

[0054] Here, respiratory status refers to, for example, the temporal change in lung ventilation volume due to respiration. Ventilation volume is measured by training device 6. Time (time of day) is measured by a real-time clock (RTC) installed in training terminal 5. For example, current status information includes information about the time and information about the period of the respiratory waveform.

[0055] The current respiratory waveform 51 and the target respiratory waveform 50 are simultaneously displayed on the screen of the display 32 of the training terminal 5. In this way, patient P can perform training while comparing the current respiratory waveform 51 and the target respiratory waveform 50 that are displayed on the screen at the same time. For example, patient P can look at the screen of the display 32, recognize the difference between the current respiratory waveform 51 and the target respiratory waveform 50, and perform breathing training so that the current respiratory waveform 51, which is being measured by the training device 6, approaches the target respiratory waveform 50.

[0056] In the example shown in Figure 7, the current respiratory waveform 51 and the target respiratory waveform 50 are displayed on the screen superimposed on each other. Alternatively, the current respiratory waveform 51 and the target respiratory waveform 50 may be displayed side by side on the screen. The target respiratory waveform 50 is included in the training information received by the training terminal 5 from the management server 3. The current respiratory waveform 51 is included in the current information transmitted from the training terminal 5 to the management server 3.

[0057] In this way, the training terminal 5 outputs the respiratory state acquired by the training device 6 and the target respiratory state created in the treatment plan in a manner that is recognizable to the patient P. This allows for effective respiratory training in order to reproduce the respiratory state at the time the treatment plan was formulated during treatment, by making the patient P aware of the respiratory state.

[0058] The training terminal 5 may also output audio from the speaker 33. For example, the control unit 35 of the training terminal 5 may refer to the target respiratory waveform 50 and output the voice "Please inhale" at the timing of maximum exhalation and the voice "Please exhale" at the timing of maximum inhalation. Patient P can understand the timing of maximum exhalation and maximum inhalation of the current respiratory waveform 51 by following the voice instructions and bring the current respiratory waveform 51 closer to the target respiratory waveform 50.

[0059] Furthermore, the management server 3 outputs the respiratory status acquired by the training device 6 and the target respiratory status in a manner that can be recognized by the instructor C. For example, a graph (Figure 7) of the current respiratory waveform 51 and the target respiratory waveform 50 is displayed on the screen of the management terminal 4's display 12. In this way, instructor C, who is in a treatment facility far from patient P, can understand patient P's respiratory status. In addition, the improvement in patient P's respiratory status is made known to treatment personnel such as instructor C, and can be used for guidance or encouragement to patient P.

[0060] In the first embodiment, respiratory waveforms 50 and 51 are displayed on the display 32 of the training terminal 5, allowing patient P to recognize their own respiratory state. Furthermore, in the first embodiment, CT images (or X-ray images) of the inside of patient P's body are displayed on the display 32, allowing patient P to recognize their own respiratory state.

[0061] In the first embodiment, first, training images 70 (Figures 5 and 6) of patient P are acquired at the treatment facility. For example, when formulating a treatment plan, the respiratory monitoring unit 11 (Figure 1) acquires the respiratory status of patient P, and at the same time, the imaging unit 10 (Figure 1) acquires a CT image (or X-ray image) of the inside of patient P's body. This becomes the training image 70. Then, based on the multiple training images 70, a video is generated showing the changes in the internal state of patient P in chronological order. This video is displayed on the display 32 of the training terminal 5. The training image 70 shows patient P's organs 71 and tumor 72 (cancer target) (Figures 5 and 6). Patient P can observe how the tumor 72 moves in response to breathing.

[0062] As shown in Figure 4, the respiratory monitoring unit 11 (Figure 1) captures training images 70 (Figures 5 and 6) corresponding to each time point T1 to T3 of the patient P's respiratory waveforms 50 and 51. For example, training images 70 are acquired at time T1 (maximum exhalation), time T2 (intermediate between maximum exhalation and maximum inspiration), and time T3 (maximum inspiration). In practice, training images 70 are captured at even finer time intervals.

[0063] Furthermore, feature quantities R1 to R3 corresponding to each time point T1 to T3 are calculated for the respiratory waveforms 50 and 51. For example, temporal features such as breathing rate being faster or slower than that of a normal person are recorded as a feature called respiratory period. Also, the size of breathing is recorded as a feature called respiratory amplitude. Here, the feature quantities R1 to R3 of patient P's respiratory waveforms 50 and 51 are calculated and linked to the training images 70 at time points T1 to T3 when these feature quantities R1 to R3 occurred.

[0064] A simple and effective method for setting features is illustrated below. For example, the origin is set with patient P exhaling completely (maximum exhalation) as the base point. The spatial coordinate movement (spatial distance) of patient P's body surface from this origin to the state where patient P inhales and inhales completely (maximum inhalation) is acquired by the respiratory monitoring unit 11 (Figure 1). Then, feature quantities R1 to R3 are calculated. As an example of the calculation, it is easiest to understand when the movement of patient P's body surface is displayed as a vector. Starting from the base state, the movement of the body surface obtained by the respiratory monitoring unit 11 is represented by a vector r(r,t) that represents the spatial position. Here, t is the synchronization time. Note that when calculating feature quantities R1 to R3 on the training terminal 5, the movement of the body surface (spatial distance) is estimated using the training device 6 (Figure 1) instead of the respiratory monitoring unit 11.

[0065] Each training image 70 (CT or X-ray image) is recorded in sync with the respiratory waveforms 50 and 51. Based on this sync time t, the spatial distance from the ground state, r, to the body surface is determined and linked to the body surface position using feature quantities R1 to R3.

[0066] In other words, each training image 70 is associated with a corresponding spatial distance on the patient P's body surface from maximum exhalation to maximum inhalation. Although the example from maximum exhalation to maximum inhalation was used, similarly, from maximum inhalation to maximum exhalation, the position of the body surface and the training image 70 are linked by the characteristic of the spatial position of the body surface via a synchronization time t.

[0067] These training images 70 are transmitted from the management server 3 to the training terminal 5. Since the training images 70 are medical images, their data size is large, and therefore they may be resized or compressed before transmission.

[0068] For the sake of understanding, the change in the position of patient P's body surface was explained using the spatial distance from maximum exhalation as an example, but other forms are also acceptable. For example, any features that show characteristics such as the rate of change of body surface (first derivative of position in time), the acceleration of the body surface (second derivative of position in time), the shape of respiratory waveforms 50, 51 (magnitude of the ratio of amplitude to period), or abnormal respiratory waveforms 50, 51 can be associated with the training image 70 as feature quantities R1 to R3.

[0069] As shown in Figures 5 and 6, the position of the tumor 72 at the time of maximum exhalation is set as the position of the irradiation area. A mark 73 indicating this irradiation area is displayed on the screen superimposed on the training image 70 showing the tumor 72. For example, a circular mark 73 is displayed. In this way, patient P can perform breathing exercises so that the part of the tumor 72 that moves with breathing overlaps with the position of the irradiation area.

[0070] For example, Figure 5 shows the state of maximum exhalation, where the tumor 72 overlaps with mark 73. On the other hand, Figure 6 shows the state of maximum inhalation, where the tumor 72 is offset from mark 73.

[0071] As shown in Figure 7, in the first embodiment, a video 74 showing the current state of the body, consisting of respiratory waveforms 50, 51 and training images 70, is displayed side by side. Patient P is trained to breathe while referring to the respiratory waveforms 50, 51, so that the tumor 72 overlaps with the mark 73 at the appropriate timing.

[0072] Next, the training information generation process performed by the control unit 21 of the management server 3 will be explained using the flowchart in Figure 8. Refer to the aforementioned diagrams as appropriate.

[0073] First, in step S1, the training image acquisition unit 63 of the control unit 21 acquires training images 70 (Figures 5 and 6). This training image acquisition unit 63 acquires training images 70 at each point in time, which changes in chronological order according to the respiratory state. At this time, the control unit 21 acquires information indicating the respiratory state of patient P, measured by the respiratory monitoring unit 11, simultaneously with the acquisition of the training images 70. This information includes respiratory waveforms 50 and 51.

[0074] Here, the training images 70 acquired by the training image acquisition unit 63 are CT images (or X-ray images) corresponding to each point in time from maximum exhalation to maximum inhalation and back to maximum exhalation. Note that these include not only CT images of patient P in an ideal respiratory state, but also CT images corresponding to various respiratory states. For example, they include CT images of a patient with irregular breathing.

[0075] In the next step S2, the feature calculation unit 64 of the control unit 21 calculates the feature quantities of the respiratory state at each time point measured by the respiratory monitoring unit 11 (Figure 1).

[0076] In the next step S3, the control unit 21 associates the training images 70 at each time point with the corresponding respiratory state (respiratory waveforms 50, 51) features at that time point. These training images 70 are stored in the memory unit 22.

[0077] In the next step S4, the irradiation area setting unit 66 of the control unit 21 sets the irradiation area to which the particle beam set in the treatment plan will be irradiated.

[0078] Here, the irradiation area, including the tumor 72 (cancer target), is set, along with predetermined margins. For example, in heavy ion beam cancer therapy, in scanning irradiation therapy, the tumors to be irradiated are set at intervals of approximately 2 mm from the deepest part of the patient P's body toward the body surface. Then, a method is used to fill the tumor with heavy ions, matching the size of the tumor in the longitudinal and transverse directions, at 2 mm intervals from the deepest part of the body toward the body surface. In actual treatment, a region PTV (Planning Target Volume) with a margin of 5 mm to 10 mm in the three-dimensional direction relative to the tumor is set as the irradiation area. The irradiation area and margins are determined by the physician or technician (e.g., supervisor C) when formulating the treatment plan.

[0079] The irradiation area of ​​the training image 70 is set by PTV. The irradiation area setting unit 66 processes the irradiation area data that has been determined by a physician or technician.

[0080] In respiratory-gated particle beam irradiation, the irradiation area corresponds to a two-dimensional projection image of the tumor 72 at a predetermined depth within the body. The particle beam is irradiated when the tumor 72 enters this irradiation area.

[0081] For example, when the training terminal 5 displays a training image 70 based on the patient P's current respiration, a mark 73 indicating the irradiation area set in the treatment plan is displayed simultaneously. This allows patient P to recognize the irradiation area and the state of organs 71 in a predetermined respiratory state, thereby enhancing the effectiveness of respiratory training.

[0082] In the next step S5, the image processing unit 65 of the control unit 21 performs at least one of the following processes on the training image 70: refinement or clarification.

[0083] Here, the specific image processing method may be image refinement of the organ 71 or tumor 72, or contrast enhancement. An example of image refinement is contour extraction of organ 71. An example of contrast enhancement is image binarization. Other methods may also be used.

[0084] The CT and X-ray images that form the basis of the training image 70 may not have as clear features as typical images. Furthermore, these images may have poor contrast. Even with such images, a doctor or technician can recognize the organs 71 and tumors 72 shown. However, a patient P without specialized knowledge may find it difficult to recognize the movement of tumors 72 from such images. Therefore, even if the CT or X-ray image is displayed as is, it may be difficult for the patient P to recognize certain organs 71. To address this, the image processing unit 65 performs image processing on the training image 70. This allows the patient P to easily recognize the organs 71 or tumors 72 shown in the training image 70.

[0085] In the next step S6, the training information generation unit 60 of the control unit 21 generates training information including training images 70 linked to feature quantities.

[0086] In the next step S7, the control unit 21 transmits training information to the training terminal 5.

[0087] Then, the control unit 21 of the management server 3 terminates the training information generation process. The above steps are at least some of the processes performed by the control unit 21 of the management server 3, and other steps may be included in the training information generation process.

[0088] Next, the breathing training process performed by the control unit 35 of the training terminal 5 will be explained using the flowchart in Figure 9. Refer to the aforementioned diagrams as appropriate.

[0089] First, in step S11, the control unit 35 determines whether or not it has received training information from the management server 3. If the training information has been received (YES in step S11), the process proceeds to step S13. On the other hand, if the training information has not been received (NO in step S11), the process proceeds to step S12.

[0090] In the next step S12, the control unit 35 performs training information reception processing. In this training information reception processing, the control unit 35 sends a request signal to the management server 3. Based on the receipt of the request signal, the management server 3 sends training information to the training terminal 5. The training terminal 5 receives the training information from the management server 3 and stores it in the storage unit 36. Then, the process proceeds to step S13.

[0091] In step S13, the control unit 35 acquires the respiratory status of patient P using the training device 6. For example, the control unit 35 estimates the ventilation volume due to respiration. The control unit 35 stores the acquired current respiratory status as current information in the storage unit 36.

[0092] In the next step S14, the feature calculation unit 48 of the control unit 35 calculates the respiratory state features acquired by the training device 6. The method for calculating these features is the same as the method for calculating features in the management server 3. However, the method for calculating features in the training terminal 5 may differ from the method for calculating features in the management server 3, as long as it can calculate the same features.

[0093] In the next step S15, the current state video generation unit 49 of the control unit 35 generates a current state video 74 (Figure 7) based on the training images 70 linked to the features calculated by the training terminal 5. This current state video 74 is generated using multiple training images 70 and shows the respiratory state acquired by the training device 6.

[0094] Here, the current video generation unit 49 extracts (selects) training images 70 associated with features calculated by the feature calculation unit 48 from among multiple training images 70 included in the training information received from the management server 3. For example, the training terminal 5 calculates the features of each point in time (time) of the current respiratory waveform 51 and generates a current video 74 by arranging the corresponding training images 70 in chronological order. In other words, the training terminal 5 generates an animation of the training images 70. By acquiring the respiratory state by the training device 6 and generating and displaying the current video 74 in real time, patient P can visually recognize how the organs 71 and tumors 72 move in accordance with the current respiratory movements.

[0095] In the next step S16, the control unit 35 performs output processing. In this output processing, for example, the waveform display unit 39 of the control unit 35 simultaneously displays the current respiratory waveform 51 included in the current information and the target respiratory waveform 50 included in the training information on the screen. Furthermore, the control unit 35 displays the current video 74 generated by the current video generation unit 49 on the screen. This current video 74 and the respiratory waveforms 50 and 51 are displayed on the screen simultaneously.

[0096] For example, as shown in Figure 7, the target respiratory waveform 50 and the current respiratory waveform 51 are displayed superimposed on the screen of the training terminal 5's display 32. Alternatively, a line 54 indicating the current position of the current respiratory waveform 51 may be displayed. Patient P adjusts their future breathing movements while looking at the line 54 to bring the current respiratory waveform 51 closer to the target respiratory waveform 50.

[0097] Furthermore, the screen displays a current video 74 showing the current state of the patient P's body. For example, the current video 74 is displayed alongside the respiratory waveforms 50 and 51. This allows patient P to recognize CT images corresponding to features that change continuously with respiration, enabling them to understand the meaning of respiratory training and the changes in the movement of organs 71 and tumors 72 due to respiration, thereby enhancing the effectiveness of the training.

[0098] Returning to Figure 9, in the next step S17, the control unit 35 determines whether patient P has performed an operation to end the breathing exercise. If the breathing exercise is to be ended (YES in step S17), the process proceeds to step S18. On the other hand, if the breathing exercise is not to be ended (NO in step S17), the process returns to step S13.

[0099] Furthermore, by repeating steps S13 to S16, the current respiratory state (e.g., tidal volume) is acquired in chronological order. The repeatedly acquired respiratory state is plotted in chronological order to generate the current respiratory waveform 51. The waveform display unit 39 then displays the target respiratory waveform 50 with its period synchronized to the period of the current respiratory waveform 51. The waveform display unit 39 may also display the current respiratory waveform 51 along with the time.

[0100] In step S18, the control unit 35 performs a current status information transmission process. In this current status information transmission process, the control unit 35 transmits the current status information stored in the storage unit 36 ​​to the management server 3.

[0101] In the next step S19, the memory information erasure unit 40 of the control unit 35 performs a memory information erasure process. In this memory information erasure process, the memory information erasure unit 40 erases the training information and current information stored in the memory unit 36. In this way, the personal information of patient P involved in treatment does not remain on the training terminal 5 located outside the treatment facility, thus preventing the leakage of personal information.

[0102] Then, the control unit 35 of the training terminal 5 terminates the breathing training process. The above steps are at least some of the processes performed by the control unit 35 of the training terminal 5, and other steps may be included in the breathing training process.

[0103] In the first embodiment, while patient P is undergoing training, the training terminal 5 stores training information and current status information. Although current communication technology has made remarkable progress, it is necessary to reduce the amount of data transmitted in areas where the communication environment is not necessarily good. In this first embodiment, by initially transferring the training information generated at the treatment facility when formulating the treatment plan to the training terminal 5, the amount of data transmitted afterward can be suppressed.

[0104] In this example, the respiratory status of patient P is acquired at the treatment facility using the respiratory monitoring unit 11 (Figure 1), and at home using the training device 6. However, other configurations are also possible. For example, the respiratory status of patient P may also be acquired at the treatment facility using the training device 6. In other words, the respiratory status may be acquired under the same conditions at both the treatment facility and home. Furthermore, the calculation of feature vectors may also be performed under the same conditions at both the treatment facility and home. For example, the training terminal 5 may access the management server 3, and the management server 3 may calculate the feature vectors of patient P's respiratory status while the patient is at home.

[0105] In the first embodiment, in respiratory training to reproduce the respiratory state at the time of treatment planning, the movement of internal organs 71 or tumors 72 can be visualized based on the respiratory state, thereby enabling effective respiratory training.

[0106] Furthermore, by overlaying the irradiation area mark 73 with the training image 70, patient P can recognize when the tumor 72 enters the irradiation area during each breathing movement. Patient P can then visually recognize and understand the relationship between the organ 71 containing the cancer target and the irradiation.

[0107] (Second Embodiment) Next, a second embodiment will be described using Figures 10 to 11. Note that components identical to those shown in the previously described embodiment are denoted by the same reference numerals, and redundant descriptions are omitted.

[0108] As shown in Figure 10, the control unit 21 of the management server 3 in the second embodiment includes a target video generation unit 67 in addition to the configuration of the first embodiment described above. This target video generation unit 67 is realized by the CPU executing a program stored in memory or HDD.

[0109] The target video generation unit 67 generates a target video 75 that shows the respiratory state, which is the training target created in the treatment plan, using multiple training images 70.

[0110] The control unit 21 of the management server 3 includes the generated target video 75 in the training information and transmits it to the training terminal 5.

[0111] As shown in Figure 11, the training terminal 5 displays the target video 75 and the current video side by side on its screen. In this way, patient P can recognize the target respiratory state movement in the target video 75 and improve their current respiratory state.

[0112] In the second embodiment, the difference between the target respiratory state set when formulating the treatment plan and the current severe condition of the organs 71 and tumors 72 becomes clear, improving the effectiveness of the training.

[0113] Although the respiratory training system, respiratory training method, and respiratory training program have been described based on the first and second embodiments, the configuration applied in any one embodiment may be applied to the other embodiments, or the configurations applied in each embodiment may be combined.

[0114] Although the flowchart of the above-described embodiment illustrates a configuration in which each step is executed in series, the order of each step is not necessarily fixed, and the order of some steps may be reversed. Also, some steps may be executed in parallel with other steps.

[0115] The respiratory training system 1 of the aforementioned embodiment comprises a control device with highly integrated processors such as a dedicated chip, FPGA (Field Programmable Gate Array), GPU (Graphics Processing Unit), or CPU (Central Processing Unit), a storage device such as ROM (Read Only Memory) or RAM (Random Access Memory), an external storage device such as HDD (Hard Disk Drive) or SSD (Solid State Drive), a display device such as a display, an input device such as a mouse or keyboard, and a communication interface. This respiratory training system 1 can be implemented with a hardware configuration using a normal computer.

[0116] The program executed by the respiratory training system 1 of the above-described embodiment is provided pre-installed on ROM or the like. Alternatively, this program may be provided as an installable or executable file stored on a computer-readable non-transient storage medium such as a CD-ROM, CD-R, memory card, DVD, or flexible disk (FD).

[0117] Furthermore, the program executed by this respiratory training system 1 may be stored on a computer connected to a network such as the Internet and provided for download via the network. Alternatively, this respiratory training system 1 can be configured by connecting and combining separate modules, each independently performing its respective function, via a network or dedicated line.

[0118] In the embodiment described above, the management server 3 is located in the treatment facility, but other configurations are also possible. For example, the management server 3 may be located in a place other than the treatment facility, such as the cloud or another facility.

[0119] In the above-described embodiment, a strain sensor 13 is exemplified as the respiratory sensor of the training device 6, but other embodiments are also possible. For example, a position sensor placed on the body surface of patient P may be used, or a measuring device that measures the actual respiratory volume of patient P may be used.

[0120] In the above-described embodiment, the management server 3 and the training terminal 5 are able to send and receive information via a network, but other configurations are also possible. For example, information can be exchanged between the management server 3 and the training terminal 5 using wireless communication with radio waves, wired communication with cables, or a USB memory stick as a portable storage medium.

[0121] In the embodiments described above, respiratory training for cancer treatment using heavy ion beams was used as an example, but other embodiments are also possible. For example, the embodiments described above may be applied to respiratory training for cancer treatment using other therapeutic radiations such as X-rays, gamma rays, and proton beams.

[0122] According to at least one embodiment described above, the training terminal 5 displays training images 70 linked to features it has calculated on its screen, thereby enabling effective respiratory training in order to reproduce the respiratory state at the time of treatment planning by visualizing the internal movements based on the respiratory state.

[0123] 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, modifications, and combinations are possible without departing from the spirit of the invention. These embodiments or their variations are included in the scope and spirit of the invention, as well as in the claims and their equivalents. [Explanation of symbols]

[0124] 1…Respiratory training system, 2…Particle beam therapy device, 3…Management server, 4…Management terminal, 5…Training terminal, 6…Training device, 7…Local area network, 8…Internet, 10…Imaging unit, 11…Respiratory monitoring unit, 12…Display, 13…Strain sensor, 14…Wearing device, 20…Communication unit, 21…Control unit, 22…Storage unit, 30…Device connection unit, 31…Input unit, 32…Display, 33…Speaker, 34…Communication unit, 35…Control unit, 36…Storage unit 39...Waveform display unit, 40...Memory information erase unit, 48...Feature quantity calculation unit, 49...Current video generation unit, 50...Target respiratory waveform, 51...Current respiratory waveform, 54...Line, 60...Training information generation unit, 61...Instruction information reception unit, 63...Training image acquisition unit, 64...Feature quantity calculation unit, 65...Image processing unit, 66...Irradiation area setting unit, 67...Target video generation unit, 70...Training image, 71...Organ, 72...Tumor, 73...Mark, 74...Current video, 75...Target video, C...Instructor, P...Patient.

Claims

1. A training terminal for conducting respiratory training for patients in locations other than treatment facilities where radiation therapy is performed, A respiratory information processing device that generates training information when formulating a treatment plan, Equipped with, The respiratory information processing device acquires a first respiratory state, which is the respiratory state of the patient, and at the same time acquires a plurality of training images, each of which changes in chronological order according to the first respiratory state, including at least one of tomographic images or X-ray images of the inside of the patient's body. The respiratory information processing device calculates a first feature quantity, which is a feature quantity of the first respiratory state at each point in time. The respiratory information processing device generates training information that links each of the training images to the first feature quantity of the corresponding first respiratory state. The training terminal acquires the training information from the respiratory information processing device, The training terminal acquires the second respiratory state, which is the patient's respiratory state, using a training device. The training terminal calculates a second feature, which is a feature of the second respiratory state acquired by the training device. The training terminal displays the training image on its screen that is associated with the first feature that matches the second feature it has calculated. It is structured in such a way. A breathing training system.

2. The respiratory information processing device performs at least one of the following processes on the training image: refinement or clarification, and generates the training information. It is structured in such a way. The respiratory training system according to claim 1.

3. The aforementioned training terminal, A target video is generated using multiple training images and shows the first respiratory state, which is the training goal created in the treatment plan, A current video showing the second respiratory state, generated using multiple training images and acquired by the training device, Display them side by side on the screen. It is structured in such a way. A respiratory training system according to claim 1 or claim 2.

4. The training terminal displays on its screen a mark indicating the irradiation area to be irradiated with the radiation set in the treatment plan, superimposed on the training image showing the tumor. It is structured in such a way. A respiratory training system according to claim 1 or claim 2.

5. The aforementioned training device is A strain sensor and A mounting device for attaching the strain sensor to at least one of the chest or abdomen of the patient, Equipped with, A respiratory training system according to claim 1 or claim 2.

6. A training terminal for conducting respiratory training for patients in locations other than treatment facilities where radiation therapy is performed, A respiratory information processing device that generates training information when formulating a treatment plan, This method uses The respiratory information processing device acquires a first respiratory state, which is the respiratory state of the patient, and at the same time acquires a plurality of training images, each of which changes in chronological order according to the first respiratory state, including at least one of tomographic images or X-ray images of the inside of the patient's body. The respiratory information processing device calculates a first feature quantity, which is a feature quantity of the first respiratory state at each point in time. The respiratory information processing device generates training information that links each of the training images to the first feature quantity of the corresponding first respiratory state. The training terminal acquires the training information from the respiratory information processing device, The training terminal acquires the second respiratory state, which is the patient's respiratory state, using a training device. The training terminal calculates a second feature, which is a feature of the second respiratory state acquired by the training device. The training terminal displays the training image on its screen that is associated with the first feature that matches the second feature it has calculated. Breathing training method.

7. A training terminal for conducting respiratory training for patients in locations other than treatment facilities where radiation therapy is performed, A respiratory information processing device that generates training information when formulating a treatment plan, It is used in a breathing training system equipped with the following features: The respiratory information processing device, A first respiratory state, which is the respiratory state of the patient, is acquired, and at the same time, a plurality of training images, each of which changes in chronological order according to the first respiratory state, are acquired, including at least one of tomographic images or X-ray images of the inside of the patient's body. The first feature, which is a characteristic of the first respiratory state at each point in time, is calculated. Each of the training images is associated with the first feature of the corresponding first respiratory state to generate training information. It is configured in such a way, The computer that controls the aforementioned training terminal, A process for acquiring the training information from the respiratory information processing device, A process to acquire the second respiratory state, which is the respiratory state of the patient, using a training device, A process to calculate a second feature, which is a feature of the second respiratory state acquired by the training device, A process of displaying the training image on the screen, which is associated with the first feature that matches the second feature calculated by the system itself, To execute A breathing training program.

Images