CN111481221A - Medical X-ray measurement device and program - Google Patents
Medical X-ray measurement device and program Download PDFInfo
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Abstract
The invention provides a medical X-ray measuring device which avoids unnecessary X-ray radiation to a subject when measuring bone density. An X-ray image is generated and displayed (S18) between the first irradiation process (S16) and the second irradiation process (S26). The examiner who refers to the X-ray image inputs a continuation instruction or a suspension instruction (S20). When the continuation instruction is input, execution of the second irradiation step is permitted. When the stop instruction is input, execution of the second irradiation step is stopped.
Description
Technical Field
The present invention relates to a medical X-ray measurement apparatus and a program, and more particularly to generation of an image showing a two-dimensional distribution of a specific component contained in a subject.
Background
DEXA (dual-energy X-ray absorption method) is generally a method of generating an image indicating a specific component included in a subject based on 2 kinds of detection data obtained by sequentially irradiating 2 kinds of X-rays having different energies to the subject. Specifically, an image showing a two-dimensional distribution of the content or content ratio of a specific component contained in a subject is generated. As such an image, a bone density (bone density) image is known. The bone density image is also called a bone mineral content (bone mineral content) image. An image showing a two-dimensional distribution of fat mass, fat percentage, fat-free mass, fat-free percentage, and the like can also be generated by the DEXA method. The fat-free amount is the amount of the tissue other than fat in the soft tissue, and the fat-free rate is the content of the tissue other than fat in the soft tissue. The DEXA method is also called DXA method.
When the DEXA method is applied, the measurement time becomes long when a planar X-ray beam is scanned to form a two-dimensional irradiation region. In contrast, if a two-dimensional irradiation region is formed by an X-ray beam having a pyramidal shape, the measurement time can be shortened.
The following methods are also known: that is, 2 types of detection data are obtained by irradiating X-rays having a wide range of energy and then differentiating the energy sensitivity in the X-ray detection stage. It is also a form of the DEXA process.
In the medical X-ray measurement apparatus described in patent document 1, an X-ray generation device that generates an X-ray beam having a three-dimensional shape is provided above a subject, and an X-ray detection device (radiographic imaging device) is provided below the subject. The X-ray detection device includes a first detector, a radiation limiting member, and a second detector stacked in a vertical direction. 2 kinds of detection data are simultaneously obtained by the first detector and the second detector.
Documents of the prior art
Patent document
Patent document 1: japanese patent laid-open publication No. 2018-23768
Problems to be solved by the invention
When 2 types of detection data are obtained simultaneously by one X-ray irradiation, the subject is generally irradiated with X-rays in a large energy range. In such a method, it is impossible to determine that the measurement is stopped during the measurement, and as a result, it is considered that radiation is generated more than necessary for the subject. In addition, in such a method, when a stacked structure including a first detector and a second detector is employed, a positional error generated between the first detector and the second detector increases as the first detector and the second detector are displaced from the beam center axis.
Disclosure of Invention
The invention aims to: so that useless X-ray irradiation to the subject can be avoided.
Alternatively, the object of the present invention is to: the problem of generating a position error between 2 pieces of detected data is avoided.
Solution scheme
The medical X-ray measurement device of the present invention is characterized by comprising: an irradiation unit that irradiates a subject with a first X-ray beam having a first energy and a three-dimensional shape in a first irradiation step, and irradiates the subject with a second X-ray beam having a second energy different from the first energy and the three-dimensional shape in a second irradiation step thereafter; a detection unit that detects X-rays that have passed through the subject in the first irradiation step to generate first two-dimensional detection data, and detects X-rays that have passed through the subject in the second irradiation step to generate second two-dimensional detection data; a main image generating unit that generates a main image indicating a two-dimensional distribution of a specific component contained in the subject based on the first two-dimensional detection data and the second two-dimensional detection data; and a control unit that permits or suspends execution of the second irradiation step in an intermediate step between the first irradiation step and the second irradiation step.
The program of the present invention is characterized by comprising: a function of controlling execution of the first irradiation step; a function of controlling execution of an intermediate step after the first irradiation step; a function of controlling execution of a second irradiation step after the intermediate step; and a function of controlling execution of a display step subsequent to the second irradiation step, in the first irradiation step, a first X-ray beam having a first energy and a three-dimensional shape is irradiated to a subject, and first two-dimensional detection data is generated by detecting the X-ray that has passed through the subject, in the intermediate step, an image for fracture diagnosis is generated and displayed based on the first two-dimensional detection data, and a continuation instruction or a suspension instruction is received, execution of the second irradiation step is permitted when the continuation instruction is received, execution of the second irradiation step is suspended when the suspension instruction is received, in the second irradiation step, a second X-ray beam having a second energy different from the first energy and the three-dimensional shape is irradiated to the subject, and second two-dimensional detection data is generated by detecting the X-ray that has passed through the subject, in the display step, a bone density image is generated and displayed based on the first two-dimensional detection data and the second two-dimensional detection data.
Effects of the invention
According to the present invention, unnecessary X-ray irradiation to the subject can be avoided. Alternatively, according to the present invention, it is possible to avoid the occurrence of a position error between a plurality of detected data.
Drawings
Fig. 1 is a diagram showing a medical X-ray measurement apparatus according to an embodiment.
Fig. 2 is a diagram showing data processing.
Fig. 3 is a flowchart showing a first operation example.
Fig. 4 is a flowchart showing a second operation example.
Fig. 5 is a flowchart showing a third operation example.
Fig. 6 is a flowchart showing a fourth operation example.
Fig. 7 is a diagram showing an example of display of an X-ray image.
Fig. 8 is a flowchart showing a fifth operation example.
Fig. 9 is a diagram showing an operation of the projector.
Fig. 10 is a diagram showing a structure of the projector.
Fig. 11 is a diagram showing the first projection image.
Fig. 12 is a diagram showing the second projection image.
Fig. 13 is a diagram showing a third projection image.
Fig. 14 is a diagram showing the fourth projection image.
Fig. 15 is a diagram showing a modification of the projection method.
Fig. 16 is a view showing a first example of the upper surface of the prosthesis (fantom).
Fig. 17 is a view showing a second example of the upper surface of the prosthesis.
FIG. 18 is a view showing a third example of the upper surface of the prosthesis.
Fig. 19 is a diagram showing an example of display of an X-ray image and a bone density image.
Description of reference numerals:
10: a measurement section; 12: an information processing unit; 18: a shooting table; 20: the person to be examined; 22: an irradiation unit; 28: a detection unit; 32: a calculation unit; 34: a control unit; 40: an X-ray image generation unit; 42: an X-ray image analysis unit; 44: an irradiation condition calculation unit; 46: a bone density image generation unit; 48: a bone density image analysis unit; 50: first two-dimensional detection data; 52: an X-ray image; 54: second two-dimensional detection data; 56: bone density images.
Detailed Description
Hereinafter, embodiments will be described with reference to the drawings.
(1) Brief description of the embodiments
The medical X-ray measurement device according to an embodiment includes an irradiation unit, a detection unit, a main image generation unit, and a control unit. The irradiation unit irradiates a first X-ray beam having a first energy and a three-dimensional shape to a subject in a first irradiation step, and irradiates a second X-ray beam having a second energy different from the first energy and the three-dimensional shape to the subject in a second irradiation step thereafter. The detection unit detects the X-ray that has passed through the subject in the first irradiation step to generate first two-dimensional detection data, and detects the X-ray that has passed through the subject in the second irradiation step to generate second two-dimensional detection data. The main image generating unit generates an image representing a two-dimensional distribution of a specific component contained in the subject based on the first two-dimensional detection data and the second two-dimensional detection data. The control unit permits or suspends the execution of the second irradiation step in an intermediate step between the first irradiation step and the second irradiation step.
According to the above configuration, an intermediate step is provided between the first irradiation step and the second irradiation step, and in the intermediate step, it is determined whether or not the second irradiation step can be executed. In the case where it is found in the intermediate step that the second irradiation step should not be performed or is unnecessary to be performed, the second irradiation step is not performed, and therefore the amount of radiation to be irradiated to the subject can be reduced accordingly. Since the first irradiation step and the second irradiation step are performed in stages, the detection unit can be shared between these steps. In other words, it is possible to use a member having a special configuration as the detection portion. When the second irradiation step is not performed, the bound state of the subject can be released as soon as possible, and thus the burden on the subject can be reduced.
The examiner usually determines whether or not the second irradiation step is executable. In this case, it is desirable to provide the examiner with information for supporting the examiner's judgment. The control unit normally permits or suspends the execution of the second irradiation step in accordance with an instruction from the inspector. However, the control unit may autonomously and automatically determine whether or not the second irradiation step is executable.
A typical example of the master image is an image representing a two-dimensional distribution of bone density (bone mineral content). The concept of the main image includes an image representing a two-dimensional distribution of the fat amount or the fat rate, and an image representing a two-dimensional distribution of the fat-free amount or the fat-free rate. The irradiation steps may be performed in 3 or more stages while the energy of the X-rays is varied. In this case, it is desirable to provide an intermediate step between the first irradiation step and the second irradiation step. However, an intermediate step or a step corresponding thereto may be provided between the adjacent 2 irradiation steps.
The medical X-ray measurement device of the embodiment includes: a sub-image generating unit that generates an X-ray image of the subject as a sub-image based on the first two-dimensional detection data in the intermediate step; a display for displaying the sub-image in the intermediate process; and an input unit which receives a continuation instruction or a suspension instruction in the intermediate process. The control unit permits execution of the second irradiation step when the continuation instruction is received, and stops execution of the second irradiation step when the stop instruction is received.
The above-described configuration allows the examiner to determine whether or not the second irradiation step is executable, and to receive a continuation instruction or a suspension instruction as a result of the determination, on the basis of providing the sub-image to the examiner. For example, when a diagnosis of a disease can be performed only from the sub-image even if the second irradiation step is not performed, or when the result of the first irradiation step cannot be used because the subject moves in the first irradiation step and the like, the bone to be diagnosed is not included in the sub-image, or the like, the stop instruction is input.
In an embodiment, the main image is a bone density image, and the main image is configured to input a continuation instruction to the input unit when the fracture site is not recognized in the diagnostic bone image in the sub image, and to input a stop instruction to the input unit when the fracture site is recognized in the diagnostic bone image in the sub image. For example, if a fragile fracture is recognized in the bone image to be diagnosed, osteoporosis can be diagnosed, and in this case, the second irradiation step does not necessarily have to be performed. Instead, the radiation is preferentially reduced, and the second irradiation step is omitted. The above structure can correspond to such a demand. However, the execution of the second irradiation step may be instructed based on the judgment of the examiner regardless of the content of the sub-image.
In the embodiment, the control unit controls so that the opinion input step is executed when the execution of the second irradiation step is suspended. It records the result of judgment based on the sub-image, and records the opinion together with the sub-image. Other processes than the opinion input process may be performed.
The medical X-ray measurement device according to the embodiment includes a calculation unit that calculates the irradiation conditions in the second irradiation step based on the first two-dimensional detection data. With this configuration, the irradiation conditions in the second irradiation step can be optimized for the subject. In an embodiment, the calculation unit includes a means for calculating a representative thickness of the subject based on the first two-dimensional detection data, and a means for correcting the irradiation conditions in the second irradiation step based on the representative thickness. For example, the second energy is increased when the average thickness of the subject is large, and the second energy is decreased when the average thickness of the subject is small. This makes it possible to achieve both measurement accuracy and radiation reduction.
The medical X-ray measurement device according to an embodiment includes an support information generation unit that generates support information for supporting the judgment of the execution availability of the second irradiation step based on the sub-image, wherein the support information is displayed on a display together with the sub-image. With this configuration, the examiner can be assisted in determining.
The medical X-ray measurement device of the embodiment includes: a shooting table for bearing a subject; and a projector that projects a projection image used when the subject is positioned onto the imaging table, wherein the projection image is an optical image representing a region irradiated with the first X-ray beam and the second X-ray beam. The size of the region irradiated with the X-ray beam is varied by adjusting the aperture or the like. The projected image allows the current irradiation region to be recognized, and the subject to be examined can be accurately positioned in accordance with the recognized irradiation region.
In an embodiment, the projected image includes elements used in positioning the calibration reference material. This element functions as, for example, a mark indicating a position or a region where the prosthesis including the calibration standard substance is to be placed. With this configuration, the calibration reference material can be easily disposed at a correct position. For example, the correction reference material can be prevented from being separated from the X-ray beam having the three-dimensional shape.
The operation method (operation control method) of the medical X-ray measurement apparatus according to the embodiment includes a first irradiation step, an intermediate step, a second irradiation step, and a display step. In the first irradiation step, a first X-ray beam having a first energy and a three-dimensional shape is irradiated to the subject, and first two-dimensional detection data is generated by detecting the X-ray that has passed through the subject. In an intermediate process, a fracture diagnosis image is generated and displayed based on the first two-dimensional detection data, and a continuation instruction or a suspension instruction is accepted. The execution of the second irradiation step is permitted when the continuation instruction is received, and the execution of the second irradiation step is suspended when the suspension instruction is received. In the second irradiation step, a second X-ray beam having a second energy and a three-dimensional shape is irradiated to the subject, and second two-dimensional detection data is generated by detecting the X-ray that has passed through the subject. In the display process, a bone density image is generated and displayed based on the first two-dimensional detection data and the second two-dimensional detection data.
In an embodiment, the above operation method is controlled in accordance with a program. The program is installed in the medical X-ray measurement apparatus or an information processing apparatus provided in the medical X-ray measurement apparatus via a portable storage medium or a network.
(2) Details of the embodiment
Fig. 1 shows a medical X-ray measurement apparatus according to an embodiment. The medical X-ray measuring apparatus has an roentgen radiography function, a bone mineral density measuring function, and the like. According to the medical X-ray measurement apparatus, the bone density can be measured without using a dedicated apparatus for measuring the bone density. When bone density measurement was performed, the DEXA method was used. In addition, the content and the content of fat and the content of fat-free (soft tissue other than fat) can be measured by the medical X-ray measurement apparatus.
In fig. 1, the medical X-ray measurement apparatus is roughly composed of a measurement unit 10 and an information processing unit 12. The measurement unit 10 is provided in the examination room 14, and the information processing unit 12 is provided in the control room 16. The measurement unit 10 and the information processing unit 12 are connected to each other by a cable. They may also be connected by wireless communication. The information processing unit 12 is constituted by a computer as an information processing device, for example. The information processing unit 12 may be constituted by a plurality of computers. In this case, they are connected to each other via a network. The x direction is a first horizontal direction, and the z direction is a vertical direction (vertical direction). The direction orthogonal to the x direction and the z direction is the y direction as the second horizontal direction.
A photographing table 18 is provided in the examination room 14. At the time of measurement, a subject (human body) 20 is placed on the imaging table 18. In this case, for example, the examinee 20 lies down on the imaging table 18 in a supine posture. In this case, the body axis (central axis of the body trunk) is parallel to the x direction. Examples of the site to be measured for bone density include lumbar vertebrae and femur.
An irradiation unit 22 is provided above the imaging table 18, that is, above the subject 20. The irradiation unit 22 is supported by the robot arm mechanism 24. The irradiation unit 22 includes an X-ray generation tube, an aperture mechanism, a projector, and the like. When performing X-ray measurement, the irradiation unit 22 generates an X-ray beam 26 having a three-dimensional shape. In particular, the X-ray beam 26 has a pyramidal form. It is also referred to as a cone beam. The propagation angle θ of the X-ray beam 26 in the xz plane may be the same as or different from the propagation angle φ of the X-ray beam in the yz plane. However, when bone density measurement is performed, the irradiation part 22 is usually positioned at a predetermined height, and the angle θ and the angle Φ are the same predetermined angle. An X-ray beam having a shape other than a quadrangular pyramid shape (for example, a conical shape) may be used.
The voltage and current of the drive signal supplied to the X-ray generation tube and the supply time of the drive signal are controlled by a control unit 34 described later. Typically, the energy of the generated X-rays is changed by changing the voltage of the drive signal. As will be described later, in the embodiment, high-energy X-rays are generated in the first irradiation step, and low-energy X-rays lower than the high energy are generated in the second irradiation step thereafter. Second energies different from each other are specified in accordance with a tissue to be measured. In an embodiment, 2 energies suitable for bone density determination are selected.
A detection unit 28 is disposed below the top plate of the imaging table 18, i.e., below the subject 20. The detection unit 28 includes a Flat Panel Detector (FPD)30, and detects X-rays with the FPD. The FPD30 is made up of many detection elements arranged in the x direction and the y direction. Each detection element includes, for example, a scintillator that converts X-rays into light, and a circuit that converts light into an electrical signal. The X-rays having passed through the subject are detected by the FPD30, thereby obtaining two-dimensional detection data.
When bone mineral density is measured, first two-dimensional detection data is generated in a first irradiation step, and second two-dimensional detection data is generated in a second irradiation step. These two-dimensional detection data are transferred to the information processing unit 12. The FPD30 of the embodiment is used in common among 2 irradiation steps. The detection unit 28 does not have a stacked structure including a plurality of detectors. In the embodiment, no positional error and no difference in magnification occur between 2 pieces of two-dimensional detection data.
Next, the information processing unit 12 will be described, the information processing unit 12 includes an arithmetic unit 32, a control unit 34, a storage unit 36, an input unit 37, and a display unit 38, the arithmetic unit 32 and the control unit 34 are configured by a CPU operating in accordance with a program, they may be configured by a plurality of processors, or they may be configured by other devices, the storage unit 36 is configured by a semiconductor memory, a hard disk, or the like, the operation control program and the arithmetic processing program are stored in the storage unit 36, data including images can be stored in the storage unit 36, the input unit 37 is configured by a keyboard, a pointing device, or the like, the input of a continuation instruction and a suspension instruction, which will be described later, is received by the input unit 37, the display unit 38 is configured by a liquid crystal display, an organic E L display, or the like, and an X-ray image and a bone density image, which will.
The control unit 34 controls generation and detection of X-rays and data processing in accordance with the operation control program. The bone density measurement process in charge of the operation control program includes a first irradiation step, an intermediate step, a second irradiation step, a display step, an opinion input step, and the like, as will be described later. Specifically, the control unit 34 performs control for formation and irradiation of X-ray beams, detection of X-rays, process transition based on instructions, image generation, and the like.
The arithmetic unit 32 has a plurality of functions. Among these functions, a plurality of functions associated with bone densitometry are shown in fig. 1 with a plurality of modules. Specifically, the calculation unit 32 includes an X-ray image generation unit 40, an X-ray image analysis unit 42, an irradiation condition calculation unit 44, a bone density image generation unit 46, and a bone density image analysis unit 48.
In the intermediate step, the X-ray image generating unit 40 generates an X-ray image as a roentgen ray image based on the first two-dimensional detection data acquired in the first irradiation step. The X-ray image includes a bone image to be diagnosed inside the measurement target portion. By this observation, the state of the bone to be measured can be grasped before the second irradiation step is performed. The X-ray image is referred to as a sub-image or an auxiliary image in terms of the relationship with a bone density image described later, and is referred to as an image for fracture diagnosis in terms of its function.
The X-ray image analysis unit 42 analyzes the X-ray image to identify an abnormal part. For analyzing the X-ray image, a learning-type image recognition technique or the like can be used. When the abnormal portion is specified, for example, a color image or a mark showing the abnormal portion is superimposed on the X-ray image.
The irradiation condition calculation unit 44 calculates the irradiation condition for the second X-ray beam based on the first two-dimensional detection data before the second irradiation step is executed. The irradiation condition calculation unit 44 of the embodiment calculates an average value or a maximum value of the thickness of the subject based on the first two-dimensional detection data, and optimizes the second energy relating to the second X-ray beam based on the representative thickness.
For example, when the representative thickness is a standard value, a predetermined value is set as the second energy, when the representative thickness is larger than the standard value, a value higher than the predetermined value is set as the second energy, and when the representative thickness is smaller than the standard value, a value lower than the predetermined value is set as the second energy. This prevents a decrease in measurement accuracy when measuring a thick subject and excessive radiation when measuring a thin subject. The calculated irradiation condition is sent from the irradiation condition calculation unit 44 to the control unit 34.
The bone density image generator 46 generates a bone density image based on the first two-dimensional detection data and the second two-dimensional detection data obtained from the subject in accordance with the DEXA method. The bone density image represents a two-dimensional distribution of bone mineral mass within the subject.
In the calculation of the bone density image, the first irradiation step and the second irradiation step are performed before the subject is placed on the imaging table 18 in order to correct the sensitivity. Thereby, the first two-dimensional detection data (first two-dimensional air coefficient data) and the second two-dimensional detection data (second two-dimensional air coefficient data) are acquired. These data are referred to as necessary at the stage of generating the bone density image. In addition, in order to correct the sensitivity, a prosthesis described later is used as necessary.
The attenuation amount image may also be displayed as an X-ray image. The attenuation amount image is an image generated from the first two-dimensional detection data and the first air coefficient data acquired in advance. Specifically, the ratio of the air coefficient to the detection data is calculated as a logarithmic value in units of pixels. The logarithmic value corresponds to the attenuation. Further, the correction based on the air coefficient and the correction using the prosthesis are techniques used in the bone density measuring apparatus.
The bone density image analysis unit 48 analyzes the bone density image to identify the abnormal portion. In this case, a learning-type image recognition technique can be used. When the abnormal portion is identified, a color image or a mark representing the abnormal portion is superimposed on the bone density image.
Fig. 2 shows a flow of data processing. By performing the first irradiation process, the first two-dimensional detection data 50 is generated. The first two-dimensional detection data 50 is constituted by a plurality of detection values 50a arranged in the x direction and the y direction. Each detection value 50a corresponds to each pixel. In an embodiment, an X-ray image 52 is generated from the first two-dimensional detection data 50 and displayed.
By observing the X-ray image 52, the examiner determines whether or not the second irradiation step can be performed. For example, when a fragile fracture is recognized with respect to a bone to be measured and osteoporosis can be diagnosed at this stage, it is determined that the second irradiation step is not necessary and the examiner inputs a suspension instruction. In addition, the stop instruction may be input when it is found that the first irradiation step is not correctly performed by observing the X-ray image 52. In order to support the observation of the X-ray image 52, the analysis result of the X-ray image 52 may be displayed.
On the other hand, when the examiner determines that the generation of the bone density image is necessary by observing the X-ray image 52, the examiner inputs a continuation instruction. If it is determined that the bone density image needs to be acquired although the fragile fracture is recognized, a continuation instruction may be input. And inputting a pause instruction and a continuation instruction by using the input device.
When the stop instruction is input, the second irradiation step is prohibited from being executed, and the second two-dimensional detection data 54 is not acquired. On the other hand, when the continuation instruction is input, the second irradiation step is executed, and the second two-dimensional detection data 54 is acquired. The second two-dimensional detection data 54 is composed of a plurality of detection values 54a corresponding to a plurality of pixels, as in the first two-dimensional detection data 50. The second irradiation conditions in the second irradiation step may be calculated from the first two-dimensional detection data 50 or the X-ray image generated based thereon before the second irradiation step. It is denoted by reference numeral 53.
After the second irradiation process is performed, a bone density image 56 is generated based on the first two-dimensional detection data 50 and the second two-dimensional detection data 54. When viewed from an X-ray image as a sub-image, it is referred to as a main image. The bone density image is displayed and analyzed as necessary.
Next, a first operation example to a fourth operation example relating to the medical X-ray measurement apparatus shown in fig. 1 will be described with reference to fig. 3 to 6. The respective steps constituting the respective operation examples are executed under the control of the control section.
Fig. 3 shows a first operation example. In S10, subject information is input to the medical X-ray measurement apparatus. The subject information includes, for example, an examination number and a name. The X-ray image and the bone density image obtained therefrom are associated with subject information. In S12, the examinee is positioned on the photographing table. The subject is positioned so that the measurement target portion enters the irradiation region. In an embodiment, a high energy is set as the energy of the first X-ray beam. In this case, low energy may be set, but high energy is set because energy is insufficient according to the physical constitution of the subject. The first irradiation condition may be displayed, and the content thereof may be confirmed by the examiner. S16 is a first irradiation step. In S16, the subject is irradiated with the first X-ray beam, and the X-ray beam having passed through the subject is detected. Thereby, the first two-dimensional detection data is acquired.
S18 and S20 constitute an intermediate step. The intermediate step may include S24 described later. In S18, an X-ray image is generated from the first two-dimensional detection data, and displayed. The examiner who observes the X-ray image determines whether the measurement is continued or stopped. If it is determined that the measurement is to be stopped, the examiner inputs a stop instruction in S20. On the other hand, when it is determined that the measurement is to be continued, the examiner inputs a continuation instruction in S20.
If the suspension instruction is input in S20, S22 is executed. This constitutes an opinion input step, and in S22, the examiner inputs opinions by using the input device. The inputted opinion information is managed in correspondence with the X-ray image. For example, the position of the fracture site and the degree of fracture are inputted as findings. The diagnosis name may also be entered.
On the other hand, when the continuation instruction is input in S20, the control unit sets the second irradiation condition in S24. The second irradiation condition may be displayed, and the content thereof may be confirmed by the examiner. S26 is performed following S24. S26 denotes a second irradiation step. That is, in S26, the second X-ray beam is irradiated to the subject, and the X-ray having passed through the subject is detected. Thereby, the second two-dimensional detection data is acquired. S28 is a display step. In S28, a bone density image is generated from the first two-dimensional detection data and the second two-dimensional detection data according to the DEXA method, and displayed.
According to the above operation example, when the stop instruction is input in S20, the second irradiation step is prohibited from being performed, and therefore unnecessary radiation to the subject can be avoided. In this case, the examinee can be released from the binding state as soon as possible.
Furthermore, 3X-rays having 3 or more energies may be irradiated in stages to generate a plurality of images (e.g., bone density image, fat mass image, and fat-free mass image). In this case, it is preferable to further provide an intermediate step between the first irradiation steps. If necessary, a step corresponding to an intermediate step may be provided between the second and subsequent irradiation steps.
Fig. 4 shows a second operation example. Fig. 4 to 6 show a part of a series of operations. The omitted portions are the same as those shown in fig. 3. In fig. 4 to 6, the steps already described are assigned the same step numbers, and the description thereof is omitted.
In the second operation example shown in fig. 4, S30 and S32 are provided behind S28. The bone density image is analyzed in S30, and the analysis result is displayed in S32. For example, when there are an abnormally high portion and an abnormally low portion in the bone density value, these portions are identified as abnormal portions, and symbols or the like representing these portions are displayed superimposed on the bone density image. According to the second operational example, diagnosis based on a bone density image can be supported.
In the third operation example shown in fig. 5, S34 to S40 are provided on the front surface of S24. Specifically, in the case where the continuation instruction is input in S20, the second irradiation condition is calculated from the first two-dimensional detection data or the X-ray image in S34. For example, the representative thickness is calculated as described above, and the second energy is adaptively set based on it. In S36, the second irradiation condition is displayed on the screen. Thereby, the examiner confirms the second irradiation condition. In S38, if the examiner has made an input to recognize the second irradiation condition, S24 is executed. On the other hand, in S38, when the examiner inputs a request to change the second irradiation conditions, S40 is executed. In S40, the examiner changes the second irradiation condition. Then, S24 is executed. According to the third operation example, the second irradiation condition can be optimized according to the situation.
In the fourth operation example shown in fig. 6, S50 to S54 are provided behind S16. Specifically, in S50, an X-ray image is generated based on the first two-dimensional detection data. Next, in S52, the X-ray image is analyzed. For example, to identify a site at which a fracture is likely. In S54, the X-ray image is displayed. At this time, the X-ray image analysis result is also displayed. For example, a region where a fracture is likely to occur is marked on the X-ray image. According to the fourth operation example, the examiner can support the judgment in the intermediate process.
An X-ray image is illustrated in fig. 7. The illustrated X-ray image contains a plurality of vertebral images. Wherein the coloring, as shown by reference numeral 60A, represents a particular vertebra that is likely to be fractured.
Fig. 8 shows a fifth operation example. In S60, it is determined whether the mode selected by the user is the intermediate instruction mode or the continuous mode. When the intermediate instruction mode is selected, S62 is executed, and the processes shown in fig. 3 to 6, that is, the processes including the intermediate step are executed. On the other hand, if the continuous mode is selected, S64 is executed. In S64, the second irradiation step is continuously performed following the first irradiation step. In this case, the input of the suspension instruction or the continuation instruction is not accepted. In addition, when the continuous mode is selected, the X-ray image may be displayed after the first irradiation step is performed. In addition, the second irradiation condition may be calculated based on the first two-dimensional detection data. In the fifth operation example, when the second irradiation step is always performed, the continuous mode can be selected, and in this case, the instruction behavior of the examiner is not required, and therefore, the burden on the examiner can be reduced.
Next, the projector and its operation will be described with reference to fig. 9 to 15.
In fig. 9, the subject 20 is carried on the imaging table 18. The irradiation portion 22 is disposed above and the detection portion 28 is disposed below. The irradiation unit 22 includes an X-ray generator 61 and a projector 62. The projector 62 generates a light beam 64 having the same shape as a quadrangular pyramid-shaped X-ray beam, and functions as a projector or a collimator.
Fig. 9 shows a prosthesis (phantom) 66 supported by a support mechanism 68. The prosthesis 66, for example, contains a first fiducial substance simulating bone and a second fiducial substance simulating soft tissue. The prosthesis 66 is supported in the tilted state such that the central axis of the prosthesis 66 coincides with the X-ray emitting direction, and the prosthesis 66 is contained in the X-ray beam space. The prosthesis 66 is used to modify the first two-dimensional test data and the second two-dimensional test data, previously utilizing itself. The support mechanism 68 may support the prosthesis 66 in a state of being in contact with the upper surface of the imaging table 18, or the support mechanism 68 may support the prosthesis 66 in a state of being lifted from the upper surface of the ceiling plate of the imaging table 18. Instead of using the support mechanism 68, a free-standing prosthesis may be provided on the top surface of the top plate of the imaging table 18.
Fig. 10 shows a configuration example of the projector 62. An aperture mechanism 62A is provided at the exit of the projector 62. The three-dimensional shape of the X-ray beam 26 is defined by the aperture mechanism 62A. The angle theta and the angle phi are specified specifically (only angle phi is shown in fig. 10). Incidentally, when measuring the bone density, the angle θ and the angle φ are respectively specified as specified angles. Thus, there is no need to make the action of the projector 62 dynamically variable.
Specifically, the projector 62 includes a light source 70, a first mirror 72, and a second mirror 74 in addition to the diaphragm mechanism 62A. Light emitted from the light source 70 is reflected by the first reflector 72, and the reflected light is further reflected by the second reflector 74. This reflected light constitutes a light beam 64. The beam 64 has a pyramidal form that coincides with the form of the X-ray beam 26.
The aperture mechanism 62A has an exit port, and a light-transmitting member 76 is disposed therein. The pattern of the light-transmitting member 76 is projected onto the ceiling of the photographing table (and the subject). The light-transmitting member 76 has light-shielding properties or contains 2 lines of black. These lines cross in a "+" shape. Therefore, the projected image includes 2 lines crossing each other. Further, it is desirable that the reflecting mirror 74 and the light transmitting member 76 be made of a material which hardly attenuates X-rays.
Next, the first to fourth projected images will be described as the distortion of the projected image formed by the projector 62 with reference to fig. 11 to 15.
Fig. 11 shows a first shadowgraph image. The projected image 80 shows the X-ray irradiated region on the top surface 18A of the top plate, and the both shapes match. The light-transmitting member 76 is colored, thereby coloring the projected image 80. The shadowgraph image 80 contains a marker 82 consisting of 2 lines 84, 86 crossed at the centre of the beam. The X-ray irradiation region can be visually confirmed as a projection region from the projection image 80. In addition, the marker 82 can accurately position the measurement site within the X-ray irradiation region.
The second shadowgraph image is shown in fig. 12. In fig. 12 to 15, the same elements as those shown in fig. 11 are denoted by the same reference numerals, and the description thereof is omitted.
In fig. 12, the projected image 80 includes a line 88 that functions as a reference when the prosthesis 90 is placed. The line 88 is produced by adding a colored line different from the surroundings to the light-transmitting member. Specifically, the prosthesis 90 is provided in a band-like region between the line 88 and an end edge (right end edge in fig. 12) of the shadowgraph image 80. The line 88 is a marker that functions as an element for locating a prosthesis. The projected image 80 including the line 88 makes it possible to reliably and easily dispose the prosthesis 90 at a position in the pyramidal X-ray beam where the prosthesis does not cause an obstacle to the examinee. The installation angle of the prosthesis 90 may be determined in advance, or the installation angle of the prosthesis 90 may be optimized by a method described later using a shadowgraph image.
Fig. 13 shows a third projection image. The projected image 80 includes markers 92, 94 that function as a reference when the prosthesis 90 is placed. The 2 marks 92 and 94 are generated by adding 2 marks, which are colored differently from the surroundings, to the light-transmitting member. For example, aligning 2 corners (2 corners on the left side in fig. 13) existing at the lower portion of the prosthesis 90 with 2 markers 92, 94, naturally optimizes the position where the prosthesis 90 is disposed. The 2 markers 92 and 94 function as elements for locating a prosthesis.
Fig. 14 shows a fourth shadowgraph image. The projected image 80 includes an image 96 indicating the arrangement position of the prosthesis 90. The image 96 has a predetermined color tone. An image 96 is generated by forming a light transmitting portion having a predetermined color tone on a part of the light transmitting member. In the fourth projection image shown in the figure, the image 96 as an element thereof is configured as a rectangular figure having, for example, the same shape as the bottom surface of the prosthesis or slightly larger than the bottom surface. If the prosthesis is arranged on the image 96, the position where the prosthesis is arranged is optimized as a result. After the prosthesis is set, a part or the whole of the image 96 may be projected onto the upper surface of the prosthesis, and it may be confirmed that the prosthesis is set to the correct position afterwards. This will be further described later using fig. 16 to 18. As described above, reference numeral 96 denotes a marker that functions as an element for locating a prosthesis.
Fig. 15 shows a modification. The shadowgraph image 80 may also be formed and a colored or adhesive tape applied to the top plate upper surface 18A to identifiably reveal the prosthesis deployment region 97. Since the projection table is generally used also in the roentgen imaging, when it is desired to avoid special processing of the imaging table, it is preferable to use the second to fourth projection images.
Several embodiments relating to the upper surface of the prosthesis 66 are shown in fig. 16-18. In the first example shown in fig. 16, a rough finish is applied to the upper surface 66A of the prosthesis 66. Thereby, reflection of light is suppressed. This can improve the visibility of the projected image. In order to further improve the visibility of the projected image, coloring or the like may be applied to upper surface 66A.
In the second example shown in fig. 17, markings 100 are depicted as landmarks on the upper surface 66B of the prosthesis 66. The marker 100 is formed by 2 lines 102, 104 crossing at the center point of the upper surface 66B. By referring to the marker 100, the position and posture of the prosthesis 66 can be easily confirmed from the relationship with the projection image.
In a third example shown in fig. 18, 2 markers 106, 108 are attached to the upper surface 66B of the prosthesis 66. On the other hand, the shadowgraph image includes 2 marker images corresponding thereto. By having 2 markers images coincide with 2 markers 106, 108, the position and pose of the prosthesis can be optimized.
According to the above-described configurations, it becomes easy to accurately position the subject, and it becomes easy to accurately position the prosthesis. The problem of the prosthesis being separated from the X-ray beam having the three-dimensional shape can be prevented. Further, the burden on the examiner when positioning the prosthesis can be reduced. If the positioning of the subject and the prosthesis is optimized, the risk of measurement failure due to positioning errors can be reduced.
The configuration shown in fig. 9 to 18 may be adopted in a medical X-ray measuring apparatus or a bone density measuring apparatus that does not perform the intermediate step. For example, the embodiments of fig. 9 to 18 may be applied to a medical X-ray measurement apparatus capable of acquiring a plurality of two-dimensional detection data corresponding to a plurality of energies by one irradiation, or a medical X-ray measurement apparatus in which a correction substance is provided in an X-ray beam together with a subject.
From such a viewpoint, the medical X-ray measurement apparatus of the present invention includes: an irradiation unit that irradiates an X-ray beam having a three-dimensional shape onto a subject on an imaging table; a detection unit that detects X-rays that have passed through the subject and outputs two-dimensional detection data; an image forming unit that forms an image representing the subject based on the X-ray detection data; and a projector that projects a guide image used when at least one of the subject and the calibration reference material is positioned onto the projection table. Preferably, the guide image is an image showing a region irradiated with the X-ray beam. Preferably, the guide image includes elements used for positioning the calibration reference material. The upper surface of the calibration standard substance or the upper surface of the member containing the calibration standard substance may be processed or colored differently from the other surfaces. A pattern which becomes a reference for positioning when the guide image is irradiated may be provided on the upper surface.
Fig. 19 shows an example of an image displayed by the medical X-ray measurement apparatus shown in fig. 1. In the display step after the second irradiation step, the X-ray image 60 and the bone density image 110 are displayed simultaneously. The X-ray image 60 includes a marker image 60A indicating an abnormal portion, and the bone density image 110 also includes a marker image 112 indicating an abnormal portion. By simultaneously observing these images 60 and 110, the bone to be measured can be comprehensively diagnosed.
The abnormality determination method based on the bone density image is explained for reference. For example, when the bone to be measured is the lumbar vertebra, the average bone density may be calculated for each of the bones of the articular cone, and when the bone density deviates from the appropriate range, it may be determined as abnormal. An average bone density may also be calculated for a plurality of vertebrae, and in the case where it deviates from the appropriate range, it is determined to be abnormal.
For example, abnormal bone density higher than the appropriate range is generated due to compression fracture, calcification of blood vessels, contrast agents, foreign substances, and the like. It is also possible to determine abnormality for each pixel and express it by brightness, hue, or the like. For example, in the case where the amount of bone mineral is low due to osteoporosis, abnormal bone density lower than the appropriate range is generated. In this case, it is also possible to determine abnormality for each pixel and express it by luminance, hue, or the like.
Claims (10)
1. A medical X-ray measuring apparatus is characterized in that,
the medical X-ray measurement device includes:
an irradiation unit that irradiates a subject with a first X-ray beam having a first energy and a three-dimensional shape in a first irradiation step, and irradiates the subject with a second X-ray beam having a second energy different from the first energy and the three-dimensional shape in a second irradiation step thereafter;
a detection unit that detects X-rays that have passed through the subject in the first irradiation step to generate first two-dimensional detection data, and detects X-rays that have passed through the subject in the second irradiation step to generate second two-dimensional detection data;
a main image generating unit that generates a main image indicating a two-dimensional distribution of a specific component contained in the subject based on the first two-dimensional detection data and the second two-dimensional detection data; and
and a control unit that permits or suspends execution of the second irradiation step in an intermediate step between the first irradiation step and the second irradiation step.
2. The medical X-ray measurement device according to claim 1,
the medical X-ray measurement device includes:
a sub-image generating unit that generates an X-ray image of the subject as a sub-image based on the first two-dimensional detection data in the intermediate step;
a display for displaying the sub-image in the intermediate step; and
an input device for receiving the continuation instruction or the suspension instruction in the intermediate process,
the control unit permits execution of the second irradiation step when the continuation instruction is received, and stops execution of the second irradiation step when the stop instruction is received.
3. The medical X-ray measuring apparatus according to claim 2,
the primary image is a bone density image,
the continuation instruction is input to the input unit when the fracture site is not recognized in the bone image to be diagnosed in the sub-image, and the suspension instruction is input to the input unit when the fracture site is recognized in the bone image to be diagnosed in the sub-image.
4. The medical X-ray measuring apparatus according to claim 2,
the control unit controls the opinion input step to be executed when the execution of the second irradiation step is suspended.
5. The medical X-ray measurement device according to claim 1,
the medical X-ray measurement device includes a calculation unit that calculates the irradiation conditions in the second irradiation step based on the first two-dimensional detection data.
6. The medical X-ray measuring device according to claim 5,
the arithmetic unit includes:
means for calculating a representative thickness of the subject based on the first two-dimensional detection data; and
and a unit for correcting the irradiation conditions in the second irradiation step based on the representative thickness.
7. The medical X-ray measuring apparatus according to claim 2,
the medical X-ray measurement apparatus includes an support information generation unit that generates support information for supporting the judgment as to whether or not execution of the second irradiation step is possible based on the sub-image,
the support information is displayed on the display together with the sub-image.
8. The medical X-ray measurement device according to claim 1,
the medical X-ray measurement device includes:
a shooting table for carrying the subject; and
a projector for projecting a guide image for positioning the subject onto the imaging table,
the guide image indicates a region irradiated with the first X-ray beam and the second X-ray beam.
9. The medical X-ray measurement device according to claim 8,
the guide image includes an element used for positioning the calibration reference material.
10. A program, characterized in that,
the program includes:
a function of controlling execution of the first irradiation step;
a function of controlling execution of an intermediate step after the first irradiation step;
a function of controlling execution of a second irradiation step after the intermediate step; and
a function of controlling the execution of the display step after the second irradiation step,
in the first irradiation step, a first X-ray beam having a first energy and a three-dimensional shape is irradiated to the subject, and first two-dimensional detection data is generated by detecting the X-ray beam having passed through the subject,
in the intermediate step, an image for fracture diagnosis is generated and displayed based on the first two-dimensional detection data, a continuation instruction or a suspension instruction is received, the execution of the second irradiation step is permitted when the continuation instruction is received, the execution of the second irradiation step is suspended when the suspension instruction is received,
in the second irradiation step, a second X-ray beam having a second energy different from the first energy and having the three-dimensional shape is irradiated to the subject, and X-rays having passed through the subject are detected to generate second two-dimensional detection data,
in the display step, a bone density image is generated and displayed based on the first two-dimensional detection data and the second two-dimensional detection data.
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