DE102011083686A1 - Method for representing highlighted patients in interventional angiographic analysis, involves creating two-dimensional images, and superimposing images with volumetric images for generating and reproducing superimposed images - Google Patents

Abstract

The method involves detecting three-dimension (3D) volumetric images of an examination object (S1), and marking a portion of the object (S2) in the volumetric images. A marked portion of the examination object is processed (S3) for determination of an object portion in the processed volumetric images. A remaining marked portion is attenuated (S4). The object and remaining portions are superimposed (S5) for generating a roadmap volume image. Two-dimensional (2D) images are created (S6) and superimposed (S7) with the volumetric images for generating and reproducing (S8) the superimposed images. The object portion is designed as a stenosis and/or a tumor-feeder. The 2D live-image is formed as a fluoroscopic image, and the 3D volumetric images are formed as digital subtraction angiography (DSA) volumetric images.

Description

The invention relates to a method for highlighting objects in interventional angiographic examinations by superimposing 3-D volume images of the objects with a 2-D live image. An angiography system that has such a highlighted representation such. B. Roadmaps allows, for example, from the US 7,500,784 B2 known, the below with reference to the 1 is explained.

The 1 shows an exemplified monoplanes X-ray system with one of a stand 1 in the form of a six-axis industrial or articulated robot held C-arm 2 at the ends of which is an X-ray source, for example an X-ray source 3 with X-ray tube and collimator, and an X-ray image detector 4 are mounted as an image recording unit.

By means of the example of the US 7,500,784 B2 Known articulated robot, which preferably has six axes of rotation and thus six degrees of freedom, the C-arm 2 be spatially adjusted, for example, by turning around a center of rotation between the X-ray source 3 and the X-ray image detector 4 is turned. The angiographic X-ray system according to the invention 1 to 4 is in particular about centers of rotation and axes of rotation in the C-arm plane of the X-ray image detector 4 rotatable, preferably around the center of the X-ray image detector 4 and around the center of the X-ray image detector 4 cutting axes of rotation.

The known articulated robot has a base frame which is fixedly mounted, for example, on a floor. It is rotatably mounted about a first axis of rotation a carousel. On the carousel is pivotally mounted about a second axis of rotation a rocker arm, on which is rotatably mounted about a third axis of rotation, a robot arm. At the end of the robot arm, a robot hand is rotatably mounted about a fourth axis of rotation. The robot hand has a fastener for the C-arm 2 which is pivotable about a fifth axis of rotation and about a perpendicular thereto extending sixth axis of rotation rotatable.

The realization of the X-ray diagnostic device is not dependent on the industrial robot. It can also find common C-arm devices use.

The X-ray image detector 4 may be a rectangular or square semiconductor flat detector, preferably made of amorphous silicon (a-Si). However, integrating and possibly counting CMOS detectors may also be used.

In the beam path of the X-ray source 3 is on a tabletop 5 a patient table a patient to be examined 6 , At the X-ray diagnostic facility is a system control unit 7 with an image system 8th connected to the image signals of the X-ray image detector 4 receives and processes (controls are not shown, for example). The X-ray images can then be displayed on a monitor 9 to be viewed as. In a processing circuit 10 For example, the required image processing such as the 3-D digital subtraction angiography (DSA) roadmap method is performed as described below.

Instead of in 1 For example, illustrated X-ray system with the stand 1 in the form of the six-axis industrial or articulated robot can, as in 2 simplified, the angiographic X-ray system also a normal ceiling or floor mounted bracket for the C-arm 2 exhibit.

Instead of the example illustrated C-arm 2 For example, the angiographic x-ray system may also include separate ceiling and / or floor mount brackets for the x-ray source 3 and the X-ray image detector 4 have, for example, are electronically rigidly coupled.

In the 3-D Roadmap, the superimposition of 3-D objects with a 2-D live image, the problem is usually that the complete, contrast agent-filled vascular tree is superimposed, as in the 7 can be seen, which will be described in more detail below. Because of this, the overlay image contains a lot of 3-D information, which the doctor usually does not need at all or is annoying for his work in viewing the overlay image.

On the other hand, however, it is important for the doctor to see 3-D information superimposed in order to obtain better spatial perception and orientation.

Recently, software packages have been increasingly developed which, however, are limited to superimposing only the relevant 3-D information, as is the case, for example, with the superposition of the center line between two vascular points located in "syngo Workplace - Embolization Guidance - Operating Instructions" from Siemens AG, printed February 2010, Order No .: AX42-010.621.70.01.01 , is described. What is negative about this type of superimposition is that the complete "omission" of the remaining 3-D information makes it very difficult to achieve orientation and spatial perception.

Typically, the physician's workflow today is to mark the relevant vessel segment (see Syngo Workplace - Embolization Guidance). This is done by marking a proximal point and then one or more distal points on the vessel section. The software (see syngo Workplace - Embolization Guidance) then segments the vessel. In the overlay step, the doctor can decide whether he wants the complete volume (cf. 7 ) or just want to get superimposed on the segmented vessel with a fluoroscopic live image.

• a) Wird das komplette Volumen überlagert, so hat der Arzt zwar eine gute räumliche Vorstellung und Orientierung; er bekommt jedoch, je nach Angulation des C-Bogens, überlappende 3-D-Information überlagert, die schwer zu differenzieren ist, so dass er ggf. wichtige Informationen wegen der Informationsvielfalt übersehen kann. Zusätzlich negativ ist, dass dieses "Zuviel" an 3-D-Information dafür sorgt, dass das zu überlagernde 2-D-Bild, typischerweise aus einer Durchleuchtung, nicht mehr in gewünschter Qualität dargestellt wird.
• b) Wird nur der segmentierte Gefäßabschnitt oder sogar nur dessen Mittellinie (Centerline) überlagert, so ist zwar keine unnötige oder redundante Information vorhanden, auch das 2-D-Bild ist deutlich sichtbar, jedoch sind die räumliche Vorstellung und Orientierung sehr schwierig.

Both choices have weak points:

• a) If the entire volume is superimposed, the doctor has a good spatial perception and orientation; however, depending on the angulation of the C-arm, it overlays overlapping 3-D information, which is difficult to differentiate, so that it can possibly overlook important information because of the variety of information. In addition, it is negative that this "too much" of 3-D information ensures that the 2-D image to be superimposed, typically from a fluoroscopy, is no longer displayed in the desired quality.
• b) If only the segmented vessel section or even its centerline is superimposed, there is no unnecessary or redundant information, the 2-D image is clearly visible, but the spatial presentation and orientation are very difficult.

The invention is based on the object, a method of the type mentioned in such a way that an overlay automatically adjusts such that on the one hand, the relevant structures are clearly displayed, and on the other hand, not too much 3D information is superimposed.

The object is achieved for an angiographic examination method of the type mentioned by the features specified in claim 1. Advantageous embodiments are specified in the dependent claims.

The object is achieved according to the invention by the following method steps:
S1) acquiring at least one 3-D volume image of the examination object,
S2) marking at least a part of the examination object in the 3-D volume image,
S3) processing the marked part of the examination subject to determine an object section in a processed volume image,
S4) attenuation of at least the remaining, unmarked part of the examination object with respect to the object section in the 3-D volume image, so that at least the parts of the examination object have different opacities,
S5) superimposition of both parts of the 3-D volume image to generate a roadmap volume image,
S6) generating at least one 2-D live image,
S7) Superimposition of the 2-D live image with the partially attenuated 3-D volume image for generation and
S8) Playback of superimposed images.

This results in a 3-D roadmap process optimized by different opacities, which automatically adjusts the overlay in such a way that on the one hand the relevant structures are visibly visualized, but on the other hand not too much 3-D information is presented superimposed.

Advantageously, the attenuation according to step S4 can be applied to the object section of the examination object on the entire 3-D volume image, so that the 3-D volume image of the examination object has different opacities compared to the processed volume image.

It has proved to be advantageous if the method for highlighting objects still has the following method steps:
S9) acquisition of a series of fluoroscopic images ( 26 ) with the object ( 27 )
S10) Subtraction of the series of fluoroscopic images ( 26 ) and a 3-D volume image ( 11 ) without contrast agent filling to generate a series of subtraction images ( 29 )
S11) superposition of the series of subtraction images ( 29 ) with a roadmap volume image ( 24 ) and
S12) Playback of superimposed images.

According to the invention, the acquisition of at least one 3-D volume image according to step S1, a subtraction of a 3-D mask image and a 3-D filling image of the examination subject and the processing of the 3-D volume image according to step S3, a segmentation of the object to determine a Object section, wherein the segmented object section ( 18 ) may be a stenosis and / or a tumor feeder.

According to the invention, the 2-D live image may be a fluoroscopic image and the 3-D volume image marked according to step S2 may be a DSA volume image.

It has proved to be advantageous if the generation of the at least one 2-D live image is effected by means of a detector with a matrix-type array of pixels.

Advantageously, the attenuation according to step S4 can be selectable.

According to the invention, the 3-D volume image or the DSA volume image according to step S4 and / or the roadmap volume image may be attenuated by means of a correction stage in accordance with step S11.

It has proved to be advantageous if the marked part of the examination object has an adjustable opacity and / or the opacity of the marked part of the examination object can be set on the basis of the current setting of a 3-D renderer.

According to the invention, the 3-D volume image of the object may be a CT, MR angiography and / or intraoperative rotational angiography for soft tissue imaging (DynaCT ^®) according to step S1.

The invention is explained in more detail with reference to embodiments shown in the drawing. Show it:

1 a known C-arm angiography system with an industrial robot as a carrying device,

2 an inventive roadmap method,

3 Procedural steps of the roadmap method according to the invention,

4 to 6 View 3-D volume images according to 2 and

7 and 8th real views of 3-D volume images according to 2 ,

At an in 2 3-D roadmap methods according to the invention become a 3-D mask image 11 for example, a head 12 without contrast agent and a 3-D filling image 13 during a contrast medium flooding, in which a 3-D vascular tree 14 is filled as a subject with contrast agent, generated and in a first subtraction stage 15 subtracted from each other, giving you a DSA volume image 16 receives in which only the contrast medium filled DSA-3-D vascular tree 17 can be seen.

This DSA 3-D vascular tree 17 in the DSA volume image 16 is partially segmented according to the invention, as will be described in more detail below, so that one has a segmented 3-D vessel section 18 in a segmented DSA volume image 19 which contains the remainder of the DSA 3-D vascular tree 20 is almost completely suppressed. In a first summing stage 21 now becomes the segmented DSA volume image 19 with that in a first correction stage 22 DSA volume image attenuated by a user-configurable factor k1 16 superimposed and together in a second correction stage 23 If necessary, it decreases by a factor k according to the current setting of a 3-D renderer, giving you a roadmap volume image 24 with a possibly slightly weakened segmented 3-D vessel section 25 and the more attenuated residual DSA-3-D vascular tree 20 receives.

A series of fluoroscopic images will be included in a roadmap study 26 or 2-D live images created in which, for example, a catheter 27 can be recognized as an object. In a second subtraction stage 28 becomes the series of fluoroscopic images 26 from the 3-D mask image associated with the view of the fluoroscopic images 11 subtracted, taking a series of subtraction pictures 29 in which essentially only the catheter is obtained 27 is recognizable.

In a second addition stage 30 becomes the series of subtraction pictures 29 with the roadmap volume image 24 superimposed, so you get a 2-D subtraction series 31 receives, in their individual images of the catheter 27 unattenuated, a 2-D vessel section 32 reduced by the factor k and a remaining 2-D vascular tree 33 as "background information" to recognize the factors k and k1 weakened.

In the 3 now the process sequence according to the invention is shown and described in detail. In a first step S1 at least a 3-D or a volume image 11 . 13 . 16 or 19 with an examination object, for example the 3-D vascular tree 14 , detected.

Subsequently, in accordance with a second step S2, a marking of at least one part takes place 18 of the examination object 14 in the 3-D volume image 11 . 13 . 16 or 19 For example, the segmented 3-D vessel section 18 , In a third step S3, the marked part 18 of the examination object 14 processed, for example, segmented.

Subsequently, according to a fourth step S4, an attenuation of the remaining, unmarked part of the 3-D volume image 11 . 13 . 16 or 19 For example, the remainder of the DSA 3-D vascular tree 20 , opposite the marked part 18 of the examination object 14 causes, so that by superimposing a fifth step S5, the 3-D roadmap image 24 arises in which the parts 18 and 20 of the examination object 14 have different opacities.

In a sixth step S6, at least one 2-D live picture is produced 26 or 29 then acquired in a seventh step S7 with the partially attenuated 3-D roadmap image 24 overlapped becomes. Finally, in a eighth step S8, a reproduction of the superimposed images takes place.

Based on 4 to 6 The mode of action of the individual process steps according to the invention will now be explained in more detail. In the 4 is a view of the DSA volume image 16 with the DSA 3-D vascular tree 17 shown from an angle. The 5 shows an intermediate picture 34 from the same perspective as the DSA volume image 16 in the step S2, a part of the DSA-3-D vascular tree by a user 17 with markings 35 has been provided and possibly segmented so that you can select a segmented vessel section 36 and a remaining 3-D information 37 of the DSA 3-D vascular tree 17 receives.

The 6 Now gives the result, the actual monitor image 38 schematically after performing the method described above, on which the selected segmented vessel section 36 with full opacity, while the rest of the DSA-3-D vascular tree 17 as weakened 3-D information 39 can be seen. This view corresponds to the roadmap volume image 24 , Instead of the segmented vessel section 36 but also only one between at least two markings 35 drawn line, for example, if the examined vessel section is difficult to segment.

The 7 and 8th give the embodiment of the invention using real X-ray images again. The 7 shows a view of the DSA volume image 16 with the DSA 3-D vascular tree 17 from an angle according to 4 , In the 8th are in the monitor picture 38 according to 6 DSA 3-D vascular tree 17 with lower opacity than attenuated 3-D information 39 and one between the marks 35 drawn line 40 or optionally the segmented vessel portion is displayed with full opacity.

• A) Segmentierter Gefäßabschnitt (z. B. Stenose, Tumor-Feeder, etc.) und
• B) Restliche 3-D-Information, die nicht Teil des segmentierten Gefäßabschnittes ist.

In summary, the following is proposed according to the invention: The 3-D information of a 3-D volume image to be superimposed is divided into two components:

• A) Segmented vascular segment (eg stenosis, tumor feeder, etc.) and
• B) Remaining 3-D information that is not part of the segmented vascular segment.

The A-information should be superimposed with full or adjusted opacity according to the current setting of the 3-D renderer, whereas the B-information should be superimposed with an opacity which is superimposed with a user-configurable factor k1 (k1 = 0 to 1 ) is multiplied.

In an advantageous realization, the factor k1 is 0.5. As a result, the B information is displayed with only half opacity (or double transparency) as the A information.

An example is a 3-D volume whose opacity is set to 70% in the 3-D renderer (factor k = 0.7). Then, the segmented vascular section with 70% opacity and the remaining 3-D information with 35% (= 70% multiplied by k1 = 0.5).

• – Es wird nur die Information in "voller" Opazität überlagert, die vom Arzt vorher ausgewählt wurde (z. B. der segmentierte 3-D-Gefäßabschnitt 18).
• – Durch die höhere Transparenz der B-Information wird zum Einen eine gute 3-D-Orientierung erreicht, und zum Anderen die Sichtbarkeit des 2-D-Bildes erhöht.
• – Die Einstellung der unterschiedlichen Opazitäten wird automatisch und ohne notwendige Nutzerinteraktion durchgeführt, so dass der Workflow des Arztes unterstützt und beschleunigt wird.

The advantages of this method according to the invention are:

• - Only the information in "full" opacity, which was previously selected by the physician (eg the segmented 3-D vessel section), is superimposed 18 ).
• - The higher transparency of the B-information on the one hand a good 3-D orientation is achieved, and on the other hand increases the visibility of the 2-D image.
• The adjustment of the different opacities is carried out automatically and without necessary user interaction, so that the workflow of the doctor is supported and accelerated.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• US 7500784 B2 [0001, 0003]

Cited non-patent literature

• "syngo Workplace - Embolization Guidance - Operating Instructions" from Siemens AG, printed February 2010, Order No .: AX42-010.621.70.01.01 [0012]

Claims (14)

Method for highlighting objects ( 27 ) in interventional angiographic examinations by superposition of 3-D volume images of an examination subject ( 14 ) with at least one 2-D live image, comprising the following steps: S1) acquiring at least one 3-D volume image ( 11 . 13 . 16 . 19 ) of the examination subject ( 14 ), S2) marking at least a part of the examination object ( 14 ) in the 3-D volume image ( 11 . 13 . 16 . 19 ), S3) processing of the marked part of the examination subject ( 14 ) for determining an object section ( 18 ) in a processed volume image ( 19 ), S4) attenuation of at least the remaining, unmarked part ( 20 ) of the examination subject ( 14 ) opposite the object section ( 18 ) in the 3-D volume image ( 11 . 13 . 16 . 19 ), so that at least the parts ( 18 . 20 ) of the examination subject ( 14 ) have different opacities, S5) superposition of both parts of the 3-D volume image ( 11 . 13 . 16 . 19 ) for generating a roadmap volume image ( 24 ), S6) generating at least one 2-D live image ( 26 . 29 ), S7) Overlay of the 2-D live image ( 26 . 29 ) with the partially attenuated 3-D volume image for generation and S8) reproduction of the overlaid images. A method according to claim 1, characterized in that the attenuation according to step S4 with respect to the object portion ( 18 ) of the examination subject ( 14 ) on the entire 3-D volume image ( 11 . 13 . 16 . 19 ) is applied so that the 3-D volume image ( 11 . 13 . 16 . 19 ) of the examination subject ( 14 ) compared to the processed volume image ( 19 ) has different opacities. Method according to Claim 1 or 2, characterized in that the method also has the following further steps: S9) acquisition of a series of fluoroscopic images ( 26 ) with the object ( 27 ), S10) subtraction of the series of fluoroscopic images ( 26 ) and a 3-D volume image ( 11 ) without contrast agent filling to generate a series of subtraction images ( 29 ), S11) superposition of the series of subtraction images ( 29 ) with a roadmap volume image ( 24 ) and S12) playback of superimposed images. Method according to one of claims 1 to 3, characterized in that the acquisition of at least one 3-D volume image according to step S1, a subtraction of a 3-D mask image ( 11 ) and a 3-D filling image ( 13 ) of the examination subject ( 14 ). Method according to one of claims 1 to 4, characterized in that the processing of the 3-D volume image according to step S3, a segmentation of the object ( 14 ) for determining an object section ( 18 ). Method according to Claim 5, characterized in that the segmented object section ( 18 ) is a stenosis and / or a tumor feeder. Method according to one of Claims 1 to 6, characterized in that the 2-D live image ( 26 . 29 ) is a fluoroscopic image. Method according to one of Claims 1 to 7, characterized in that the 3-D volume image marked according to step S2 has a DSA volume image ( 16 ). Method according to one of Claims 1 to 8, characterized in that the generation of the at least one 2-D live image ( 26 . 29 ) by means of a detector ( 4 ) with a matrix-like array of pixels. Method according to one of claims 1 to 9, characterized in that the attenuation according to step S4 is selectable. Method according to one of claims 1 to 10, characterized in that the 3-D volume image ( 11 . 13 . 16 . 19 ) or DSA volume image ( 16 ) according to step S4 and / or the roadmap volume image ( 24 ) are attenuated according to step S11 by means of a correction stage. Method according to one of claims 1 to 11, characterized in that the marked part ( 18 ) of the examination subject ( 14 ) has an adjustable opacity. Method according to claim 12, characterized in that the opacity of the marked part ( 18 ) of the examination subject ( 14 ) is adjustable due to the current setting of a 3-D renderer. Method according to one of claims 1 to 13, characterized in that the 3-D volume image of the object ( 14 ) according to step S1 is a CT, MR angiography and / or intraoperative rotational angiography for soft tissue imaging.

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