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JPH09276274

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DESCRIPTION JPH09276274
[0001]
BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an
ultrasound observation and treatment probe for performing ultrasound diagnosis and treatment
with focused ultrasound irradiation in a body cavity.
[0002]
2. Description of the Related Art As a prior art, a therapeutic ultrasonic endoscope disclosed in
JP-A-62-127050 is known. This therapeutic ultrasonic endoscope is provided with a back-to-back
observation ultrasonic transducer (image acquisition ultrasonic transducer) and a therapeutic
ultrasonic transducer (therapeutic ultrasonic transducer) at the distal end of the insertion section.
This makes it possible to perform both ultrasound diagnosis and ultrasound treatment, and
reduce the diameter of the tip of the endoscope insertion portion.
[0003]
SUMMARY OF THE INVENTION In the therapeutic ultrasonic endoscope disclosed in Japanese
Patent Application Laid-Open No. 62-127050, the observation ultrasonic transducer and the
therapeutic ultrasonic transducer are integrated back to back. , Treatment of the lesion,
observation could only be performed from the same direction.
[0004]
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1
When the treatment is performed by the therapeutic ultrasonic transducer, the focusing point is
heated by the ultrasound focused for treatment (abbreviated as therapeutic focusing ultrasonic
wave), and the tissue at the focusing point causes protein denaturation.
Protein-denatured tissue differs in acoustic impedance from surrounding tissue.
[0005]
Therefore, ultrasound is likely to be reflected at the protein-denatured portion. In addition, since
ultrasound is apt to be attenuated in a protein-denatured tissue, therapeutic focused ultrasound
can not reach further away.
[0006]
On the other hand, the heat conduction from the focusing point and the action of the focused
ultrasound for treatment cause the protein on the side closer to the therapeutic ultrasonic
transducer than the focusing point to be denatured. Moreover, as the irradiation time of focused
ultrasound increases, the protein denatured region expands in the direction near the therapeutic
ultrasound transducer according to the beam shape of the focused ultrasound.
[0007]
Therefore, when observation is performed by the observation ultrasonic transducer from the
same position, attenuation of the observation ultrasonic wave occurs due to the protein
denatured tissue portion on the therapeutic ultrasonic transducer side of the focusing point, and
ultrasonic diagnosis of the focusing point There is a problem that it is difficult to observe an
image and it is difficult to confirm whether or not the lesion set at the focusing point can be
surely cauterized.
[0008]
The present invention has been made in view of the above-described point, and its object is to
provide a focusing point without being hindered by the protein-denatured tissue on the
therapeutic ultrasound transducer side from the focusing point after irradiation with the focused
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2
therapeutic ultrasound. An object of the present invention is to provide a probe for ultrasonic
treatment which can confirm whether or not a nearby lesion has been cauterized with
observation images.
[0009]
An insertion portion insertable into a body cavity, an ultrasonic transducer for image acquisition
provided at the distal end side of the insertion portion, an ultrasonic transducer for image
acquisition, and a length of the insertion portion A therapeutic ultrasonic transducer provided in
the insertion portion, spaced apart in a direction, for delivering an ultrasonic beam to focus on a
focusing point, and provided on the distal end side of the insertion portion, focusing the
therapeutic ultrasonic transducer A curved portion is provided to move at least one of the image
acquisition ultrasonic transducer and the therapeutic ultrasonic transducer so that the point is
located within the field of view of the image acquisition ultrasonic transducer.
Therefore, it is possible to arrange a focusing point to be treated by the therapeutic ultrasonic
transducer in the observation field of view of the ultrasonic transducer for image acquisition by
curving the bending portion, and to irradiate the focused ultrasonic beam by the therapeutic
ultrasonic transducer. Later, it is possible to obtain an ultrasound observation image in the
vicinity of the focusing point without being blocked by the tissue whose attenuation on the
therapeutic ultrasonic transducer side is larger than the focusing point.
[0010]
BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be
specifically described below with reference to the drawings.
(First Embodiment) FIGS. 1 and 2 relate to a first embodiment of the present invention, and FIG. 1
is a schematic diagram showing an entire configuration of an ultrasonic diagnostic treatment
system having the first embodiment. FIG. 2 is a view showing a state of using the ultrasonic
treatment probe according to the first embodiment.
[0011]
As shown in FIG. 1, the ultrasonic diagnostic treatment system 1A having the first embodiment
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3
includes the ultrasonic observation treatment means for performing ultrasonic observation and
treatment according to the first embodiment. A therapeutic probe (hereinafter simply referred to
as an ultrasonic probe) 2A, a signal processing means 4 for performing signal processing on the
ultrasonic observation means 3 built in the ultrasonic probe 2A, and a drive means for the
ultrasonic treatment means 5 And a color monitor 10 as display means 9 for displaying an
ultrasonic image signal generated by signal processing for the ultrasonic observation means 3.
Ru.
[0012]
As shown in FIG. 1, the ultrasonic probe 2A has a thin tubular insertion portion 11 so that the
ultrasonic probe 2A can be inserted into a body cavity, and a first grip portion 12 formed at the
rear end of the insertion portion 11 and gripped by the operator. A wide operating portion 13
formed adjacent to the rear of the holding portion 12 and performing a bending operation, a
second holding portion 14 formed adjacent to the rear of the operating portion 13, and the
holding portion 14 and has a connection cord 15.
As shown in FIG. 1, the connector 16 provided at the end of the connection cord 15 can be
detachably connected to the ultrasonic diagnostic treatment apparatus 7A.
[0013]
The insertion portion 11 in this embodiment includes a rigid distal end portion 18 on which an
ultrasonic transducer for image acquisition or an ultrasonic transducer 17 for observation for
obtaining an observation image by ultrasonic waves is disposed, and a rear portion of the distal
end portion 18. The bending tube 19 is formed of a bendable bending portion 19 formed
adjacent to the end, and a long, rigid insertion tube 20 extending from the rear end of the
bending portion 19 to the front end of the first holding portion 12. The configuration is such that
a concave focusing type therapeutic ultrasonic transducer or therapeutic ultrasonic transducer
21 is disposed in the vicinity of the tip of 20.
[0014]
That is, in the present embodiment, the bendable bending portion 19 is sandwiched at the tip end
side of the insertion portion 11 and observed on one side of the bending portion 19 (specifically,
the tip portion 18 at the tip end side of the bending portion 19). The ultrasonic transducer 17 is
provided, and the therapeutic ultrasonic beam is emitted (or delivered) so as to be focused on the
other side (specifically, in the vicinity of the tip of the insertion tube 20 on the rear end side than
03-05-2019
4
the bending portion 19). A therapeutic ultrasonic transducer 21 is provided.
[0015]
The operation section 13 is provided with a bending operation knob 22 for performing a bending
operation, and the bending section 19 can be bent, for example, in the vertical direction by
rotating the bending operation knob 22, as shown in FIG. 1 and FIG. It shows a state of being
curved upward.
The configuration of the bending portion 19 and the bending operation knob 22 is the same as
that of the bending portion and the bending operation knob of the endoscope.
[0016]
A signal pulse 23 for observation means connected to the ultrasonic transducer 17 for
observation is inserted through the insertion portion 11, and a transmission pulse generation
circuit generating a transmission pulse provided in the ultrasonic treatment apparatus 7A
through the connector 16 24 are connected to a reception processing circuit 25 that performs
signal processing on the received ultrasonic echo signal.
[0017]
An output signal of the reception processing circuit 25 is converted into a standard video signal
by a digital scan converter (abbreviated as DSC) 26, and further, is input to the color monitor 10
through the mixer 27, and an ultrasonic tomographic image is displayed on the display surface of
the color monitor 10. The image 28 is displayed.
[0018]
Further, a (rotary) encoder 29 for detecting a bending amount or a bending angle is connected to
the rotation member 40 of the bending operation knob 22. This encoder 29 is used for ultrasonic
vibration in the ultrasonic diagnostic treatment apparatus 7A. It is connected to a focal point
marker generating circuit 32 which generates a focal point marker signal for displaying the focal
point marker 31 at the image position corresponding to the focal point 30 of the element 21.
[0019]
The concave focusing type therapeutic ultrasonic transducer 21 built in the vicinity of the tip of
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5
the insertion tube 20 adjacent to the rear end of the bending portion 19 is also connected to the
therapeutic signal line 33 inserted into the insertion portion 11, The signal line 33 is connected
to a drive signal generation circuit 34 which generates a drive signal for treatment provided in
the ultrasonic diagnostic treatment apparatus 7A.
[0020]
Further, a keyboard provided in the ultrasonic diagnostic treatment apparatus 7A for performing
key input for instructing the level of the drive signal etc. to the controller 35 for controlling the
transmission pulse generation circuit 24, the reception processing circuit 25 and the drive signal
generation circuit 34. 36 and a foot switch 37 for instructing output / output stop of the drive
signal are connected.
[0021]
As shown in FIG. 1, in the bending portion 19, substantially ring-shaped bending pieces 38a,
38b,... Are rotatably connected in the longitudinal direction of the insertion portion 11.
The ends of wires 39a and 39b for bending operation are fixed to the bending piece 38a at the
end with a fixing member (not shown), and the rear end sides of these wires 39a and 39b
inserted into the insertion tube 20 at the back of the bending portion 19 are curved The
proximal end of the operation knob 22 is attached and fixed to the rotatable rotation member 40
to constitute a bending mechanism.
[0022]
As shown in FIG. 2, in this embodiment, the ultrasonic transducer 17 for observation as the
ultrasonic observation means 3 provided at the distal end portion 18 specifically adopts an
electronic linear scan type ultrasonic transducer 17a. ing.
The ultrasonic transducer 21 for treatment provided as ultrasonic treatment means 5 provided in
the vicinity of the front end of the insertion tube 20 adjacent to the rear end of the bending
portion 19 is concave and gradually focuses the ultrasonic beam emitted from the concave
Concave focusing type vibrator is adopted.
03-05-2019
6
[0023]
Further, as shown in FIG. 1, an ultrasonic transmission medium 42 is enclosed in the internal
space of the insertion tube 20 around the ultrasonic transducer 21 for treatment, and an
ultrasonic beam of the ultrasonic transducer 21 for treatment is transmitted or An ultrasonic
wave transmission window 43 formed of a member that transmits ultrasonic waves is formed on
the transmission surface side to be transmitted, and ultrasonic waves can be transmitted through
the ultrasonic wave transmission window 43.
[0024]
In this case, the therapeutic ultrasonic transducer 21 is circular, and one surface emitting the
ultrasonic wave is a concave surface with a predetermined curvature in the longitudinal direction
and a concave surface with the same curvature in the width direction. .
Further, in the ultrasonic transducer for treatment 21, the central axis in the longitudinal
direction is disposed along the central axis of the insertion tube 20, and the concave surface of
the ultrasonic transducer for treatment 21 faces the upward direction of the bending portion 19.
There is.
[0025]
The observation ultrasonic transducer 17 disposed at the distal end portion 18 curves the
bending portion 19 upward, and as shown in FIG. 1, the observation ultrasonic transducer 17
and the therapeutic ultrasonic transducer 21 face each other. When the ultrasonic transducer 17
for observation is used, the ultrasonic transducer 17 for observation is such that the central axis
of the ultrasonic transducer 17 for observation in the longitudinal direction and the central axis
of the ultrasonic transducer 21 for treatment in the longitudinal direction exist in the same plane.
Are arranged in the longitudinal direction of the tip portion 18.
For example, it is disposed along the side surface (longitudinal direction) of the tip portion 18
which is the upper side when the bending portion 19 is bent.
[0026]
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7
And, even when the value of the amount of bending (the bending angle) is changed, the central
axis of the ultrasonic transducer for observation 17 in the longitudinal direction and the central
axis of the ultrasonic transducer for treatment 21 in the longitudinal direction are always the
same plane (Quote in the P plane.
In FIG. 1, the paper surface is in the plane P).
[0027]
Further, the observation ultrasonic transducer 17 is configured, for example, by arranging a
plurality of electron linear scan type transducer elements in an array in the longitudinal
direction.
Then, a plurality of electronic linear scan type transducer elements are sequentially driven
electronically to obtain an ultrasonic tomographic image 28 by the electronic linear scan with
respect to the ultrasonic observation area 46 indicated by the two-dot chain line in FIG. .
[0028]
The focusing point 30 of the therapeutic ultrasonic transducer 21 is on the P plane, and the
ultrasonic observation area 46 is also on the P plane. Therefore, the bending angle is changed to
be in the ultrasonic observation area 46. When the focusing point 30 is set, an image including
the focusing point 30 can be obtained on the ultrasonic tomographic image 28 obtained by the
observation ultrasonic transducer 17.
In addition, when the value of the bending angle is changed, the focusing point 30 in (or outside)
the ultrasonic observation area 46 moves according to the value.
[0029]
As shown in FIG. 2, the ultrasonic probe 2A configured as described above is inserted into the
insufflated body cavity through the trocar 44, and the ultrasonic transducer 21 for treatment of
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8
the ultrasonic probe 2A is observed and treated. To the back side of the organ 45 to perform the
bending operation as it is, and the ultrasonic transducer 17 for observation of the distal end
portion 18 is also brought into contact with the surface of the organ 45.
[0030]
The bending operation is performed by rotating the bending operation knob 22 provided in the
operation unit 13 shown in FIG. 1 to rotate the rotating member 40, and with this rotation, one
of the pair of wires 39a and 39b is pulled. The pair of wires 39a, 39b, the other of which is
relaxed, can be advanced and retracted to bend the bending pieces 38a, 38b,... Of the bending
portion 19 toward the towed side.
[0031]
Next, the transmission pulse from the transmission pulse generation circuit 24 of the ultrasonic
diagnostic treatment apparatus 7A shown in FIG. 1 is applied to the ultrasonic transducer 17 for
observation to excite the ultrasonic transducer 17 for observation, as shown in FIG. Thus, the
observation ultrasonic wave is emitted to the organ 45 side.
[0032]
The observation ultrasonic waves are reflected at portions having different acoustic impedances
to be reflected ultrasonic waves and received by the observation ultrasonic transducer 17.
The received ultrasonic wave is converted into an electric signal by the observation ultrasonic
transducer 17, passes through the observation signal line 23, is signal processed by the
reception processing circuit 25, and is converted into a video signal.
This video signal is converted into a standard video signal (television signal) by the DSC 26, and
is input to the color monitor 10, and a rectangular (including square) ultrasonic tomographic
image 28 by electronic linear scanning is displayed on the display surface thereof. Is displayed.
[0033]
In this case, the ultrasonic pulse is intermittently emitted in the range of the ultrasonic
03-05-2019
9
observation region 46 indicated by the two-dot chain line in FIG. 1 and FIG. 2, and the reflected
ultrasonic wave is used for observation ultrasonic transducer 17 (more specifically Are received
at 17a) and converted into electrical signals.
Signals transmitted and received in the range of the ultrasonic observation area 46 are subjected
to signal processing by the reception processing circuit 25 and passed through the DSC 26 to the
display surface of the color monitor 10 as a tomographic image by ultrasound inside an organ,
that is, an ultrasonic tomographic image 28 It will be extracted. Therefore, the ultrasonic
observation area 46 is an observation field of view by the ultrasonic transducer 17 for
observation.
[0034]
Furthermore, the amount of movement detected from the encoder 29 connected to the bending
operation knob 22 is input to the focusing point marker generation circuit 32, and this focusing
point marker generation circuit 32 receives the information input from the encoder 29 and the
therapeutic ultrasound. The bending angle and the focusing point 30 are calculated with
reference to the information of the distance to the focusing point 30 of the vibrator 21 and the
like, and the focusing point is displayed at the timing to display the focusing point marker 31 at
the image position of the focusing point 30. The marker signal is output to the mixer 27,
superimposed on the video signal output from the DSC 26, and the focal point marker 31 is
displayed on the ultrasonic tomographic image 28.
[0035]
The bending portion 19 is bent and position adjustment is performed so that the focusing point
marker 31 appears on the ultrasound tomographic image 28, and the focusing point 30 of the
treatment ultrasound is adjusted in the ultrasound observation area 46. .
[0036]
Next, the insertion unit 11 is moved so that the lesion 47 is extracted on the ultrasonic
tomographic image 28.
The positioning setting is performed by moving the position or the like of the insertion portion
11 so that the focusing point marker 31 on the ultrasonic diagnostic image 28 matches the
position of the lesion 47.
03-05-2019
10
After positioning is set so that the focusing point marker 31 matches the position of the lesion
47, that is, after the focusing point 30 is set at the position of the lesion 47, the drive signal
generation circuit 34 generates therapeutic focusing ultrasonic waves of necessary intensity.
Irradiation is performed from the concave focusing type therapeutic ultrasonic transducer 21
shown in FIG.
[0037]
The drive signal from the drive signal generation circuit 34 has a signal level higher than the
signal level of the transmission pulse for driving the observation ultrasonic transducer 17, and
the therapeutic ultrasonic transducer 21 is formed into a concave shape. Each part of is formed
so as to exist in a spherical shape with a radius of curvature centered on the set focusing point.
[0038]
The ultrasonic wave emitted from the concave focusing type therapeutic ultrasonic transducer
21 advances with its wave front becoming concave, and becomes tapered like the therapeutic
focused ultrasonic area 48 as shown in FIG. It propagates as a therapeutic focused ultrasound
having a beam shape focused at 30.
[0039]
At this focusing point 30, there are very high intensity ultrasonic waves, ie acoustically high
energy density.
Therefore, when a large amplitude drive signal is applied to the concave focusing transducer 21
with the diseased tissue placed near the focusing point 30, high-density acoustic energy based on
the generated strong ultrasonic waves is concentrated at the focusing point 30. Do.
The application of the drive signal is performed by stepping on the foot switch 37 to turn on the
switch, and the controller 35 performs control to output the drive signal of the drive signal
generation circuit 34.
[0040]
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11
When irradiated with the above-mentioned high-intensity therapeutic focusing ultrasound, the
lesion 47 set at the position of the focusing point 30 rapidly rises in temperature due to the
ultrasonic absorption in the living tissue of the focusing point 30 and its vicinity, Cauter the
affected tissue. When ultrasound irradiation continues, therapeutic focused ultrasound is likely to
be attenuated in tissue that is denatured of protein whose acoustic impedance is different from
the surrounding tissue, and the ultrasound is likely to be thermal energy, so that the protein
denaturation region is expanded.
[0041]
On the other hand, due to the heat conduction from the focusing point 30 and the action of the
focusing ultrasound for treatment, the tissue 49 closer to the therapeutic ultrasonic transducer
21 than the focusing point 30 is also denatured. If the application of the continuous wave drive
signal to the concave focusing type therapeutic ultrasonic transducer 21 is stopped by stopping
the output of the drive signal of the drive signal generation circuit 34, the ablation treatment by
the ultrasonic irradiation can be ended. .
[0042]
The application is stopped by stepping on the foot switch 37 and turning off the switch, and the
controller 35 stops outputting the drive signal of the drive signal generation circuit 34. Also, by
performing key input of level setting from the keyboard 36, the level of the drive signal output
from the drive signal generation circuit 34 can be variably set.
[0043]
The state of protein denaturation of the tissue after this cauterization is observed on the
ultrasonic tomographic image 28 obtained by the electronic linear scan type ultrasonic
transducer 17a.
[0044]
In the present embodiment, by changing the value of the bending angle, ultrasonic observation
03-05-2019
12
can be performed from another angle different from the transmitting direction of the therapeutic
ultrasonic wave.
That is, in the case where the therapeutic ultrasonic waves shown in FIG. 2 are focused and
irradiated, the ultrasonic vibration of the concave focusing type is more focused than the
focusing point 30 which has been denatured by the heat conduction from the focusing point 30
after the irradiation. The tissue 49 on the side of the child 21 is also denatured by protein, and
the attenuation of the ultrasonic wave at that portion becomes large. In this case, (the attenuation
at the tissue 49 on the front side of the focusing point 30 becomes large if the transmitting
direction of the therapeutic ultrasonic wave and the observation direction by the observing
ultrasonic wave are the same as in the conventional example) Therefore, it becomes difficult to
observe the tissue state in the vicinity of the focusing point 30 on the other side, whereas in the
present embodiment, for example, as shown in FIG. Since observation by the observation
ultrasonic wave can be performed from this, it can eliminate that observation becomes difficult
like that.
[0045]
Further, in the state as shown in FIG. 2, that is, in the case where the observation ultrasonic wave
is observed from the side opposite to the delivery direction of the therapeutic ultrasonic wave,
the tissue near the point where it starts diverging after focusing at the focusing point 30 Even if
a case where protein denaturation occurs in the area adjacent to the focusing point 30 in 2 and
on the side opposite to the tissue 49 side, changing the value of the bending angle from the other
direction (the above-mentioned tissue prevents Can be observed).
[0046]
It is confirmed whether the lesion 47 is protein degeneration only necessary to cause necrosis of
the lesion cells, and additional irradiation is performed in the same manner as described above
until the protein degeneration as necessary is achieved, and the treatment ultrasound Repeat the
treatment by irradiation of.
When it is confirmed that the lesioned part 47 has been completely cauterized, all treatments are
ended.
[0047]
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13
According to the first embodiment, the treatment shown in FIG. 2 can be performed by
irradiating the ultrasound radiation direction to the lesion 47 of the ultrasound observation
means 3 and the ultrasound treatment means 5 from different directions. The ultrasound
observation image of the ultrasonic observation means 3 can be obtained without being hindered
by the tissue 49 on the concave focusing type vibrator 21 side from the protein-denatured
focusing point 30 by the heat conduction of the focusing point 30 later. It can be confirmed from
the observation image whether or not 47 can be surely cauterized.
[0048]
Therefore, cauterization can be repeated while confirming whether or not the lesioned part 47
has been surely cauterized by the ultrasonic observation image, and it is possible to easily
perform reliable observation and treatment of the lesioned part 47.
[0049]
The arrangement of the ultrasonic observation means 3, the bending part 19, the ultrasonic
treatment means 5, and the insertion tube 20 from the distal end 18 side of the insertion part 11
according to the first embodiment is the distal end 18 side of the insertion part 11. From the
above, the ultrasonic treatment means 5, the bending portion 19, the ultrasonic observation
means 3, and the insertion tube 20 may be used.
That is, in FIG. 1, the therapeutic ultrasonic transducer 21 may be built in the distal end portion
18 or the like, and the observation ultrasonic transducer 17 may be provided in the vicinity of
the distal end of the insertion tube 20.
[0050]
Also in this case, by changing the value of the bending angle of the bending portion 19, the
focusing point 30 by the therapeutic ultrasonic transducer 21 is set in the observation field of
view by the ultrasonic transducer 17 for observation or the position thereof It can move.
In addition, the insertion tube 20 may be a flexible insertion tube or a flexible tube that can be
bent without being made rigid.
03-05-2019
14
[0051]
Second Embodiment Next, a second embodiment of the present invention will be described with
reference to FIG. FIG. 3 shows an ultrasonic diagnostic treatment system 1B provided with the
ultrasonic probe 2B of the second embodiment. The main configuration is the same as in the first
embodiment, so only the changes will be described.
[0052]
As shown in FIG. 3, in this embodiment, the therapeutic ultrasonic transducer 21 which is the
ultrasonic therapeutic means 5 formed in the insertion portion 11 is a fixing means (not shown)
at the tip of a flexible shaft 51 having a flexible characteristic. It is connected by. The flexible
shaft 51 is inserted into the insertion portion 11 and further connected to the moving plate 53 of
the moving means 52 provided on the second holding portion 14 through the first holding
portion 12 and the operation portion 13 by fixing means (not shown). It is The flexible shaft 51
has, for example, a configuration of a spiral tube in which a metal band is spirally wound.
[0053]
A therapeutic signal line 33 connected to the therapeutic ultrasonic transducer 21 is inserted
into the flexible shaft 51 as shown in the enlarged view. The therapeutic signal line 33 inserted
into the flexible shaft 51 is connected to the drive signal generation circuit 34 in the ultrasonic
diagnostic treatment apparatus 7B.
[0054]
In the moving plate 53, a ball screw screw hole 54 is provided in a direction parallel to the axis
of the insertion portion 11, and the ball screw 55 is inserted. The moving plate 53 is provided
with a guide hole 53a parallel to the axial direction of the ball screw 55, and a linear guide 56
fixed to the second grip portion 14 by a fixing means (not shown) is provided in the guide hole
53a. It is inserted.
03-05-2019
15
[0055]
The hand side of the ball screw 55 is connected to the rotation shaft of the stepping motor 57
fixed to the second operation unit 14 by fixing means (not shown). The stepping motor 57 is
connected to the control circuit 60 via a motor driver 59 in a motor control means 58 provided
in the ultrasonic diagnostic treatment apparatus 7B. The control circuit 60 is connected to the
controller 35 and can be controlled via the controller 35 by key input operation from the
keyboard 36 or the like.
[0056]
Then, by driving the stepping motor 57 to rotate, the moving plate 53 is moved in the axial
direction of the ball screw 55, and with this movement, the flexible shaft 51 is advanced and
retracted in the axial direction of the insertion portion 11, and the treatment provided at the tip
The ultrasonic transducer 21 is also movable from a position near the tip of the insertion tube 20
to near the tip of the bending portion 19. The main setting position is indicated by a two-dot
chain line. Further, the position of the focusing point 30 can also be moved as indicated by a twodot chain line when the therapeutic ultrasonic transducer 21 is moved.
[0057]
An ultrasonic wave transmission window 43 'is provided in the range in which the therapeutic
ultrasonic transducer 21 moves. In addition, an ultrasonic transmission medium 42 is enclosed in
the internal space (of the insertion portion 11) in the range where the therapeutic ultrasonic
transducer 21 moves, so that ultrasonic waves can be transmitted through the ultrasonic wave
transmission window 43 '. ing.
[0058]
The material of the bending piece that forms the bending portion 19 used in this embodiment
uses a material that transmits ultrasonic waves. In the present embodiment, the therapeutic
ultrasonic transducer 21 can be moved to a designated position in the axial direction by
performing key input of the movement position from the keyboard 36. The movement position
can be set, for example, as follows.
03-05-2019
16
[0059]
Based on the amount of rotation of the stepping motor 57 by one control pulse transmitted by
the control circuit 60, the control circuit 60 transmits to the stepping motor 57 the control pulse
necessary to move to the designated movement position. The movement direction is switched by
the control circuit 60 rotating the stepping motor 57 forward and backward.
[0060]
Further, the control circuit 60 is connected to the focal point marker generation circuit 32, and
the control circuit 60 sends information on the axial position of the insertion portion 11 of the
ultrasonic transducer 21 for treatment to the focal point marker generation circuit 32. The
generation circuit 32 also refers to this information when determining the generation position of
the focusing point marker 31.
[0061]
The other configuration is the same as that of the first embodiment, and the same components
are denoted by the same reference numerals and the description thereof will be omitted.
Next, the operation of the present embodiment will be described. In the ultrasonic probe 2B of
the present embodiment, when the movement position or movement instruction is issued from
the keyboard 36 or the like, the instruction is sent to the control circuit 60 via the controller 35,
and the control circuit 60 is instructed Control is performed to supply a control pulse for driving
the stepping motor 57 from the motor driver 59 to the stepping motor 57 disposed in the
moving means 52 so as to move by the movement amount. When the stepping motor 57 rotates,
the rotation is transmitted to the ball screw 55.
[0062]
The flexible shaft 51 connected to the movable plate 53 and the movable plate 53 is axially
advanced and retracted by the rotation of the ball screw 55 and the ball screw screw holes 54
opened in the movable plate 53, and connected to the tip of the flexible shaft 51. The therapeutic
ultrasonic transducer 21 is moved in the axial direction of the insertion portion 11.
03-05-2019
17
[0063]
The encoder 29 connected to the rotating member 40 of the bending operation knob 22
determines the amount of rotation of the rotating member 40 and determines the bending angle
of the bending portion 19.
The position in the insertion axial direction of the ultrasonic transducer 21 for treatment is
determined from the amount of rotation of the stepping motor 57 and the size of the ball screw
55 and the pitch of the ball screw 55 which are known from the number of control pulses
transmitted to the stepping motor 57 by the control circuit 60 Information is sent to focus point
marker generation circuit 32.
[0064]
The focusing point marker generation circuit 32 determines the focusing point 30 of the
therapeutic ultrasonic transducer 21 from the bending angle of the bending portion 19 and the
axial position of the insertion portion 11 of the therapeutic ultrasonic transducer 21, and the
position of the focusing point 30 The corresponding focal point marker signal is output to the
mixer 27 so that the focal point marker 31 is displayed, and superimposed on the video signal of
the observation ultrasonic image output from the DSC 26 to be displayed on the ultrasonic crosssectional image 28. Display on
[0065]
The bending portion 19 is bent and position adjustment is performed so that the focusing point
marker 31 appears on the ultrasound tomographic image 28 so that the focusing point 30 of the
focused ultrasound for treatment is located in the ultrasound observation area 46. .
[0066]
Next, the insertion unit 11 is moved so that the lesion 47 is extracted on the ultrasonic
tomographic image 28.
The position of the insertion unit 11 is moved so that the focal point marker 31 on the
ultrasound diagnostic image 28 matches the position of the lesion 47.
03-05-2019
18
Further, the movement position is key-input from the keyboard 36, and the treatment ultrasonic
transducer 21 is moved in the axial direction, etc. to set the positioning of treatment.
[0067]
After setting of the positioning, the lesion 47 is cauterized by irradiating the therapeutic focusing
ultrasonic wave of necessary intensity by the drive signal generation circuit 34 from the concave
focusing type therapeutic ultrasonic transducer 21 shown in FIG. Can.
[0068]
In addition, the lesion 47 can be cauterized while moving the therapeutic ultrasonic transducer
21 in the axial direction.
By inputting the movement range as a key from the keyboard 36, the therapeutic ultrasonic
transducer 21 can be moved in the axial direction by the specified movement range. The setting
method of the movement range is as follows.
[0069]
Based on the amount of rotation of the stepping motor 57 by one control pulse transmitted by
the control circuit 60, the control circuit 60 transmits to the stepping motor 57 a control pulse of
rotation necessary to move the designated moving range.
[0070]
When the therapeutic ultrasonic transducer 21 is moving in the movement range, cauterization
can be performed while moving in the axial direction by pressing the foot switch 37 and applying
a drive signal to the concave focusing transducer 21.
When movement of the movement range is completed, the cauterization is completed by
depressing the foot switch 37 and turning off the switch.
03-05-2019
19
[0071]
Furthermore, the movement speed of the therapeutic ultrasonic transducer 21 in the axial
direction can be changed by key-inputting the movement speed level from the keyboard 36. The
moving speed setting method is as follows.
[0072]
If the transmission interval of the control pulse transmitted by the control circuit 60 is shortened,
the moving speed can be increased. In addition, moving speed can be reduced by increasing the
transmission interval.
[0073]
According to the second embodiment, the ultrasonic treatment means 5 can be moved in the
axial direction of the insertion portion 11, whereby the ablation range can be expanded. In
addition, since the ultrasonic treatment means 5 can be moved to the portion to be cauterized,
alignment to the lesion 47 can be performed easily and accurately.
[0074]
Third Embodiment Next, a third embodiment of the present invention will be described with
reference to FIG. FIG. 4 shows an ultrasonic diagnostic treatment system 1C provided with the
ultrasonic probe 2C of the third embodiment. The main configuration is the same as that of the
second embodiment, so only the changes will be described.
[0075]
As shown in FIG. 4, the therapeutic ultrasonic transducer 21 as the ultrasonic therapeutic means
5 formed in the insertion portion 11 used in the ultrasonic probe 2C of this embodiment has a
minimum curvature radius 71 of the bending portion 19 and It has the same focusing point
03-05-2019
20
distance 72. Further, in the present embodiment, the ultrasonic treatment means 5 is structured
to move in the bending portion 19 (may be movable also on the insertion tube 20 side as in the
second embodiment). The other configuration is the same as that of the second embodiment.
[0076]
Next, the operation of the present embodiment will be described with reference to FIG. The main
action is the same as in the second embodiment, so only the changes will be described. Insert it
into the insufflated body cavity through trocar 44, bring the ultrasonic transducer 21 for
treatment of the ultrasonic probe 2C into contact with the back side of the organ 45 to be used
for observation and treatment, and perform the bending operation as it is. At the maximum
amount, the observation ultrasonic transducer 17 of the tip 18 is also brought into contact with
the surface of the organ 45.
[0077]
The insertion unit 11 is moved so that the lesion 47 is extracted on the ultrasonic tomographic
image 28. The position of the insertion unit 11 is moved so that the focusing point marker 31
displayed on the ultrasound tomographic image 28 is positioned at the lesion 47 on the
ultrasound tomographic image 28. Thereafter, as in the second embodiment, a therapeutic
ultrasonic wave is transmitted from the therapeutic ultrasonic transducer 21 to perform a
therapeutic treatment.
[0078]
The present embodiment has the following effects. In the first and second embodiments,
cauterization of the lesion 47 can be performed more reliably if the time for irradiating the
convergent ultrasonic wave for treatment is increased. However, when high intensity therapeutic
focused ultrasound is irradiated for a long time at the same position, the temperature of the
ultrasound delivery window 43 'rises due to the therapeutic focused ultrasound absorbed and
attenuated by the ultrasound delivery window 43'. Go.
[0079]
03-05-2019
21
The surface of the organ 45 to be treated is in close contact with the ultrasound transmission
window 43 '. When the temperature of the ultrasonic delivery window 43 'rises to a temperature
that causes the tissue to be denatured, the surface of the closely contacting organ 45 is
denatured by heat conduction from the ultrasonic delivery window 43'.
[0080]
Therefore, in the first and second embodiments, the irradiation time needs to be performed in a
short time. In the third embodiment, the focal point distance 72 of the therapeutic ultrasonic
transducer 21 and the minimum radius of curvature 71 of the bending portion 19 of the probe
are the same. Therefore, when the amount of bending is maximized, the therapeutic ultrasonic
transducer 21 is moved so that the position of the focusing point 30 does not change. Therefore,
the same portion can be continuously cauterized without moving the therapeutic ultrasonic
transducer 21 and raising the temperature of the ultrasonic wave delivery window 43 '.
[0081]
Since the temperature of the ultrasonic wave delivery window 43 'does not rise, only the lesion
47 can be reliably cauterized without causing the surface of the organ 45 to be denatured.
[0082]
Fourth Embodiment Next, the fourth embodiment of the present invention will be described with
reference to FIG.
FIG. 5 shows an ultrasonic diagnostic treatment system 1D provided with an ultrasonic probe 2D
according to the fourth embodiment. The main configuration is the same as in the first
embodiment, so only the changes will be described.
[0083]
As shown in FIG. 5, the ultrasonic transducer 21 for treatment as the ultrasonic treatment means
5 formed in the insertion portion 11 used in the ultrasonic probe 2D of this embodiment has a
03-05-2019
22
plurality of transducer elements (described below) It is fixed to the bending piece so that it is
described as a vibrator bending piece). Each vibrator bending piece 75 is fixed to the upper
surface (in the case of bending) of the bending piece forming the bending portion 19 by fixing
means (not shown).
[0084]
Respective transducer bending pieces 75 fixed to the bending pieces by fixing means (not shown)
are connected to the independent treatment signal lines 33, and all the treatment signal lines 33
are ultrasonic diagnostic treatment devices 7D. Are connected to the drive signal generating
circuit 34 '.
[0085]
Further, the therapeutic ultrasonic transducer 21 used in this embodiment has the same focusing
point distance 72 as the minimum radius of curvature 71 of the bending portion 19.
The other configuration is the same as that of the first embodiment. Next, the operation of the
present embodiment will be described. The main action is the same as in the first embodiment, so
only the changes will be described.
[0086]
Insert the trocar 44 into the insufflated body cavity, bring the ultrasonic transducer 21 for
treatment of the ultrasound probe 2 into contact with the back side of the organ 45 to be
observed and treated, and perform the curving operation as it is to bend in the upward direction
And the observation ultrasonic transducer 17 at the tip 18 is also brought into contact with the
surface of the organ 45.
[0087]
The insertion unit 11 is moved or the like so that the lesion 47 is extracted on the ultrasonic
tomographic image 28.
The position of the insertion unit 11 is moved so that the focusing point marker 31 displayed on
03-05-2019
23
the ultrasound tomographic image 28 is positioned at the lesion 47 on the ultrasound
tomographic image 28.
[0088]
The therapeutic signal line to which the controller 35 sends a voltage from the drive signal
generation circuit 34 'by keying in the number of the therapeutic ultrasonic transducer 21 (more
specifically, the transducer bending piece 75) used from the keyboard 36 33 is selected, and a
voltage is applied only to the keyed therapeutic ultrasonic transducer 21. The number of the
therapeutic ultrasonic transducer 21 and the number of the therapeutic signal line 33
correspond to each other.
[0089]
The present embodiment has the following effects. In the fourth embodiment, the focal point
distances 72 of the plurality of transducer bending pieces 75 disposed in the bending portion 19
and the minimum radius of curvature 71 of the bending portion 19 of the probe are the same.
Therefore, high-power therapeutic focused ultrasound can be applied to the lesion 47 with one
therapeutic focused ultrasound.
[0090]
When high-power therapeutic focused ultrasound is applied to the lesion 47, the lesion 47 at the
focusing point 30 has a third temperature rise time due to ultrasonic absorption attenuation at
the focusing point 30 and the living tissue in the vicinity thereof. It is faster than the embodiment
and the irradiation time can be short.
[0091]
Further, by being able to select the therapeutic ultrasonic transducer 21 to be used, it is possible
to adjust the power of the focused ultrasound for treatment for cauterizing the lesion 47 and
perform cauterization according to the size of the lesion 47. It is possible.
[0092]
03-05-2019
24
Fifth Embodiment A fifth embodiment of the present invention will now be described with
reference to FIG.
FIG. 6 shows an ultrasonic diagnostic treatment system 1E provided with an ultrasonic probe 2E
according to the fifth embodiment.
The main configuration is the same as in the first embodiment, so only the changes will be
described. The main configuration is the same as in the first embodiment, so only the changes
will be described.
[0093]
As shown in FIG. 6, the observation signal line 23 connected to the observation ultrasonic
transducer 17 formed at the distal end portion 18 used in this embodiment is inserted into the
insertion portion 11, and ultrasonic diagnostic treatment is performed. It is connected to the
transmission pulse generation circuit 24 and the reception processing circuit 25 in the device 7E.
The reception processing circuit 25 is connected to the comparator 81, and the comparator 81 is
connected to the address generator 82. The address generator 82 is connected to the arithmetic
circuit 83, and the arithmetic circuit 83 is connected to the focal point marker generator 32.
Focusing point marker generation circuit 32 is connected to mixer 27, which is connected to
color monitor 10.
[0094]
The ultrasonic probe 2E of this embodiment is provided with a switch (not shown) for instructing
an enlargement of an image on the operation unit 13 or the like in the ultrasonic probe 2A of
FIG. 1, and this switch is received via a signal line not shown The reception processing circuit 25
is connected to the processing circuit 25 and operates the switch to perform signal processing
for displaying an enlarged image. The other configuration is the same as that of the first
embodiment.
[0095]
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25
Next, the operation of the present embodiment will be described. The main action is the same as
in the first embodiment, so only the changes will be described. The transmission pulse from the
transmission pulse generation circuit 24 of the ultrasonic diagnostic treatment apparatus 7E is
applied to the observation ultrasonic transducer 17 to excite the observation ultrasonic
transducer 17 to emit observation ultrasonic waves toward the organ 45 side. The observation
ultrasonic waves are reflected at portions having different acoustic impedances and received by
the observation ultrasonic transducer 17.
[0096]
The received ultrasonic wave is converted into an electric signal by the observation ultrasonic
transducer 17, passes through the observation signal line 23, is signal processed by the
reception processing circuit 25, and is converted into a video signal. The video signal includes an
echo image 84 of the therapeutic ultrasonic transducer 21 as indicated by a two-dot chain line in
FIG. Further, the echo image 84 of the therapeutic ultrasonic transducer 21 is a high level echo
image as compared to the echo image of the living tissue.
[0097]
The video signal subjected to signal processing by the reception processing circuit 25 is output
to the comparator 81 and output to the DSC 26. The signal converted into a standard video
signal by the DSC 26 is input to the color monitor 10 and displayed as an ultrasonic tomographic
image 28 on the display surface of the color monitor 10. Note that FIG. 6 shows an enlarged
display on the entire display surface of the color monitor 10.
[0098]
The comparator 81 compares the input signal with the comparison potential, and outputs a logic
signal of high level when the input signal exceeds the comparison potential. This means that the
echo image 84 of the therapeutic ultrasonic transducer 21 is detected from the signal input to
the comparator 81.
[0099]
03-05-2019
26
The address generator 82 counts and outputs an address value when the input signal is a high
level logic signal, that is, when the echo image 84 of the therapeutic ultrasonic transducer 21 is
detected. In this case, when the echo image 84 of the therapeutic ultrasonic transducer 21 is
detected, the address value is counted and output. The address value in this case indicates the
shape of the echo image 84 of the ultrasonic transducer 21 for treatment.
[0100]
The arithmetic circuit 83 calculates an area and a diameter from the input address value. Further,
the position of the focusing point 30 of the therapeutic ultrasonic transducer 21 is calculated
from the area and diameter. The calculation result of the arithmetic circuit 83 is input to the
focal point marker generation circuit 32.
[0101]
The focusing point marker 31 is superimposed on the video signal output from the DSC 26 by
the mixer 27 from the focusing point marker generation circuit 32 and displayed on the
ultrasonic tomographic image 28.
[0102]
The present embodiment has the following effects.
Since the position of the ultrasonic transducer for treatment 21 can be detected from the
ultrasonic tomographic image 28, it is possible to calculate the display position of the focal point
marker 31 from the rotation angle of the bending operation knob 22 as in the first embodiment.
The focal point marker 31 can be displayed at a position on the accurate ultrasonic tomographic
image 28. In addition, the lesion 47 can be cauterized more reliably.
[0103]
In the above embodiment, for example, the observation ultrasonic transducer 17 is not limited to
one performing electronic linear scan, but one performing electronic sector scan, one performing
electronic radial scan, and one performing electronic convex scan. It may be good, or it may be
one which mechanically performs linear scan, sector scan, radial scan or the like.
03-05-2019
27
[0104]
Also, for example, the back side (the opposite side of the ultrasonic wave transmitting surface) of
the concave-shaped therapeutic ultrasonic transducer 21 is attached to a plate-like (a plurality of
divided in the longitudinal direction if necessary) piezoelectric element By applying a voltage to
the piezoelectric element, the piezoelectric element can be bent in the longitudinal direction, so
that the substantial curvature of the ultrasonic wave transmitting surface of the therapeutic
ultrasonic transducer 21 can be changed. It is also possible to provide focusing point distance
changing means capable of changing the distance to the focusing point.
Note that different embodiments may be configured by partially combining the above-described
embodiments and the like.
[0105]
1. An insertion portion which can be inserted into a body cavity, an ultrasonic transducer for
image acquisition provided on the distal end side of the insertion portion, an ultrasonic
transducer for image acquisition and a longitudinal direction of the insertion portion, and the
insertion portion is separated A therapeutic ultrasonic transducer provided for delivering an
ultrasonic beam to focus on a focusing point, and provided on the distal end side of the insertion
portion, the focal point of the therapeutic ultrasonic transducer being the ultrasonic transducer
for image acquisition A probe for ultrasonic treatment, comprising: a bending portion which
makes it possible to move at least one of the ultrasonic transducer for image acquisition and the
ultrasonic transducer for treatment so as to be located within the field of view of.
[0106]
2. The ultrasonic treatment probe according to appendix 1, wherein the image acquisition
ultrasonic transducer is disposed on the distal side with respect to the bending portion, and the
therapeutic ultrasonic transducer is disposed at the insertion portion after the bending portion.
3. The ultrasonic treatment probe according to appendix 2, wherein the therapeutic ultrasonic
transducer has a rigid insertion tube portion from the position where the therapeutic ultrasonic
transducer is provided to the rear end of the insertion portion at the rear of the bending portion.
03-05-2019
28
[0107]
4. The ultrasonic treatment probe according to claim 2, wherein the therapeutic ultrasonic
transducer has a soft insertion tube portion from the position where the therapeutic ultrasonic
transducer is provided to the rear end of the insertion portion at the rear of the bending portion.
5. The probe for ultrasonic treatment according to any one of appendices 1 to 4, further
comprising moving means for moving the therapeutic ultrasonic transducer in the axial direction
of the insertion portion. The therapeutic range of the ultrasonic treatment means can be
expanded, and the alignment between the ultrasonic treatment means and the lesion can be
performed easily and accurately.
[0108]
6. The ultrasonic treatment probe according to appendix 5, wherein the minimum radius of
curvature of the curved portion is made to substantially coincide with the focal length of the
therapeutic ultrasonic transducer. (Action of Supplementary Note 6) It is possible to reliably treat
only the lesion without making the surface of the treated organ protein-denatured.
[0109]
7. The therapeutic ultrasonic transducer is provided in a plurality in the axial direction of the
bending portion, and the minimum curvature radius of the bending portion is made to
substantially coincide with the focal length of each of the ultrasonic transducer for wave
treatment. The ultrasonic treatment probe according to any one of 1 to 3. (Operation of the
supplementary note 7) The irradiation time of the treatment ultrasonic wave of the ultrasonic
treatment means becomes short, and the irradiation according to the size of the lesion can be
performed by selecting the ultrasonic treatment means to be used.
[0110]
8. The position and focus position of the therapeutic ultrasonic transducer from the drive unit
that performs an image acquisition operation by the ultrasonic transducer for image acquisition
03-05-2019
29
when the ultrasonic transducer for treatment is driven, and the ultrasonic image acquired by the
drive control unit The computer-readable storage medium according to any one of appendices 1
to 4, characterized in that it comprises: calculation means for calculating H.sub.2; and display
control means for displaying the calculated position and focus position of the therapeutic
ultrasonic transducer in the ultrasonic image. Ultrasound treatment probe. (Function of
Supplementary Note 8) A focal point marker can be displayed at an accurate position to more
reliably treat a lesion.
[0111]
As described above, according to the present invention, an insertion portion which can be
inserted into a body cavity, an ultrasonic transducer for image acquisition provided at the distal
end side of the insertion portion, and an ultrasonic transducer for image acquisition And a
therapeutic ultrasonic transducer which is provided in the insertion portion so as to be spaced
apart in the longitudinal direction of the insertion portion and sends out an ultrasonic beam to
focus on a focusing point, and is provided on the distal end side of the insertion portion A curved
portion which makes it possible to move at least one of the image acquisition ultrasonic
transducer and the therapeutic ultrasonic transducer such that the focal point of the ultrasonic
transducer is located within the field of view of the image acquisition ultrasonic transducer; The
treatment ultrasound tiger is placed in the observation field of view of the ultrasound transducer
for image acquisition by curving the bending portion. In addition to being able to place a
focusing point for treatment with a inducer, after the irradiation of the focused ultrasound beam
by the therapeutic ultrasonic transducer, the tissue on the therapeutic ultrasonic transducer side
has a greater attenuation than the focusing point without being impeded An ultrasound
observation image near the focusing point can be obtained.
[0112]
Brief description of the drawings
[0113]
1 is a block diagram of an ultrasonic diagnostic treatment system including the ultrasonic
treatment probe according to the first embodiment of the present invention.
[0114]
2 is a diagram showing a state of using the first embodiment.
[0115]
03-05-2019
30
3 is a configuration diagram of an ultrasonic diagnostic treatment system provided with a probe
for ultrasonic treatment according to a second embodiment of the present invention.
[0116]
4 is a configuration diagram of an ultrasonic diagnostic treatment system provided with a probe
for ultrasonic treatment according to a third embodiment of the present invention.
[0117]
5 is a configuration diagram of an ultrasonic diagnostic treatment system provided with an
ultrasonic treatment probe according to a fourth embodiment of the present invention.
[0118]
6 is a diagram showing the configuration of an ultrasonic diagnostic treatment apparatus for the
fifth embodiment of the present invention.
[0119]
Explanation of sign
[0120]
1A ... ultrasonic diagnostic treatment system 2A ... ultrasonic treatment probe 3 ... ultrasonic
observation means 4 ... signal processing means 5 ... ultrasonic treatment means 6 ... treatment
drive signal generating means 7 A ... ultrasonic diagnosis treatment device 9 ... display means
DESCRIPTION OF SYMBOLS 10 ... Color monitor 11 ... Insertion part 13 ... Operation part 17 ...
Ultrasonic transducer 18 for observation ... Tip part 19 ... Curved part 20 ... Insertion tube 21 ...
Ultrasonic transducer 22 for medical treatment ... Bending operation knob 24 ... Transmission
pulse generation Circuit 25 Reception processing circuit 26 DSC 28 Ultrasonic tomographic
image 30 Focusing point 31 Focusing point marker 32 Focusing point marker generation circuit
45 Organ 46 Ultrasonic observation area 47 Lesion
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