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WO2011158113A1 - Dispositif de localisation et de pistage magnétique - Google Patents

Dispositif de localisation et de pistage magnétique Download PDF

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Publication number
WO2011158113A1
WO2011158113A1 PCT/IB2011/001682 IB2011001682W WO2011158113A1 WO 2011158113 A1 WO2011158113 A1 WO 2011158113A1 IB 2011001682 W IB2011001682 W IB 2011001682W WO 2011158113 A1 WO2011158113 A1 WO 2011158113A1
Authority
WO
WIPO (PCT)
Prior art keywords
magnetic
patient
post
emitter
coils
Prior art date
Application number
PCT/IB2011/001682
Other languages
English (en)
Inventor
Stéphane Lavallee
Original Assignee
Minmaxmedical
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Minmaxmedical filed Critical Minmaxmedical
Publication of WO2011158113A1 publication Critical patent/WO2011158113A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/128—Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations
    • A61G13/1295—Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations having alignment devices for the patient's body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00—Operating tables; Auxiliary appliances therefor
    • A61G13/10—Parts, details or accessories
    • A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205—Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2072—Reference field transducer attached to an instrument or patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G2205/00—General identification or selection means
    • A61G2205/60—General identification or selection means using magnetic or electronic identifications, e.g. chips, RFID, electronic tags

Definitions

  • the invention relates to the field of computer assisted surgery, and more particularly to a device and a method for tracking sensors using a magnetic localizer.
  • a highly important issue in surgical navigation systems is related the localization device that can track trackers attached to instruments or to structures of a patient body.
  • Optical localization devices are highly popular because they are accurate and robust against major perturbations. However, they present the drawback that the line of sight must remain visible between the camera of the optical localization device and the trackers.
  • magnetic localization devices have been introduced.
  • This type of device comprises a magnetic emitter, made in general of at least three coils, and trackers, which are magnetic sensors made of at least one coil.
  • the magnetic emitter generates some magnetic field along several dimensions.
  • each coil of the magnetic emitter is generating magnetic fields that can be separated from each other, using time synchronization such as in the DC systems manufactured by Ascension Technologies (Burlington, VT, USA), or using different frequencies such as in the AC systems manufactured by Northern Digital Inc. (Waterloo, Canada).
  • Recent magnetic sensors are made of one, two or three miniature coils that can be inserted at the tip of small instruments such as needles, in order to compensate for bending of the needle since only the tip of the needle matters for localization. Indeed, in an optical system, the tracker is large and must be fixed to the back part of the needle, it cannot be fixed to the needle tip. This compensation of bending is another advantage of magnetic localization systems over optical localization systems.
  • the measurements made by the magnetic sensor for each activation of the individual emitter coils are used to compute the six degrees of freedom that characterize the position and orientation of the sensor. This represents the position and orientation of the magnetic sensor with respect to the magnetic emitter.
  • This computation can be done using well known methods, in which the emitters are modeled by dipoles and the measurement made by a sensor coil is the projection of the magnetic field generated by the dipole on the sensor coil axis.
  • the emitter coils, on one hand, and the sensor coils, on the other hand have perfectly known relative geometry.
  • the invention aims at providing a magnetic localization device that overcomes these problems.
  • An object of the invention is a device for localization of a magnetic sensor comprising:
  • a post configured to be fixed to a patient table and to maintain a patient in a predefined lying position on said patient table
  • said post comprising a magnetic emitter, for the localization of at least a magnetic sensor embedded in an instrument or in said patient's body.
  • the magnetic emitter may comprise a plurality of magnetic coils, e.g. at least three magnetic coils.
  • the post comprises:
  • a first part configured to be fixed to the patient table and to maintain the patient in the predefined lying position on said patient table, said first part comprising a first magnetic emitter, and
  • the post comprises:
  • a first part configured to be fixed to the patient table and to maintain the patient in the predefined lying position on said patient table, said first part comprising a first plurality of magnetic emitters, and
  • the post comprises:
  • a first part configured to be fixed to the patient table and to maintain the patient in the predefined lying position on said patient table, said first part comprising a first plurality of magnetic emitters, and
  • a second part consisting of an extension bar rigidly linked to said first part and comprising at its extremity a second plurality of magnetic emitters.
  • the post advantageously comprises: [a] a first part, configured to be fixed to the patient table and to maintain the patient in the predefined lying position on said patient table, said first part comprising a first set of at least three magnetic coils, and
  • a second part consisting of an extension linked to said first part and comprising a second set of at least three magnetic coils.
  • the post is preferably selected from the list consisting of a pubis post, a lateral decubitus post, and a patient supine post.
  • the post may be adjustable in height.
  • the extension has a shape of an arch adapted to fit the patient's thigh anatomy.
  • Another object of the invention is a system for localizing a medical instrument, comprising:
  • a medical instrument comprising at least one embedded magnetic sensor
  • Another object of the invention is a system for localizing a magnetic sensor embedded in a patient's body, comprising
  • the magnetic sensor preferably comprises a plurality of magnetic coils.
  • Another object of the invention is a medical imaging system comprising the localizing device as described above.
  • the invention further relates to a method for localizing a magnetic sensor during a surgical intervention, comprising the steps of:
  • the post comprises:
  • the magnetic sensor is rigidly fixed to a patient's bone.
  • the post advantageously contacts the portion of the patient's body wherein the surgical intervention is carried out.
  • the distance between the magnetic emitter and the magnetic sensor is preferably of less than 10 cm.
  • FIG. 1 is a perspective view of one embodiment of the device during hip arthroscopy procedure.
  • FIG. 2 is a detailed perspective view of another embodiment of the device during hip arthroscopy procedure.
  • FIG. 3 is a perspective view of magnetic sensors attached to bones and instruments.
  • FIG. 4 is a perspective view of a magnetic emitter and a magnetic sensor embedded in an instrument.
  • FIG. 5 is a perspective view of a magnetic emitter with integrated coils.
  • FIG. 6 is a perspective view of an embodiment of the device comprising an extension.
  • Fig. 7 is a schematic view of a shaver with a miniature sensor.
  • Errors of magnetic localization devices are mainly due to the presence of metallic or motorized objects in the vicinity of the magnetic emitter or sensor. Since the magnetic field of a dipole measured by another dipole depends on the inverse of the cube of the distance between the emitter and the sensor, when a metallic object is present, the relative distance between the emitter/sensor on one hand and emitter/object or sensor/object on the other hand plays a very significant role. Small distances between the emitter and the sensor relative to distances to metallic objects are required. The emitter must be as close as possible to the surgical areas where sensors will be present.
  • a first function of the device is to act as a post to maintain the patient in a fixed position.
  • the post is configured to be fixed to a patient table and to maintain the patient in a predefined lying position on said patient table.
  • the post can be fixed to the patient table 3 like any conventional post (e.g. by screws, quick release, clip mechanism, or any known attachment means).
  • the materials used to manufacture the post and the attachment means of the post to the patient table are non magnetic metals or plastic, that do not generate artefacts on the measurements. Traction is usually applied to the patient leg to create a pressure on the post that maintains the patient position fixed.
  • a second function of the device 1 is to embed a magnetic emitter that constitutes the emitter of a localization device used to measure the localization and orientation of magnetic sensors, such as miniature sensors, which are embedded in an instrument or in the patient body.
  • the post 1 comprises a magnetic emitter, for the localization of at least a magnetic sensor embedded in an instrument or in a patient body.
  • the magnetic emitter comprises at least a magnetic coil.
  • the magnetic emitter comprises a plurality of coils, preferably at least three coils.
  • Each magnetic sensor comprises in general at least one coil, preferably two or three coils.
  • sensors can be miniature sensors mounted at the extremity of an instrument 6 (arthroscope, probe, shaver, canula), as shown in Figure 2.
  • the magnetic sensor can be in this embodiment embedded in an instrument, such as a medical instrument.
  • placing at least one pair of miniature coils 12 at the tip 16 of a shaver 6 mounted on a motor 7 is performed in order to locate the shaver tip position in real time with respect to a reference system attached to the device 1 comprising the magnetic emitter.
  • Miniature sensors can be also directly placed inside the bones in order to track the bone.
  • each magnetic sensor can be made of at least two coils embedded in a shell that can be fixed rigidly to the bone.
  • the magnetic sensor is adapted to be embedded in a patient body.
  • One magnetic sensor 1 1 can be placed in the femur bone 8, for instance in the area of the greater trochanter, and one magnetic sensor 10 can be placed in the pelvis bone 9, for instance in the area of the iliac spine.
  • Emitters and sensors have cables that link them to a computer control unit. For clarity, the cables and the computer control unit are not represented.
  • Different known techniques can be used to register the bone with a 3D image of the patient, which means to compute a transform between the coordinate of the 3D image and the coordinate of a reference system attached to a patient reference tracker.
  • This 3D image includes Computed Tomography (CT) or Magnetic Resonance (MR) images.
  • CT Computed Tomography
  • MR Magnetic Resonance
  • the localization device comprises a magnetic emitter contained in a plastic housing with size ranging from one cm x one cm x one cm up to ten cm x ten cm x ten cm.
  • Finding a good location for the localization device made of the emitter in hip arthroscopy is a difficult problem since metal objects or obstacles are present all around the operated area of the hip.
  • No satisfactory solution have been proposed in the prior art. Indeed, below the patient is the operating table 4. Above the patient is the image intensifier of the x-ray imaging device 2 that is mounted on a C-arm.
  • the shaver motor is very often an electric motor that generates significant artefacts in the magnetic localization device.
  • the distance between the emitter coils included in the post 1 and the magnetic sensors is around two to ten centimeters which is sufficiently small to reach a good accuracy and obtain reliable measurements not affected by metal objects and motors in the surroundings. Those distances are very easy to reproduce from one patient to another for the surgeon and the medical staff.
  • the installation of the device 1 on the operating table 4 is done exactly as in the way a conventional post is installed. The only difference for the user is that a cable, not represented on the figures, must be installed between the device 1 and a computer control unit in order to transmit electrical signals to the coils of the magnetic emitter.
  • the device 1 has a cylindrical shape that includes at least three coils with arbitrary positions.
  • a calibration process can be applied to measure the exact location of the center and axis of each individual coil with respect to a reference frame attached to the magnetic emitter.
  • Such calibration can be performed after manufacturing by using a sensor with a known geometry and varying the sensor position along different dimensions using calibrated linear displacement actuators, for instance in three directions.
  • the emitter contains four coils in order to provide redundant measurements. Indeed, each coil generates a magnetic field and each sensor measures one value which is the projection of the local magnetic field on its axis. Using four coils and an instrument made of three miniature embedded coils provide twelve measurements, that are sufficient to track the sensor in position and orientation in a three dimensional space. Using four coils in the emitter to track a sensor made of two miniature coils shall provide eight measurements that provide redundancy to locate the six degrees of freedom of the sensor, which is a very interesting feature since it reinforces the accuracy and safety of measurements. Least squares techniques are used to take into account those redundant measurements. The methods for locating a sensor in the reference system of an emitter are not described in this invention since they are well known by the one ordinary skilled in the art.
  • a patient is maintained in a predefined lying position on a patient table using a post fixed to said patient table, said post comprising a magnetic emitter.
  • the magnetic emitter then emits a magnetic field, or a plurality of magnetic fields, and the magnetic field at the level of the magnetic sensor embedded in an instrument or the patient body is measured, in order to infer the localization of said magnetic sensor.
  • the coils that constitute the emitter 1 are integrated together. For instance, this is achieved by rolling wires all around a cube along the three directions X, Y, and Z of the cube.
  • the post 1 comprises a first part, configured to be fixed to the patient table and to maintain the patient in the predefined lying position on said patient table, said first part comprising a first magnetic emitter, and a second part, linked to said first part and comprising a second magnetic emitter.
  • the first magnetic emitter can comprise a plurality of coils, such as three coils or more
  • the second magnetic emitter can comprise a plurality of coils, such as three coils or more.
  • said first part and second parts are linked rigidly together with a known geometrical relationship.
  • the first part and second parts are linked rigidly together with an unknown geometrical relationship. In the latter case, a calibration step is required at the beginning of the procedure, which consists in placing a set of magnetic sensors in the vicinity of the first and second part, for multiple positions, retain the measurement values of the relative sensor to emitter positions that are consistent together and average them.
  • the device 1 can contain as a second part an extension 5 that contains additional coils 14.
  • the coils 14 can be inside the extension 5.
  • the extension is a long bar that contains additional coils 14 at its extremity. The shape of said bar is designed to be above the patient with minimal size.
  • the extension offers several advantages, since it implements the concept of using multiple magnetic emitters to improve the accuracy and reliability of measurements. First, it generates more volume to embed more coils, and having more coils improves the accuracy of measurements. Second, the coils 14 generate independent measurements of the coils 13 included in the post 1.
  • the extension can contain more than just three coils.
  • the coils that are the closest from the magnetic sensors will be used at a given instant.
  • a magnetic field is emitted with the coil of the first plurality of coils 13 or second plurality of coils 14 for which the distance between said coil and the magnetic sensor embedded in an instrument or the patient body is the shortest. Then, the magnetic field at the level of the magnetic sensor is measured.
  • the extension 5 is placed above and on the side of the first part of the post, which has for instance a cylindrical shape, such that it goes above the junction between the body and the thigh.
  • the extension 5 has a shape like an arch that fits with the anatomy in this area of the body, for instance the thigh's anatomy. This design makes it possible to perform a flexion, extension, abduction, rotation of the leg with no impingement between the leg and the device.
  • An adjustment TZ of the height of the post 1 is then proposed to fit the size of patients such that the emitter is as close as possible to the patient whilst leg motions are still possible.
  • the post 1 is adjustable in height.
  • a miniature sensor is embedded in the tip of the instrument which is most often a shaver.
  • the rotating shaft 15 of a shaver blade is attached to the motor 7.
  • the tip of the shaver blade can have several shapes such as a sphere 16.
  • the sphere 16 can be partially covered by the housing in one direction to create a protection, not represented on the figures. It acts like a milling tool.
  • the housing 6 of the shaft 15 is containing two holes.
  • the first one 17 is a long hollow used to pass the shaft 15.
  • the second one 18 is a small and long hollow used to pass the sensor and the wires that go to the basis of the shaver.
  • the section of the housing 6 has a pear shape.
  • This design makes it possible to bring the sensor mounted on the instrument quite close to the emitter for hip arthroscopy procedures in the embodiment described in this invention and the location of a shaver is predominantly important for navigation of this type of surgery since it is one of the most widely used tools.
  • the device described above can be used for many applications.
  • the invention also provides a medical imaging system comprising the device previously described, such as a CT scan.
  • the post is adapted for a patient supine, lying on the back on operating table.
  • the exact same device can be used when the patient is lying on the table in lateral decubitus, lying on the side.
  • the axis of the cylindrical shape of the post will be horizontal instead of vertical.
  • a pubis post is also commonly used with a more squared external shape.
  • the device 1 can be easily adapted to fit this particular embodiment by placing the emitters in the pubis post device.
  • the post can be notably selected from the list consisting of a pubis post, a lateral decubitus post, a patient supine post.
  • the device can be used for computer assisted surgery wherein a mechanical fixation device such as a post is used.
  • ADVANTAGES :
  • the invention offers accurate and reliable measurements in a magnetic localization system used for computer assisted surgery, whilst the invention is not more cumbersome than the conventional set up of surgical devices for patient fixation.
  • the invention is compact, can be easily integrated in conventional devices, such as medical imaging system, patient table, and provides a flexible solution.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Robotics (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Measurement Of Length, Angles, Or The Like Using Electric Or Magnetic Means (AREA)

Abstract

L'invention concerne un dispositif (1) permettant de localiser un capteur magnétique et comprenant [a] un montant conçu pour être fixé à une table de patient (3) et pour maintenir un patient dans une position allongée prédéfinie sur ladite table de patient, [b] ledit montant comprenant un émetteur magnétique pour la localisation d'au moins un capteur magnétique implanté dans un instrument ou dans le corps dudit patient.
PCT/IB2011/001682 2010-06-16 2011-06-15 Dispositif de localisation et de pistage magnétique WO2011158113A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US35521310P 2010-06-16 2010-06-16
US61/355,213 2010-06-16

Publications (1)

Publication Number Publication Date
WO2011158113A1 true WO2011158113A1 (fr) 2011-12-22

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PCT/IB2011/001682 WO2011158113A1 (fr) 2010-06-16 2011-06-15 Dispositif de localisation et de pistage magnétique

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014033583A1 (fr) * 2012-08-28 2014-03-06 Koninklijke Philips N.V. Système de guidage d'intervention avec configuration de suivi intégré
US11602399B2 (en) 2019-10-04 2023-03-14 Depuy Ireland Unlimited Company Systems and methods to adjust bone cut positioning based on bone hardness
US11737830B2 (en) 2018-10-23 2023-08-29 Depuy Ireland Unlimited Company Surgical navigation trackers with guards

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6314310B1 (en) * 1997-02-14 2001-11-06 Biosense, Inc. X-ray guided surgical location system with extended mapping volume
US20040199072A1 (en) * 2003-04-01 2004-10-07 Stacy Sprouse Integrated electromagnetic navigation and patient positioning device
US20070106282A1 (en) * 2003-05-02 2007-05-10 Perception Raisonnement Action En Medecine Determination of the position of an anatomical element
EP1857069A1 (fr) * 2006-05-16 2007-11-21 BrainLAB AG Dispositif médical de positionnement et de repérage de hanche

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6314310B1 (en) * 1997-02-14 2001-11-06 Biosense, Inc. X-ray guided surgical location system with extended mapping volume
US20040199072A1 (en) * 2003-04-01 2004-10-07 Stacy Sprouse Integrated electromagnetic navigation and patient positioning device
US20070106282A1 (en) * 2003-05-02 2007-05-10 Perception Raisonnement Action En Medecine Determination of the position of an anatomical element
EP1857069A1 (fr) * 2006-05-16 2007-11-21 BrainLAB AG Dispositif médical de positionnement et de repérage de hanche

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014033583A1 (fr) * 2012-08-28 2014-03-06 Koninklijke Philips N.V. Système de guidage d'intervention avec configuration de suivi intégré
JP2015530144A (ja) * 2012-08-28 2015-10-15 コーニンクレッカ フィリップス エヌ ヴェ トラッキングセットアップと一体化した介入誘導システム
US11583697B2 (en) 2012-08-28 2023-02-21 Koninklijke Philips N.V. Interventional guidance system with integrated tracking setup
US11737830B2 (en) 2018-10-23 2023-08-29 Depuy Ireland Unlimited Company Surgical navigation trackers with guards
US11602399B2 (en) 2019-10-04 2023-03-14 Depuy Ireland Unlimited Company Systems and methods to adjust bone cut positioning based on bone hardness

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