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WO2012072112A1 - Tracking of a medical instrument - Google Patents

Tracking of a medical instrument Download PDF

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Publication number
WO2012072112A1
WO2012072112A1 PCT/EP2010/068522 EP2010068522W WO2012072112A1 WO 2012072112 A1 WO2012072112 A1 WO 2012072112A1 EP 2010068522 W EP2010068522 W EP 2010068522W WO 2012072112 A1 WO2012072112 A1 WO 2012072112A1
Authority
WO
WIPO (PCT)
Prior art keywords
instrument
reference point
data
patient
tracking device
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/EP2010/068522
Other languages
French (fr)
Inventor
Malcolm Williams
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Elekta AB
Original Assignee
Elekta AB
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 Elekta AB filed Critical Elekta AB
Priority to PCT/EP2010/068522 priority Critical patent/WO2012072112A1/en
Publication of WO2012072112A1 publication Critical patent/WO2012072112A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • 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
    • 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
    • A61B90/11—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 with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • A61B2017/3407—Needle locating or guiding means using mechanical guide means including a base for support on 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
    • A61B2034/2055—Optical 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
    • A61B2034/2046—Tracking techniques
    • A61B2034/2059—Mechanical position encoders
    • 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
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/062—Measuring instruments not otherwise provided for penetration depth
    • 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
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
    • 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

Definitions

  • the present invention relates generally to image guided surgery, and more specifically, to systems and methods for tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure.
  • Image guided medical and surgical procedures utilize patient images obtained prior to or during a medical procedure to guide a physician performing the procedure.
  • imagining technology including computed tomography (CT), magnetic resonance imagining (MRI), isocentric C-arm fluoroscopic imagining, and positron emission tomography (PET) has increased the interest in image guided medical procedures, for example, for diagnosis, during implantations or during treatment of neurological diseases and disorders by neurosurgery.
  • CT computed tomography
  • MRI magnetic resonance imagining
  • PET positron emission tomography
  • medical procedures such as, for example, diagnosis of tumors in the brain or neurological diseases, implantations of for example depth electrode or catheters in the brain, or treatment of tumors in the brain, neurological diseases and disorders by neurosurgery require a very high accuracy, often on a sub-millimeter level. Therefore, it would be very appealing to obtain an accurate and reliable way of tracking and navigating medical instruments in such medical procedures.
  • DBS deep brain stimulation
  • stimulation electrodes In particular, stimulation electrodes.
  • DBS therapy is used as a supplement to medication for treatment of neurological disorders including movement disorders.
  • the surgical requirements for effective DBS demand accurate, sub-millimeter targeting of the region to be stimulated.
  • One standard procedure involves initial targeting of the position to be stimulated from a medical image such as a cranial magnetic resonance image (MRI) followed by acquisition of MRI.
  • MRI cranial magnetic resonance image
  • microelectrode data to refine the initial targeting.
  • the microelectrode data is acquired by hand, plotted on graph paper, and compared to a printed brain atlas to determine the position in the patient's brain that corresponds to a similar anatomic or physiologic position in the atlas. Due to the manual data acquisition and the use of printed brain atlas, there are several inherent limitations placed on microelectrode data acquisition.
  • an object of the present invention is to provide an improved system and method for accurately tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure.
  • Another object of the present invention is to provide systems and methods for tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure that provide the physician, for example, the neurosurgeon with accurate and prompt feedback of the instrument position.
  • a system for tracking an instrument in a region of a patient comprising an optical tracking device adapted to track a position of the instrument during an insertion of the instrument into the patient, the optical tracking device including a light emitting unit is arranged to, in operation, emit light towards the instrument; and a light detecting unit arranged to, in operation, receive reflected light from the instrument, and wherein the light detecting unit is adapted to produce consecutive output signals representing a movement of the instrument relative to a reference point based on the output signals; and wherein the optical tracking device is adapted to provide position data including position changes of the instrument relatively to the reference point.
  • a feedback device in communication with the tracking device is configured to gather the position data and to determine a present position of the instrument relative to the reference point.
  • a method for tracking an instrument in a region of a patient comprises using an optical tracking device adapted to track a position of the instrument during an insertion of the instrument into the patient, the optical tracking device including a light emitting unit is arranged to, in operation, emit light towards the instrument; and a light detecting unit arranged to, in operation, receive reflected light from the instrument, and wherein the light detecting unit is adapted to produce consecutive output signals representing a movement of the instrument relative to a reference point based on the output signals.
  • the method includes providing position data including a position of the instrument relatively the reference point and determining a present position of the instrument relative to the reference point.
  • the present invention provides several advantages. For example, the precision of instrument or electrode targeting to areas of, for example, the brain during a medical procedure such as, for example, a surgical procedure can be enhanced and improved due to the fact that the optical tracking device obtains measurement data directly from the instrument itself. Further, the operator or physician, for example, a neurosurgeon performing the medical procedure can be provided with an accurate indication of the position of the instrument or electrode relative to the target area in real time due to the synchronization between the position data and image data over the target region, for example, over a target located in the patient ' s brain. Thus, the physician e.g. the neurosurgeon is provided with an immediate feedback in real time of a movement of the instrument or position change of the instrument.
  • the present invention is particularly advantageous in medical procedures such as, for example, diagnosis of tumors in the brain or neurological diseases, implantations of for example depth electrode or catheters in the brain, or treatment of tumors in the brain, neurological diseases and disorders by neurosurgery requiring accuracy on a sub- millimeter level.
  • medical procedures such as, for example, diagnosis of tumors in the brain or neurological diseases, implantations of for example depth electrode or catheters in the brain, or treatment of tumors in the brain, neurological diseases and disorders by neurosurgery requiring accuracy on a sub- millimeter level.
  • medical procedures include biopsies on different types of tumors, injections and aspirations by means of medical devices such as needles for injection of radioactive nuclides and cytostatic agents as well as puncture of cysts and deep brain stimulation (DBS) therapy.
  • DBS deep brain stimulation
  • the feedback device is configured to synchronize the position data with image data of the region; and superimpose a position indication for the instrument onto an image of the region created by the image data by using the synchronized positional data and image data.
  • the tracking system includes a display unit adapted to display the image of the region of the patient with the superimposed position indication for the instrument.
  • the precision of instrument or electrode targeting to areas of, for example, the brain during a medical procedure can be enhanced and improved further due to the fact that the optical tracking device obtains measurement data directly from the instrument itself (measuring directly on the instrument) and that the position is displayed for the physician.
  • the operator or physician performing the medical procedure can be provided with a visual position indication in real time by overlaid position data for the instrument or electrode on images of e.g. the patient ' s brain.
  • the present invention enables visualization of instrument position data in combination with, for example, the patient ' s cranial anatomy.
  • the operator or physician, for example, a neurosurgeon is thereby provided with an immediate feedback of the present position of the instrument or electrode.
  • the optical tracking device comprises a light emitting unit arranged to, in operation, emit light pulses towards the instrument and a light detecting unit arranged to, in operation, receive reflected light pulses from the instrument.
  • the light detecting unit is adapted to produce consecutive output signals representing a movement of the instrument relative to the reference point.
  • the feedback device uses this data representing a movement of the instrument to
  • the physician e.g. a neurosurgeon, can automatically be provided with fast and accurate feedback of position changes of the instrument, for example, movements of the instrument in real time.
  • the feedback device is adapted to determine a reference point by instructing the optical tracking device to perform a reference measurement on specific part of the instrument when the instrument is placed in an initial position, wherein position data for the initial position is obtained and the reference point is determined based on the position data.
  • the position data provided by the optical tracking device can be related to a specific part of an instrument during a medical procedure.
  • the physician can accordingly relate a position indication for the instrument to that specific part thereby increasing the accuracy of the position indication.
  • the position data includes information of a linear movement along a longitudinal axis of the instrument relative to the reference point and/or a rotation of the instrument around the longitudinal axis.
  • the feedback device is adapted to use the consecutive output signals from the optical tracker device so as to determine the linear movement and/or the rotation of the instrument.
  • the image data is obtained from computed tomography, CT, magnetic resonance imagining, MRI, isocentric C-arm fluoroscopic imagining, or positron emission
  • Fig 1 is a partly exploded perspective view of a head of a patient and an implementation of the tracking system according to the present invention
  • Fig. 2 is a perspective view of an embodiment of the optical tracking device according to the present invention.
  • Fig. 3 is a perspective view of a head of a patient and another implementation of the tracking system according to the present invention
  • Fig. 4 is a detailed view of the implementation of the tracking system according to the present invention shown in Fig. 3;
  • Fig 5 is detailed view of the implementation of the tracking system according to the present invention shown in Fig. 3;
  • Fig. 6 is block diagram showing the step of a method according to the present invention a general level.
  • fig 1 in which a field of application for the present invention is illustrated in a perspective view.
  • the present invention will now be described in connection with tracking of a probe device.
  • the present invention can be used with other types of medical instruments, as shown in for example, Fig. 3, 4 and 5, where the instrument movement can be tracked by means of an optical tracking device.
  • the optical tracking according to the present invention is based on light reflections from reflecting surfaces of the medical instrument.
  • an injection device comprising an outer tube 4 of a suitable surgical material, for example, stainless steel.
  • a distal tube portion 1 1 is adapted to be positioned adjacent to a target area 1 in the patient ' s body.
  • the injections device comprises a proximal tube portion 13.
  • a typical injection device has a length of about 200 mm and has an outer diameter of about 1 - 2 mm.
  • the tube 4 is inserted in the patient ' s skull 2 through a hole 3 in the cranial bone for guiding e.g. a probe 15 to the target area 1 .
  • the probe is preferably made of stainless steel.
  • a system 20 for tracking an instrument in a region of a patient comprises an optical tracking device 21 adapted to track a position of the probe 15 and to provide position data including position changes of the probe relative to a reference point.
  • the tube 4 also can be tracked by using the present invention.
  • a reference point may be determined by performing a measurement session when the tip 16 of the probe 15 is adjacent to the optical tracking device 21 .
  • a feedback device 23 is, wirelessly or via a network, in
  • the feedback device 23 is configured to determine positions of the probe 15, e.g. a present position relative a reference point. In embodiments of the present invention, the feedback device 23 is adapted to synchronize the position data with image data of the region and to superimpose a position indication for the probe 15 onto an image of the region created by the image data by using the
  • the image data can be based on images obtained by means of computed tomography (CT), magnetic resonance imagining (MRI), isocentric C-arm fluoroscopic imagining, or positron emission tomography (PET).
  • CT computed tomography
  • MRI magnetic resonance imagining
  • PET positron emission tomography
  • a display unit 24 may be connected to the feedback device 23 and is adapted to display an image of the region of the patient with the superimposed position indication for probe 15.
  • the display unit 24 is integrated in a computer device, such as a laptop or a personal computer.
  • the feedback device 23 may also be integrated in a computer device, such as a laptop or a personal computer.
  • the feedback device 23 may be arranged at the optical tracking device 21 .
  • the optical tracking device 21 comprises a light emitting unit 25 adapted to emit light pulses.
  • the light emitting unit 25 is a light emitting diode emitting infra-red light.
  • the light emitting unit 25 is arranged to, in operation, emit light pulses 26 directed toward the probe 15, for example, the tip 16 of the probe 15.
  • the optical tracking device 21 comprises a light detecting unit 28 arranged to, in operation, receive light pulses 27 resulting from reflections of the emitted light pulses 26 on a detector surface (not shown) of the light detecting unit 28.
  • the light detecting unit 28 is adapted to produce consecutive output signals each representing an image captured by the detector surface.
  • the optical tracking device 21 comprises a light emitting diode 25, which according to this embodiment emits light pulses via a lens system 30 arranged on a base plate 34 towards a surface of the instrument 31 .
  • the light pulses are reflected on the surface of the instrument 31 and are received by the light detecting unit 28 (sensor) via the lens system 30 and are captured on the sensor surface (not shown).
  • irregularities in the surface structure of the instrument 31 or man-made identification means such as scores or marks may cause reflections that can be used to determine a position of the instrument 31 .
  • the light emitting diode 25 and the sensor 28 are arranged on a PCB 33. Further, the optical tracking device 21 comprises a clip 35 for fixating the optical tracking device at, for example, an instrument guide as are shown in Figs. 3, 4 and 5.
  • a position data determining unit 29 is adapted to produce position data based on the consecutive output signals from the light detecting unit 28.
  • the position determining unit 29 may also be adapted to deliver the position data to the feedback device 23 via cable or wirelessly.
  • the light receiving unit 28 produces the position data and a position data transmitting unit 48 (see Fig. 4) is adapted to transmit the position data to the feedback device 23 via cable or wirelessly.
  • the position data includes information of a movement of the probe 15 relatively the reference point.
  • the reference point is where the tip 16 of the probe 15 is just about to be inserted into the tube 4. Thereby, it is possible to track where the tip 16 of the probe 15 is located relatively to its starting point or initial point and relatively to the target 1 .
  • the position data includes information of a linear movement along an longitudinal axis of the probe 15 indicated with the arrow marked with X relatively the reference point and/or a rotation of the probe 15 around the longitudinal axis X, where the rotational direction is indicated with Y.
  • the instrument i.e. in this embodiment the probe 15
  • the position change or movement of the probe 15 is determined by comparing consecutive output signals each representing an image captured by the light receiving unit 28.
  • Fig. 3, 4 and 5 a further implementation or embodiment example of the present invention will be discussed.
  • the present invention is used together with a Stop and Guide System in a Leksell Stereotactic system ® provided by ELEKTA AB for stereotactic neurosurgery.
  • a stereotactical frame 40 based on the center-or-arc principle is fixated relative to a patient ' s head 42 by means of adjustable fixations posts 43 having self-tapping screws.
  • the Leksell Stereotactic system ® is compatible with all types of imaging techniques such as CT, MR, X-ray, DSA or PET.
  • the arc or frame 40 is positioned such that a center of a coordinate system with X-, Y- and Z-coordinates coincide with the selected cerebral target 45.
  • a stop and guide system 46 is mounted on the frame 40 and a biopsy needle 47 is placed in the stop and guide system 46 for guiding the biopsy needle 47 to the target 45. As shown in Fig.
  • the optical tracking device 21 can be mounted at the stop and guide system 46 by means of the clip 35 for determining the position of the biopsy needle and, in particular, for determining a present position of the tip 49 of the needle 47 relative to an initial position of the tip 49.
  • the biopsy needle 47 is advanced into the brain of the patient in the direction indicated by the arrow A.
  • a communication unit or bus 48 is arranged on the optical tracking device for, wirelessly or via cable, transferring position data to the feedback device 23.
  • a reference point can be
  • the optical tracking device 21 determines by instructing the optical tracking device 21 to perform a measurement on specific part of the instrument when the instrument is placed in an initial position, wherein position data for the initial position is obtained and the reference point is determined based on the position data.
  • the instruction can be manually delivered by the neurosurgeon via, for example, a personal computer connected to the optical tracking device 21 or by the feedback device 23 upon activation of a instrument tracking session, which session may be initiated by the neurosurgeon.
  • the optical tracking device 21 will continuously deliver or provide position data of the actual position of the medical instrument to the feedback device 23.
  • the position data is based on the movement of the surface of the instrument passing the optical tracking device 21 .
  • the feedback device 23 is continuously provided with real time position data providing position data including a position of the instrument relatively a reference point.
  • the position data is synchronized with image data (obtained, for example, by means of computed tomography, CT, magnetic resonance imagining, MRI, isocentric C-arm fluoroscopic imagining, or positron emission tomography, PET) of the anatomic region of the patient in which the target is located.
  • image data obtained, for example, by means of computed tomography, CT, magnetic resonance imagining, MRI, isocentric C-arm fluoroscopic imagining, or positron emission tomography, PET
  • a position indication for the instrument is superimposed onto an image of the region created by the image data by using the synchronized positional data and image data.
  • an image of the region of the patient with the superimposed position indication for the instrument is displayed in real time.

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Abstract

The present invention relates generally to image guided surgery, and more specifically, to system and methods for tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure. The system for tracking an instrument in a region of a patient comprises an optical tracking device (21) adapted to track a position of the instrument (15) during an insertion of the instrument into the patient, the optical tracking device including a light emitting unit (25) is arranged to, in operation, emit light pulses towards the instrument; and a light detecting unit (28) arranged to, in operation, receive reflecting light pulses from the instrument and wherein the light detecting unit is adapted to produce consecutive output signals representing a movement of the instrument relative a reference point; and wherein the optical tracking device is adapted to provide position data including a position of the instrument relatively the reference point. A feedback device (23) in communication with the tracking device is configured to gather the position data and to determine a present position of the instrument relative the reference point.

Description

TRACKING OF A MEDICAL INSTRUMENT
Field of the invention
The present invention relates generally to image guided surgery, and more specifically, to systems and methods for tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure.
Background of the invention
Image guided medical and surgical procedures utilize patient images obtained prior to or during a medical procedure to guide a physician performing the procedure. Recent advances in imagining technology including computed tomography (CT), magnetic resonance imagining (MRI), isocentric C-arm fluoroscopic imagining, and positron emission tomography (PET) has increased the interest in image guided medical procedures, for example, for diagnosis, during implantations or during treatment of neurological diseases and disorders by neurosurgery.
Generally, medical procedures such as, for example, diagnosis of tumors in the brain or neurological diseases, implantations of for example depth electrode or catheters in the brain, or treatment of tumors in the brain, neurological diseases and disorders by neurosurgery require a very high accuracy, often on a sub-millimeter level. Therefore, it would be very appealing to obtain an accurate and reliable way of tracking and navigating medical instruments in such medical procedures.
For example, when performing biopsies on different types of tumors, it would be useful with an accurate and reliable way of tracking and navigating medical instruments such as biopsy needles. During injections and
aspirations by means of medical devices such as needles for injection of radioactive nuclides and cytostatic agents as well as puncture of cysts it would also be useful with an accurate and reliable way of tracking and navigating medical instruments. Furthermore, in deep brain stimulation (DBS) therapy it would be useful with an accurate and reliable way of tracking and navigating medical instruments, in particular, stimulation electrodes. DBS therapy is used as a supplement to medication for treatment of neurological disorders including movement disorders. The surgical requirements for effective DBS demand accurate, sub-millimeter targeting of the region to be stimulated. There are a number of techniques for providing the neurologist and neurosurgeon with the data necessary to make a decision with respect to placement of a stimulating electrode. One standard procedure involves initial targeting of the position to be stimulated from a medical image such as a cranial magnetic resonance image (MRI) followed by acquisition of
microelectrode data to refine the initial targeting. The microelectrode data is acquired by hand, plotted on graph paper, and compared to a printed brain atlas to determine the position in the patient's brain that corresponds to a similar anatomic or physiologic position in the atlas. Due to the manual data acquisition and the use of printed brain atlas, there are several inherent limitations placed on microelectrode data acquisition.
Hence, there is a need within the art for accurate and reliable devices and methods for tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure.
Furthermore, there is a need within the art for devices and methods for tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure that provide the physician, for example, the neurosurgeon with accurate and prompt feedback of the instrument position.
Summary of the invention
Thus, an object of the present invention is to provide an improved system and method for accurately tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure. Another object of the present invention is to provide systems and methods for tracking a medical instrument and assisting in navigating and/or positioning the instrument in a body structure during, for example, a surgical procedure that provide the physician, for example, the neurosurgeon with accurate and prompt feedback of the instrument position.
These and other objects are fulfilled by the present invention as defined by the independent claims. Preferred embodiments are defined by the dependent claims.
According to an aspect of the present invention, there is provided a system for tracking an instrument in a region of a patient. The system comprises an optical tracking device adapted to track a position of the instrument during an insertion of the instrument into the patient, the optical tracking device including a light emitting unit is arranged to, in operation, emit light towards the instrument; and a light detecting unit arranged to, in operation, receive reflected light from the instrument, and wherein the light detecting unit is adapted to produce consecutive output signals representing a movement of the instrument relative to a reference point based on the output signals; and wherein the optical tracking device is adapted to provide position data including position changes of the instrument relatively to the reference point. A feedback device in communication with the tracking device is configured to gather the position data and to determine a present position of the instrument relative to the reference point.
According to another aspect of the present invention, there is provided a method for tracking an instrument in a region of a patient. The method comprises using an optical tracking device adapted to track a position of the instrument during an insertion of the instrument into the patient, the optical tracking device including a light emitting unit is arranged to, in operation, emit light towards the instrument; and a light detecting unit arranged to, in operation, receive reflected light from the instrument, and wherein the light detecting unit is adapted to produce consecutive output signals representing a movement of the instrument relative to a reference point based on the output signals. Further, the method includes providing position data including a position of the instrument relatively the reference point and determining a present position of the instrument relative to the reference point.
The present invention provides several advantages. For example, the precision of instrument or electrode targeting to areas of, for example, the brain during a medical procedure such as, for example, a surgical procedure can be enhanced and improved due to the fact that the optical tracking device obtains measurement data directly from the instrument itself. Further, the operator or physician, for example, a neurosurgeon performing the medical procedure can be provided with an accurate indication of the position of the instrument or electrode relative to the target area in real time due to the synchronization between the position data and image data over the target region, for example, over a target located in the patient's brain. Thus, the physician e.g. the neurosurgeon is provided with an immediate feedback in real time of a movement of the instrument or position change of the instrument.
The present invention is particularly advantageous in medical procedures such as, for example, diagnosis of tumors in the brain or neurological diseases, implantations of for example depth electrode or catheters in the brain, or treatment of tumors in the brain, neurological diseases and disorders by neurosurgery requiring accuracy on a sub- millimeter level. Examples of such procedures include biopsies on different types of tumors, injections and aspirations by means of medical devices such as needles for injection of radioactive nuclides and cytostatic agents as well as puncture of cysts and deep brain stimulation (DBS) therapy.
According to an aspect of the present invention, the feedback device is configured to synchronize the position data with image data of the region; and superimpose a position indication for the instrument onto an image of the region created by the image data by using the synchronized positional data and image data.
According to an embodiment of the present invention, the tracking system includes a display unit adapted to display the image of the region of the patient with the superimposed position indication for the instrument.
Thereby, the precision of instrument or electrode targeting to areas of, for example, the brain during a medical procedure such as, for example, a surgical procedure can be enhanced and improved further due to the fact that the optical tracking device obtains measurement data directly from the instrument itself (measuring directly on the instrument) and that the position is displayed for the physician. The operator or physician performing the medical procedure can be provided with a visual position indication in real time by overlaid position data for the instrument or electrode on images of e.g. the patient's brain. Hence, the present invention enables visualization of instrument position data in combination with, for example, the patient's cranial anatomy. The operator or physician, for example, a neurosurgeon is thereby provided with an immediate feedback of the present position of the instrument or electrode.
According to an embodiment of the present invention, the optical tracking device comprises a light emitting unit arranged to, in operation, emit light pulses towards the instrument and a light detecting unit arranged to, in operation, receive reflected light pulses from the instrument. The light detecting unit is adapted to produce consecutive output signals representing a movement of the instrument relative to the reference point. The feedback device uses this data representing a movement of the instrument to
determine the actual position of the instrument relative to the target and the region of the patient in which the target is located by synchronizing the position data, i.e. the output signals from the optical tracking device with image data over the region and by superimposing the position indication for the instrument onto the image of the region. Thereby, the physician, e.g. a neurosurgeon, can automatically be provided with fast and accurate feedback of position changes of the instrument, for example, movements of the instrument in real time.
According to an embodiment of the present invention, the feedback device is adapted to determine a reference point by instructing the optical tracking device to perform a reference measurement on specific part of the instrument when the instrument is placed in an initial position, wherein position data for the initial position is obtained and the reference point is determined based on the position data. Thereby, the position data provided by the optical tracking device can be related to a specific part of an instrument during a medical procedure. The physician can accordingly relate a position indication for the instrument to that specific part thereby increasing the accuracy of the position indication.
According to an embodiment of the present invention, the position data includes information of a linear movement along a longitudinal axis of the instrument relative to the reference point and/or a rotation of the instrument around the longitudinal axis.
According to an embodiment of the present invention, the feedback device is adapted to use the consecutive output signals from the optical tracker device so as to determine the linear movement and/or the rotation of the instrument.
According to an embodiment of the present invention, the image data is obtained from computed tomography, CT, magnetic resonance imagining, MRI, isocentric C-arm fluoroscopic imagining, or positron emission
tomography, PET.
As the skilled person realizes, certain steps of the method according to the present invention, as well as preferred embodiments thereof, are suitable to realize as computer program or as a computer readable medium.
Further objects and advantages of the present invention will be discussed below by means of exemplifying embodiments.
Brief description of the drawings
The invention will hereinafter be described, by way of example, with reference to the accompanying drawings, in which:
Fig 1 is a partly exploded perspective view of a head of a patient and an implementation of the tracking system according to the present invention;
Fig. 2 is a perspective view of an embodiment of the optical tracking device according to the present invention;
Fig. 3 is a perspective view of a head of a patient and another implementation of the tracking system according to the present invention;
Fig. 4 is a detailed view of the implementation of the tracking system according to the present invention shown in Fig. 3; Fig 5 is detailed view of the implementation of the tracking system according to the present invention shown in Fig. 3; and
Fig. 6 is block diagram showing the step of a method according to the present invention a general level.
Description of preferred embodiments
Reference is first made to fig 1 in which a field of application for the present invention is illustrated in a perspective view. The present invention will now be described in connection with tracking of a probe device. However, as a person skilled within the art realizes, the present invention can be used with other types of medical instruments, as shown in for example, Fig. 3, 4 and 5, where the instrument movement can be tracked by means of an optical tracking device. According to embodiments of the present invention, the optical tracking according to the present invention is based on light reflections from reflecting surfaces of the medical instrument.
With reference first to Fig. 1 , an injection device is shown comprising an outer tube 4 of a suitable surgical material, for example, stainless steel. A distal tube portion 1 1 is adapted to be positioned adjacent to a target area 1 in the patient's body. Further, the injections device comprises a proximal tube portion 13. A typical injection device has a length of about 200 mm and has an outer diameter of about 1 - 2 mm. In Fig. 1 , the tube 4 is inserted in the patient's skull 2 through a hole 3 in the cranial bone for guiding e.g. a probe 15 to the target area 1 . The probe is preferably made of stainless steel.
A system 20 for tracking an instrument in a region of a patient according to the present invention comprises an optical tracking device 21 adapted to track a position of the probe 15 and to provide position data including position changes of the probe relative to a reference point.
However, it should be noted that the tube 4 also can be tracked by using the present invention.
A reference point may be determined by performing a measurement session when the tip 16 of the probe 15 is adjacent to the optical tracking device 21 . A feedback device 23 is, wirelessly or via a network, in
communication with the tracking device 21 and is adapted to gather position data obtained by the optical tracking device 21 . The feedback device 23 is configured to determine positions of the probe 15, e.g. a present position relative a reference point. In embodiments of the present invention, the feedback device 23 is adapted to synchronize the position data with image data of the region and to superimpose a position indication for the probe 15 onto an image of the region created by the image data by using the
synchronized positional data and image data. For example, the image data can be based on images obtained by means of computed tomography (CT), magnetic resonance imagining (MRI), isocentric C-arm fluoroscopic imagining, or positron emission tomography (PET).
Furthermore, a display unit 24 may be connected to the feedback device 23 and is adapted to display an image of the region of the patient with the superimposed position indication for probe 15. In embodiment of the present invention, the display unit 24 is integrated in a computer device, such as a laptop or a personal computer. The feedback device 23 may also be integrated in a computer device, such as a laptop or a personal computer. Alternatively, the feedback device 23 may be arranged at the optical tracking device 21 .
According to an embodiment of the present invention, the optical tracking device 21 comprises a light emitting unit 25 adapted to emit light pulses. In embodiments of the present invention, the light emitting unit 25 is a light emitting diode emitting infra-red light. Preferably, the light emitting unit 25 is arranged to, in operation, emit light pulses 26 directed toward the probe 15, for example, the tip 16 of the probe 15. Further, the optical tracking device 21 comprises a light detecting unit 28 arranged to, in operation, receive light pulses 27 resulting from reflections of the emitted light pulses 26 on a detector surface (not shown) of the light detecting unit 28. The light detecting unit 28 is adapted to produce consecutive output signals each representing an image captured by the detector surface.
In Fig. 2, an embodiment of an optical tracking device 21 is shown in more detail. The optical tracking device 21 comprises a light emitting diode 25, which according to this embodiment emits light pulses via a lens system 30 arranged on a base plate 34 towards a surface of the instrument 31 . The light pulses are reflected on the surface of the instrument 31 and are received by the light detecting unit 28 (sensor) via the lens system 30 and are captured on the sensor surface (not shown). For example, irregularities in the surface structure of the instrument 31 or man-made identification means such as scores or marks may cause reflections that can be used to determine a position of the instrument 31 .
The light emitting diode 25 and the sensor 28 are arranged on a PCB 33. Further, the optical tracking device 21 comprises a clip 35 for fixating the optical tracking device at, for example, an instrument guide as are shown in Figs. 3, 4 and 5.
Returning now to Fig. 1 , a position data determining unit 29 is adapted to produce position data based on the consecutive output signals from the light detecting unit 28. The position determining unit 29 may also be adapted to deliver the position data to the feedback device 23 via cable or wirelessly. Alternatively, in embodiments of the present invention, the light receiving unit 28 produces the position data and a position data transmitting unit 48 (see Fig. 4) is adapted to transmit the position data to the feedback device 23 via cable or wirelessly.
The position data includes information of a movement of the probe 15 relatively the reference point. In this illustrated example, the reference point is where the tip 16 of the probe 15 is just about to be inserted into the tube 4. Thereby, it is possible to track where the tip 16 of the probe 15 is located relatively to its starting point or initial point and relatively to the target 1 .
Preferably, the position data includes information of a linear movement along an longitudinal axis of the probe 15 indicated with the arrow marked with X relatively the reference point and/or a rotation of the probe 15 around the longitudinal axis X, where the rotational direction is indicated with Y.
Accordingly, it is possible to track the instrument (i.e. in this embodiment the probe 15) in two dimensions, namely in X and Y directions, i.e. depth and rotation. The position change or movement of the probe 15 is determined by comparing consecutive output signals each representing an image captured by the light receiving unit 28. With reference now to Fig. 3, 4 and 5, a further implementation or embodiment example of the present invention will be discussed. In this implementation, the present invention is used together with a Stop and Guide System in a Leksell Stereotactic system® provided by ELEKTA AB for stereotactic neurosurgery.
A stereotactical frame 40 based on the center-or-arc principle is fixated relative to a patient's head 42 by means of adjustable fixations posts 43 having self-tapping screws. The Leksell Stereotactic system® is compatible with all types of imaging techniques such as CT, MR, X-ray, DSA or PET. The arc or frame 40 is positioned such that a center of a coordinate system with X-, Y- and Z-coordinates coincide with the selected cerebral target 45. In this example, a stop and guide system 46 is mounted on the frame 40 and a biopsy needle 47 is placed in the stop and guide system 46 for guiding the biopsy needle 47 to the target 45. As shown in Fig. 4 and 5, the optical tracking device 21 can be mounted at the stop and guide system 46 by means of the clip 35 for determining the position of the biopsy needle and, in particular, for determining a present position of the tip 49 of the needle 47 relative to an initial position of the tip 49. During operation, the biopsy needle 47 is advanced into the brain of the patient in the direction indicated by the arrow A. In this embodiment, a communication unit or bus 48 is arranged on the optical tracking device for, wirelessly or via cable, transferring position data to the feedback device 23.
With reference now to Fig. 6, an embodiment of the method for tracking a position of a medical instrument according to the present invention will be discussed. After the medical instrument has been properly mounted, installed or in other placed for operation on the patient, a reference
measurement is performed at step S100. A reference point can be
determined by instructing the optical tracking device 21 to perform a measurement on specific part of the instrument when the instrument is placed in an initial position, wherein position data for the initial position is obtained and the reference point is determined based on the position data. The instruction can be manually delivered by the neurosurgeon via, for example, a personal computer connected to the optical tracking device 21 or by the feedback device 23 upon activation of a instrument tracking session, which session may be initiated by the neurosurgeon. Then, at step S1 10, the optical tracking device 21 will continuously deliver or provide position data of the actual position of the medical instrument to the feedback device 23. As has been described above, the position data is based on the movement of the surface of the instrument passing the optical tracking device 21 . Hence, the feedback device 23 is continuously provided with real time position data providing position data including a position of the instrument relatively a reference point. Thereafter, at step S120, the position data is synchronized with image data (obtained, for example, by means of computed tomography, CT, magnetic resonance imagining, MRI, isocentric C-arm fluoroscopic imagining, or positron emission tomography, PET) of the anatomic region of the patient in which the target is located. At step S130, a position indication for the instrument is superimposed onto an image of the region created by the image data by using the synchronized positional data and image data. At step S140, an image of the region of the patient with the superimposed position indication for the instrument is displayed in real time.
Although exemplary embodiments of the present invention have been shown and described, it will be apparent to those having ordinary skill in the art that a number of changes, modifications, or alterations to the inventions as described herein may be made. Thus, it is to be understood that the above description of the invention and the accompanying drawings is to be regarded as a non-limiting.
Finally, it is to be noted that an inclusion in the appended claims of reference numerals used in the figures of drawings is purely for illustrative purposes and not to be construed as having a limiting effect on the scope of the claims.

Claims

1 . A system for tracking an instrument in a region of a patient comprising:
an optical tracking device adapted to track a position of said instrument during an insertion of said instrument into said patient, said optical tracking device including a light emitting unit is arranged to, in operation, emit light towards said instrument; and a light detecting unit arranged to, in operation, receive reflected light from said instrument, and wherein said light detecting unit is adapted to produce consecutive output signals representing a movement of said instrument relative a reference point; and wherein said optical tracking device is adapted to provide position data including a position change of said instrument relatively said reference point based on the output signals; and
a feedback device in communication with said tracking device configured to gather said position data and to determine a present position of said instrument relative said reference point.
2. The system according to claim 1 , wherein said feedback device is configured to:
synchronize said position data with image data of said region; and
superimpose a position indication for said instrument onto an image of said region created by said image data by using said synchronized positional data and image data.
3. The system according to claim 1 or 2, further comprising display unit adapted to display said image of said region of said patient with the superimposed position indication for said instrument.
4. The system according to claim 1 - 3, wherein said feedback device is adapted to determine a reference point by instructing said optical tracking device to perform a measurement on a specific part of said instrument when said instrument is placed in an initial position, wherein position data for said initial position is obtained and said reference point is determined based on said position data.
5. The system according to claim 1 - 4, wherein said position data includes information of a linear movement along an longitudinal axis of said instrument relatively said reference point and/or a rotation of said instrument around said longitudinal axis.
6. The system according to claim 1 - 5, wherein said feedback device is adapted to use said consecutive output signals from said optical tracker device so as to determine said linear movement and/or said rotation of said instrument.
7. The device according to claim 1 - 6, wherein said image data is obtained from computed tomography, CT, magnetic resonance imagining, MRI, isocentric C-arm fluoroscopic imagining, or positron emission tomography, PET.
8. A method for tracking an instrument in a region of a patient comprising:
using an optical tracking device adapted to track a position of said instrument during an insertion of said instrument into said patient, said optical tracking device including a light emitting unit is arranged to, in operation, emit light towards said instrument; and a light detecting unit arranged to, in operation, receive reflected light from said instrument, and wherein said light detecting unit is adapted to produce consecutive output signals representing a movement of said instrument relative a reference point;
providing position data including a position change of said instrument relatively said reference point; and
determining a present position of said instrument relative said reference point.
9. The method according to claim 8, further comprising:
synchronizing said position data with image data of said region; superimposing a position indication for said instrument onto an image of said region created by said image data by using said synchronized positional data and image data; and
tracking a position of said instrument during an insertion of said instrument into said patient using said superimposed position indication.
10. The method according to claim 9, further comprising displaying said image of said region of said patient with the superimposed position indication for said instrument.
1 1 . The method according to claim 8 - 10, further comprising:
determining a reference point by performing a measurement on specific part of said instrument when said instrument is placed in an initial position, wherein position data for said initial position is obtained and said reference point is determined based on said position data.
12. The method according to claim 8 - 1 1 , wherein said position data includes information of a linear movement along an longitudinal axis of said instrument relatively said reference point and/or a rotation of said instrument around said longitudinal axis.
13. The method according to claim 8 - 12, wherein said image data is obtained from computed tomography, CT, magnetic resonance imagining, MRI, isocentric C-arm fluoroscopic imagining, or positron emission tomography, PET.
PCT/EP2010/068522 2010-11-30 2010-11-30 Tracking of a medical instrument Ceased WO2012072112A1 (en)

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