[go: up one dir, main page]

WO2007066096A2 - Procede et appareil de localisation d'un dispositif interventionnel - Google Patents

Procede et appareil de localisation d'un dispositif interventionnel Download PDF

Info

Publication number
WO2007066096A2
WO2007066096A2 PCT/GB2006/004543 GB2006004543W WO2007066096A2 WO 2007066096 A2 WO2007066096 A2 WO 2007066096A2 GB 2006004543 W GB2006004543 W GB 2006004543W WO 2007066096 A2 WO2007066096 A2 WO 2007066096A2
Authority
WO
WIPO (PCT)
Prior art keywords
image
region
movement
dimensional
imaging apparatus
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/GB2006/004543
Other languages
English (en)
Other versions
WO2007066096A3 (fr
Inventor
Derek Hill
Raza Razavi
Kawal Rhode
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.)
University College London
Kings College London
Original Assignee
University College London
Kings College London
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 University College London, Kings College London filed Critical University College London
Publication of WO2007066096A2 publication Critical patent/WO2007066096A2/fr
Publication of WO2007066096A3 publication Critical patent/WO2007066096A3/fr
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
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/12—Arrangements for detecting or locating foreign bodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; Determining position of diagnostic devices within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4416—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to combined acquisition of different diagnostic modalities, e.g. combination of ultrasound and X-ray acquisitions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Clinical applications
    • A61B8/0833—Clinical applications involving detecting or locating foreign bodies or organic structures

Definitions

  • the present invention relates to a method of and apparatus for determining the position of an interventional device introduced into a body of a human or other animal, and finds application in particular, though not exclusively, in the field of cardiovascular catheterisation.
  • Cardiovascular catheterisation procedures are traditionally carried out under X-ray fluoroscopic guidance.
  • the catheters, guidewires and other endo-vascular instruments employed are designed to be X-ray visible and can be seen throughout the part of their length that lies in the field of view, since X-ray imaging is a projecting imaging modality. Also, since images can be acquired relatively rapidly, typically at 25 frames per second, cardiac motion does not cause significant motion artifacts.
  • X-ray imaging is a projection imaging modality, more than one view is necessary to gain an appreciation of the three-dimensional location and path of the catheter.
  • an electroanatomical mapping system whereby catheters are tracked in three dimensions using electromagnetic tracking technology with internal or external antennae.
  • Such systems can be used to provide an approximate localization of the endocardial surface using the tracked catheters and to align pre-treatment CT or MRI scans with a catheter coordinate system.
  • Such systems are expensive to purchase, and require the use of single use (disposable) trackable catheters, which are between 10 and 100 times more expensive than standard catheters.
  • a method of determining the position of an interventional device introduced into a body of a human or other animal comprising the steps of producing an image of a region of the body into which the device is to be introduced, using 3 -dimensional imaging apparatus; displaying the 3 -dimensional image on a two-dimensional display screen; detecting the device in the body using single-plane detecting apparatus, thereby to determine the position of the device substantially in two dimensions; superimposing the image of the region of the body onto an image of the detected device on the display screen in registration therewith; detecting the movement of the device in response to internal movement of the body, thereby to determine the position of the device in three dimensions relative to the 3 -dimensional image; and displaying the position of the interventional device on the image on the display screen.
  • apparatus for determining the position of an interventional device introduced into a body of a human or other animal comprising imaging apparatus for producing a 3-dimensional image representative of a region of the body into which the device is to be introduced; a display device for displaying the 3-dimensional image on a two-dimensional screen; .
  • single-plane detecting apparatus for detecting the position of the device in the body in substantially two dimensions, and producing an image in accordance therewith; means for registering the images of the region of the body produced by the 3-dimensional imaging apparatus and the single-plane detecting apparatus and superimposing the two images, showing the two-dimensional position of the device, on the display device; means for detecting movement of the device in response to internal movement of the body; and means for determining from said movement of the device the position of the device on said screen.
  • the three dimensional imaging apparatus comprises magnetic resonance imaging (MRI) apparatus, or computed tomography (CT) scanning apparatus, or ultrasound imaging apparatus.
  • MRI magnetic resonance imaging
  • CT computed tomography
  • the single plane detecting apparatus comprises X-ray apparatus.
  • the interventional device will be a catheter, or a flexible wire acting as a guide therefor, but it is also envisaged that the device could be a needle, or a stent being inserted.
  • the internal movement of the body that produces the movement of the device that is to be detected will typically comprise respiratory and/or cardiac cycle movement.
  • the motion of the organs in the body with the cardiac or respiratory cycle may be estimated from independent measurements made on the body, e.g: using X-ray visible markers or ultrasound, and used to improve the accuracy of the tracking of the device. Whilst typically it would be the tip of the device whose position is required to be determined, it is envisaged that two or more portions, such as points or locations along the length of the device, may be detectable by the single plane detecting apparatus.
  • a medical practitioner when a medical practitioner introduces an interventional device into the body, for example a catheter into the heart, the practitioner will be able to determine when the device abuts a wall of that region of the body either from the force feedback or from a sensor, e.g: an electrical recording electrode, at the tip.
  • a sensor e.g: an electrical recording electrode
  • the three dimensional imaging apparatus may be arranged to produce an image of the region of the body into which the device is to be inserted by deriving the image remote from the actual body that is subject to X-ray investigation, by operation on a corresponding region of a reference body, for example a standard heart. If necessary, particular variable features of the actual heart may be noted in real time so that the image derived from the reference body may be appropriately modified, thereby to enhance the accuracy of the measurement, when the reference body image is superimposed upon the X-ray image of the device. However, it is also envisaged that the three dimensional image may be derived in situ and in real time from the same body into which the device is introduced.
  • the accuracy of the determined position of the device is evaluated, and an indication may be provided to the practitioner should the determined accuracy fall below a predetermined level.
  • the method may be arranged to store successive position determinations so that a history of the route taken by the device is retained and is displayed.
  • the necessary registration of the images obtained by the three dimensional apparatus and the single plane detecting apparatus may be achieved by the application of a marker or markers physically applied on the outer surface of the body. It will be appreciated, that the marker(s) would be such as to be detectable by each of these pieces of apparatus.
  • the registration of the two images may be achieved by noting at least one anatomical landmark identified on both images, and such a landmark advantageously comprises a bony structure of the body, for example the spine, or a vascular structure, such as a blood vessel.
  • the position of the device may be monitored as it is moved through the body, either on a continuous basis or from one region to another.
  • the size of the region of the. body displayed on the display screen is advantageously varied in dependence on the speed of the movement of the device, such that a larger region would be displayed the higher the speed of movement of the device.
  • the position of the device may be determined only in accordance with cardiac movement of the body, with the heart typically beating at 70 times per minute, but also beating at up to 100 or even 300 times per minute, whilst the respiratory movement of the body is arrested, for example by requiring the patient to hold his breath.
  • the position of the device may be monitored only at substantially the same point in successive cardiac cycles, thereby removing the effect of cardiac movement, so that the position of the device is determined only in accordance with the internal respiratory movement of the body, which is typically at the rate of 10 cycles per minute.
  • advantage can be taken of the significantly different frequencies of these two kinds of movement such that the position of the device is determined even when both cardiac and respiratory cyclical movements are occurring.
  • the single plane detecting apparatus comprises a substantially point source of radiation that is located at one side of the body so as to direct radiation therethrough, and a planar detector, such as image intensifier or flat panel, that is located at an opposing side of the body so as to receive radiation passing therethrough; wherein the radiation is arranged to pass through a region of the body that is subject to internal movement; wherein the device is introduced into the said region such that a portion of the device, preferably its tip, is in contact with an inner surface of a chamber of the body; and wherein the extent of the detector that receives radiation varies in accordance with the internal movement of the body, and a determination is made as to whether the device is in contact with a surface of the chamber that is closer to or further away from the detector.
  • a planar detector such as image intensifier or flat panel
  • Such treatment may comprise cardiac treatment, for example a cardiac electrophysiology procedure, or a radio-frequency (RF) ablation procedure.
  • Figure 1 is a schematic representation of the determination of the position of the tip of a catheter located in a patient's heart unambiguously when moving in accordance with respiratory motion of the patient, using a single plane X-ray detecting apparatus;
  • Figure 2 is an X-ray image showing four electrophysiology catheters placed in the right ventricle of a patient's heart.
  • One of the catheters is provided with an electrode at its tip and is shown in contact with the inner ventricular surface as it has been moved therealong;
  • Figure 3 shows a 3D anatomical model of the heart derived from magnetic resonance imaging of that region of- the patient, overlaid onto the X-ray image.
  • the arrow indicates a tracked electrode of the catheter so that the tracked tip of the catheter is in contact with the inner ventricular surface;
  • Figure 4 shows the position of the tracked tip of a catheter and the path of the catheter on which it lies displayed on the 3D anatomical model of the heart.
  • a human heart is shown schematically at H at one extreme of the respiratory motion of the patient, and at H' at the other extreme of the respiratory motion.
  • Ei and E 2 are points on opposed positions of the inner surface of the heart H, and moved by the same amount to points E 1 ' and E 2 ' of the heart H' as a result of the respiratory motion.
  • Four lines of radiation are shown emanating from an X-ray source X 8 , passing through each of the four points, terminating in respective positions P 1 , P 2 , P 2 ' and Pi' on a linear X-ray detector X D .
  • Points Pi and P 1 ' are separated by the distance d ⁇ and points P 2 and P 2 ' by the distance d 2 .
  • the cardiologist will introduce an electrophysiology catheter into the heart for carrying out an endovascular cardiovascular intervention, the progress of the catheter being monitored on a display screen upon which the image from the X-ray apparatus is projected.
  • the X-ray image shows four electrophysiology catheters located in the right ventricle of the heart, each of which is provided with an X-ray opaque electrode at its tip.
  • the position of catheter Ci has been tracked, with the current position CN of its electrode tip indicated in the position in which the catheter C 1 is in contact with the inner ventricular surface. It will be appreciated that from the image of Figure 2, it is not possible to tell whether the inner ventricular surface that is contacted is that which is nearer to or further away from the detector.
  • Magnetic resonance imaging apparatus for example, has been used to derive a 3D anatomical model of the heart in a known manner, and, provided the heart of the patient under investigation is not significantly abnormal, the heart model used for the magnetic resonance imaging can be that of a standard heart, and thus can be stored in a computer associated with the X-ray equipment. As described in the IEEE papers referred to above, the X-ray and MRI images are then overlaid, with the result as shown in Figure 3.
  • the arrow indicates the tracked electrode catheter tip C N in contact with the inner ventricular surface.
  • FIG. 4 shows the position of the tracked catheter tip CN and the path of the catheter displayed in the 3D anatomical model of the heart.
  • the model may be manipulated so as to show any required view of the heart and catheter on the display screen.
  • d] or d 2 ( Figure 1) of the detected tip of the catheter during respiratory motion of the patient's heart it can thus be determined whether the catheter is at the lower position E 1 or the upper position E 2 of the ventricle, which positions would otherwise be indistinguishable from the X-ray image.
  • Figure 1 indicates that the motion of the heart is purely due to the respiratory cycle, the discrepancy between di and d 2 , and thus the determination of the catheter position, could result also from cardiac motion alone or more likely a combination of respiratory and cardiac motion.
  • the present invention thus requires only a single plane X-ray set, and that for many cases there will be no need to take an MRI (or CT) scan of the particular patient, since the model of a standard heart may be employed.
  • the 3D dimensional scan can be obtained directly from the patient being treated in realtime, along with the provision of the X-ray data.
  • the historical position of the catheter may be presented in a different colour to the colour representing the current position of the tip, so that the movement of the catheter to and fro within the body can be distinguished.
  • a determination of the initial position of the device in three dimensions may be obtained by synchronising two views of the device moving under cardiac and/or respiratory motion provided by a single plane detection apparatus, such as X-ray apparatus.

Landscapes

  • Life Sciences & Earth Sciences (AREA)
  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Biophysics (AREA)
  • Public Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Human Computer Interaction (AREA)
  • High Energy & Nuclear Physics (AREA)
  • Optics & Photonics (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
  • Magnetic Resonance Imaging Apparatus (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)

Abstract

La position d'un dispositif interventionnel, comme un cathéter, introduit dans un organisme humain est déterminée par la production d'une image d'une zone de l'organisme dans laquelle le dispositif doit être introduit, à l'aide d'un appareil d'imagerie 3D; l'affichage de l'image tridimensionelle sur un écran d'affichage bidimensionnel; la détection du dispositif dans l'organisme à l'aide d'un appareil de détection en un plan pour ainsi déterminer la position du dispositif sensiblement dans deux dimensions; la superposition de l'image de la zone de l'organisme sur une image du dispositif détecté à l'écran d'affichage de manière à les faire coïncider ; la détection du déplacement du dispositif en réaction au mouvement interne de l'organisme, pour ainsi déterminer la position du dispositif dans les deux dimensions susmentionnées; et l'affichage de la position du dispositif dans l'image de l'écran d'affichage.
PCT/GB2006/004543 2005-12-07 2006-12-05 Procede et appareil de localisation d'un dispositif interventionnel Ceased WO2007066096A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB0524974.3 2005-12-07
GB0524974A GB0524974D0 (en) 2005-12-07 2005-12-07 Interventional device location method and apparatus

Publications (2)

Publication Number Publication Date
WO2007066096A2 true WO2007066096A2 (fr) 2007-06-14
WO2007066096A3 WO2007066096A3 (fr) 2007-11-15

Family

ID=35735719

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB2006/004543 Ceased WO2007066096A2 (fr) 2005-12-07 2006-12-05 Procede et appareil de localisation d'un dispositif interventionnel

Country Status (2)

Country Link
GB (1) GB0524974D0 (fr)
WO (1) WO2007066096A2 (fr)

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102007032786A1 (de) * 2007-07-13 2009-01-22 Siemens Ag Verfahren und Vorrichtung zur Fusion oder Überlagerung eines 3D-Bildes und eines 2D-Bildes von einem bewegten Gewebebereich eines Lebewesens
US8886288B2 (en) 2009-06-16 2014-11-11 MRI Interventions, Inc. MRI-guided devices and MRI-guided interventional systems that can track and generate dynamic visualizations of the devices in near real time
US8897516B2 (en) 2011-03-16 2014-11-25 Biosense Webster (Israel) Ltd. Two-dimensional cardiac mapping
EP2259726B1 (fr) * 2008-04-03 2018-10-31 Koninklijke Philips N.V. Appareil d évaluation de la respiration
CN111710028A (zh) * 2020-05-27 2020-09-25 北京东软医疗设备有限公司 三维造影图像的生成方法、装置、存储介质和电子设备
CN114246684A (zh) * 2020-09-25 2022-03-29 西门子医疗有限公司 导入到患者身体中的对象的安置质量的确定
EP2524351B1 (fr) * 2010-01-12 2024-10-02 Koninklijke Philips N.V. Navigation d'un dispositif interventionnel

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2440130A4 (fr) 2009-06-08 2015-06-03 Mri Interventions Inc Systèmes chirurgicaux guidés par irm avec alertes de proximité
WO2015101948A2 (fr) * 2014-01-06 2015-07-09 Body Vision Medical Ltd. Dispositifs chirurgicaux et leurs méthodes d'utilisation

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE10160532C1 (de) * 2001-12-10 2003-06-26 Dornier Medizintechnik Verfahren und Vorrichtung zur dreidimensionalen Ortung eines Konkrements
DE10210646A1 (de) * 2002-03-11 2003-10-09 Siemens Ag Verfahren zur Bilddarstellung eines in einen Untersuchungsbereich eines Patienten eingebrachten medizinischen Instruments
DE10240727A1 (de) * 2002-09-04 2004-03-18 Philips Intellectual Property & Standards Gmbh Bildgebendes System und Verfahren zur Optimierung einer Röntgenabbildung
US20080234570A1 (en) * 2004-03-05 2008-09-25 Koninklijke Philips Electronics, N.V. System For Guiding a Medical Instrument in a Patient Body

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102007032786A1 (de) * 2007-07-13 2009-01-22 Siemens Ag Verfahren und Vorrichtung zur Fusion oder Überlagerung eines 3D-Bildes und eines 2D-Bildes von einem bewegten Gewebebereich eines Lebewesens
DE102007032786B4 (de) * 2007-07-13 2015-03-05 Siemens Aktiengesellschaft Verfahren und Vorrichtung zur Fusion oder Überlagerung eines 3D-Bildes und eines 2D-Bildes von einem bewegten Gewebebereich eines Lebewesens
EP2259726B1 (fr) * 2008-04-03 2018-10-31 Koninklijke Philips N.V. Appareil d évaluation de la respiration
US8886288B2 (en) 2009-06-16 2014-11-11 MRI Interventions, Inc. MRI-guided devices and MRI-guided interventional systems that can track and generate dynamic visualizations of the devices in near real time
EP2524351B1 (fr) * 2010-01-12 2024-10-02 Koninklijke Philips N.V. Navigation d'un dispositif interventionnel
US8897516B2 (en) 2011-03-16 2014-11-25 Biosense Webster (Israel) Ltd. Two-dimensional cardiac mapping
CN111710028A (zh) * 2020-05-27 2020-09-25 北京东软医疗设备有限公司 三维造影图像的生成方法、装置、存储介质和电子设备
CN114246684A (zh) * 2020-09-25 2022-03-29 西门子医疗有限公司 导入到患者身体中的对象的安置质量的确定

Also Published As

Publication number Publication date
GB0524974D0 (en) 2006-01-18
WO2007066096A3 (fr) 2007-11-15

Similar Documents

Publication Publication Date Title
EP1699361B1 (fr) Systeme de guidage d'un instrument medical dans le corps d'un patient
US10546396B2 (en) System and method for registration of fluoroscopic images in a coordinate system of a medical system
JP5019877B2 (ja) 心臓における電気生理学的カテーテル療法の視覚的支援のための装置の作動方法およびこの方法を実施するための装置
US8364242B2 (en) System and method of combining ultrasound image acquisition with fluoroscopic image acquisition
EP1912565B1 (fr) Systeme de navigation de catheter
KR101061670B1 (ko) 심장에 카테터의 전기생리학적 적용을 시각적 지원을 위한 방법 및 장치
EP2524351B1 (fr) Navigation d'un dispositif interventionnel
US20090306497A1 (en) Calibration method for catheter tracking system using medical imaging data
US7590442B2 (en) Method for determining the position of an instrument with an x-ray system
CN100591282C (zh) 用于在患者体内引导医疗器械的系统
US20030181809A1 (en) 3D imaging for catheter interventions by use of 2D/3D image fusion
US20090281418A1 (en) Determining tissue surrounding an object being inserted into a patient
JP7157074B2 (ja) 医療機器、特に心臓カテーテルのためのナビゲーション・プラットフォーム
JP2006512950A (ja) 医用器具を追跡する方法及び装置
US7778689B2 (en) Method for localizing a medical instrument introduced into the body of an examination object
CN1647759A (zh) 对准和重叠医疗成像的系列拍摄中的图像数据的方法
JP2007185503A (ja) 臓器の標的部位に治療物質を正確に生体内送達する方法
US20080306378A1 (en) Method and system for images registration
US20240341860A1 (en) System and method for illustrating a pose of an object
WO2007066096A2 (fr) Procede et appareil de localisation d'un dispositif interventionnel
WO2001030254A1 (fr) Catheter muni de marqueurs radio-opaques pour localiser une position en 3d
CN100473355C (zh) 用于把医疗仪器导入到病人体内的系统
WO2025221620A1 (fr) Systèmes et procédés de fusion de tomodensitométrie
WO2024214057A1 (fr) Système et procédé d'illustration de la pose d'un objet
CN116894865A (zh) 结果数据集的提供

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application
NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 06820427

Country of ref document: EP

Kind code of ref document: A2