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WO2011121516A2 - Déploiement d'endroprothèse virtuel - Google Patents

Déploiement d'endroprothèse virtuel Download PDF

Info

Publication number
WO2011121516A2
WO2011121516A2 PCT/IB2011/051295 IB2011051295W WO2011121516A2 WO 2011121516 A2 WO2011121516 A2 WO 2011121516A2 IB 2011051295 W IB2011051295 W IB 2011051295W WO 2011121516 A2 WO2011121516 A2 WO 2011121516A2
Authority
WO
WIPO (PCT)
Prior art keywords
stent
anatomical structure
computer program
image data
actual
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/IB2011/051295
Other languages
English (en)
Other versions
WO2011121516A3 (fr
Inventor
Irina Waechter-Stehle
Reinhard Kneser
Helko Lehmann
Juergen Weese
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.)
Philips Intellectual Property and Standards GmbH
Koninklijke Philips NV
Original Assignee
Philips Intellectual Property and Standards GmbH
Koninklijke Philips Electronics NV
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 Philips Intellectual Property and Standards GmbH, Koninklijke Philips Electronics NV filed Critical Philips Intellectual Property and Standards GmbH
Publication of WO2011121516A2 publication Critical patent/WO2011121516A2/fr
Publication of WO2011121516A3 publication Critical patent/WO2011121516A3/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
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T19/00—Manipulating 3D models or images for computer graphics
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2210/00—Indexing scheme for image generation or computer graphics
    • G06T2210/41—Medical

Definitions

  • the invention relates to the field of stents. Particularly, the invention relates to a computer program and a system for supporting a positioning of a stent in an anatomical structure.
  • Heart valve diseases are among the most prominent causes for heart failure. 3 to 4 million people will require heart valve replacement at some point in their live. Heart valves can be replaced during an open surgery. But open heart surgery is very invasive with long recovery time, it is very expensive, and the patient group is limited as for some patients the risk of anesthesia and open surgery is too high.
  • Minimally invasive valve replacement in the cathlab promises a less invasive treatment at much lower cost for more patients.
  • the artificial valve is mounted in a stent which is positioned using a catheter under x-ray guidance . This is a challenging procedure which still bears a not negligible risk for the patient.
  • US 7,650,179 B2 discloses a computerized workflow method for stent planning and conducting procedure, wherein characteristics of a lesion to be stented are determined from a 3D planning image of the region and selection of an actual stent for stenting the lesion is made with computer-assisted analysis of the lesion based on the characteristics.
  • a virtual stent is electronically generated based on the actual stent, and, using the virtual stent, a best position for the actual stent, for effectively stenting the lesion, is determined.
  • a real time 2D image of the lesion-containing region is displayed during the stenting procedure, with the virtual stent included therein at the
  • a stent for aortic valve replacement is crucial, since, if the stent is placed too low, the mitral valves might be disturbed; if it is placed too high, the flow into the coronaries might be impeded; and if it is placed in an inappropriate angle, the positioning might not be stable. Additionally, bad positioning can lead to embolization and paravulvular insufficiency.
  • the anatomical structure may include the natural aortic valves.
  • the image data may be received directly from an image device, for example a live 2D C-arm based X-ray device.
  • This image data may represent both the anatomical structure and the stent relative to the anatomical structure.
  • image data representing the anatomical structure seperately from the stent relative to the anatomical structure.
  • the image data may otherwise be received from a data base at which previously recorded image data are stored, wherein the image data of the data base may be for example data from 3D computer tomography, 3D ultrasound or a rotational X-ray scan.
  • the image data should be registered with for example live 2D images, providing for a link between the geometrical information extracted from the image data of the data base, and the identified position of the stent relative to the currently imaged anatomical structure.
  • the stent may be tracked, so that the identification of the position of the stent relative to the anatomical structure is performed automatically.
  • a tracking may be realized by an identification of for example a marker at the stent visible in an image, by an electro -magnetic tracking independent from a visualization of the stent or by methods for measuring the shape of a catheter.
  • the stent may be identified, so that the simulation may additionally be based on at least one parameter of the stent, which may be a deployed length, a deployed diameter, an elasticity and an deployed shape.
  • anatomical structure together with the simulated stent as deployed at the identified position may be visualized.
  • a corresponding computer program is preferably loaded into a work memory of a data processor.
  • the data processor or processing unit is thus equipped to carry out the method of the invention.
  • the invention relates to a computer- readable medium such as a CD-ROM at which the computer program may be stored.
  • the computer program may also be presented over a network like the World Wide Web and can be downloaded into the working memory of the data processor from such a network.
  • a system for supporting a positioning of a stent in an anatomical structure comprises an imaging device capable of generating image data representing an anatomical structure and a stent relative to the anatomical structure, processing means capable of extracting geometrical information of the anatomical structure, capable of identifying a position of the stent relative to the anatomical structure, and capable of simulating a deployment of the stent at the identified position, and a monitor for visualizing the anatomical structure and at the identified position the simulated stent.
  • the processing means may be realized by only one processor performing all the steps of the invention, or by a group or plurality of processors, for example a system processor for processing the image data, a separate processor specialized on a simulation of a deployment of a stent, and a further processor for controlling a monitor for visualizing the result.
  • the system may further comprise a computer program as mentioned above, wherein the computer program may be executable on the processing means.
  • the system may further comprise input means for manually identifying the stent and/or the position of the stent.
  • input means for manually identifying the stent and/or the position of the stent.
  • Such input device may be for example a computer keyboard, a computer mouse or a touch screen.
  • the system may comprise storage means providing for a data base including parameter data of the stent. It will be understood, that such storage means may also be provided in a network to which the system according to the invention may be connected and information related to the stent, i.e. different types of stents and parameter thereof, may be received over that network.
  • Fig. 1 shows a flow chart of steps perfomed in accordance with the invention.
  • Fig. 2 shows a schematical illustration of a system according to the invention.
  • Fig. 3 shows an exemplary segmentation of an anatomical structure.
  • Fig. 4 shows exemplary images of a stent implantation.
  • Fig. 5 shows a visualization of a virtually deployed stent.
  • the key question during a stent implantation is: If the stent would be opened starting from a current position, how would it be positioned after deployment.
  • the idea of this intervention is to simulate the deployment of the stent taking into account the patient anatomy, the stent geometry and the current stent position. To achieve this, the patient anatomy is determined from a 3D imaging modality and the position and orientation of the unopened or not yet fully opened stent is determined from the live x-ray image. Then, the opening of the stent is simulated taking into account all available information.
  • the results of the virtual stent deployment are visualized and certain risk structures could be highlighted.
  • the visualization can also be overlaid onto the life x-ray stream.
  • Fig. 1 illustrates the principle of the steps performed in accordance with the invention. It will be understood that the steps described, are major steps, wherein these major steps might be differentiated or divided into several sub- steps. Furthermore, there might be also sub-steps between these major steps. Therefore, a sub-step is only mentioned if this step may be important for the understanding of the principles of the method according to the invention.
  • a stent is determined, which means that a stent to be implanted is selected and identified, out of a plurality of stent potentially usable.
  • the parameter of the stent for example the length, the diameter and the elasticity or the shape may be identified for an un-deployed and a deployed state.
  • image data are received.
  • an X-ray device may provide image data of a region including the heart of a patient, wherein artificial heart valves should be implanted as supplement of the native aortic valves.
  • the image data may be received from a data base.
  • step S3 geometrical information are extracted from the image data, that is, the 3D contour of the aortic bulbus and the aortic valves are determined based on the received image data.
  • step S4 a current position of the introduced but not yet deployed actual stent is identified. This may be done by for example clicking with a mouse at the position at which the un-deployed stent is visible in an X-ray image. Otherwise, the stent may be automatically tracked, so that the current position of the stent is automatically determined. In this case, any kind of input may trigger the following step.
  • step S5 a deployment of the actual stent is simulated resulting in a virtual visualization of the deployed stent.
  • step S6 this virtually deployed stent is shown onto an X-ray image at the site at which the actual stent would have been located if actually deployed.
  • Fig. 2 shows an exemplary embodiment of a system according to the invention. Substantially, necessary for performing the steps according to the invention, a processing unit 100 together with a monitor 400 is part of the system.
  • the exemplary imaging device 200 includes an X-ray source 240, and an X-ray detector 260, wherein these two devices are mounted on a C-arm 220. It will be understood that the system in accordance with the invention may also comprise a noninvasive imaging modality like a computer tomography device, a magnetic resonance device, or an ultrasound device as imaging device instead of or additional to the shown C-arm based X-ray device.
  • a noninvasive imaging modality like a computer tomography device, a magnetic resonance device, or an ultrasound device as imaging device instead of or additional to the shown C-arm based X-ray device.
  • system in fig. 2 includes an input device 300, by means of which for example a manual selection of a utilized stent or a manual identification of the current position of the stent may be performed. Also shown is a connection (as dotted line) to a data base 600, located for example in a network.
  • a region of interest 500 for example a heart of a patient may be located which is subject of an implantation of an artificial heart valve. Examples of images from an imaging device 200, can be seen in figures 3 and 4.
  • a segmentation In fig. 3, examples for a segmentation are shown.
  • the 3D geometry of the aortic bulbus, the coronary ostia, the aortic valve, the left ventricular outflow tract and the mitral valve are determined. This can be achieved using a model-based segmentation, as disclosed in O. Ecabert, J. Peters, H. Schramm, C. Lorenz, J. von Berg, M. J. Walker, M. Vembar, M. E. Olszewski, K. Subramanyan, G. Lavi, and J. Weese: "Automatic Model-Based Segmentation of the Heart in CT images," IEEE Transactions on Medical Imaging, Vol. 27(9), p. 1189-1201, 2008.
  • the geometry can be determined from pre-interventional images, like CT or MRI, or from peri-interventional images, like 3D ultrasound or rotational angiography.
  • the simulation of the stent deployment must be able to take the current position of stent and catheter into account. This can be achieved by tracking the stent and the catheter in the live x-ray image during the intervention.
  • Example x-ray images from a minimally invasive valve replacement are shown in Figure 4.
  • contrast agent is injected into the aorta. These images can be utilized to register the x-ray projection images to the 3D patient anatomy which was obtained earlier. Then, the stent is deployed, i.e. released from the catheter (upper right and lower left images of figure 4). After deployment (lower right image in figure 4), the function of the stent may be controlled by injecting a contrast agent, as shown.
  • the stent deployment When the initial position of the stent with respect to the patient anatomy is known, it is possible to simulate the stent deployment.
  • the patient geometry and the stent geometry may be represented by a mesh. Then, the forces on the stent and the resulting displacements can be computed. Depending on the type of the stent, it is either deployed by removing a sheath from the stent or by expanding a balloon inside the stent. This has to be taken into account when modeling the forces on the stent.
  • the stent may be represented by a deformable simplex mesh, it is initialized using the centerline of the vessel, and it is deformed by internal and external forces onto the mesh taking into account some stent shape constraints.
  • a stent representation may be gathered from I. Larrabide, A. F. Frangi: "Virtual stent deployment with simplex meshes,” 5th European Congress on Computational Methods in Applied Sciences and Engineeering, 2008.
  • results of virtual stent deployment can be visualized together with for example a geometric model of the patient so that the quality of the positioning can be assessed by the clinician.
  • An example of such a visualization is shown in Figure 5.
  • the results can by overlaid onto the x-ray image.
  • the result can be used to automatically assess the quality of the positioning of the stent.
  • the clinician may actually deploy the stent and thus position the actual stent as simulated.
  • the computer program may be stored/distributed on a suitable medium such as an optical storage medium or a solid-state medium supplied together with or as a part of another hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems. Any reference signs in the claims should not be construed as limiting the scope.

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  • Engineering & Computer Science (AREA)
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  • Medical Informatics (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
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  • Biomedical Technology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • General Engineering & Computer Science (AREA)
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Abstract

L'invention propose de simuler un déploiement d'une endoprothèse réelle à une position actuelle de ladite endoprothèse, la simulation étant basée sur les informations géométriques extraites des données d'images reçues depuis un dispositif d'imagerie, les données d'images représentant une structure anatomique et l'endoprothèse relative à la structure anatomique, et sur une position identifiée de l'endoprothèse. L'endoprothèse simulée peut être visualisée en même temps qu'une image aux rayons X de la structure anatomique.
PCT/IB2011/051295 2010-04-01 2011-03-28 Déploiement d'endroprothèse virtuel Ceased WO2011121516A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
EP10158903 2010-04-01
EP10158903.4 2010-04-01

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WO2011121516A2 true WO2011121516A2 (fr) 2011-10-06
WO2011121516A3 WO2011121516A3 (fr) 2011-12-08

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Cited By (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2015101545A1 (fr) 2014-01-06 2015-07-09 Koninklijke Philips N.V. Modélisation de pose
WO2016001278A1 (fr) 2014-07-03 2016-01-07 Koninklijke Philips N.V. Dispositif et procédé pour afficher des informations tridimensionnelles pour une procédure interventionnelle
EP3025638A4 (fr) * 2013-10-31 2017-05-17 Galgo Medical S.L. Procédé de détermination de la longueur finale d'endoprothèses avant leur mise en place
JP2020525155A (ja) * 2017-06-29 2020-08-27 コーニンクレッカ フィリップス エヌ ヴェＫｏｎｉｎｋｌｉｊｋｅ Ｐｈｉｌｉｐｓ Ｎ．Ｖ． 生体組織における折り畳み可能インプラントの展開状態を予測するためのデバイス及び方法
JP2021020069A (ja) * 2019-07-29 2021-02-18 タレス リアルタイムでの内部人工器官の展開の改良されたシミュレーション
US20220110695A1 (en) * 2020-10-13 2022-04-14 Bard Access Systems, Inc. Fiber Optic Enabled Deployable Medical Devices for Monitoring, Assessment and Capture of Deployment Information
US11850338B2 (en) 2019-11-25 2023-12-26 Bard Access Systems, Inc. Optical tip-tracking systems and methods thereof
US11883609B2 (en) 2020-06-29 2024-01-30 Bard Access Systems, Inc. Automatic dimensional frame reference for fiber optic
US11931112B2 (en) 2019-08-12 2024-03-19 Bard Access Systems, Inc. Shape-sensing system and methods for medical devices
US12038338B2 (en) 2020-08-03 2024-07-16 Bard Access Systems, Inc. Bragg grated fiber optic fluctuation sensing and monitoring system
US12064569B2 (en) 2020-09-25 2024-08-20 Bard Access Systems, Inc. Fiber optics oximetry system for detection and confirmation
US12130127B2 (en) 2019-11-25 2024-10-29 Bard Access Systems, Inc. Shape-sensing systems with filters and methods thereof
US12140487B2 (en) 2017-04-07 2024-11-12 Bard Access Systems, Inc. Optical fiber-based medical device tracking and monitoring system
US12232821B2 (en) 2021-01-06 2025-02-25 Bard Access Systems, Inc. Needle guidance using fiber optic shape sensing
US12264996B2 (en) 2020-07-10 2025-04-01 Bard Access Systems, Inc. Continuous fiber optic functionality monitoring and self-diagnostic reporting system
US12343117B2 (en) 2022-06-28 2025-07-01 Bard Access Systems, Inc. Fiber optic medical systems and methods for identifying blood vessels
US12349984B2 (en) 2022-06-29 2025-07-08 Bard Access Systems, Inc. System, method, and apparatus for improved confirm of an anatomical position of a medical instrument
US12390283B2 (en) 2020-06-26 2025-08-19 Bard Access Systems, Inc. Malposition detection system
US12419694B2 (en) 2021-10-25 2025-09-23 Bard Access Systems, Inc. Reference plane for medical device placement
US12426954B2 (en) 2021-01-26 2025-09-30 Bard Access Systems, Inc. Fiber optic shape sensing system associated with port placement
US12490937B2 (en) 2021-05-18 2025-12-09 Bard Access Systems, Inc. Anatomical oscillation and fluctuation sensing and confirmation system

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O. ECABERT, J. PETERS, H. SCHRAMM, C. LORENZ, J. VON BERG, M. J. WALKER, M. VEMBAR, M. E. OLSZEWSKI, K. SUBRAMANYAN, G. LAVI: "Automatic Model-Based Segmentation of the Heart in CT images", IEEE TRANSACTIONS ON MEDICAL IMAGING, vol. 27, no. 9, 2008, pages 1189 - 1201, XP011226714, DOI: doi:10.1109/TMI.2008.918330

Cited By (29)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3025638A4 (fr) * 2013-10-31 2017-05-17 Galgo Medical S.L. Procédé de détermination de la longueur finale d'endoprothèses avant leur mise en place
US10176566B2 (en) 2013-10-31 2019-01-08 Galgo Medical, S.L. Method for determining the final length of stents before the positioning thereof
WO2015101545A1 (fr) 2014-01-06 2015-07-09 Koninklijke Philips N.V. Modélisation de pose
CN105899138A (zh) * 2014-01-06 2016-08-24 皇家飞利浦有限公司 部署建模
US10019800B2 (en) 2014-01-06 2018-07-10 Koninklijke Philips N.V. Deployment modelling
CN105899138B (zh) * 2014-01-06 2019-11-05 皇家飞利浦有限公司 部署建模
WO2016001278A1 (fr) 2014-07-03 2016-01-07 Koninklijke Philips N.V. Dispositif et procédé pour afficher des informations tridimensionnelles pour une procédure interventionnelle
US12140487B2 (en) 2017-04-07 2024-11-12 Bard Access Systems, Inc. Optical fiber-based medical device tracking and monitoring system
JP2020525155A (ja) * 2017-06-29 2020-08-27 コーニンクレッカ フィリップス エヌ ヴェＫｏｎｉｎｋｌｉｊｋｅ Ｐｈｉｌｉｐｓ Ｎ．Ｖ． 生体組織における折り畳み可能インプラントの展開状態を予測するためのデバイス及び方法
US12070273B2 (en) 2019-07-29 2024-08-27 Thales Simulation of the deployment of an endoprosthesis in real time
JP2021020069A (ja) * 2019-07-29 2021-02-18 タレス リアルタイムでの内部人工器官の展開の改良されたシミュレーション
JP7628004B2 (ja) 2019-07-29 2025-02-07 タレス リアルタイムでの内部人工器官の展開の改良されたシミュレーション
US11931112B2 (en) 2019-08-12 2024-03-19 Bard Access Systems, Inc. Shape-sensing system and methods for medical devices
US11850338B2 (en) 2019-11-25 2023-12-26 Bard Access Systems, Inc. Optical tip-tracking systems and methods thereof
US12403288B2 (en) 2019-11-25 2025-09-02 Bard Access Systems, Inc. Optical tip-tracking systems and methods thereof
US12130127B2 (en) 2019-11-25 2024-10-29 Bard Access Systems, Inc. Shape-sensing systems with filters and methods thereof
US12390283B2 (en) 2020-06-26 2025-08-19 Bard Access Systems, Inc. Malposition detection system
US11883609B2 (en) 2020-06-29 2024-01-30 Bard Access Systems, Inc. Automatic dimensional frame reference for fiber optic
US12397131B2 (en) 2020-06-29 2025-08-26 Bard Access Systems, Inc. Automatic dimensional frame reference for fiber optic
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