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WO2013100517A1 - Procédé de coordination d'un espace opération chirurgicale et d'un espace image - Google Patents

Procédé de coordination d'un espace opération chirurgicale et d'un espace image Download PDF

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Publication number
WO2013100517A1
WO2013100517A1 PCT/KR2012/011375 KR2012011375W WO2013100517A1 WO 2013100517 A1 WO2013100517 A1 WO 2013100517A1 KR 2012011375 W KR2012011375 W KR 2012011375W WO 2013100517 A1 WO2013100517 A1 WO 2013100517A1
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WO
WIPO (PCT)
Prior art keywords
space
marker
patient
image
preliminary
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/KR2012/011375
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English (en)
Korean (ko)
Inventor
김남국
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.)
Asan Foundation
Original Assignee
Asan Foundation
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 Asan Foundation filed Critical Asan Foundation
Publication of WO2013100517A1 publication Critical patent/WO2013100517A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • 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
    • A61B5/065—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
    • A61B5/066—Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • 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
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3991—Markers, e.g. radio-opaque or breast lesions markers having specific anchoring means to fixate the marker to the tissue, e.g. hooks
    • 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
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • 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

Definitions

  • the present disclosure relates to a method of matching an image space and an operating space, and more particularly, to a position of a patient that is virtually installed and virtually installed with a micro marker in the image space for registration of the operating space and the image space. It relates to a matching method using a guide that can accurately place the micro marker in.
  • Medical imaging apparatuses include, for example, computed tomography (hereinafter referred to as 'CT apparatus') and magnetic resonance imaging apparatus (hereinafter referred to as 'MRI apparatus'). Plays an important role. Since the CT and MRI devices have different advantages and disadvantages, they can be selectively used for the purpose of diagnosis, or they can be taken with as many imaging devices as possible to make more accurate diagnosis and treatment. And analyze the images obtained through the shooting.
  • CT apparatus' computed tomography
  • 'MRI apparatus' magnetic resonance imaging apparatus
  • a surgical navigation system Medical Navigation System
  • Surgical navigation device stores medical images taken by CT or MRI devices before surgery, and displays the images corresponding to the affected part of the patient that the doctor wants to see through the monitor provided in the surgical navigation device. Allow this to proceed.
  • image space the image stored in the surgical navigation apparatus
  • surgical space the corresponding body part of the patient
  • the registration may be made by various methods, and a method of using an index point is generally known.
  • a surgical image registration method and a surgical navigation method are known in Korean Patent Nos. 10-0529119 and 10-0957727.
  • the registration method of the surgical space and the image space according to Korean Patent No. 10-0957727 requires a lot of input from the operator, and it is difficult to be applied in a realistic surgical environment such as maintaining a marker used as an index point from the operation to the operating room.
  • a troublesome problem such as specifying the index point again from the beginning as a surgical tool and matching.
  • a first step of obtaining image data of a patient before surgery A second step of virtually installing a micro marker on the image data of the patient before surgery; A third step of actually placing the micromarker in the same patient's position as the virtual position;
  • a fourth step of matching the image space and the surgical space by using the virtual micromarker and the real micromarker as an index point is provided.
  • FIG. 1 is a flowchart illustrating a micro marker placement process according to an embodiment of the present disclosure
  • FIG. 2 is a flowchart illustrating a micro marker placement process according to another embodiment of the present disclosure
  • FIG. 3 is a view showing a coupling state of the formwork according to an embodiment of the present disclosure
  • FIG. 4 is a view showing a guide according to an embodiment of the present disclosure
  • FIG. 5 is a view showing a coupling state of a guide according to an embodiment of the present disclosure.
  • FIG. 6 is a view showing a micro marker placement state according to an embodiment of the present disclosure
  • FIG. 7 is a flowchart illustrating a matching process through an image matching technique between an image space and a surgery space according to an embodiment of the present disclosure
  • FIG. 8 is a conceptual diagram illustrating a registration process through an image registration technique of an image space and a surgical space according to an embodiment of the present disclosure
  • FIG. 9 is a conceptual diagram illustrating a matching process through a sensing means technique of an image space and a surgery space according to an embodiment of the present disclosure.
  • FIGS. 1 and 2 are a flow chart illustrating a micro marker placement process according to an embodiment of the present disclosure
  • Figures 3 and 5 is a view showing a coupling state of the formwork and the guide according to an embodiment of the present disclosure
  • Figure 4 6 is a view showing a guide according to an embodiment of the present disclosure
  • Figure 6 is a view showing a micro marker placement state according to an embodiment of the present disclosure.
  • an image of a body part to be operated on is performed. Take a picture (S11), and establish a surgical plan based on the captured image data.
  • a virtual position for placing the micro marker 14 in the image space is determined (S12).
  • Imaging may be performed using a conventional CT device or MRI device, and both of them are used to obtain an optimal image of a surgical site including a hard tissue. It is preferable to determine a specific position for placing the micro marker 14 on the surface of the hard tissue by using the obtained image data, and at this time, determine a plurality of positions.
  • a guide 13 having a shape corresponding to the hard tissue of the surgical site is manufactured using the photographed image data (S13).
  • the guide 13 is configured to guide the micro markers to be placed at the correct position when the micro markers 14 are placed in the hard tissue.
  • One side surface of the guide 13 for this purpose is manufactured in a negative shape corresponding to the surface of the hard tissue in close contact, and a hole through which the micromarker penetrates is formed at the position where the micromarker 14 is placed.
  • a plurality of holes may be formed according to the number of the micro markers 14, and a plurality of holes 13 may also be formed.
  • the position where the micromarker 14 is to be placed and the hole formation in the corresponding guide 13 may be formed by a predetermined program, which is a surgical type having a negative shape of a three-dimensional surface of hard tissue extracted from pre-operative CT and MRI images.
  • a hole is formed that guides the micro marker precisely to the location planned in the program.
  • the hole portion in which the micro marker 14 is placed is preferably made of a metal or reinforcing material that can prevent wear.
  • the guide 13 may be manufactured through a rapid prototyping machine. Rapid molding machines are available in a variety of materials. 3D System's SLA machine can be made using transparent photocurable polymer resin of liquid resin, and DTM's SLS machine is made by fusion of powder using laser, and made by Stratasys. FDM machines can be made using a thin threaded thermoplastic material. After the guide is produced, a slight polishing can be performed to produce a transparent or colored guide.
  • the guide 13 is coupled to the hard tissue surface while entering the actual surgical step (S14).
  • the guide 13 forms a negative shape corresponding to the surface of the hard tissue, as shown in FIG. 5, accurate coupling may be achieved.
  • the micro marker 14 is placed (S15). Since the guide 13 is formed with a hole through which the micro marker 14 penetrates, the micro marker 14 may be placed on the surface of the hard tissue at an accurate position while being guided by the hole.
  • the guide is removed (S16).
  • the micro marker 14 remaining in the hard tissue is used as an index for registration of the surgical space and the image space. As shown in FIG. 6, a plurality of such micro markers 14 may be placed, and at least three or four or more micro markers 14 may be placed.
  • a preliminary marker may be implanted outside the soft tissue before surgery, and a surgical plan may be established based on the preliminary marker. That is, as shown in Figure 2, the micro-marker implantation process according to another embodiment of the present disclosure, the process of combining the formwork on the surface of the soft tissue (Soft Tissue) in the pre-stage step is first performed (S21). Taking a picture of the surgical site in the form of the combination is coupled, a series of processes for producing the guide and the micro markers according to the surgical plan is performed in the same (S22 to S27).
  • the die 11 is coupled to the surface of the soft tissue of the surgical site, the die 11 may be produced by using a variety of hard materials such as gypsum or rapid rapid molding machine (RapidPro-totyping) as a guide.
  • a plurality of preliminary markers 12 are placed in the formed die 11. As shown in FIG. 3, the die 11 is coupled at both sides of the soft tissue, and two die markers 12 are usually placed in each die, so that four preliminary markers 12 appear as a whole during imaging.
  • the preliminary marker 12 may be placed in the formwork in a state in which the formwork 11 is coupled to the soft tissue, and the formwork 11 in which the preliminary marker 12 is implanted may be coupled to the soft tissue.
  • the preliminary marker 12 may be used as an index when planning a surgery by using preoperative CT or MRI images. That is, by establishing a surgical plan using the plurality of preliminary markers 12 and hard tissue information shown in the CT or MRI image data, it is possible to more precisely determine the virtual position where the micro markers are to be placed. Therefore, by using a die in which a preliminary marker is placed before surgery, more precise surgery can be performed. After determining the virtual position where the micro marker is to be placed using the preliminary marker 12, a guide is manufactured and a process of implanting the micro marker using the same is performed.
  • registration of the image space and the surgical space may be performed using the micromarker as an index point.
  • Registration of the imaging space and the surgery space may be performed in two ways. The first method is through image matching and the second method is using sensing means.
  • FIG. 7 is a flowchart illustrating a matching process using an image matching technique between an image space and a surgery space according to an embodiment of the present disclosure
  • FIG. 8 is a matching process using an image matching technique between an image space and a surgery space according to an embodiment of the present disclosure.
  • Conceptual diagram showing the process.
  • the micro marker 14 is automatically detected during a surgical procedure (S32), and the image with the detected micro markers and the virtual micro markers.
  • An image matching technique is applied to the image having the image space and the operation space to be matched (S33).
  • the detection image of the micro marker may be detected using C-Arm or CT Fluoroscopy, and as shown in FIG. 8, registration of the 3D image space and the surgical space using the 2D C-Arm or CT Fluoroscopy image This is done.
  • the image matching technique may be generally performed through a transform matrix calculation method, and the transform matrix calculation method is exemplified in Korean Patent Registration No. 10-0529119.
  • the image matching technique can be used to manually match the surface points in addition to the automatic method using the transform matrix calculation method.
  • the micro marker is detected again, and the image registration technique is applied again to the image with the virtual micro marker. That is, when hard tissue moves according to the patient's movement in the operating room space, the image is acquired by real-time monitoring of C-Arm or CT Fluoroscopy to detect the position of the relocated micromarker, and the image space and the surgical space are newly renewed according to the transform matrix calculation method. Is matched.
  • FIG. 9 is a conceptual diagram illustrating a matching process through a sensing means technique of an image space and a surgery space according to an embodiment of the present disclosure.
  • a surgical navigation device 15, an infrared camera 16, a reference frame 17 and a monitor 18 are provided in the operating room. Meanwhile, as part of the patient, the bone (BN), the tumor (TM) metastasized into the bone (BN), the internal tissue (TS) relatively movable relative to the bone (BN) and the epidermis (S) covering the internal tissue (TS) Is shown.
  • the reference frame 17 may be fixed to the bone BN after incision of the internal tissue TS at the operating room.
  • at least three micro markers 19, 20, and 21 are embedded in the bone BN, which is used as an index in registration of the surgical space and the image space.
  • each of the micro markers 19, 20, and 21 is designated by using a surgical tool or probe 23 having an infrared reflector 22, the micro marker and the virtual micro marker are associated with the surgical space and the virtual micro marker. Matching of the image space is achieved.
  • the registration method of the surgical space and the image space in this manner is described in Korean Patent No. 10-0957727.
  • an infrared reflector and an infrared camera are described as sensing means, but the present invention is not limited thereto.
  • a magnetic sensor using electromagnetic waves may be used as the sensing means, and the infrared reflector may be replaced by a coil.
  • the dangerous part of the part where there is no field of view or is not visible at the time of surgery due to the matching of the image space and the operation space can sound a warning when the surgical instruments are approaching, determine whether the surgical instruments are located correctly according to the preoperative plan, and control the surgical robot to move accurately according to the preplan.
  • an image for detecting a new position of the micro marker using C-Arm or CT Fluoroscopy provided in the operating room is obtained.
  • the image matching technique can be easily applied to an image having a virtual micro marker to easily match the surgery space with the image space.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Molecular Biology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Gynecology & Obstetrics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Human Computer Interaction (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
  • Magnetic Resonance Imaging Apparatus (AREA)
PCT/KR2012/011375 2011-12-29 2012-12-24 Procédé de coordination d'un espace opération chirurgicale et d'un espace image Ceased WO2013100517A1 (fr)

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KR10-2011-0145618 2011-12-29
KR20110145618 2011-12-29

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10499997B2 (en) 2017-01-03 2019-12-10 Mako Surgical Corp. Systems and methods for surgical navigation

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* Cited by examiner, † Cited by third party
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WO2014168350A1 (fr) 2013-04-10 2014-10-16 재단법인 아산사회복지재단 Procédé pour distinguer l'artère pulmonaire de la veine pulmonaire, et procédé l'utilisant pour quantifier les vaisseaux sanguins
KR102089959B1 (ko) * 2019-09-20 2020-03-17 의료법인 명지의료재단 경비인대 결합나사의 올바른 삽입방향 설정방법

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KR20060028398A (ko) * 2003-06-05 2006-03-29 이스쿨랍 아게 앤드 코. 카게 정위장치를 사용한 크로스체크
JP2008526422A (ja) * 2005-01-13 2008-07-24 メイザー サージカル テクノロジーズ リミテッド 鍵穴脳神経外科用画像ガイドロボットシステム
KR20090112727A (ko) * 2007-01-25 2009-10-28 워쏘우 오르쏘페딕 인코포레이티드 수술용 내비게이션 정보 및 신경감시 정보의 통합적 시각화
JP2009061132A (ja) * 2007-09-07 2009-03-26 Ono Kogyo:Kk 医療用ナビゲーションシステムにおけるレジストレーション用テンプレートの製造方法
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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10499997B2 (en) 2017-01-03 2019-12-10 Mako Surgical Corp. Systems and methods for surgical navigation
US11707330B2 (en) 2017-01-03 2023-07-25 Mako Surgical Corp. Systems and methods for surgical navigation
US12383347B2 (en) 2017-01-03 2025-08-12 Mako Surgical Corp. Systems and methods for surgical navigation

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KR20130077788A (ko) 2013-07-09
KR101441089B1 (ko) 2014-09-23

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