Classifications

• • 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
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
  • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B2018/1405—Electrodes having a specific shape
  • A61B2018/1425—Needle
  • A61B2018/143—Needle multiple needles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B2018/1405—Electrodes having a specific shape
  • A61B2018/1425—Needle
  • A61B2018/1432—Needle curved
• • 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
  • A61B2090/3954—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI

Definitions

• the invention relates to an applicator for medical intervention, in particular medical thermotherapy, according to the preamble of claim 1 , to a method for determining the position of an applicator for medical intervention, in particular medical thermotherapy, and to a method for medical thermotherapy.
• An applicator of this kind may serve to position for example an optical fiber for applying energy by means of a laser or an RF application means to a patient within the context of medical thermotherapy.
• An applicator of this kind comprises an outer cannula comprising a longitudinal bore and at least one inner cannula being arranged in the longitudinal bore of the outer cannula and being movable relative to the outer cannula.
• An applicator of this kind may comprise one or multiple inner cannulas being arranged within the outer cannula. Within the innermost cannula an optical fiber or an RF application means may be guided such that, through the innermost cannula, the optical fiber or the RF application means may be moved towards a region of interest to be treated within a patient.
• PITT percutaneous intradiscal thermotherapy
• two therapy methods namely a technique called percutaneous laser disc decompression (PLDD) and a technique referred to as intradiscal electrotherapy (IDET) are combined to treat a spinal disc of a patient in a two-step procedure in which, in a first PLDD step, tissue is removed from a nucleus of the spinal disc by means of vaporization and shrinking of tissue and, in a second IDET step, pain receptors within a degenerated fiber ring of the spinal disc are obliterated and proteins of the fiber ring are coagulated (so called annuloplasty).
• PITT percutaneous intradiscal thermotherapy
• PLDD percutaneous laser disc decompression
• IDT intradiscal electrotherapy
• an applicator suitable for PITT comprises an outer cannula which can be used to pierce the spinal disc and to access the nucleus of the spinal disc.
• an outer cannula which can be used to pierce the spinal disc and to access the nucleus of the spinal disc.
• a movable inner cannula is placed which can be slid out of the outer cannula to access the desired region of the spinal disc to be treated and may be curved to allow for an easy navigation to the desired region of interest.
• an optical fiber for supplying laser energy or an RF application means for providing RF energy may be brought towards the region to be treated within the spinal disc to supply energy for the purpose of thermal therapy.
• the applicator is applied using for example X-Ray imaging systems for assessing the correct positioning of the applicator. This requires a repeated imaging using X-Ray, which interrupts the intervention procedure and makes the process cumbersome.
• MRI magnetic resonance imaging
• At least one of the outer cannula and the at least one inner cannula comprises an orientation marker providing information about the position of the outer cannula or the at least one inner cannula by using magnetic resonance imaging.
• the instant invention is based on the idea to use magnetic resonance imaging to facilitate a medical intervention procedure, for example a thermotherapy procedure in order to facilitate the step of applying the applicator to access the region to be treated within a patient and to guide an energy application means (an optical fiber or an RF application means) to the region to be treated.
• an energy application means an optical fiber or an RF application means
• the outer cannula and/or the at least one inner cannula comprise a marker which can easily be seen within a magnetic resonance image and which provides information with regard to the positioning, in particular the rotational position, of the outer cannula and/or the at least one inner cannula to allow an assessment of the positioning of the applicator.
• An orientation marker of this kind may for example be made of a ferromagnetic material, for example ferromagnetic nanoparticles. Because the orientation marker is made of a ferromagnetic material, it produces an artifact within a magnetic resonance image which can easily be identified by an operator such that the positioning of the applicator, in particular of its cannulas, can easily be assessed.
• Using a ferromagnetic material to provide the orientation marker has the advantage that artifacts are produced which are visible not only within the particular imaging plane the applicator is positioned in, but can be seen also within adjacent planes such that information regarding the positioning of the applicator may be obtained even if the applicator is not fully positioned within the imaging plane.
• Said orientation marker may in particular be constituted to produce an artifact within a magnetic resonance image which varies depending on the rotational position of the outer cannula or the at least one inner cannula around a longitudinal axis along which the outer cannula extends.
• the orientation marker will produce a certain artifact of a particular shape when the outer cannula and/or the at least one inner cannula are in their desired rotational position (for the inner cannula to follow a desired curved path), then the applicator may be brought easily in such a rotational position in which the required artifact arises, hence making sure that the applicator is in the desired rotational position when moving an inner cannula with regard to the outer cannula to access a region to be treated within a patient.
• An orientation marker may in particular be arranged on the at least one inner cannula, in particular on such inner cannula exhibiting a strong curvature.
• One or multiple markers may be placed on each cannula, possibly displaced along the longitudinal axis of extension of the respective cannula.
• the rotational position of the applicator may be assessed prior to moving the at least one inner cannula out of the outer cannula and hence in a retracted state of the at least one inner cannula. Hence, it may be assessed whether the at least one inner cannula is positioned correctly with regard to its rotation prior to sliding it out of the outer cannula such that it can be made sure that the at least one inner cannula moves along the desired path prior to sliding the at least one inner cannula out of the outer cannula.
• the applicator may for example comprise a first inner cannula having a longitudinal inner bore and a second inner cannula being arranged in the longitudinal bore of the first inner cannula and being movable relative to the first inner cannula.
• the second inner cannula being arranged within the first inner cannula together with the first inner cannula and the outer cannula serves as guide means for guiding medical instrument such as an optical fiber or an RF application means to the region to be treated within a patient, the optical fiber or the RF application means being slidable through the outer cannula, the first inner cannula and the second inner cannula once the second inner cannula has been brought into engagement with the region to be treated.
• the cannulas of the applicator may also serve to guide a medical instrument other than an energy application means for the purpose of medical thermotherapy, for example medical pliers to perform a minimal-invasive surgery.
• the first inner cannula and the second inner cannula serve to allow a movement along a curved path.
• the first inner cannula may be fabricated such that it is curved having a predefined first radius of a curvature.
• the shape of the outer cannula which for example may be straight.
• the first inner cannula is slid out of the outer cannula it resumes its curved shape such that a section extending beyond the outer cannula exhibits the predefined first radius of curvature and, hence, is curved.
• the first inner cannula may be moved along a curved path, such curved path being defined by the predefined first radius of curvature inherent to the first inner cannula.
• the second inner cannula when slid out of the first inner cannula, may comprise a predefined second radius of curvature different than the predefined first radius of curvature.
• the second inner cannula in a state in which a section of the second inner cannula extends beyond a far end of the first inner cannula, the second inner cannula exhibits, within such section, a curvature being defined by the second radius of curvature which is different than the first radius of curvature of the first inner cannula.
• the second radius of curvature may for example be infinite, such that the second inner cannula in its section extending beyond the far end of the first inner cannula is straight.
• Such sections of the second inner cannula being retracted into the first inner cannula acquire the shape of the first inner cannula such that they follow the curved shape of the first inner cannula.
• the outer cannula, the first inner cannula and the second inner cannula are curved differently (the outer cannula for example may be straight, the first inner cannula may be curved having a first radius of curvature, and the second inner cannula may be curved having a second radius of curvature different than the first radius of curvature), by moving the first inner cannula relative to the outer cannula and the second inner cannula relative to the outer cannula and the first inner cannula such cannulas may describe a curved path facilitating the guiding of the energy application means to the region of interest within a patient.
• the applicator may be applied by piercing the outer cannula towards the region of interest with the first inner cannula and the second inner cannula being retracted into the outer cannula, by then sliding the first inner cannula out of the outer cannula to move the first inner cannula along a curved path, and by then sliding the second inner cannula out of the first inner cannula to finally access the region of interest to apply energy to the region of interest by guiding an energy application means through the outer cannula, the first inner cannula and the second inner cannula towards the region of interest.
• the outer cannula and the at least one inner cannula preferably are fabricated from a non-magnetic material.
• the cannulas of the applicator are compatible with magnetic resonance imaging and for themselves do not produce any artifacts within magnetic resonance images - except of course for orientation markers arranged on the outer cannula and/or the at least one inner cannula.
• the outer cannula may for example be made of titanium and may be comparatively rigid.
• the at least one inner cannula is preferably made from a shape memory alloy, for example a nickel-titanium alloy such as an alloy denoted as nitinol exhibiting advantageous shape memory characteristics as well as low magnetic susceptibility.
• Nitinol is an alloy having a high strength, a beneficial corrosion resistance and exhibits a pronounced shape memory effect.
• a component being made of a shape memory alloy resumes a particular prior shape even after having been subjected to a strong deformation.
• the applicator may further comprise a mandrin which, in a state in which the applicator is applied to a patient, is arranged in a longitudinal bore of the at least one inner cannula.
• the mandrin serves as a filling wire for the innermost cannula and may enhance a so-called needle artifact of the innermost cannula when being oriented parallel to the direction of the main magnetic field of a magnetic resonance imaging device.
• the cannulas of the applicator themselves may be passively visualized by means of a sharply confined needle artifact without any image distortions.
• the mandrin may for example be made of a cobalt-nickel-chrome alloy.
• the outer cannula may for example be fixedly arranged on a housing.
• the at least one inner cannula in contrast, may be movably arranged on the housing, wherein the at least one inner cannula may comprise a thread piece arranged on the housing and engaging a screw thread of an adjustment piece of the housing. By turning the adjustment piece relative to a housing body of the housing, then, the at least one inner cannula can be moved with respect to the outer cannula to slide the at least one inner cannula out of the outer cannula to approach the region of interest within the patient.
• the threading of the thread piece of the at least one inner cannula and the screw thread of the adjustment piece of the housing may for example have a trapezoidal shape.
• Different adjustment pieces for different inner cannulas herein may provide for a different lift such that for example the first inner cannula is moved by longer distance per turn of the associated adjustment piece then the second inner cannula per turn of its associated adjustment piece.
• the object underlying the invention is also achieved by means of a method for determining the position of an applicator for medical intervention, the applicator comprising an outer cannula having a longitudinal bore and at least one inner cannula being arranged in the longitudinal bore of the outer cannula and being movable relative to the outer cannula.
• the method is characterized in that the position of at least one of the outer cannula and the at least one inner cannula is determined by using magnetic resonance imaging according to an orientation marker arranged on the outer cannula or the at least one inner cannula.
• the positioning of the applicator may in particular be assessed using real time magnetic resonance imaging such that a direct information with regard to the positioning of the applicator is obtained while applying the applicator to the patient.
• the object underlying the invention is furthermore achieved by means of a method for medical thermotherapy, the method comprising the steps of:
• thermotherapy of at least one body part of the patient.
• the method may further comprise the step of observing, while applying energy, the temperature of tissue at the position of the energy application using magnetic resonance thermometry.
• magnetic resonance thermometry a temperature map of the region of interest may be obtained which allows for a direct assessment of treatment performance within the region of interest and, in particular, allows for controlling the duration of the treatment as well as the correct location of the treatment.
• the positioning of the applicator may in particular be assessed using real time magnetic resonance imaging such that a direct information with regard to the positioning of the applicator is obtained while applying the applicator to the patient.
• an image of the treated body part of the patient may be obtained using magnetic resonance imaging, hence allowing for a planning of the intervention as well as for a comparison of images obtained prior to and after the treatment.
• the imaging prior and after the intervention and the invention itself may be performed in the same magnetic resonance imaging device without having to move the patient such that a "one-stop-shop" procedure is obtained, allowing for a significant reduction in the duration of the procedure from the planning via the actual intervention to the subsequent imaging for assessing the success of the procedure.
• energy may be supplied via the applicator to remove tissue within a nucleus of a spinal disc, and subsequently the applicator may be adjusted in its position to supply energy to another region of the spinal disc, for example to a dorsal fiber ring of the spinal disc, hence in the first step allowing for a vaporization and/or shrinking of tissue and in the second step obliterating pain receptors and/or coagulating fiber ring proteins within a spinal outer fiber ring.
• Fig. 1 shows a schematic view of a spinal disc, with an applicator guiding an optical fiber to a nucleus of the spinal disc for a thermal vaporization of tissue
• Fig. 2A shows a schematic view of the spinal disc, with the applicator adjusted to provide energy to a fiber ring of the spinal disc for the purpose of coagulation of fiber ring proteins
• Fig. 2B shows a schematic view of the spinal disc, with the applicator accessing the fiber ring of the spinal disc in a different manner compared to Fig. 2A;
• Fig. 3 shows a schematic view of an applicator comprising an outer cannula, a first inner cannula and a second inner cannula;
• Fig. 4 shows a schematic view of an orientation marker arranged on an outer cannula;
• Fig. 5 shows a schematic view of orientation markers arranged on the outer cannula, the first inner cannula and the second inner cannula; shows a schematic view of an applicator including a housing; shows a schematic view of a magnetic resonance imaging device;
• Fig. 8A shows a schematic view of an RF application means arranged in an inner cannula, in a retracted state
• Fig. 8B shows a schematic view of the RF application means in a state in which the RF application means is slid out of the inner cannula.
• Fig. 1 shows a spinal disc 1 comprising a nucleus 10 being formed by colloidal tissue and being surrounded by a fiber ring 1 1 being formed by concentrical layers of collageneous connective tissue fibers.
• the nucleus is also denoted, in scientific terms, as “nucleus pulposus”.
• the fiber ring is denoted as "annulus fibrosus”.
• an optical fiber 3 is guided to the nucleus 10 such that energy may be provided to the nucleus 10 via the optical fiber 3 by transmitting laser radiation into the nucleus 10.
• the optical fiber 3 is guided by means of the outer cannula 20, the first inner cannula 21 and the second inner cannula 22 of the applicator 2 towards the fiber ring 1 1 of the spinal disc 1 towards a region of ruptures 1 1 1 of the fiber ring 1 1 .
• energy may be provided to the fiber ring 1 1 of the spinal disc 1 to obliterate pain receptors within the fiber ring 1 1 and to cause a coagulation and denaturization of fiber ring proteins to stabilize the fiber ring 1 1 in the region of the ruptures 1 1 1 .
• the pressure within the nucleus 10 can be reduced by causing a vaporization defect within the nucleus 10 leading to an intradiscal pressure reduction and, in addition, causing a shrinking effect by means of ablation of discal tissue (caused by the collageneous fiber structure, also outer regions of the spinal disc 1 shrink due to heat generation within the spinal disc 1 leading also to an extradiscal pressure reduction).
• pain receptors are destroyed within a dorsal region of the fiber ring 1 1 and the fiber ring 1 1 is stabilized by means of coagulation and denaturization of proteins (so called "annuloplasty").
• Fig. 2A and 2B two alternative approaches to guide the optical fiber 3 towards the dorsal region of the fiber ring 1 1 exist.
• First it is possible to pass the first inner cannula 21 around the nucleus 10 to guide the optical fiber 3 to the region of interest within the fiber ring 1 1 .
• the outer cannula 20 extends into the nucleus 10, and the first inner cannula 21 and the second inner cannula 22 are slid out of the outer cannula 20 to move around the nucleus 10 towards the dorsal region of the fiber ring 1 1 .
• Second it alternatively is also possible, as shown in Fig.
• the applicator 2 For guiding the optical fiber 3 towards the nucleus 10 and the fiber ring 1 1 an applicator 2 is provided as it is schematically shown in Fig. 3.
• the applicator 2 comprises, as mentioned already above, an outer cannula 20 extending straight along a longitudinal axis L, a first inner cannula 21 arranged in a longitudinal bore 201 of the outer cannula 20 and a second inner cannula 22 being arranged in an inner bore 21 1 of the first inner cannula 21 .
• the outer cannula 20, the first inner cannula 21 and the second inner cannula 22 are made of non-magnetic materials.
• the outer cannula 20 may be made of titanium.
• the first inner cannula 21 and the second inner cannula 22 can be made of a nickel-titanium alloy such as, for example, nitinol.
• the outer cannula 20, as visible in Fig. 3, extends straight along the longitudinal axis L and is made of a rigid material.
• the first inner cannula 21 and the second inner cannula 22, in contrast, are made of a shape memory alloy, for example nitinol, which is characterized by a shape memory effect causing the first inner cannula 21 and the second inner cannula 22 to resume their predefined shape even after a strong deformation.
• the first inner cannula 21 and the second inner cannula 22, in a retracted state are fully retracted into the inner bore 201 of the outer cannula 20 and adapt to the (straight) shape of the outer cannula 20.
• the applicator 2 can be used to access the nucleus 10 by piercing the applicator 2 through the back B of a patient and guiding the optical fiber 3 towards the nucleus 10.
• the first inner cannula 21 is movable within the inner bore 201 of the outer cannula 20 and can be slid out of the outer cannula 20. Once it extends beyond a far end 202 of the outer cannula 20, a section 21 A of the first inner cannula 21 resumes its predefined shape and in particular resumes a curvature defined by a radius of curvature R1 . Hence, by sliding the first inner cannula 21 out of the outer cannula 20 the applicator 2 may move along a curved path, as in particular shown in Fig. 2A.
• the second inner cannula 22 arranged in the inner bore 21 1 of the first inner cannula 21 adapts to the shape of the first inner cannula 21 .
• a section 22A of the second inner cannula 22 extending beyond the first inner cannula 21 resumes its predefined shape, which for example may be straight (with an infinite radius of curvature R2) or curved (with a radius of curvature R2 different than the radius of curvature R1 of the first inner cannula 21 ).
• the applicator 2 may be used to guide the optical fiber 3 along a curved path and to access regions of the spinal disc 1 which possibly may not be easily accessable on a straight path.
• a desired path may be followed and the optical fiber 3 may be guided to the region of interest in a desired way.
• a mandrin 23 may be used to fill an inner bore 221 of the second inner cannula 22.
• the mandrin 23 may serve to stabilize the second inner cannula 22 when sliding it out of the first inner cannula 21 , and further may enhance a so called needle artifact when imaging the applicator 2 using magnetic resonance imaging to assess the positioning of the applicator 2 when applying the applicator 2 to a patient.
• the first inner cannula 21 in the described embodiment is curved having a radius of curvature R1 , it is critical in what orientation the first inner cannula 21 is arranged within the outer cannula 20 during an actual procedure. In particular, depending on the rotational position of the first inner cannula 21 within the outer cannula 20 the plane in which the first inner cannula 21 is slid out of the outer cannula 20 varies.
• orientation markers 4, 4A, 4B, 4C are arranged on the outer cannula 20, the first inner cannula 21 and/or the second inner cannula 22.
• the orientation markers may for example be fabricated from a ferromagnetic material, for example from ferromagnetic nanoparticles, and are applied to the outer surface 200, 210, 220 of the respective cannula 20, 21 , 22.
• orientation markers 4, 4A, 4B, 4C are made of a ferromagnetic material they cause an artifact when using magnetic resonance imaging for assessing the positioning of the applicator 2. Such artifacts are clearly visible within a magnetic resonance image and extend comparatively far such that there are not confined to a particular imaging plane, but are visible also within neighboring imaging planes.
• the orientation markers 4, 4A, 4B, 4B, 4C in particular may cause an artifact within a magnetic resonance image which varies depending on the rotational position of the outer cannula 20, the first inner cannula 21 and/or the second inner cannula 22 around the longitudinal axis L. In this way, the rotational position in particular of the first inner cannula 21 can be assessed already in a state in which the first inner cannula 21 is still retracted into the outer cannula 20.
• the rotational position of the first inner cannula 21 can be adjusted until the desired appearance of the artifact arises, hence knowing that the first inner cannula 21 has reached its desired rotational position.
• Orientation markers 4, 4A, 4B, 4C allow for an assessment of the positioning of the applicator 2 and its cannulas 20, 21 , 22 when administering the applicator 2 to a patient.
• the rotational position of the inner cannulas 21 , 22 may already be assessed while they are (still) retracted into the bore (201 ) of the outer cannula 20.
• the assessment may be performed using a real time magnetic resonance imaging thus obtaining information with regard to the positioning of the applicator 2 in real time.
• Fig. 6 shows a schematic view of the applicator 2 comprising a housing 5 to which the outer cannula 20 is fixedly attached.
• the housing 5 comprises a body 50 carrying an orientation indicator 53 according to which a rough assessment of the orientation of at least the outer cannula 20 is possible.
• the first inner cannula 21 and the second inner cannula 22 are engaged with a first adjustment piece 51 and a second adjustment piece 52, respectively, which can be rotated along the direction of arrows P1 , P2 around the longitudinal axis L.
• the first inner cannula 21 and the second inner cannula 22 are connected to a thread piece 213, 223 each, which engages an associated screw thread 510, 520 of the associated adjustment piece 51 , 52.
• the respective inner cannula 21 , 22 hence can be moved along the longitudinal axis L to slide the inner cannula 21 , 22 out of or into the outer cannula 20.
• the threading of the end piece 213, 223 and the screw thread 510, 520 may be trapezoidal in shape.
• the threading of the end piece 213 and the screw thread 510 associated with the first inner cannula 21 may have a larger lift than the threading of the end piece 223 and the screw thread 520 associated with the second inner cannula 22, such that one turn of the adjustment piece 51 yields a movement of the first inner cannula 21 by a larger distance than the distance the second inner cannula 22 moves per turn of the associated adjustment piece 52.
• the applicator 2 is in particular suitable for applying thermotherapy to a patient P under control of a magnetic resonance imaging device MRT, as shown in Fig 7.
• the magnetic resonance imaging device MRT in particular may be an open magnetic resonance imaging device which does not have a bore a patient P is placed in for imaging but provides a larger space for positioning a patient P.
• the applicator 2 may be administered to the patient P, and in real time by using real time magnetic resonance imaging the positioning and orientation of the applicator 2 and its cannulas 20, 21 , 22 can be assessed and adjusted to access the desired region of interest within the patient P.
• magnetic resonance thermometry the intake of energy and the heating of tissue of the patient P within the region of interest can be assessed such that the procedure of applying energy to a region of the patient P can be visualized and controlled.
• thermotherapy procedure in a single imaging device becomes possible including a pre-therapy imaging as well as an after-therapy imaging.
• a procedure may for example include positioning the patient P in the magnetic resonance imaging device MRT, acquiring a first magnetic resonance image prior to thermotherapy, administering the applicator 2 under assessment and control using magnetic resonance imaging, applying thermotherapy, and acquiring a magnetic resonance image subsequent to thermotherapy to assess the success of the thermotherapy procedure.
• a "one-stop-shop" procedure is obtained which can be carried out in a single imaging device, hence avoiding a repositioning of the patient P in between imaging and therapy.
• the applicator 2 may be used to guide an optical fiber 3 to a region of interest within a patient P to provide energy to the patient P via the optical fiber 3 for example by means of a laser. It also is possible, however, to guide an radio frequency (RF) application means 3' as shown in Fig. 8A and 8B, through the second inner cannula 22 towards the region of interest.
• RF application means 3' in a state positioned in the second inner cannula 22, may be fully enclosed by the second inner cannula 22 and assumes an umbrella-like shape once it is slid out of a far end 212 of the second inner cannula 22, as shown in Fig. 8B.
• RF application means 3' RF energy may be transmitted towards the region of interest within a patient P to heat up tissue within the region of interest for the purpose of thermotherapy.
• the applicator described herein can be used not only for a PITT procedure, but may also be useful within other minimal-invasive therapy procedures for guiding an energy application means or another medical instrument to a region of interest within a patient.
• an applicator of the kind described herein is not limited to the use within therapy of a spinal disc of a patient.
• List of Reference Numerals are not limited to the use within therapy of a spinal disc of a patient.

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Citations (5)

• 2012
  • 2012-03-09 WO PCT/EP2012/054092 patent/WO2013131577A1/fr not_active Ceased
  • 2012-03-09 DE DE112012006001.6T patent/DE112012006001T5/de not_active Withdrawn

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