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WO2014174069A1 - Unité autonome à ultrasons pour la chirurgie guidée par l'image - Google Patents

Unité autonome à ultrasons pour la chirurgie guidée par l'image Download PDF

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Publication number
WO2014174069A1
WO2014174069A1 PCT/EP2014/058444 EP2014058444W WO2014174069A1 WO 2014174069 A1 WO2014174069 A1 WO 2014174069A1 EP 2014058444 W EP2014058444 W EP 2014058444W WO 2014174069 A1 WO2014174069 A1 WO 2014174069A1
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WO
WIPO (PCT)
Prior art keywords
ultrasound
unit
images
guided surgery
interface
Prior art date
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Ceased
Application number
PCT/EP2014/058444
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English (en)
Inventor
Atle Kleven
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.)
SONOWAND AS
Original Assignee
SONOWAND AS
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Filing date
Publication date
Application filed by SONOWAND AS filed Critical SONOWAND AS
Publication of WO2014174069A1 publication Critical patent/WO2014174069A1/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
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/46—Arrangements for interfacing with the operator or the patient
    • A61B6/461—Displaying means of special interest
    • A61B6/462—Displaying means of special interest characterised by constructional features of the display
    • 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
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4417—Constructional features of apparatus for radiation diagnosis related to combined acquisition of different diagnostic modalities
    • 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
    • A61B6/46—Arrangements for interfacing with the operator or the patient
    • A61B6/461—Displaying means of special interest
    • A61B6/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
    • 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
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/501—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of the head, e.g. neuroimaging or craniography
    • 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
    • A61B8/0808—Clinical applications for diagnosis of the brain
    • 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
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/461—Displaying means of special interest
    • A61B8/462—Displaying means of special interest characterised by constructional features of the display
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/461—Displaying means of special interest
    • A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/461—Displaying means of special interest
    • A61B8/464—Displaying means of special interest involving a plurality of displays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
    • A61B8/5261—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image combining images from different diagnostic modalities, e.g. ultrasound and X-ray
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B90/36—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
    • A61B2090/365—Correlation of different images or relation of image positions in respect to the body augmented reality, i.e. correlating a live optical image with another image
    • 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
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • 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]
    • A61B6/032—Transmission 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
    • A61B6/56—Details of data transmission or power supply, e.g. use of slip rings
    • 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
    • A61B8/0841—Clinical applications involving detecting or locating foreign bodies or organic structures for locating instruments
    • 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
    • A61B8/4405—Device being mounted on a trolley

Definitions

  • the present invention relates to a stand-alone unit utilizing ultrasound, designed for intraoperative imaging and image guided surgery, diagnostic probes, microscopic probes, surgical instruments (e.g. aspiration, biopsy needle, biopsy forceps, etc.).
  • Minimally invasive procedures are used increasingly, but often have the disadvantage of lack of visibility and open access.
  • Preoperative Computerised tomography (CT) scans and magnetic resonance (MR) imagery can provide detailed 3D images of the interior of the brain for example. They have the disadvantage of being static images as they are taken before surgery, giving very little indication of how and where an operative probe (tool) is presently being inserted into the brain, to remove a tumor for example.
  • Intraoperative CT and MR exist and are used, but these systems have the disadvantage of being larger, more expensive systems and for both technologies the radiation has to be taken into account when used because magnetic resonance (MR) generates strong magnetic fields, and CT radiates x-rays.
  • MR magnetic resonance
  • a number of systems track the position and orientation in three dimensions of operative tools by optically or magneticly tracking a plurality of specific points on arms extending from the tool handle and always free of the surgeons hand as the surgeon uses the tool. This tracking of certain points enables the system to compute the position and orientation of the tool in relation to the patient, particularly when moving and orienting the tool as it approaches contact and insertion into the patient.
  • these tracking or navigation systems work mainly based on preoperative 3D images recorded using CT or MR.
  • One image guided surgery (IGS) unit having the capacity for intraoperative imaging in 3D, developed by the present assignee has the additional feature of an integrated ultrasound system to image at any time during the surgery the position and orientation of the tool as it is inserted.
  • the ultrasound image can be
  • the present assignee' s unit also has the capacity to acquire volumetric ultrasound images (3D) to generate an updated navigable image volume or "map" of the brain.
  • the navigation information processed by the standard IGS system can then be transferred to assignee's unit and utilized to generate volumetric imagery to further assist the surgical procedures and provide intraoperative imaging based on 3D ultrasound.
  • the intraoperative volumetric imagery can be combined with preoperative static MR or CT images provided by the IGS system, in overlays or other means of visualization.
  • IGS image-guided surgery
  • a stand-alone ultrasound- based add-on unit be provided to work in conjunction with an existing IGS unit without ultrasound capacity.
  • This add-on unit can function completely on its own to display both 2D and 3D ultrasound images.
  • This add-on unit via an interface in the add-on unit and a wired or wireless connection, can also receive from the existing IGS unit, patient registration data, preoperative volumetric image data (CT, MR), patient and preoperative image position data and the calculated tool position data.
  • CT, MR preoperative volumetric image data
  • the add-on unit can fuse the CT or MR volume with the real time ultrasound images or acquired volumetric 3D intraoperative ultrasound imagery, to provide the same
  • an advantage is that the surgeon will use the IGS unit's navigation tools both for navigation in the preoperative images and in the intra-operative ultrasound images.
  • the IGS unit's tracking system is used also to track localizers placed on the ultrasound probes. Thus, no additional surgical navigation tools, particularly for the assignee's ultrasound unit, are required.
  • Fig. 1 shows the stand-alone add-on unit according to the invention in its relation to an existing IGS unit.
  • Fig. 2 shows a typical surgical probe for use in image guided surgery.
  • Fig. 3 shows four different ultrasound wands (probes) for use together with the stand-alone add-on unit.
  • a stand-alone add-on unit 1 according to the present invention is shown to the right. It is designed for medical personnel to utilize an ultrasound probe 2 to provide an ultrasonic image 4 on a screen 3.
  • the stand-alone unit 1 can, completely on its own, provide 2D ultrasound intraoperative images.
  • inventive advantages are however realized when the add-on unit 1 is operated together with an existing IGS unit 8 which does not have integrated ultrasound function.
  • the existing IGS unit 8 has a binocular bar 9 with two cameras 9a and 9b at a predetermined spacing.
  • the two cameras 9a and 9b are able to track four passive optical positioners 19 fixed to a surgical tool 17 (see Fig. 2).
  • the operator holds the tool 17, cradling the handle 18 in his hand, with the passive optical positioners always being visible to the two cameras 9a and 9b.
  • the IGS unit can calculate the position of the tool.
  • Preoperative CT or MR image volumes of the patient' s head for example have been pre-loaded into the IGS unit 8.
  • the calculated position and orientation of the tool as it approaches the skull for example is shown on a display 10 in relation to various pre-loaded views 11, 12 in 2D or 3D.
  • the existing IGS unit 8 alone, does not provide up-dated visualisation of the structures, for example in the brain due to movements of tissue, also called brain-shift, and thus does not visualize the actual position of the tool when inserted during an operation. Viewing the actual position in the patient and not just the calculated position in relation to a stored
  • preoperative image can be of crucial importance in brain surgery for example. Brain shift will normally also occur during an operation after a tumor is resected for example. At that time it is very important that the new actual positions of the brain structure and the tool be known and not just calculated or, more properly, not calculated at all, since navigation based on pre-operative images will be inaccurate. If the hospital has invested in an Imaged Guided Surgery (IGS)unit without an integrated ultrasound capability, it may be advantageous to buy the add-on unit 1 according to the invention instead of buying a completely new and expensive IGS unit with integrated ultrasound function.
  • IGS Imaged Guided Surgery
  • the add-on unit 1 has an interface, with a dedicated data protocol for transfer 20a (see Fig. 1) of patient registration data, stereotactic positional data and preoperative CT or MR images volumes from the existing IGS unit to the add-on unit.
  • the interface can also transfer control messages, from the add-on unit 1 to the IGS unit 8, concerning a virtual target set, by the surgeon, in the 3D ultrasound volume which shall be the focal point of a microscope connected to the IGS unit.
  • the add- on unit 1 has software to fuse the CT or MR image volumes from the IGS unit to the intra-operative ultrasound images generated in the add-on unit, thus providing integrated and precise viewing on the screen 3 of the add-on unit of the structures and tissue in, i.e.
  • the interface protocol is designed to require minimal adjustment of the IGS unit when the add-on unit 1 is coupled thereto.
  • the present assignee ' s unit has the capacity to acquire volumetric ultrasound images (3D) to generate an updated navigateable map of the brain by tracking the ultrasound probe 2.
  • the IGS system is responsible for this tracking and presenting the tracking data to the ultrasound unit via a protocol 20a.
  • the navigation information processed from the standard IGS system is thus utilized to generate volumetric imagery to assist in the surgical procedures.
  • the intraoperative volumetric imagery can be combined with preoperative static MR or CT images provided by the IGS system, in overlays or other means of visualization.
  • connection between the two units can be effected by wires (Ethernet, bus etc.) or it can be done by a wireless connection.
  • Ultrasound images, 2D or 3D could be any kind of ultrasound type images like standard B-mode images, images with doppler information to visualize blood vessels and flow (blood flow, 3D angio), tissue stiffness or strain information etc.
  • Fig. 3 shows 4 examples of ultrasound probes which can be used together with the apparatus described here.
  • Each probe is provided with passive optical tracking points 22 and 23 fixed on trackers which can be removably attached to the probes.
  • Magnetic tracking system and magnetic trackable tools and localizers will thus replace the optical tracking system and optical tools and localizers.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Physics & Mathematics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Optics & Photonics (AREA)
  • High Energy & Nuclear Physics (AREA)
  • Neurology (AREA)
  • Human Computer Interaction (AREA)
  • Neurosurgery (AREA)
  • Dentistry (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Robotics (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)
  • Magnetic Resonance Imaging Apparatus (AREA)

Abstract

La présente invention concerne un dispositif destiné à être utilisé dans la chirurgie guidée par l'image. L'invention concerne un dispositif (1) autonome basé sur des ultrasons, destiné à être utilisé dans un système de chirurgie guidée par l'image, comprenant : - une interface (20a) appropriée pour une interaction avec une première unité de neuronavigation (8) qui n'est pas basée sur une modalité d'ultrasons, pour recevoir, à partir de ladite unité de neuronavigation non à ultrasons, des images tomodensitométriques ou de résonance magnétique statiques préopératoires et des informations en temps réel sur la position et le mouvement d'outils et de sondes utilisés pour la chirurgie guidée par l'image, et - des moyens d'affichage d'images à ultrasons (3), appropriés pour représenter des images, en temps réel, à deux dimensions et à ultrasons volumétriques intraopératoires acquises, comprenant le positionnement et le mouvement intraopératoires de sondes et d'outils et pouvant afficher lesdites images à ultrasons superposées sur les images statiques de TDM ou de RM reçues via ladite interface.
PCT/EP2014/058444 2013-04-26 2014-04-25 Unité autonome à ultrasons pour la chirurgie guidée par l'image Ceased WO2014174069A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201361816199P 2013-04-26 2013-04-26
US61/816,199 2013-04-26

Publications (1)

Publication Number Publication Date
WO2014174069A1 true WO2014174069A1 (fr) 2014-10-30

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Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20210177376A1 (en) * 2019-12-16 2021-06-17 Biosense Webster (Isreal) Ltd. Guidewire ultrasound (us) probe for a minimally perturbing measurement of blood flow in brain vessel
WO2021114226A1 (fr) * 2019-12-12 2021-06-17 珠海横乐医学科技有限公司 Système de navigation chirurgicale utilisant un enregistrement de vaisseau sanguin intrahépatique
US12004821B2 (en) 2022-02-03 2024-06-11 Medtronic Navigation, Inc. Systems, methods, and devices for generating a hybrid image
US12249099B2 (en) 2022-02-03 2025-03-11 Medtronic Navigation, Inc. Systems, methods, and devices for reconstructing a three-dimensional representation
US12295797B2 (en) 2022-02-03 2025-05-13 Medtronic Navigation, Inc. Systems, methods, and devices for providing an augmented display

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001034051A2 (fr) * 1999-10-28 2001-05-17 Medtronic Surgical Navigation Technologies Superposition d'informations de navigation sur une imagerie a ultrasons

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001034051A2 (fr) * 1999-10-28 2001-05-17 Medtronic Surgical Navigation Technologies Superposition d'informations de navigation sur une imagerie a ultrasons

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
KERSTIN PINGEL, VALENTIN ELEFTERIU: "GPS for the brain", 13 August 2010 (2010-08-13), XP002727373, Retrieved from the Internet <URL:http://www.leica-microsystems.com/science-lab/microsurgery/gps-for-the-brain/> [retrieved on 20140717] *

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021114226A1 (fr) * 2019-12-12 2021-06-17 珠海横乐医学科技有限公司 Système de navigation chirurgicale utilisant un enregistrement de vaisseau sanguin intrahépatique
US20210177376A1 (en) * 2019-12-16 2021-06-17 Biosense Webster (Isreal) Ltd. Guidewire ultrasound (us) probe for a minimally perturbing measurement of blood flow in brain vessel
US12004821B2 (en) 2022-02-03 2024-06-11 Medtronic Navigation, Inc. Systems, methods, and devices for generating a hybrid image
US12249099B2 (en) 2022-02-03 2025-03-11 Medtronic Navigation, Inc. Systems, methods, and devices for reconstructing a three-dimensional representation
US12295797B2 (en) 2022-02-03 2025-05-13 Medtronic Navigation, Inc. Systems, methods, and devices for providing an augmented display

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