CN107913102A - 使用超声进行的解剖图像与位置跟踪系统的术前配准 - Google Patents

使用超声进行的解剖图像与位置跟踪系统的术前配准 Download PDF

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CN107913102A
CN107913102A CN201710903790.8A CN201710903790A CN107913102A CN 107913102 A CN107913102 A CN 107913102A CN 201710903790 A CN201710903790 A CN 201710903790A CN 107913102 A CN107913102 A CN 107913102A
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positioning control
bone tissue
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CN107913102B (zh
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A.戈瓦里
V.格里纳
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Biosense Webster Israel Ltd
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Abstract

本发明题为“使用超声进行的解剖图像与位置跟踪系统的术前配准”。本发明公开了一种包括接收多个测量值的方法，该多个测量值是使用包括超声(US)换能器和位置跟踪系统的位置传感器的配准工具来获取的。该测量值是通过将配准工具附接到患者头部上的多个部位并获取位置传感器的位置测量值和该部位处骨组织的US测量值来获取的。该骨组织的第一位置是基于使用配准工具获得的位置测量值和US测量值来计算的。该骨组织的第二位置是在患者头部的解剖图像中识别的。通过将第一位置和第二位置相关联来将解剖图像与位置跟踪系统的坐标系配准，以实现使用与位置跟踪系统配准的解剖图像来跟踪医疗器械，该医疗器械插入患者头部中并且包括位置跟踪系统的另一个位置传感器。

Description

使用超声进行的解剖图像与位置跟踪系统的术前配准
技术领域
本发明大体涉及图像引导的医疗规程，并且具体地涉及用于解剖图像与位置跟踪系统的配准的方法和系统。
背景技术
超声(US)换能器和位置跟踪系统可用于各种医疗应用诸如图像引导的规程中。
例如，其公开内容以引用方式并入本文的美国专利5,575,288描述了一种超声成像系统，该超声成像系统具有远程超声控制台和连接到远程超声控制台用于检查身体内部区域的的探头。超声成像系统包括设置在该探头的远端处的扫描头外壳。换能器被安装在该扫描头外壳内的支撑结构上，并电连接到超声成像系统。磁位置传感器位于该扫描头外壳内，并联接到超声成像系统。
其公开内容以引用方式并入本文的美国专利7,751,868描述了一种与计算机辅助或图像引导的外科系统一起使用的集成的、可安装到皮肤的多功能装置和使用该装置的方法。该多功能装置包括可安装到患者的部分，该可安装到患者的部分具有至少一个位置指示元件和至少一个可成像图案，该至少一个可成像图案的几何形状在该至少一个位置指示元件的坐标系中是已知的，其中该可成像图案在成像模态上是可见的。
其公开内容以引用方式并入本文的美国专利申请公布2006/0253031描述了一种用于使用目标的预先获取的图像以及具有位置传感器和超声成像传感器的导管对患者体内的目标进行成像的系统和方法。将导管放置于患者体内，并且使用位置传感器确定导管的一部分在患者体内的位置信息。导管用于使用超声成像传感器生成目标的超声图像。图像处理器用于确定目标的超声图像的任何像素的位置信息并将预先获取的图像与超声图像进行配准，并且显示器用于显示配准的预先获取的图像和超声图像。
发明内容
本文所述的本发明的实施方案提供了一种包括接收多个测量值的方法，该多个测量值是使用包括超声(US)换能器和位置跟踪系统的位置传感器的配准工具获取的。该测量值是通过将该配准工具附接到患者头部上的多个相应部位并获取位置传感器的相应位置测量值和该部位处骨组织的相应US测量值来获取的。多个部位处骨组织的第一位置是基于使用配准工具获得的位置测量值和US测量值来计算的。多个部位处骨组织的第二位置是在患者头部的解剖图像中识别的。通过将第一位置和第二位置相关联来将解剖图像与位置跟踪系统的坐标系配准，以便实现使用与位置跟踪系统配准的解剖图像来跟踪医疗器械，所述医疗器械插入患者头部中并且包括位置跟踪系统的另一个位置传感器。
在一些实施方案中，US换能器相对于位置传感器设置在固定位移处，并且计算第一位置包括在计算第一位置时考虑该固定位移。在其它实施方案中，US换能器和位置传感器是同心的。在其它实施方案中，解剖图像包括一个或多个计算机断层摄影(CT)图像。
在一个实施方案中，解剖图像包括一个或多个计算机断层摄影(CT)图像。在另一个实施方案中，位置跟踪系统包括磁位置跟踪系统。在另一个实施方案中，接收US测量值包括接收在头部外表面和相应骨组织之间的每个部位处穿越的US脉冲的往返传播时间。
在一些实施方案中，医疗器械包括鼻窦扩张导管。在其它实施方案中，该配准工具包括手持式探测棒(wand)。
根据本发明的实施方案，另外提供了一种包括配准工具和处理器的设备。该配准工具包括超声(US)换能器和位置跟踪系统的位置传感器。该US换能器被配置成当将配准工具顺序地附接到患者头部上的多个相应部位时获取该部位处骨组织的相应US测量值。位置传感器被配置成获取该部位处配准工具的相应位置测量值。处理器被配置成接收由配准工具获取的多个US测量值和相应位置测量值，基于位置测量值和US测量值来计算多个部位处骨组织的第一位置，在患者头部的解剖图像中识别多个部位处骨组织的第二位置，并且通过将第一位置和第二位置相关联将解剖图像与位置跟踪系统的坐标系进行配准，以便实现使用与位置跟踪系统配准的解剖图像跟踪插入到患者头部中并且包括位置跟踪系统的另一个位置传感器的医疗器械。
从以下结合附图的本发明实施方案的详细说明，将更全面地理解本发明，在附图中：
附图说明
图1是根据本发明的实施方案的鼻窦扩张外科系统的示意性图解；
图2是根据本发明的实施方案的配准工具的示意性图解；并且
图3是示意性地示出根据本发明的另一个实施方案的用于将解剖图像与位置跟踪系统的坐标系进行配准的方法的流程图。
具体实施方式
综述
一些医疗规程诸如鼻窦扩张需要相关器官的解剖图像与位置跟踪系统的坐标系的配准。使用配准，将配有位置传感器的外科工具导航到治疗的器官并且可视化并覆盖在解剖图像上。
原则上，可以使用配有位置跟踪系统的位置传感器的一些外部配准工具进行配准。此类工具可以附接到患者面部上预先选定的部位(例如，鼻尖和两颊的中心)。然后可以基于预先选定的部位处骨组织的测量位置将解剖图像配准到位置跟踪系统的坐标系。
然而，这种可能的解决方案可能不准确并且不适合用于鼻窦扩张过程，其中获得在优于1mm的准确度水平下的解剖图像的配准通常是重要的。由于面部元件包括自然变形(例如，由于一天中面颊中液体水平的变化)的软组织，并且因为面部上的配准工具施加不受控制的压力，所以这种假设的解决方案的准确度可能变得不可接受。
下文所述的本发明的实施方案提供了用于将解剖图像与位置跟踪系统的坐标系配准的改进技术。在所公开的实施方案中，配准工具包括联接到位置跟踪系统的位置传感器的超声(US)换能器。为了执行配准，操作者(例如，医师)将配准工具附接到患者面部上多个预定义的部位。在每个预定义的部位处，执行以下测量：
·位置跟踪系统测量装配在配准工具中的位置传感器的位置和取向。
·US换能器对在相应部位处的骨组织进行成像。
然后，处理器使用上述测量值针对患者面部上每个预定义的部位计算相应骨组织在位置跟踪系统的坐标系中的位置。
针对患者面部上给定的预定义的部位，US换能器的输出表示US换能器和骨组织之间的距离。US换能器和位置传感器之间的相对位移(如果有的话)是固定的并且已知的。位置传感器的位置已经在位置跟踪系统的坐标系中进行了测量。因此，处理器使用上述测量值计算骨组织在位置跟踪系统的坐标系中的确切位置。这个位置在本文中称之为患者面部上预定义的部位的骨组织的“US坐标”。对多个预定义的部位中的每一个预定义的部位重复上述过程以产生一组US坐标。
另外，处理器识别预定义的多个部位处的骨组织在预先获取的计算机断层摄影(CT)图像中的位置。这些位置在本文中称之为骨组织的“CT坐标”。然后，处理器例如通过计算将US坐标与相应CT坐标匹配的几何变换将CT图像与位置跟踪系统的坐标系配准。
由于所公开的配准方法是基于骨组织的坐标之间的相关性，所以与软组织相反，它高度准确并且对上文所述的损害不敏感。因此，所提出的技术实现例如插入患者头部中并且包括位置跟踪系统的另一个位置传感器的鼻窦扩张外科工具的导航的改进。此外，所公开的技术对由于自然变化和由于配准工具所施加的压力所致的组织变形不敏感。
系统描述
图1是根据本发明的实施方案的鼻窦扩张外科系统20的示意性图解。系统20包括磁位置跟踪系统，该磁位置跟踪系统被配置成跟踪患者22头部中的一个或多个位置传感器的位置。磁位置跟踪系统包括磁场发生器和一个或多个位置传感器。位置传感器响应于从场发生器感测的外部磁场生成位置信号，从而使处理器34能够对每个传感器在位置跟踪系统的坐标系中的位置进行绘图，如下文将描述的。
这种位置感测的方法在各种医疗应用中实现，例如在由强生公司(BiosenseWebster Inc.)(Diamond Bar,Calif.)生产的CARTOTM系统中实现，并且详细地描述于美国专利5,391,199、6,690,963、6,484,118、6,239,724、6,618,612和6,332,089、PCT专利公布WO 96/05768，以及美国专利申请公布2002/0065455 A1、2003/0120150 A1和2004/0068178A1中，这些专利的公开内容全部以引用方式并入本文。
在本示例中，系统20包括部位垫40，部位垫40包括固定在框架46上的多个场发生器44。在图1所示的示例性构造中，垫40包括五个场发生器44，但是可以使用任何其它合适数量的发生器44。垫40还包括放置于患者22头部41下方的枕块42，使得发生器44位于患者体外的固定的已知位置处。系统20还包括控制台33，该控制台33包括被配置成用合适的信号驱动场发生器44的驱动电路(未示出)，以便在围绕头部41的预定义的工作空间中生成磁场。
在一个实施方案中，处理器34通常是通用计算机，包括合适用于通过缆线32从外部源接收数据以及从探测棒30接收测量值并且用于控制系统20的其它部件的前端和接口电路。控制台33还包括输入装置39和被配置成显示数据的用户显示器36。
在一些实施方案中，系统20包括诸如手持式探测棒30之类的配准工具，该配准工具由系统20用于将磁位置跟踪系统的坐标系与预先获取的CT图像的坐标系配准。配准工具被配置成获取超声和位置测量值，并且在下图2中详细描绘。
通常，医师24将探测棒30顺序地附接到患者头部41外表面上的多个预定义的部位。每个预定义的部位通常被选择为头部41上可容易识别的特征部，诸如颊骨突起、鼻梁26(位于患者22的眼睛之间)、鼻尖26、下巴或任何其它合适的可识别特征部。
在一个实施方案中，处理器34接收使用外部CT系统(未示出)获得的计算机断层摄影(CT)图像35。处理器34使用图像35形成患者头部41的至少一部分的表面图像。在一些实施方案中，处理器34可使用与作为空气的标准标度的为-1000的HU相比范围在700和3000之间的亨氏单位(hounsfield unit,HU)来确定患者面部中骨的放射密度，以确定患者面部的边界。在另选的实施方案中，高于500的HU可用于确定骨的放射密度，-200和以下的HU可用于空气，并且范围在-200和500之间的HU可用于肌肉组织。另选地，可以使用任何其它合适的值。还另选地，处理器34可使用任何其它合适的标准或技术来辨别CT图像中不同类型的组织，并且特别是识别骨组织。
在一个实施方案中，当放置于患者头部上的预定义的部位处时，探测棒30被配置成(i)获取骨组织的US测量值，并且(ii)生成表示这个预定义的部位在磁位置跟踪系统的坐标系中的位置的位置信号。在下图2中详细描述了通过探测棒30获取骨组织测量值。
在一些实施方案中，处理器34被配置成计算患者头部上每个预定义的部位的两个坐标–“US坐标”和“CT坐标”。US坐标是从在这个预定义的部位处探测棒30的US测量值和位置测量值得出的，并且表示在这个部位处的骨组织在磁位置跟踪系统的坐标系中的坐标。CT测量值表示在这个部位处的骨组织的坐标，如在CT图像中所识别的。
在一个实施方案中，处理器34被配置成将图像35中的预定义的部位的US坐标和CT坐标之间相关联，以便将CT图像与位置跟踪系统的坐标系配准。
配准过程通常在实际鼻窦扩张过程之前执行。在鼻窦扩张过程期间，医师24可向头部41中插入包括位置跟踪系统的附加位置传感器的医疗装置(未示出)，诸如鼻窦扩张导管或其它外科工具。由于CT图像已经与位置跟踪系统配准，所以医师24可将其远端显示在CT图像上的医疗装置导航到头部41中的目标部位。
在另选的实施方案中，处理器34被配置成接收使用另一种合适的解剖成像技术(诸如荧光镜透视检查或磁共振成像(MRI))获取的一个或多个图像代替CT图像35，并且能够将这些解剖图像与如上所述的坐标系配准。
为了简单和清楚起见，图1仅示出与所公开的技术有关的元件。系统20通常包括附加模块和元件，所述附加模块和元件与所公开的技术不直接相关，并且因此从图1和对应的描述中被有意地省略。
处理器34可用软件编程以执行由系统使用的功能，并且将数据存储在待由软件处理或以其它方式使用的存储器(未示出)中。例如，可通过网络将软件以电子形式下载到处理器，或者可将软件提供在非临时性有形介质上，诸如，光学、磁性或电子存储介质。另选地，处理器34的一些或全部功能可由专用的或可编程的数字硬件部件进行。
使用超声将解剖图像与位置跟踪系统进行配准
图2是根据本发明的实施方案的探测棒30的示意性图解。该图示出了放置于患者头部41上多个预定义的部位之一处的探测棒30。在一些实施方案中，探测棒30包括外壳58，该外壳58含有同心地设置在超声(US)换能器66周围的位置传感器60。US换能器被配置成在组织中产生US脉冲70。图2示出了示例组织结构，包括皮肤层50、中间组织52、骨组织56以及组织52和56之间的界面层54。
在一个实施方案中，医师24将探测棒30的尖端59附接到在预定义的部位(例如，鼻梁26)之一处的皮肤50，并且致动换能器66以便产生US脉冲70。US脉冲70穿越皮肤层50和中间组织52朝向界面层54和骨组织56。脉冲70从界面54反射并行进穿过组织52和皮肤层50，返回到探测棒30。
探测棒30被配置成测量US脉冲的往返传播时间，也代表飞行时间(TOF)。基于组织52和皮肤层50中US脉冲的已知速度，处理器34被配置成将测得的TOF转换成组织52的厚度，即，转换成换能器66和骨组织56之间的距离。在一个实施方案中，探测棒30被配置成将从传感器60获得的位置测量值和使用US换能器66测量的TOF通过缆线32传递到处理器34。
在一些实施方案中，传感器60同心地设置于换能器66周围。处理器34被配置成使用传感器60的位置和换能器66的TOF测量值计算US坐标，即，骨组织在位置跟踪系统的坐标系中的位置。
在另选的实施方案中，传感器60和换能器66可按任何其它合适的布置同心地布置。在另选的实施方案中，传感器60可装配在相对于换能器66的固定的已知位移处，因此，处理器34可在计算骨组织的US坐标时考虑该固定位移。
如图2所描绘，由尖端59施加的压力可使皮肤层50和组织52变形。因为配准是基于骨组织相关性，所以处理器34实质上防止此类变形使配准畸变。
图3是示意性地示出根据本发明的另一个实施方案的用于将CT图像35与位置跟踪系统的坐标系进行配准的方法的流程图。该方法以CT图像获取步骤100开始，在CT图像获取步骤100中处理器34接收捕获头部41骨组织的一个或多个CT图像(本文称之为CT骨图像)。
在配准工具附接步骤102中，医师24将探测棒30顺序地附接到头部41中的多个预定义的部位。在这些预定义的部位中的每一个部位处执行后续的步骤(104-110)。
在位置计算步骤104中，处理器34从传感器50接收位置测量值并且计算换能器66在位置跟踪系统的坐标系中的位置。在US测量步骤106中，系统20致动换能器66以便获得US测量值。在组织位置计算步骤108中，处理器34从换能器66接收位置信号并且从换能器66接收TOF测量值，并计算US坐标，即，骨组织在位置跟踪系统的坐标系中的位置。在CT组织识别步骤110处，处理器34使用本领域中已知的任何合适的技术识别对应的CT坐标，即，骨组织在CT图像35中的位置。如上文所述，每个预定义的部位重复步骤104-110。
在配准步骤112中，处理器34通过将头部41中预定义的部位处的US骨组织坐标和对应的CT骨组织坐标之间相关联来将CT图像35与位置跟踪系统的坐标系配准。
尽管本文所述的实施方案主要解决鼻窦扩张规程，但是本文所述的方法和系统也可以用于其它应用诸如矫形规程中，在该规程中医师24可将探测棒30附接到人体上任何合适的可变形的特征部。
因此，应当理解，上文所述的实施方案以举例的方式引用，并且本发明不限于上文已具体示出和描述的内容。相反，本发明的范围包括上文所述的各种特征的组合与子组合，以及本领域技术人员在阅读上述说明时会想到且未在现有技术中公开的其变型和修改。以引用方式并入本专利申请的文献将视为本专利申请的整体部分，不同的是如果在这些并入的文献中定义的任何术语与在本说明书中明确或隐含地给出的定义相冲突，则应只考虑本说明书中的定义。

Claims (18)

1.一种方法，包括：
接收多个测量值，所述多个测量值是使用包括超声(US)换能器和位置跟踪系统的位置传感器的配准工具来获取的，其中所述测量值是通过将所述配准工具附接到患者头部上多个相应部位并获取所述位置传感器的相应位置测量值和所述部位处骨组织的相应的US测量值来获取的；
基于使用所述配准工具获得的所述位置测量值和所述US测量值来计算在所述多个部位处所述骨组织的第一位置；
在所述患者头部的解剖图像中识别所述多个部位处所述骨组织的第二位置；以及
通过将所述第一位置和所述第二位置相关联来将所述解剖图像与所述位置跟踪系统的坐标系配准，以便实现使用与所述位置跟踪系统配准的所述解剖图像来跟踪医疗器械，所述医疗器械插入所述患者头部中并包括所述位置跟踪系统的另一个位置传感器。
2.根据权利要求1所述的方法，其中所述US换能器相对于所述位置传感器设置在固定位移处，并且其中计算所述第一位置包括在计算所述第一位置时考虑所述固定位移。
3.根据权利要求1所述的方法，其中所述US换能器和所述位置传感器是同心的。
4.根据权利要求1所述的方法，其中所述解剖图像包括一个或多个计算机断层摄影(CT)图像。
5.根据权利要求1所述的方法，其中所述部位包括选自由以下项组成的列表的骨特征的部位：颊骨突起、鼻梁、鼻尖和下巴。
6.根据权利要求1所述的方法，其中所述位置跟踪系统包括磁位置跟踪系统。
7.根据权利要求1所述的方法，其中接收所述US测量值包括接收在所述头部的外表面和相应骨组织之间的每个部位处穿越的US脉冲的往返传播时间。
8.根据权利要求1所述的方法，其中所述医疗器械包括鼻窦扩张导管。
9.根据权利要求1所述的方法，其中所述配准工具包括手持式探测棒。
10.一种设备，包括：
配准工具，所述配准工具包括：
超声(US)换能器，所述超声(US)换能器被配置成当所述配准工具顺序地附接到患者头部上的多个相应部位时获取所述部位处骨组织的相应US测量值；和
位置跟踪系统的位置传感器，所述位置传感器被配置成获取所述部位处所述配准工具的相应位置测量值；和
处理器，所述处理器被配置成：
接收由所述配准工具获取的所述多个US测量值和所述相应位置测量值；
基于所述位置测量值和所述US测量值来计算所述多个部位处所述骨组织的第一位置；
在所述患者头部的解剖图像中识别所述多个部位处所述骨组织的第二位置；以及
通过将所述第一位置和所述第二位置相关联来将所述解剖图像与所述位置跟踪系统的坐标系配准，以便实现使用与所述位置跟踪系统配准的所述解剖图像来跟踪医疗器械，所述医疗器械插入所述患者头部中并包括所述位置跟踪系统的另一个位置传感器。
11.根据权利要求10所述的设备，其中所述US换能器相对于所述位置传感器设置在固定位移处，并且其中所述处理器被配置成在计算所述第一位置时考虑所述固定位移。
12.根据权利要求10所述的设备，其中所述US换能器和所述位置传感器是同心的。
13.根据权利要求10所述的设备，其中所述解剖图像包括一个或多个计算机断层摄影(CT)图像。
14.根据权利要求10所述的设备，其中所述部位包括选自由以下项组成的列表的骨特征的部位：颊骨突起、鼻梁、鼻尖和下巴。
15.根据权利要求10所述的设备，其中所述位置跟踪系统包括磁位置跟踪系统。
16.根据权利要求10所述的方设备，其中所述多个US测量值包括在所述头部外表面和相应骨组织之间的每个部位处穿越的US脉冲的往返传播时间。
17.根据权利要求10所述的设备，其中所述医疗器械包括鼻窦扩张导管。
18.根据权利要求10所述的设备，其中所述配准工具包括手持式探测棒。
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