CN114159161A - Surgical navigation system - Google Patents

Surgical navigation system Download PDF

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Publication number
CN114159161A
CN114159161A CN202010950200.9A CN202010950200A CN114159161A CN 114159161 A CN114159161 A CN 114159161A CN 202010950200 A CN202010950200 A CN 202010950200A CN 114159161 A CN114159161 A CN 114159161A
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China
Prior art keywords
surgical
pose
electromagnetic
positioning assembly
medical image
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Pending
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CN202010950200.9A
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Chinese (zh)
Inventor
何滨
叶招明
李伟栩
童睿
郭宏瑞
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Hangzhou Santan Medical Technology Co Ltd
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Hangzhou Santan Medical Technology Co Ltd
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Priority to CN202010950200.9A priority Critical patent/CN114159161A/en
Publication of CN114159161A publication Critical patent/CN114159161A/en
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    • 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
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
    • A61B2017/00119—Electrical control of surgical instruments with audible or visual output alarm; indicating an abnormal situation
    • 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
    • A61B2034/2051—Electromagnetic tracking systems
    • 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
    • A61B2034/2065—Tracking using image or pattern recognition
    • 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
    • A61B2034/2072—Reference field transducer attached to an instrument or patient

Abstract

The invention discloses a surgical navigation system, comprising: a magnetic field generator for generating an electromagnetic field; the first electromagnetic positioning assembly is fixed on the target object and used for generating a first induction current under an electromagnetic field; the second electromagnetic positioning assembly is fixed on the surgical instrument and used for generating a second induction current under the electromagnetic field; the controller is used for acquiring the first induction current and the second induction current and determining a first pose of the target object and a second pose of the surgical instrument according to the first induction current and the second induction current respectively; and the controller is also used for determining the conversion relation between the image coordinate system of the three-dimensional medical image and the magnetic field coordinate system of the electromagnetic field according to the three-dimensional medical image of the target object, the first two-dimensional medical image containing the target object and the surgical instrument, the first pose and the second pose, guiding the operation of the surgical instrument and realizing navigation.

Description

Surgical navigation system
Technical Field
The invention relates to the technical field of surgical navigation, in particular to a surgical navigation system.
Background
In recent years, surgical operations have been developed, but the difficulty and risk of the operations are still high for the diseased regions with complicated anatomical structures. Taking a spinal surgery as an example, the anatomical structure of the spine is complex and is adjacent to important vascular nerves, accurate placement of pedicle screws in the spinal surgery is a premise for completing good correction, and great vessels and nerves around the vertebral body are easily damaged in the process of placing the screws, so that accurate screw implantation operation becomes a key and technical difficulty of the surgery.
The operation guide system can help medical personnel to locate the pathological change part, reduces operation difficulty and risk, and is increasingly used for surgical operation. However, the accuracy of the conventional surgical guidance system is still to be improved, and the medical images are required to be taken in real time to obtain the information of the diseased region of the patient and the position of the surgical instrument, which increases the radiation dose to the patient.
Disclosure of Invention
The invention provides a surgical navigation system to solve the defects in the related art.
Specifically, the invention is realized by the following technical scheme:
in a first aspect, a surgical navigation system is provided, comprising:
a magnetic field generator for generating an electromagnetic field;
the first electromagnetic positioning assembly is fixed on a target object and used for generating a first induced current under the electromagnetic field;
the second electromagnetic positioning assembly is fixed on a surgical instrument and used for generating a second induced current under the electromagnetic field; wherein the surgical instrument is used for performing a surgical operation on the target object;
a controller for acquiring the first induced current and the second induced current, and determining a first pose of the target object and a second pose of the surgical instrument according to the first induced current and the second induced current respectively;
the controller is further used for determining a conversion relation between an image coordinate system of the three-dimensional medical image and a magnetic field coordinate system of the electromagnetic field according to the three-dimensional medical image of the target object, the first two-dimensional medical image containing the target object and the surgical instrument, the first pose and the second pose, and guiding the operation of the surgical instrument.
Optionally, the controller comprises:
the calibration module is used for determining the conversion relation between the image coordinate system and the magnetic field coordinate system;
and the conversion module is used for respectively converting the real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly into space coordinates under the image coordinate system according to the conversion relation so as to guide the operation of surgical instruments.
Optionally, the first electromagnetic positioning assembly comprises:
a fixing needle, a needle head of which is used for implanting into the target object;
and the electromagnetic positioning coil is arranged in the fixing needle and used for generating the first induced current under the electromagnetic field.
Optionally, the first electromagnetic positioning assembly further comprises:
and the identification unit is detachably fixed on the fixing needle, so that the controller determines the first pose according to the identification point on the identification unit.
Optionally, the identification unit includes:
the fixing seat is fixed on the fixing needle;
the identification frame is fixed on the fixed seat;
at least four identification balls dispersedly arranged on the identification frame, wherein the identification balls are used as the identification points.
Optionally, the material of the identification ball and/or the fixing pin is a nonmagnetic metal material.
Optionally, the second electromagnetic positioning assembly comprises:
an electromagnetic positioning coil for generating the second induced current under the electromagnetic field.
Optionally, the surgical navigation system further comprises: a driver;
the controller is further used for planning a moving path of the surgical instrument according to the current pose and the spatial position of the second electromagnetic positioning assembly;
the driver is used for driving the surgical instrument to move to the space position according to the moving path.
Optionally, the surgical navigation system further comprises: a display;
the controller is further configured to fuse the real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly with the three-dimensional medical image according to the first transformation relationship and the second transformation relationship;
and the display is used for displaying the fusion result.
Optionally, the surgical navigation system further comprises: a prompter;
the controller is further configured to send a shooting instruction to the shooting device to trigger the shooting device to shoot the target object to obtain a second two-dimensional medical image when the surgical instrument completes a surgical operation;
the controller is further used for determining the position deviation of the position of the surgical operation in the second two-dimensional medical image and the target position, and generating prompt information under the condition that the position deviation is larger than a deviation threshold value;
and the prompter is used for prompting the prompt information.
The technical scheme provided by the embodiment of the invention can have the following beneficial effects:
in the embodiment of the invention, the space pose of the diseased part of a patient and the space pose of a surgical instrument are positioned and tracked in real time by utilizing the electromagnetic navigation tracking technology so as to perform surgical navigation, the accuracy is high, the damage to the peripheral structure of a vertebral body and important visceral organs and blood vessels in the nail placing process is avoided, and the occurrence of surgical complications is avoided. Moreover, the diseased region and the surgical instrument do not need to be shot in real time in the operation, so that the radiation dose of the patient shot by the medical image in the operation can be reduced.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed.
Drawings
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments consistent with the invention and together with the description, serve to explain the principles of the invention.
FIG. 1 is a schematic structural diagram of a surgical navigation system according to an exemplary embodiment of the present invention;
FIG. 2a is a schematic structural diagram illustrating a mounting pin of a first electromagnetic positioning assembly in accordance with an exemplary embodiment of the present invention;
FIG. 2b is a schematic diagram of a structure of an identification unit of a first electromagnetic locating assembly in accordance with an exemplary embodiment of the present invention;
FIG. 2c is a schematic diagram of a first electromagnetic positioning assembly according to an exemplary embodiment of the present invention
FIG. 3 is a schematic structural view of a surgical device shown in an exemplary embodiment of the present invention;
FIG. 4 is a flow chart illustrating a surgical navigation method in accordance with an exemplary embodiment of the present invention;
fig. 5 is a schematic structural diagram of another surgical navigation system according to an exemplary embodiment of the present invention.
Detailed Description
Reference will now be made in detail to the exemplary embodiments, examples of which are illustrated in the accompanying drawings. When the following description refers to the accompanying drawings, like numbers in different drawings represent the same or similar elements unless otherwise indicated. The embodiments described in the following exemplary embodiments do not represent all embodiments consistent with the present invention. Rather, they are merely examples of apparatus and methods consistent with certain aspects of the invention, as detailed in the appended claims.
The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used in this specification and the appended claims, the singular forms "a", "an", and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. It should also be understood that the term "and/or" as used herein refers to and encompasses any and all possible combinations of one or more of the associated listed items.
It is to be understood that although the terms first, second, third, etc. may be used herein to describe various information, these information should not be limited to these terms. These terms are only used to distinguish one type of information from another. For example, first information may also be referred to as second information, and similarly, second information may also be referred to as first information, without departing from the scope of the present invention. The word "if" as used herein may be interpreted as "at … …" or "when … …" or "in response to a determination", depending on the context.
Fig. 1 is a schematic structural diagram of a surgical navigation system according to an exemplary embodiment of the present invention, which includes a first electromagnetic positioning assembly 1, a second electromagnetic positioning assembly 2, a controller 3 and a magnetic field generator 4. The controller is respectively connected with the first electromagnetic positioning component 1, the second electromagnetic positioning component 2 and the magnetic field generator 4.
The magnetic field generator 4 may be activated under the control of the controller 3 to generate a variable electromagnetic field such that the first and second electromagnetic locating components 1, 2 located in the electromagnetic field generate an induced current/voltage whose characteristics depend on the position and orientation of the magnetic locator and the combination of the strength and phase of the varying magnetic field. The controller 3 can respectively obtain the induced currents/voltages of the first electromagnetic positioning assembly 1 and the second electromagnetic positioning assembly 2, convert the induced currents/voltages into numbers and send the numbers to an external controller to calculate the poses of the first electromagnetic positioning assembly and the second electromagnetic positioning assembly, or the controller can calculate the poses of the first electromagnetic positioning assembly and the second electromagnetic positioning assembly based on the induced currents/voltages to track the poses of the first electromagnetic positioning assembly and the second electromagnetic positioning assembly in a magnetic field coordinate system in real time. The pose is the pose of the locator coordinate system relative to the magnetic field coordinate system. The pose comprises position parameters and attitude parameters, the pose can be represented by six degrees of freedom, the position parameters in the six degrees of freedom refer to space coordinates (x, y and z), and the attitude parameters are a horizontal rotation angle, a pitch angle and a roll angle.
The first electromagnetic positioning assembly includes a fixed pin and an identification unit. Fig. 2a is a schematic structural diagram of a fixing pin of a first electromagnetic positioning assembly according to an exemplary embodiment of the present invention, the fixing pin includes a pin head 111, a pin tail 112, and a pin body 113, the pin head 111 and the pin tail 112 are respectively located at two ends of the pin body 113, and the fixing pin may be integrally formed. The needle tip 111 of the fixation needle may be implanted in the target object and the needle tail 112 is used to fix the identification unit. The inner or outer surface of the needle body 113 is provided with an electromagnetic positioning coil. If the electromagnetic positioning coil is arranged on the inner surface and the outer surface of the needle body 113, a plurality of grooves can be arranged on the outer surface of the needle body, and the electromagnetic positioning coil is wound in the grooves to prevent the electromagnetic positioning coil from falling off. The fixing needle is made of nonmagnetic metal material, such as stainless steel, titanium alloy and the like.
The target object may be, for example, a tissue organ (lesion) of a patient requiring an operation, such as a head and a cervical vertebra of the patient.
Fig. 2b is a schematic structural diagram of a marking unit of a first electromagnetic positioning assembly according to an exemplary embodiment of the present invention, where the marking unit includes a fixing base 121, a marking frame 122, and a marking ball 123. Referring to fig. 2c, the identification unit may be detachably fixed to the needle tail of the fixing needle by a fixing base. The identification balls 123 are arranged on the identification frame 122, the number of the identification balls 123 is at least 4, and the at least 4 identification balls 123 can be dispersedly arranged on the identification frame. The diameter of the marker ball 123 is 2mm to 8mm, and the diameters of the at least 4 marker balls may be the same or different. The marker ball is made of nonmagnetic metal materials, such as aluminum alloy materials or titanium alloy materials. The material of the marker housing may be, but is not limited to, hard plastic such as POM (polyoxymethylene), PEEK (polyetheretherketone), and the like. The fixing seat 121, the mark frame 122 and the mark ball 123 can be integrally formed; or the fixing seat 121 and the mark frame 122 are integrally formed, and the mark ball 123 is detachably arranged on the mark frame 122; or the identification ball 123 and the identification frame 122 are integrally formed; or the fixing seat 121, the mark frame 122 and the mark ball 123 are all detachably arranged.
When the first electromagnetic positioning component is fixed on the focus part of a patient, the identification unit is positioned outside the body, and is provided with an identification ball for realizing coordinate system calibration, so that a large operation incision can be avoided being cut on the human body by means of the identification unit.
The second electromagnetic positioning component comprises an electromagnetic positioning coil which can be pre-buried in the surgical instrument or coated on the surface layer of the surgical instrument, so that the positioning and tracking are convenient. The surgical instrument is used for performing a surgical operation on a target object.
Surgical navigation is also required by means of a surgical device, and fig. 3 is a schematic structural diagram of a surgical device according to an exemplary embodiment of the present invention, which includes a robot trolley 31 and a shooting device 32. The mechanical arm trolley 31 is provided with a surgical instrument 311 and a multi-axis mechanical arm 312, the surgical instrument 311 can perform surgical operation on a patient under the driving of the multi-axis mechanical arm 312, and the multi-axis mechanical arm 312 can realize up-down lifting, front-back moving, left-right moving and rotation around a base. The photographing apparatus 32 includes a couch 321, a gantry assembly 322, a support assembly 323, and a photographing assembly 324. The supporting component 323 is used for supporting the scanning bed 321, and the supporting component 323 can move and rotate up, down, left, right, front and back so as to adjust the pose of the scanning bed 321. The frame assembly 322 can also move and rotate up, down, left, right, front and back to adjust the pose of the shooting assembly, so that the shooting assembly 324 can shoot the patient 33 on the scanning bed 321 from any angle to obtain a medical image, and the requirements of medical staff for observing the diseased part of the patient and surgical instruments from different angles are met. The frame assembly 322 is not limited to use with the C-arm machine shown in the figures, but may also be used with an O-arm machine. The robot arm cart 31 and the photographing apparatus 32 may establish communication connection by wire or wirelessly. Of course, the robot trolley may further include a control system not shown in the drawings, and the photographing apparatus may also include a control system for controlling the respective multi-axis robot arms to move.
The following describes the procedure of surgical navigation in detail with reference to fig. 1, 2a to 2c and 3, taking the operation on a diseased spine (target object) as an example.
Before surgical navigation, a first electromagnetic positioning assembly needs to be fixed on a diseased spine, for example, a needle head of the first electromagnetic positioning assembly is implanted into a spine process of the diseased spine, and an identification unit is located outside a body to monitor the pose and change state of the diseased spine in the surgical process; and fixing the second electromagnetic positioning assembly on the surgical instrument so as to monitor the pose and change state of the surgical instrument in the surgical process.
Fig. 4 is a flow chart illustrating a surgical navigation method, applied to a controller, according to an exemplary embodiment of the present invention, which may include the steps of:
step 401, acquiring a two-dimensional medical image obtained by shooting the diseased spine by a shooting device.
Before shooting, the pose of the shooting device needs to be adjusted so that the diseased spine of the patient is in the shooting visual field of the shooting device. The obtained two-dimensional medical image is a two-dimensional image obtained in the operation process of the pathological spine, and the image not only contains the pathological spine, but also contains a first electromagnetic positioning assembly fixed on the pathological spine.
Currently, an X-ray machine is generally used to capture an X-ray image (two-dimensional image) for navigation.
The two-dimensional medical image obtained in step 401 is used to determine a transformation relationship between an electromagnetic field coordinate system and an apparatus coordinate system of the photographing apparatus, and to determine a transformation relationship between an image coordinate system of a three-dimensional medical image and an apparatus coordinate system, that is, the two-dimensional medical image is used to calibrate three coordinate systems, and it is difficult to ensure calibration accuracy of the three coordinate systems by using one two-dimensional medical image, so that at least two-dimensional medical images obtained by photographing a target object at different photographing angles can be obtained. The shooting equipment is in different poses at different shooting angles, and the two-dimensional medical images shot at different shooting angles can be mutually constrained in coordinate system calibration.
It should be noted that the difference of the shooting angles can be realized by adjusting the pose of the frame assembly.
Step 402, obtaining a three-dimensional medical image of a target object, and determining a first conversion relation between an image coordinate system of the three-dimensional medical image and a magnetic field coordinate system of an electromagnetic field according to a position coordinate of a first electromagnetic positioning component in the two-dimensional medical image, a first position of the first electromagnetic positioning component when the two-dimensional medical image is shot, and the three-dimensional medical image.
Before performing the surgery, medical personnel generally need to take medical images of the target object to make a preliminary diagnosis of the target object and to make a surgical plan. In order to facilitate medical preoperative diagnosis and surgical planning, medical images with higher spatial resolution, such as CT images, PET images, MRI (magnetic resonance imaging) images, etc., are generally acquired preoperatively. In this embodiment, coordinate calibration and surgical navigation may be performed with the aid of a three-dimensional medical image acquired before an operation.
When the first transformation relationship is determined, a second transformation relationship between an equipment coordinate system and a magnetic field coordinate system of the shooting equipment is determined according to the position coordinates and the first pose, the three-dimensional medical image and the two-dimensional medical image are subjected to image registration, a third transformation relationship between the image coordinate system and the equipment coordinate system is determined according to the image registration result, and then the first transformation relationship is determined according to the second transformation relationship and the third transformation relationship.
The first posture of the first electromagnetic positioning component can be determined based on induced current or induced voltage generated by the first electromagnetic positioning component under an electromagnetic field, and the first posture represents the posture of a diseased spine when a two-dimensional medical image is shot.
In the process of surgical navigation, the controller starts the magnetic field generator, the magnetic field generator generates an electromagnetic field, the electromagnetic positioning coil of the first electromagnetic positioning assembly generates induction current or induction voltage when the first electromagnetic positioning assembly is in an electromagnetic field environment, the intensity of the induction current or the induction voltage can reflect the relative position change and the relative posture change between the magnetic field generator and the first electromagnetic positioning assembly, and the pose of the first electromagnetic assembly under a magnetic field coordinate system can be monitored in real time according to the induction current or the induction voltage, namely the transformation relation T1 between the coordinate system of the first electromagnetic assembly and the magnetic field coordinate system.
Because the fixing pin of the first electromagnetic positioning component is implanted into the spine, the marking ball cannot be arranged, and the marking ball is used for realizing the purpose. When the fixing needle and the identification unit are detachably arranged, the fixing needle corresponds to one coordinate system, the identification unit corresponds to one coordinate system, the fixing needle is implanted into the spine all the time in an operation and used for tracking the pose of the spine, and the identification unit can be detached, so that the coordinate system of the fixing needle can be used as the coordinate system of the first electromagnetic positioning assembly. The coordinate system of the identification unit and the mutual coordinate system of the fixing pin can be calibrated in advance, and the identification Ball can be directly taken for use in the operation, so that the position coordinate (which can be determined through measurement) of the identification Ball under the coordinate system of the identification unit can be known, the space position of the identification Ball under the coordinate system of the fixing pin can be known, and the identification Ball is recorded as Ball (x, y, z). According to the formula BallMagnetic field(x, y, z) ═ T1 Ball (x, y, z), the space coordinate Ball of the marker Ball in the magnetic field coordinate system can be calculatedMagnetic field(x,y,z)。
When a second conversion relation T2 between the device coordinate system and the magnetic field coordinate system is determined, a second pose of the first electromagnetic positioning assembly in the device coordinate system may be determined according to the position coordinate of the first electromagnetic positioning assembly in the two-dimensional medical image and the projection transformation matrix of the photographing device; and determining a second conversion relation T2 according to the second pose and the first pose. Wherein, the projection transformation matrix can be obtained by preoperative calibration.
The position coordinates of the first electromagnetic positioning assembly can be represented by coordinates of the identification ball, the area where the identification ball is located in the two-dimensional medical image is identified based on an image identification algorithm, and two-dimensional coordinates B (x, y) of the center of sphere of each identification ball in the two-dimensional medical image are calculated. Based on the two-dimensional coordinates B (x, y), the projective transformation matrix A, and the formula B (x, y) ═ A × BallDevice(x, y, z) can determine the second attitude Ball of the first electromagnetic positioning component under the equipment coordinate systemDevice(x, y, z), and further according to the second posture BallDevice(x,yZ), space coordinates BallMagnetic field(x, y, z) and the formula BallDevice(x,y,z)＝T2*BallMagnetic field(x, y, z) a second transformation T2 between the device coordinate system of the photographing device and the magnetic field coordinate system of the electromagnetic field is determined.
The position and size of the lesion site reflected in the two-dimensional medical image are correlated with the pose of the photographing apparatus, and the correspondence of the spatial position between the three-dimensional medical image and the two-dimensional medical image is determined, which is equivalent to the correspondence between the pose of the photographing apparatus and the three-dimensional medical image, that is, the third transformation relation T3 between the image coordinate system of the three-dimensional medical image and the apparatus coordinate system is determined. If the two-dimensional tomography image is acquired before the operation, a three-dimensional medical image needs to be reconstructed according to the two-dimensional tomography image.
In one embodiment, image registration of a two-dimensional medical image with a three-dimensional medical image may include:
and S1, establishing a two-dimensional analog image corresponding to the three-dimensional medical image based on a digital image reconstruction algorithm (DRR).
In order to facilitate medical preoperative diagnosis, a medical image with higher spatial resolution is generally acquired preoperatively, and only a two-dimensional image, such as an X-ray image, can be generally acquired intraoperatively, so that the three-dimensional medical image needs to be reduced to two-dimensional when image registration is realized in the operation process, namely a two-dimensional simulation image (DRR image) corresponding to the three-dimensional medical image is established based on a DRR algorithm.
And S2, carrying out image registration on the two-dimensional simulation image and the two-dimensional medical image.
In the image registration process, a registration space coordinate system can be defined by self, for example, a global coordinate system of a shooting device is taken as an example, one or a plurality of DRR images are reconstructed from three-dimensional medical image data in the global coordinate system of the shooting device, and the DRR images and the two-dimensional images obtained in the step 401 are registered in sequence, so that information such as real-time poses of patients in operation, size transformation of lesion parts in imaging and the like can be obtained. The image registration algorithm may employ, but is not limited to, a rigid body transformation, an affine transformation, a projective transformation, an elastic transformation, and the like.
In order to improve the accuracy of image registration and reduce the amount of calculation, in one embodiment, in the process of performing image registration on the two-dimensional medical image and the three-dimensional medical image, a first region where the target object (spine) is located in the two-dimensional medical image and a second region where the target object (spine) is located in the three-dimensional medical image may be identified, and only the first region and the second region are subjected to image registration when performing image registration.
After the second and third transfer relationships are determined, the first transfer relationship T1-T2-T3 may be determined by, but is not limited to, the following formula.
And 403, respectively converting the real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly into space coordinates under an image coordinate system according to the first conversion relation so as to guide the operation of the surgical instrument.
The second electromagnetic positioning component is fixed on the surgical instrument and is positioned in an electromagnetic field generated by the magnetic field generator.
The real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly are respectively determined according to induction currents or induction voltages generated by the first electromagnetic positioning assembly and the second electromagnetic positioning assembly under an electromagnetic field, and real-time positioning tracking of the pose of the target object and the pose of the surgical instrument is achieved through monitoring of the real-time poses.
After the first conversion relation is determined, the identification unit on the identification fixing needle can be detached, and the real-time pose of the first electromagnetic positioning assembly, the real-time pose of the second electromagnetic positioning assembly and the three-dimensional medical image can be unified under the same coordinate system according to the determined first conversion relation, so that the three components are fused. For example, but not limited to, by the following formula MMagnetic field＝T1*MctAnd respectively converting the real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly into space coordinates under an image coordinate system of the three-dimensional medical image. Wherein M isMagnetic fieldRepresenting the pose, M, of the first or second electromagnetic locating elementsctRepresents that M isMagnetic fieldAnd converting the space coordinates into space coordinates in an image coordinate system. Thereby, canThe real-time position relation dynamic image of the lesion part and the surgical instrument in the three-dimensional medical image is obtained, the operation of the surgical instrument of medical personnel can be guided through the dynamic image displayed in real time by the display screen, and the surgical navigation is realized.
Before performing an operation, medical staff may formulate an operation plan by using a three-dimensional medical image acquired before an operation, for example, a nail placement position Mct '(target position) is marked on the three-dimensional medical image, and the Mct' represents an operation path in a coordinate system of the three-dimensional medical image, that is, the nail placement path may be a space line segment including a start point and an end point.
According to M'Magnetic fieldThe spatial position M 'in the magnetic field coordinate system corresponding to the position of the nail marked on the three-dimensional medical image can be calculated by T1 Mct'Magnetic fieldThe spatial position is also the position where the nail needs to be placed so as to guide the operation of the surgical instrument.
FIG. 5 is a schematic structural diagram of another surgical navigation system according to an exemplary embodiment of the present invention, the surgical navigation system further including a display; the controller can also fuse the real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly with the three-dimensional medical image according to the first conversion relation and the second conversion relation, and send the fusion result to the display for displaying. The real-time pose of the first electromagnetic positioning assembly represents the real-time pose of the pathological spine, the real-time pose of the second electromagnetic positioning assembly represents the real-time pose of the surgical instrument, data fusion is realized by fusing the real-time pose of the surgical instrument, the real-time pose of the shooting equipment and the three-dimensional medical image, and a fusion result is displayed to obtain a real-time position relation dynamic image of the pathological spine and the surgical instrument. The display can be a common display screen or a mixed reality head-mounted display.
In the embodiment, the space pose of the vertebral body and the space pose of the surgical instrument are positioned and tracked in real time by utilizing the electromagnetic navigation tracking technology, the positioning and tracking result is displayed, the positioning and tracking accuracy is high, the display result has no image drift, and the dynamic image displayed in real time by the display is used for medical personnel to perform synchronous operation by observing the display, so that the visual navigation of the operation is realized, the damage to the structures around the vertebral body and the blood vessels of important organs in the operation nail setting process is avoided, and the occurrence of operation complications is avoided. Moreover, the diseased region and the surgical instrument do not need to be shot in real time in the operation, so that the radiation dose of the patient shot by the medical image in the operation can be reduced.
In one embodiment, the medical personnel can manually manipulate the multi-axis robotic arm of the surgical instrument by viewing the display so that the surgical operation is performed on the patient by the surgical instrument under the drive of the multi-axis robotic arm, for example, implanting a set screw into the spine to accomplish a good orthopedic procedure.
In another embodiment, the surgical navigation system further comprises a driver, which can realize automatic manipulation of the multi-axis mechanical arm, specifically: medical staff can select a nail placing position (operation position) on a three-dimensional medical image presented by a display, a controller can plan a moving path of a surgical instrument according to the nail placing position, the conversion relation among coordinate systems, the pose of the current surgical instrument and the pose of shooting equipment, and a driver can drive the surgical instrument to move to a space position corresponding to the nail placing position according to the moving path so as to perform operation. Through path planning, the surgical instrument can run in the shortest path, and the positioning safety and efficiency of the surgical instrument can be improved.
In another embodiment, an ultrasonic sensor, an infrared sensor, a camera and the like can be further arranged on the mechanical arm trolley, so that the mechanical arm trolley has an obstacle avoidance function, and when the surgical instrument moves, collision with surrounding objects or people is avoided.
In another embodiment, in the case that the surgical instrument completes the surgical operation, the controller may trigger the photographing device to photograph the target object to obtain a two-dimensional medical image, where the two-dimensional medical image may reflect a specific position of the surgical operation, that is, a nail placement position; the three-dimensional simulation image corresponding to the two-dimensional medical image can be reconstructed according to the image registration result, and the three-dimensional simulation image is displayed in a display, the display for displaying the three-dimensional simulation image can share the display with the display relation dynamic image, namely two three-dimensional simulation images are displayed on one display; of course, the two three-dimensional simulation images can be displayed on different displays. Medical personnel can determine whether the specific position of the operation is in accordance with the expectation according to the two three-dimensional medical images, for example, whether a fixing screw is driven at the correct position, and correct the error in time under the condition that the fixing screw is not in accordance with the expectation, so that serious medical accidents are avoided.
In another embodiment, the surgical navigation system further comprises a prompting device, and in the case that the surgical instrument completes the surgical operation, the controller may further calculate the position of the surgical operation in the three-dimensional simulation image, for example, the position of the fixing screw implantation, and the position offset from the marked nail placement position Mct on the three-dimensional medical image, and if the position offset is greater than the threshold value, which indicates that the surgical expectation is not met, and a re-operation may be required, prompt information may be generated and sent to the prompting device, so that the prompting device prompts the prompting information. The prompt information may be sent out by means of voice, text, etc.
In another embodiment, an electromagnetic positioning coil may also be implanted in the fixing screw, the implantation position of the fixing screw is positionally tracked according to an electromagnetic navigation tracking technology, and a medical staff is prompted in time when the implantation path of the fixing screw does not match the expectation. The fixing screw is used for fixing and treating the spine.
It should be noted that although in the above detailed description several units/modules or sub-units/modules of the electronic device are mentioned, such a division is merely exemplary and not mandatory. Indeed, the features and functionality of two or more of the units/modules described above may be embodied in one unit/module according to embodiments of the invention. Conversely, the features and functions of one unit/module described above may be further divided into embodiments by a plurality of units/modules.
The above description is only for the purpose of illustrating the preferred embodiments of the present invention and is not to be construed as limiting the invention, and any modifications, equivalents, improvements and the like made within the spirit and principle of the present invention should be included in the scope of the present invention.

Claims (10)

1. A surgical navigation system, comprising:
a magnetic field generator for generating an electromagnetic field;
the first electromagnetic positioning assembly is fixed on a target object and used for generating a first induced current under the electromagnetic field;
the second electromagnetic positioning assembly is fixed on a surgical instrument and used for generating a second induced current under the electromagnetic field; wherein the surgical instrument is used for performing a surgical operation on the target object;
a controller for acquiring the first induced current and the second induced current, and determining a first pose of the target object and a second pose of the surgical instrument according to the first induced current and the second induced current respectively;
the controller is further used for determining a conversion relation between an image coordinate system of the three-dimensional medical image and a magnetic field coordinate system of the electromagnetic field according to the three-dimensional medical image of the target object, the first two-dimensional medical image containing the target object and the surgical instrument, the first pose and the second pose and guiding the operation of the surgical instrument.
2. The surgical navigation system of claim 1, wherein the controller includes:
the calibration module is used for determining the conversion relation between the image coordinate system and the magnetic field coordinate system;
and the conversion module is used for respectively converting the real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly into space coordinates under the image coordinate system according to the conversion relation so as to guide the operation of surgical instruments.
3. The surgical navigation system of claim 1, wherein the first electromagnetic positioning assembly includes:
a fixing needle, a needle head of which is used for implanting into the target object;
and the electromagnetic positioning coil is arranged in the fixing needle and used for generating the first induced current under the electromagnetic field.
4. The surgical navigation system of claim 3, wherein the first electromagnetic positioning assembly further includes:
and the identification unit is detachably fixed on the fixing needle.
5. The surgical navigation system of claim 4, wherein the identification unit includes:
the fixing seat is fixed on the fixing needle;
the identification frame is fixed on the fixed seat;
at least four identification balls dispersedly arranged on the identification frame, wherein the identification balls are used as the identification points.
6. The surgical navigation system of claim 5, wherein the marker ball and/or the fixation pin are made of a non-magnetic metal material.
7. The surgical navigation system of claim 1, wherein the second electromagnetic positioning assembly includes:
an electromagnetic positioning coil for generating the second induced current under the electromagnetic field.
8. The surgical navigation system of claim 1, further comprising: a driver;
the controller is further used for determining the spatial position of the target position in the three-dimensional medical image under the magnetic field coordinate system according to the conversion relation, and planning the moving path of the surgical instrument according to the current pose of the second electromagnetic positioning assembly and the second spatial coordinate;
the driver is used for driving the surgical instrument to move to the space position according to the moving path.
9. The surgical navigation system of claim 1, further comprising: a display;
the controller is further used for fusing the real-time pose of the first electromagnetic positioning assembly and the real-time pose of the second electromagnetic positioning assembly with the three-dimensional medical image according to the conversion relation;
and the display is used for displaying the fusion result.
10. The surgical navigation system of claim 1, further comprising: a prompter;
the controller is further configured to send a shooting instruction to the shooting device to trigger the shooting device to shoot the target object to obtain a second two-dimensional medical image when the surgical instrument completes a surgical operation;
the controller is further used for determining the position deviation of the position of the surgical operation in the second two-dimensional medical image and the target position, and generating prompt information under the condition that the position deviation is larger than a deviation threshold value;
and the prompter is used for prompting the prompt information.
CN202010950200.9A 2020-09-10 2020-09-10 Surgical navigation system Pending CN114159161A (en)

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Application Number Priority Date Filing Date Title
CN202010950200.9A CN114159161A (en) 2020-09-10 2020-09-10 Surgical navigation system

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
CN202010950200.9A CN114159161A (en) 2020-09-10 2020-09-10 Surgical navigation system

Publications (1)

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CN114159161A true CN114159161A (en) 2022-03-11

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