CN114601539B - Puncture guiding method based on 3D image - Google Patents
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- 230000029058 respiratory gaseous exchange Effects 0.000 claims abstract description 140
- 239000000700 radioactive tracer Substances 0.000 claims abstract description 27
- 238000005070 sampling Methods 0.000 claims abstract description 7
- 238000003384 imaging method Methods 0.000 claims abstract description 4
- 239000003086 colorant Substances 0.000 claims description 5
- 238000007667 floating Methods 0.000 claims description 3
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- 230000003187 abdominal effect Effects 0.000 description 2
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- 210000000038 chest Anatomy 0.000 description 2
- 238000010586 diagram Methods 0.000 description 2
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- 206010006322 Breath holding Diseases 0.000 description 1
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- 206010056342 Pulmonary mass Diseases 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
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- 239000000284 extract Substances 0.000 description 1
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
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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
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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
- A61B2034/2046—Tracking techniques
- A61B2034/2065—Tracking using image or pattern recognition
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Abstract
The invention discloses a puncture guiding method based on 3D images, which comprises the following steps: synchronizing the time of the 3D image equipment and the time of the breathing curve acquisition equipment; scanning a patient through a 3D imaging device to obtain a registered image containing a focus of the patient and a tracer of the patient, and sampling a motion track of a respiration collector placed on the patient in real time through a respiration curve collecting device to obtain a respiration curve of the patient; identifying the focus of the patient on the registered image, planning a puncture channel, extracting the sampling time of a slice at the tail end of the puncture channel as the alignment time, obtaining a puncture phase by combining a respiration curve of the patient, and guiding puncture according to the puncture phase. According to the invention, through time synchronization, the limit of the focus corresponding to the planned puncture channel on the respiration curve is obtained as prompt information, and accurate puncture guidance is realized by matching with high-precision navigation positioning.
Description
Technical Field
The invention relates to the technical field of surgical navigation, in particular to a puncture guiding method based on a 3D image.
Background
In clinical practice, particularly in clinical practice of tumor treatment, medical images are more and more widely used for guidance, and then the mechanical arm is used for assisting in positioning of an operation tool, so that minimally invasive surgery is performed, the wound surface of a patient is reduced, and the recovery speed of the patient is accelerated.
During operations such as biopsy and ablation of lung puncture, the patient is in a state of continuous breathing, and the main parts of puncture and ablation are the parts of the lung, the liver and the like which are greatly affected by breathing. Because the patient breathes and causes the mediastinum to move, the displacement of focus point in the organ can reach 5cm at most, so even the doctor with abundant experience can not guarantee one hundred percent of puncture success rate. The surgical navigation auxiliary robot for lung puncture and ablation becomes a future trend, and because the motion law of the lung is difficult to grasp, the current surgical navigation auxiliary robot cannot accurately grasp the motion law of the lung, and the precise operation of a focus point is difficult to realize.
The medical operation navigation robot provides a high-precision navigation position and angle for a doctor in the fields of percutaneous puncture, biopsy, ablation and the like, reduces the hand feeling dependence of the doctor on the puncture angle, but is not negligible for the respiratory motion image of a patient on the lung, the liver and the like. The puncture channel planning is performed by a doctor based on physiological anatomical features, actual scenes of a patient and the like, belongs to static features, and is easily performed to a planning channel by carrying a tail end based on an image marker and an optical/electromagnetic navigation technology. The difficulty lies in that the normal respiratory motion of a patient can cause the spatial motion of pulmonary nodules in different degrees, the pulmonary nodules belong to dynamic characteristics, the patient is difficult to cooperate by conventional active or passive breath-holding operation, more doctors judge the respiratory condition of the patient through years of experience aiming at the difficult problem, the motion position of the nodules is deduced, and the lower lung or the small nodules with large motion amplitude are not always handed down by the multi-step needle-inserting CT rechecking.
Disclosure of Invention
The purpose of the invention is as follows: in view of the above problems, the present invention provides a 3D video based puncture guiding method that does not depend on high-end video equipment such as 4D video.
The technical scheme is as follows:
a puncture guiding method based on 3D images comprises the following steps:
synchronizing the time of the 3D image equipment and the time of the breathing curve acquisition equipment;
scanning a patient through a 3D imaging device to obtain a registered image containing a focus of the patient and a tracer of the patient, and sampling a motion track of a respiration collector placed on the patient in real time through a respiration curve collecting device to obtain a respiration curve of the patient;
identifying the focus of the patient on the registered image, planning a puncture channel, extracting the sampling time of a slice at the tail end of the puncture channel as the alignment time, obtaining a puncture phase by combining a respiration curve of the patient, and guiding puncture according to the puncture phase.
And corresponding the alignment time to the time of the respiration curve so as to obtain a target puncture phase corresponding to the alignment time, and obtaining the puncture phase by taking the target puncture phase as a reference.
And equally dividing the peak value and the peak value on a respiration curve of a complete cycle to form a plurality of respiration phase sections, and taking any phase in the respiration phase sections in which the target puncture phase falls as the puncture phase.
And taking the target puncture phase as a reference, and taking any phase in front and back preset phase sections as the puncture phase.
And taking the target puncture phase as a reference, and taking any phase within the range of +/-150 milliseconds of the corresponding time on the respiration curve as the puncture phase.
An indicator light is installed at any position which can be observed by a doctor, and indication is carried out when the breathing phase of the breathing curve reaches the puncture phase.
The indicator light is installed at the tail end of a mechanical arm of the robot.
The number of the indicator lights is 2N +1, and the 2N indicator lights are symmetrically distributed by taking the middle light as a reference; the indicator lights start to gradually light from the lights at the two ends farthest from the middle light until the middle light lights when the breathing phase reaches the puncture phase, and the color of the middle light is different from the colors of the other lights.
Equally dividing peak and peak values on a respiration curve of a complete cycle to form a plurality of respiration phase sections, and taking any phase in the respiration phase sections in which the target puncture phase falls as the puncture phase;
starting from N breathing phase sections before the breathing phase section where the breathing phase is located is reached by the breathing phase, gradually turning on the lamps at two ends farthest from the middle lamp, and highlighting one lamp every time when the breathing phase section is crossed until the breathing phase section where the breathing phase is located is reached, wherein the middle lamp is turned on, and gradually turning off the indicator lamp from near to far relative to the middle lamp after the breathing phase is far away from the breathing phase section where the breathing phase is located.
The pilot lamp sets up to 2N symmetrical arrangement, arrives from breathing the phase place and breathes in and begin to progressively light up, lights up until reaching the end of breathing in all lamps, later gets into the expiration stage, starts to breathe the end lamp from the expiration and progressively extinguishes the pilot lamp, and at this in-process, the pilot lamp that the puncture phase place corresponds is often bright and the colour is different with the colour of other lamps.
When the respiratory phase reaches the puncture phase, a prompt lamp corresponding to the puncture phase flickers or is replaced by another color.
The motion trail of the respiration collector is multidimensional data, and data and time parameters in the maximum floating direction are selected according to the multidimensional data to obtain a respiration curve or a one-dimensional visualization curve corresponding to the time parameters, namely the respiration curve, is generated by a dimension reduction algorithm.
And selecting the motion amplitude of the human body in the chest-back direction as the characteristic of the one-dimensional respiration curve.
Has the advantages that: according to the invention, the respiration curve is obtained by acquiring the respiration fluctuation data of the patient in real time, the doctor plans the puncture channel in the 3D image, and the limit of the focus corresponding to the planned puncture channel in the respiration curve is acquired as prompt information by time synchronization between the CT equipment and the optical tracking system, and the accurate puncture guidance is realized by matching with high-precision navigation positioning.
Drawings
Fig. 1 is a flowchart of a puncture guiding method under a 3D image;
FIG. 2 is a schematic graph of abdominal breathing fluctuations;
FIG. 3 is a graph of the spatial motion law of the pulmonary nodules at different respiratory phases;
FIG. 4 is a schematic diagram of respiratory phase segmentation;
fig. 5 is a schematic diagram of each system coordinate system.
Detailed Description
The invention is further elucidated with reference to the drawings and the embodiments.
Fig. 1 shows a flow chart of a 3D image-based puncture guiding method according to the present invention, which includes the following steps:
(1) time synchronization: connecting the 3D image equipment and the breathing curve acquisition equipment through a network cable, and realizing time synchronization of the 3D image equipment and the breathing curve acquisition equipment through a Network Time Protocol (NTP); in the invention, the 3D imaging equipment adopts CT equipment.
(2) Acquiring a registration image and a breathing curve:
performing CT scanning on a patient to obtain a registration image, wherein the registration image comprises a patient tracer and a patient focus, and the reconstruction precision of the CT image is recommended to be not less than 1 mm;
the method comprises the following steps that when a registered image is scanned, a breathing curve acquisition device samples the motion track of a breathing collector installed on a patient in real time, so that the fluctuation of the patient along with breathing is obtained; in the embodiment disclosed by the invention, the motion amplitude in the direction with the largest floating is selected as a one-dimensional respiration curve characteristic and is aligned with a corresponding time parameter to obtain a respiration curve, and further, the motion amplitude in the chest-back direction of a patient is selected as a one-dimensional respiration curve characteristic, as shown in fig. 2, in other embodiments, a one-dimensional visualization curve corresponding to the time parameter can be generated by a dimension reduction algorithm to serve as the respiration curve.
Placing a patient tracer near the focus of the patient for tracing the position of the focus of the patient, and obtaining the position by identifying through an optical tracking system, and further placing the patient tracer at a first part which is less influenced by the respiration of the patient (optimally, the influence is least influenced by the respiration of the patient); placing a respiration collector at a second part which is greatly influenced and floated by respiration on a patient (optimally selected to be the most influenced by the respiration of the patient) and used for an optical tracking system to identify so as to obtain the fluctuation motion of the patient along with the respiration, wherein a plurality of target balls are arranged in the patient tracer and the respiration collector according to a topological structure which can be identified by certain mathematics, the arrangement parameters of the plurality of target balls of the patient tracer and the respiration collector are inconsistent, and the coordinate position of each target ball can be actually measured by three coordinates;
in particular, the respiration collector may adopt a respiration abdominal belt or other devices capable of moving along with the respiration of the patient, more specifically, a respiration tracer, and correspondingly, an optical tracking system (NDI) is used by the respiration curve collecting device.
(3) Calculating a puncture phase:
the doctor identifies the lesion of the patient in the registered image, plans a puncture channel, extracts the sampling time (i.e. the time stamp of the exposure of the slice) of the section where the tail end (i.e. the lesion position) of the puncture channel is located (i.e. the slice with Tag ID of 0008|0032 in the registered image) as the alignment time, and defines the slice as the target slice.
The pulmonary nodules are like-periodic, three-dimensional and hysteresis loop movements in the lung cavity, as shown in fig. 3, wherein L-R represents the left and right directions of the arms of the human body, a-P represents the front and back directions of the chest and back of the human body, and I-S represents the direction of the toes of the human body; therefore, in a breathing cycle, when the breathing amplitudes are the same, the positions of the lung nodules corresponding to different breathing phases are different, and in order to realize accurate puncture, the breathing amplitudes need to be distinguished.
Corresponding the alignment time to the time of the respiration curve so as to obtain a target puncture phase corresponding to the alignment time, eliminating a system delay error and obtaining a puncture phase; when the breathing phase of the breathing curve reaches the puncture phase again, the state corresponding to the aligning time is reached again by representing the chest expansion change (the motion position of the pulmonary nodule), and the accurate puncture can be realized by needle insertion puncture at the moment.
In the present invention, the breathing curve is specifically divided into phases, which are as follows: calculating time corresponding to the peak value and the valley value of the amplitude of the respiration curve obtained in the step (2), selecting a time range corresponding to two adjacent peak values or valley values as a complete respiration curve period, carrying out phase division on the respiration curve of the complete period, and equally dividing the peak values into a plurality of respiration phase sections; namely, the peak values or valley values at the two ends are used as end points, the corresponding valley value or peak value position at the middle part is used as a midpoint, a breathing curve of a complete cycle is evenly divided into 10 breathing phase sections at intervals, so as to form 11 phase points, which are sequentially an inspiration start, an inspiration middle-lower part, an inspiration middle-upper part, an inspiration end, an expiration start, an expiration upper part, an expiration middle-lower part, an expiration end, and the 10 breathing phase sections respectively correspond to InA, InB, InC, InD, InE, ExA, ExB, ExC, ExD and ExE in the figure 4; if the respiratory phase is in one of the respiratory phase sections, any phase in the respiratory phase section can be used as a puncture phase for puncture.
Furthermore, after the target puncture phase is obtained, the target puncture phase can be used as a reference, any phase in the front and back preset phase sections can be used as a puncture phase, and puncture can be performed when the respiratory phase reaches the puncture phase; any phase within ± 150 milliseconds of the time of the breathing curve corresponding to the target puncture phase may be used as the puncture phase.
(4) The robot executes the planning channel:
acquiring a patient tracer in the registered image obtained in the step (2), performing centroid extraction to obtain coordinates of the patient tracer in an image coordinate system, combining the patient tracer obtained by the optical tracking system and coordinates of a tail end tracer placed on a Robot end effector in the optical tracking system coordinate system and coordinates of the tail end tracer in a Robot coordinate system, and obtaining a conversion relation among the image coordinate system, the optical tracking system coordinate system and the Robot coordinate system through a registration algorithm of a corresponding point set, as shown in fig. 5, wherein makerbarday represents the patient tracer, makerbeat represents a respiratory tracer, OTS represents the optical tracking system, Robot represents the Robot, and C represents C makerbody Representing the patient tracer coordinate system, C makerbreath Representing the respiratory tracer coordinate system, C OTS Representing the optical tracking system coordinate system, C Robot Representing a robot coordinate system; specifically, the method comprises the following steps:
the optical tracking system converts the acquired 6Dof data of the patient tracer and the tail end tracer into 4x4 position matrixes respectively
、
Using the patient tracer as a reference (i.e. using the patient tracer coordinate system as a reference coordinate system), then
Wherein,
the resulting position vector in 6Dof of the patient tracer is acquired in real time for the optical tracking system,
of end tracers obtained in real time for optical tracking systems6Dof, the coordinates of the end tracer can be converted into a patient tracer coordinate system, so that the problems of reference change and the like caused by movement of an optical tracking system, propulsion of a CT (computed tomography) bed, movement of a patient and the like are prevented; furthermore, the invention can also take the end tracer as the reference;
the robot converts the planned puncture channel into a robot coordinate system according to a transformation relation between an image coordinate system and the robot coordinate system to generate a target pose of an end effector of the robot, when the end effector reaches the target pose, an optical tracking system acquires the position of an end tracer on the end effector in real time and calculates to obtain the actual pose of the end effector, the error between the actual pose and the target pose is compared, and the robot is guided to carry out iterative motion step by step according to the error until the end effector reaches the target pose.
(5) And (3) guiding puncture:
the robot acquires and displays a breathing curve in real time, and prompts according to the puncture phase obtained in the step (3) for a doctor to judge the puncture time;
furthermore, an indicator light for indicating puncture is further mounted at the tail end of the mechanical arm of the robot, and the indication is carried out when the breathing phase reaches the puncture phase; wherein, the indicator light adopts a breathing light;
furthermore, in an embodiment of the present invention, 2N +1 indicator lights are disposed at the end of the robot arm, the 2N indicator lights are symmetrically distributed on the basis of the middle light, the middle light is a green light, and the symmetrical 2N indicator lights are yellow lights; the robot is also provided with a control system for controlling the on and off of each lamp of the indicator lamps according to a respiration curve generated by respiration data acquired by the optical tracking system in real time and the puncture phase acquired in the step (3), the lamps at two ends farthest from the lamp in the middle start to gradually light from the time when the respiration phase is far away from the puncture phase until the lamp in the middle lights up when the puncture phase is reached, and the indicator lamps are gradually turned off from near to far relative to the lamp in the middle after the respiration phase is far away from the puncture phase; further, the indicator light can be set to be gradually turned off from near to far relative to the middle light within a set time from the puncture phase to the distance from the puncture phase, and the light-off mode is the same as the light-on mode.
In the invention, the colors of the 2N indicator lamps can be set to other colors, and the color of the middle indicator lamp can be set to a color inconsistent with the colors of the 2N indicator lamps.
More specifically, according to the method for phase-dividing the breathing curve in step (3), starting from N breathing phase segments before the breathing phase segment where the breathing phase reaches the puncturing phase, gradually lighting up the lamps at two ends farthest from the middle lamp, gradually lighting up one lamp every time when one breathing phase segment is crossed until the breathing phase segment where the puncturing phase exists is reached, lighting up the middle lamp, gradually turning off the indicator lamp from near to far relative to the middle lamp after the breathing phase segment where the puncturing phase exists, wherein the lighting-off mode is the same as the lighting-on mode.
In another embodiment of the invention, the indicator lights are arranged in 2N symmetrical arrangement, and a pair of indicator lights which are symmetrical to each other are used as the indicator lights for indicating the puncture phase, the indicator lights are gradually lightened from the beginning of inspiration when the respiration phase reaches the end of inspiration until all the indicator lights are lightened, then the indicator lights are gradually extinguished from the beginning of expiration to the end of inspiration when the expiration phase reaches the end of inspiration, and in the process, the indicator lights corresponding to the puncture phase are normally lightened and the color of the indicator lights is different from that of other indicator lights;
more specifically, in the process, the prompting lamp corresponding to the puncture phase can be set to be normally on, and the color of the prompting lamp is replaced by another color or flickers when the respiration phase reaches the puncture phase; through the design, the whole puncture process can display normal breathing change, and can also prompt puncture phase, so that puncture information prompt is better provided for puncture doctors.
And after phase division is carried out on a breathing curve, the lamps are gradually lightened from the beginning of breathing phase to inspiration, one lamp is lightened after each breathing phase section is crossed until all the lamps are lightened at the end of inspiration, then the expiration stage is carried out, the indicator lamps are gradually extinguished from the middle lamp to the middle lamp from the beginning of expiration to the end of breathing, and the light-off mode is the same as the light-on mode.
In the present invention, the indicator light may be installed at any position of the robot that can be observed by the doctor.
(6) The doctor performs the puncture: the motion law of breathing curve is observed to the doctor, and when the patient respiratory disorder, pacify patient's mood and make breathing curve present cycle amplitude as far as stable, the doctor combines the suggestion of real-time breathing curve, puncture phase place and pilot lamp to carry out accurate puncture.
The invention records the external respiration motion curve of the patient in real time, obtains the phase of the focus on the respiration curve as prompt information through the time synchronization mechanism of the CT equipment and the optical tracking system, and realizes accurate puncture guidance by matching with high-precision navigation positioning.
Although the preferred embodiments of the present invention have been described in detail, the present invention is not limited to the details of the foregoing embodiments, and various equivalent changes (such as number, shape, position, etc.) may be made to the technical solution of the present invention within the technical spirit of the present invention, and these equivalent changes are all within the protection scope of the present invention.
Claims (12)
1. A puncture guiding method based on 3D images is characterized in that: the method comprises the following steps:
(1) synchronizing the time of the 3D image equipment and the time of the breathing curve acquisition equipment through a network time protocol;
(2) scanning a patient through a 3D imaging device to obtain a registered image containing a focus of the patient and a tracer of the patient, and sampling a motion track of a respiration collector placed on the patient in real time through a respiration curve collecting device to obtain a respiration curve of the patient;
(3) identifying the focus of the patient on the registered image, planning a puncture channel, extracting sampling time of a slice where the tail end of the puncture channel is located in all slices forming the registered image as alignment time, corresponding the alignment time to the time of the respiration curve, obtaining a respiration phase corresponding to the alignment time as a target puncture phase, and obtaining the puncture phase by taking the target puncture phase as a reference.
2. The puncture guide method according to claim 1, characterized in that: and equally dividing peak values on a respiration curve of a complete cycle to form a plurality of respiration phase sections, and taking any phase in the respiration phase sections in which the target puncture phase falls as the puncture phase.
3. The puncture guide method according to claim 1, characterized in that: and taking the target puncture phase as a reference, and taking any phase in front and back preset phase sections as the puncture phase.
4. The puncture guide method according to claim 3, characterized in that: and taking the target puncture phase as a reference, and taking any phase within the range of +/-150 milliseconds of the corresponding time on the respiration curve as the puncture phase.
5. The puncture guide method according to claim 1, characterized in that: an indicator light is installed at any position which can be observed by a doctor, and indication is carried out when the breathing phase of the breathing curve reaches the puncture phase.
6. The puncture guide method according to claim 5, characterized in that: the indicator light is installed at the tail end of a mechanical arm of the robot.
7. The puncture guide method according to claim 5, characterized in that: the number of the indicator lights is 2N +1, and the 2N indicator lights are symmetrically distributed by taking the middle light as a reference; the indicator lights start to gradually light from the lights at the two ends farthest from the middle light until the middle light lights when the breathing phase reaches the puncture phase, and the color of the middle light is different from the colors of the other lights.
8. The puncture guide method according to claim 7, wherein: equally dividing peak and peak values on a respiration curve of a complete cycle to form a plurality of respiration phase sections, and taking any phase in the respiration phase sections in which the target puncture phase falls as the puncture phase;
starting from N breathing phase sections before the breathing phase section where the breathing phase reaches the puncture phase, gradually lighting lamps at two ends farthest from the middle lamp, lighting one lamp when the breathing phase section crosses one breathing phase section until the breathing phase section where the puncture phase exists is reached, lighting the middle lamp, and gradually turning off the indicator lamp from near to far relative to the middle lamp after the breathing phase is far away from the breathing phase section where the puncture phase exists.
9. The puncture guide method according to claim 5, characterized in that: the pilot lamp sets up to 2N symmetrical arrangement, arrives from breathing the phase place and breathes in and begin to progressively light up, lights up until reaching the end of breathing in all lamps, later gets into the expiration stage, starts to breathe the end lamp from the expiration and progressively extinguishes the pilot lamp, and at this in-process, the pilot lamp that the puncture phase place corresponds is often bright and the colour is different with the colour of other lamps.
10. The puncture guide method according to claim 9, wherein: when the breathing phase reaches the puncture phase, a prompting lamp corresponding to the puncture phase flashes or is replaced by another color.
11. The puncture guide method according to claim 1, characterized in that: the motion trail of the respiration collector is multidimensional data, and data and time parameters in the maximum floating direction are selected according to the multidimensional data to obtain a respiration curve or a one-dimensional visualization curve corresponding to the time parameters, namely the respiration curve, is generated by a dimension reduction algorithm.
12. The puncture guide method according to claim 11, wherein: and selecting the motion amplitude of the human body in the chest-back direction as the characteristic of the one-dimensional respiration curve.
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| WO2013013142A1 (en) * | 2011-07-21 | 2013-01-24 | The Research Foundation Of State University Of New York | System and method for ct-guided needle biopsy |
| CN106798568A (en) * | 2017-02-27 | 2017-06-06 | 南京大学 | A kind of method of target area motion in real-time estimation body |
| EP3666212A1 (en) * | 2018-12-14 | 2020-06-17 | Globus Medical, Inc. | Surgical robotic automation with tracking markers |
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| CN114176726B (en) * | 2021-12-10 | 2023-08-04 | 佗道医疗科技有限公司 | Puncture method based on phase registration |
| CN114271909B (en) * | 2021-12-13 | 2024-08-09 | 杭州堃博生物科技有限公司 | Information processing method, device, system, equipment and medium for chest puncture |
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