CN217014241U

CN217014241U - Positioning apparatus and positioning system

Info

Publication number: CN217014241U
Application number: CN202122317715.8U
Authority: CN
Inventors: 西尔万·杜森; 马丁·雷夸尔特
Original assignee: Siemens Healthineers AG
Current assignee: Siemens Healthineers AG
Priority date: 2020-09-25
Filing date: 2021-09-24
Publication date: 2022-07-22
Anticipated expiration: 2031-09-24
Also published as: DE102020212118A1; DE102020212118B4

Abstract

In particular, a localization device or system is provided for localizing one or more target objects in an anatomical region of a patient during an integrated imaging and interventional and/or therapeutic medical procedure. The positioning apparatus has a mounting section, a positioning section, and a guiding section. The mounting section is configured such that the positioning device is detachably mounted at the patient receiving device and is positioned relative thereto. The positioning section is designed such that it can be arranged at least partially in a detection region of a first imaging modality for imaging and interventional and/or therapeutic medical procedures in a patient during a medical procedure for imaging detection of one or more target objects by suitable mounting of the positioning device at the patient receiving device. The guide section is designed such that it can be placed in and relative to the positioning section. The guiding section is used to indicate a reference position relative to the positioning section, which is used as a reference position for performing an interventional and/or therapeutic procedure facing one or more target objects.

Description

Positioning apparatus and positioning system

Technical Field

The present invention relates to a method and a device for supporting a correct positioning of a patient during a combined imaging and interventional procedure.

Background

In the identification of pathological tissue changes, imaging by means of magnetic resonance systems is often the option. A magnetic resonance apparatus (in other words a magnetic resonance tomography scanner) is an imaging apparatus which orients the nuclear spins of an examination subject for the purpose of imaging the examination subject by means of a strong external magnetic field and excites precession around this orientation by means of an alternating magnetic field. Precession or return of spins from the excited state to a state with lower energy in turn generates an alternating magnetic field received via the antenna in response.

The signals are spatially encoded by means of the gradient magnetic fields, which then enables the received signals to be correlated with the volume elements. The received signals are then evaluated and a three-dimensional image of the examination object is provided. For receiving the signals, local receiving antennas, so-called local coils, are preferably used, which are arranged directly at the examination subject for achieving a better signal-to-noise ratio. The receiving antenna can also be incorporated in a patient-receiving device, such as, for example, an examination table.

Due to the principle of action, magnetic resonance examinations have a high sensitivity to pathological tissue changes. According to the problem, the sensitivity can be further improved by supplying a contrast agent. Contrast agents are usually paramagnetic compounds which have a certain affinity for the target object of diagnostic importance, such as for example a lesion or tumor tissue. In contrast agent based magnetic resonance recordings, a patient is injected with a contrast agent and a series of magnetic resonance recordings are recorded. The contrast agent then produces a temporally improved contrast of the regions with higher affinity.

Although imaging by a magnetic resonance apparatus is generally well suited for reliable initial detection and localization of abnormal tissue changes, unfortunately, concomitant imaging using this technique is often difficult during further intervention and/or treatment of abnormal tissue changes. Such further interventional and/or therapeutic procedures can be, for example, extracting a tissue sample of the identified pathologic change during biopsy, performing minimally invasive surgery for correcting or ablating the pathologic tissue change, and/or performing radiation therapy during radiotherapy. For the accompanying imaging of the procedure, magnetic resonance imaging is therefore generally less suitable, since the structural principles of magnetic resonance apparatuses already strongly limit the accessibility of the examination volume to be delineated for other medical procedures. Furthermore, the time required for creating a magnetic resonance recording is often not compatible with the requirements of the accompanying imaging, in which the optical monitoring recording must be carried out in approximately real time. Furthermore, it is often not reasonable to continue using contrast agents for medical reasons.

This results in the identification and localization of pathological tissue changes and the planning of further interventional and/or therapeutic procedures, which are usually based on magnetic resonance recordings, while other imaging modalities, such as X-ray-based modalities (e.g. computed tomography devices or X-ray fluorescence-based modalities) or ultrasound-based modalities, if possible, are used when performing the further interventional and/or therapeutic procedures.

This poses the problem that the coordinate system in which the initial imaging and planning of the medical procedure is performed, i.e. typically the coordinate system of the magnetic resonance imaging, has to be synchronized with the coordinate system in which the further procedure takes place. It is known from the prior art to place markers on the patient in registration with the coordinate system of the magnetic resonance system for this purpose. The markers can then be used during further therapeutic and/or interventional procedures in order to establish a reference relative to the coordinate system of the magnetic resonance imaging. In order to place the marking on the patient, for example, a laser marking system can be used which directs a laser beam at one or more defined locations on the skin surface of the patient. The points marked in this way can then be marked with permanent markings, for example by a doctor or a medical technical assistant. Difficulties can arise here for the following reasons: such laser marking systems have to be produced very precisely and registered precisely with the magnetic resonance apparatus in order to be able to reliably preset the marking points. Furthermore, suitable laser marking systems must be adapted to the geometry of the magnetic resonance apparatus (usually so that a projecting bridge or gantry device is used) and also be able to withstand the high field strengths in the direct surroundings of the magnetic resonance apparatus. All this results in that such laser marking systems are very expensive and difficult to install components.

SUMMERY OF THE UTILITY MODEL

It is therefore an object of the present invention to propose an improved device or an improved method for locating an anatomical target object of a patient during an integrated or imaging and interventional and/or therapeutic procedure. In particular, it is an object of the utility model to provide an improved apparatus or an improved method for positioning an anatomical target object of a patient during an integrated or imaging and interventional and/or therapeutic procedure, wherein the imaging procedure is performed with the aid of a first imaging modality, which can be in particular an imaging modality based on magnetic resonance imaging.

According to the utility model, the proposed object is achieved by means of a localization device according to the utility model for localizing an anatomical structure of a patient during an integrated imaging and interventional and/or therapeutic medical procedure, a corresponding method with a localization device, a computer program product and a computer-readable storage medium. Advantageous refinements are given in the following description.

In the following, the solution according to the utility model of the stated object is described not only with reference to the claimed apparatus but also with reference to the claimed method. Features, advantages, or alternative embodiments described herein are equally applicable to other claimed subject matter, and vice versa. In other words, embodiments of the entity (which are, for example, oriented towards a positioning device) can also be improved by means of the features described or claimed in connection with the method. The corresponding functional features of the method are formed by corresponding physical modules.

According to an aspect of the present invention, a localization device for localizing one or more target objects in an anatomical region of a patient during an integrated imaging and interventional and/or therapeutic medical procedure is provided. During a medical procedure, a patient is disposed on the patient holding device. In the context of a medical procedure, by suitable positioning of the patient receiving device, the anatomical region of the patient is placed in the examination region of the first imaging modality, and for examination of the at least one target object or a plurality of target objects is depicted by means of the first imaging modality. The positioning device has a positioning section, a mounting section and a guiding section. The mounting section is designed such that the positioning device can be detachably mounted on the patient receiving device, such that the positioning device can be positioned relative to the patient receiving device such that, when the anatomical region is delineated by the first imaging modality, the positioning section is at least partially arranged together with the anatomical region in a detection region of the first imaging modality. The guiding section is designed such that it can be placed in the positioning section for the purpose of indicating a reference position relative to the positioning section, which serves as a reference position for carrying out an interventional and/or therapeutic procedure facing the target object or objects. The marker portion or the marker element is designed such that it can be detected by a second imaging modality, wherein the second imaging modality carries out an imaging method different from the first imaging modality and is used in particular during an interventional or therapeutic procedure.

An imaging and interventional and/or therapeutic medical procedure can be understood in particular as a combined or integrated procedure consisting of two sub-procedures. The first sub-process is an imaging process. By means of the imaging procedure, a target object for an interventional or therapeutic procedure can be identified and the interventional or therapeutic procedure can be planned. Whereby the interventional or therapeutic procedure is a second sub-procedure. The interventional or therapeutic procedure can be directed to the manipulation or treatment of the target object by means of an interventional and/or therapeutic institution. The interventional and/or therapeutic procedure can include, for example, biopsy, surgery, in particular minimally invasive surgery, radiation therapy, and the like.

The anatomical region can be, for example, a body part of a patient, such as, for example, a thigh or a chest region. The anatomical region can in particular be a partial volume of the patient. The anatomical region can be, in particular, a volume within the body of the patient. The target object or the target objects can have one or more anatomical structures, which can be pathologically changing, in particular. The target object can include, for example, one or more lesions, pathological tissue changes, calcification, deposits, and the like.

The first imaging modality can generally be configured for delineating an object and in particular the internal structure of the object in the examination area of the first imaging modality. The first imaging modality can in particular constitute a volume for delineating an anatomical region and in particular a patient's body. The first imaging modality may depict the anatomical region in the form of (medical) image data showing the anatomical region (and possibly the anatomical structure contained therein). The first imaging modality can, for example, carry out a magnetic resonance-based imaging method. Alternatively, the first imaging modality can implement imaging methods based on X-radiation or ultrasound signals. Correspondingly, the first imaging modality can have a magnetic resonance apparatus, a computed tomography scanner, an X-ray apparatus, an ultrasound apparatus or the like.

The patient support device can in particular have an examination table (patient table) for supporting a patient.

The mounting section can be designed in particular for the purpose of mounting the positioning device on the patient support device or the examination table in a reversible manner at any time without damage. The mounting section can be designed, for example, to produce a plug connection and/or a clamping connection and/or a screw connection with the patient support device or the examination table. By means of the mounting section, the positioning device is particularly portable between different patient accommodation devices. The mounting section can be connected to or with the positioning section.

The mounting section and/or the positioning section are designed such that the positioning device can be mounted on the patient receiving device such that the positioning section can be brought at least partially together with the anatomical region of the patient into the examination region of the first imaging modality. In other words, the positioning section is therefore in particular of a suitable size for this.

The positioning segment serves as a basis for flexibly determining the reference position for interventional or therapeutic procedures that are to be performed after imaging, outside the patient or independently of the patient. The positioning section is preferably designed in a planar manner, i.e., it has one or more surface elements. The positioning section is designed such that it at least partially covers the anatomical region to be delineated in a viewing direction through the positioning device onto the anatomical region when the positioning device is properly mounted on the patient receiving device. In other words, the positioning section expands the examination volume, the anatomical region is then at least partially disposed in the examination volume or can be disposed at least partially in the examination volume.

The positioning section and the guide section interact as follows: a reference location for performing an interventional or therapeutic procedure can be identified. The positioning section serves here as a reference frame in which a reference position with the guide section can be precisely determined. The reference position can be understood, for example, as a reception point (Aufpunkt) for placing an interventional and/or therapeutic medical instrument, from which, for example, a path for the medical instrument to be fed to one or more target objects can be planned. Furthermore, the reference position can be used as a reference point for positioning or orienting the treatment device, such as, for example, an irradiation device, on the target object. Furthermore, the reference position can be used, for example, as a reference point for registering the coordinate system of the imaging procedure with the coordinate system of the therapeutic or interventional procedure or for quality monitoring of the calibration of the localization device.

The reference position can be marked in particular by means of the guide section in the following manner: i.e. the guiding sections are arranged or provided in or at corresponding locations at the positioning sections.

In summary, a reference position for an interventional or therapeutic treatment of a patient can be determined by means of a positioning device having a simple mechanical mechanism. By means of the mechanical determination, the reference position can be simply transferred between the different sub-processes. It is therefore already sufficient for this to position the patient support device appropriately for the interventional or therapeutic procedure. The embodiment of the positioning section in which the positioning section can be inserted into the examination region of the first imaging modality and there overlaps with an important anatomical region of the patient can on the one hand enable a reference position to be determined by means of the first imaging modality on the basis of the image data and in particular in relation to the depicted target object. On the other hand, the reference position can be selected in the spatial vicinity of the anatomical region and thus in a position suitable for the interventional or therapeutic procedure. The mounting section on the one hand enables the positioning device to be mounted as defined at the patient receiving device. On the other hand, the positioning device can be designed to be portable and can be simply placed on the patient support device or simply switched between different patient support devices as required. The features of the locating device thereby cooperate synergistically to achieve a cost-effective and flexibly usable device that allows determining a reference position for treating one or more target objects within a patient.

According to one aspect, the positioning section and/or the guide section is designed such that the guide section can be fixed in or at a reference position at the positioning section. This ensures that the guide section does not move during the performance of the medical procedure. The fixation can be achieved, for example, by inserting the guide section or an element of the guide section into a recess in the positioning section, screwing or screwing the guide section into the positioning section, or by clamping the guide section or an element of the guide section into the positioning section.

According to one aspect, the locating device has a marking section which is designed such that it can be detected by means of the first imaging modality. The marking section enables the detection of the positioning device by means of the first imaging modality. The positioning device can thus be registered in a simple manner with the image data. The marking section can be configured, for example, as a so-called "fiducial mark".

According to one aspect, the marking section can be integrated into the positioning section, which facilitates a simple, error-free and at the same time precise operation of the positioning device.

According to one aspect, the guide section can be designed such that it can be detected by means of the first imaging modality. The guide section can in particular have a marking element which can be detected by means of the first imaging modality. Alternatively, the guide section itself can also be designed to be detectable by means of the first imaging modality. The position of the guide section in the positioning section can thus be checked directly by means of the first imaging modality. Whereby for example quality monitoring can be performed. Furthermore, a path or a treatment plan for the interventional or therapeutic procedure can be adjusted.

According to one aspect, the marking section and/or the guidance section or the marking element are designed such that they can be detected by a second imaging modality, wherein the second imaging modality carries out an imaging method different from the first imaging modality and is used in particular during an interventional or therapeutic procedure. The second imaging modality can generally be configured for depicting the object in the examination area of the second imaging modality and in particular for depicting the internal structure of the object. The second imaging modality can in particular constitute a volume for delineating an anatomical region and in particular the body of a patient. The second imaging modality can depict the anatomical region in the form of (medical) image data that exhibits the anatomical region (and possibly the anatomical structure contained therein).

The first imaging modality can be based on (implement) magnetic resonance imaging, for example, while the second imaging modality uses or implements X-ray based imaging (or vice versa). Thus, the first imaging modality can have a magnetic resonance device, while the second imaging modality can have an X-ray device and/or a computer tomography scanner (or vice versa).

By being able to detect the marker segment and/or the guide element or the marker element from the two participating imaging modalities, the positioning device can be simply registered with the image data in both sub-processes. Furthermore, possible delineation errors of one of the imaging modalities can be identified and corrected. Magnetic resonance-based imaging methods therefore often have artifacts due to spatial distortions due to inhomogeneities in the electromagnetic field, which are practically unavoidable only. By using a bivalent (bi-value) marker, the artifacts can be corrected by means of a separate imaging modality, in particular before a therapeutic or interventional procedure is performed.

According to one aspect, the positioning device has a plurality of guide sections which can be arranged independently of one another in or on or at the positioning section to mark a plurality of different reference positions. Thus, for example, reference positions can be determined for a plurality of target objects, to which an interventional or therapeutic procedure is to be directed in each case. Furthermore, it may be possible to achieve a more accurate position determination of the target object, for example in the course of triangulation. Furthermore, checking and correcting the imaging errors (for example the display of spatial distortions) of the first imaging modality can be achieved if the guide segments are in a defined positional relationship with one another and can also be detected by the first imaging modality.

According to one aspect, the guide section is designed for guiding the interventional device during an interventional procedure. By "guiding" it can be meant here that the guiding section presets the position and/or the feed direction of an interventional device, such as for example a catheter robot or a biopsy robot. The performance of the interventional procedure can thereby be further simplified.

Alternatively, the guide section can also be designed as a placement aid for the treatment device during the treatment process. For this purpose, the guide section can have, for example, a marking element that can be detected by means of the second imaging modality. Alternatively or additionally, the guide section can have a laser marking device, such as for example a laser pointer, by means of which optical markings can be projected onto the skin surface of the patient.

According to one aspect, the positioning section is designed such that it can span the patient accommodated on the patient accommodating device in the lateral direction of the patient when the positioning device is mounted on the patient accommodating device. For this purpose, the positioning section can be formed, for example, in an arcuate or portal shape. The mounting section can then be formed on both sides of the "foot" of the bow or door. The patient-spanning contouring of the positioning segments has the following advantages: the anatomical region can be well covered by the positioning section. This simplifies registration, limits relative movement between the patient and the positioning device and allows for ample clearance when positioning the one or more guide sections.

According to one aspect, the positioning section has a plurality of positioning surfaces which are designed in such a way that they delimit the examination volume on different sides. In other words, the locating surfaces respectively surround the anatomical region on different sides of the anatomical region. This also simplifies the registration, limits the relative movement between the patient and the positioning device and allows for a wide clearance when placing the one or more guide sections.

According to one aspect, the positioning section has three positioning surfaces, which are designed such that, when the positioning device is mounted on the patient-receiving device, the positioning section spans the patient received on the patient-receiving device in the transverse direction of the patient. One of the three positioning surfaces can in particular be a centrally arranged positioning surface, and the two further positioning surfaces as lateral positioning surfaces are connected to the centrally arranged positioning surface, in particular substantially at right angles. The lateral positioning surfaces are substantially parallel to one another. The lateral positioning surfaces can each have a mounting section opposite the connecting edge of the central positioning surface. The lateral positioning faces can be spaced apart from one another substantially by the width of the examination table. The positioning section thus defines an examination volume of substantially rectangular cross-section. Alternatively, other angles of the lateral positioning faces are also possible, so that for example a trapezoidal cross-sectional examination volume is produced (in the transverse direction of the patient).

The aspect also simplifies registration, limits relative movement between the patient and the positioning device and allows for ample clearance when positioning one or more guide sections.

According to one aspect, each positioning surface has associated with it at least one guide section which can be placed in or at the respective positioning surface. Thus, for example, reference positions for a plurality of target objects can be determined, to which an interventional or therapeutic procedure is to be directed. Furthermore, a more precise position determination of the target object can be achieved, for example, in the course of triangulation. Furthermore, checking and correcting the imaging errors (for example the display of spatial distortions) of the first imaging modality can be achieved if the guide segments are in a defined positional relationship with one another and can also be detected by the first imaging modality.

According to one aspect, the positioning section is designed to physically determine the position of the anatomical region of the patient, in particular by contact with at least a part of the patient. The described design of the positioning section can be achieved, for example, by sufficient form stability and optionally by a shaping of the positioning section that is adapted to the anatomical shape of the patient. Thereby, relative movements between the patient and the positioning device can be limited, which allows a more accurate positioning of the one or more target objects. This effect can be further enhanced if the aspect is combined with a shaping of the positioning section which is adapted to span the patient accommodated on the patient accommodating device in the lateral direction of the patient (see above).

According to one aspect, the positioning section has a grid, in particular grid-shaped, for supporting the arrangement of the guide section at or in or on the positioning section. The grid and/or the guide section can be designed, for example, such that the guide section can be inserted into the grid or pushed onto the grid or fixed relative to the grid. The grid-like design of the grid can, for example, support the penetration of the lead-through or positioning section of the interventional device by the therapeutic radiation.

The above-listed objects are also achieved by a positioning system for positioning an anatomical structure of a patient during an integrated imaging and interventional and/or therapeutic medical procedure. The positioning system has a positioning device according to one or more of the above aspects, and a patient accommodating device.

According to one aspect, the patient support device is designed such that the position of the patient relative to the patient support device can be determined physically. In this way, relative movements of the patient relative to the patient receiving device and thus relative to the positioning device can be suppressed, which simplifies the positioning of the one or more target objects by means of the positioning device.

Furthermore, a computer-implemented method for localizing one or more target objects in an anatomical region of a patient (in particular within the patient) during an integrated imaging and interventional and/or therapeutic medical procedure with a localization device according to any of the above-mentioned aspects is disclosed. Here, the patient is arranged on the patient holding device during a medical procedure. The method has a number of steps. The first step is directed to receiving image data generated by means of a first imaging modality, said image data at least partially depicting (or comprising) an anatomical region of a patient (and in particular one or more target objects). Another step is directed to registering the positioning device with the image data. Thereby, in other words, a relationship is created between the positioning device and the image data or the coordinates of the first imaging modality. The position defined with respect to the image data can thereby be converted into a position defined with respect to the positioning device and vice versa. Another step is directed to outputting the image data to a user via a user interface. Another step is oriented to receiving user input by a user via a user interface relating to one or more target objects in an anatomical region. Another step is directed to calculating a reference position relative to the located segment based on the registration and the user input, the reference position serving as a reference position for performing an interventional or therapeutic procedure directed to the one or more target objects. The reference position can in particular be in the positioning section. Calculating can include calculating a path for the interventional or therapeutic procedure from the reference location to the one or more target objects. Another step is directed to outputting the reference position via a user interface to mark the reference position by means of the guiding section.

The advantages of the proposed method substantially correspond to the advantages of the proposed positioning device. Features, advantages, or alternative embodiments are equally applicable to other claimed subject matter, and vice versa.

According to one aspect, the guide section is designed such that it can be detected by means of the first imaging modality. The method also comprises a step of receiving second image data recorded using the first imaging modality, said second image data representing the guide section. The second image data is recorded in particular temporally after the image data. Furthermore, the method has a step of checking and/or adjusting the reference position on the basis of the second image data, as a result of which a continuous quality assurance can be achieved during the medical procedure. The step of checking and/or adjusting can in particular comprise calculating the position of the guide section on the basis of the registration and the second image data and comparing the calculated position of the guide section with a reference position. Further, the step of verifying and/or adjusting can include providing a user output to the user based on the comparison via the user interface.

According to one aspect, the locating device further has the above-mentioned marker segment and the received image data further depicts the marker segment. Then, a step of registration can be performed based on the image data. As mentioned above, the registration can alternatively be established based on a known geometric relationship between the positioning segments and the first imaging modality.

According to one aspect, the marking section and/or the guiding section is also designed such that it can be detected by the second imaging modality. The second imaging modality performs an imaging method that is different from the first imaging modality and is used in particular during an interventional or therapeutic procedure. The method also has a step of receiving third image data recorded by means of a second imaging modality, which third image data describes the marking section and/or the guiding section. Another step is directed to verifying and/or adjusting the reference position based on the third image data. The step of checking and/or adjusting can in particular comprise calculating the position of the guide section on the basis of the third image data and comparing the calculated position of the guide section with a reference position. Further, the step of verifying and/or adjusting can include providing a user output to the user based on the step of comparing via the user interface.

A further aspect relates to a computer program product comprising a program and being directly loadable into a memory of a programmable processing device and having program segments, such as a program library, and auxiliary functions for implementing a method, in particular according to any of the above aspects, when the computer program product is run.

Here, the computer program product can include: software with source code that also has to be compiled and linked or that only has to be interpreted; or executable software code which for execution should only be loaded into the processing means. The method can be implemented quickly, identically reproducibly and robustly by means of a computer program product. The computer program product is configured such that it is capable of carrying out the method steps of one or more of the above-mentioned aspects by means of a processing device. The processing device must in this case each have a precondition, for example a corresponding working memory, a corresponding graphics card or a corresponding logic unit, so that the respective method steps can be carried out efficiently.

The computer program product is stored, for example, on a computer-readable medium or in a network or server, from where it can be loaded into a processor of a processing device, which processor can be directly connected to or formed as part of the processing device. Furthermore, the control information of the computer program product can be stored on an electronically readable data carrier. The control information of the electronically readable data carrier can be configured such that it executes the method according to the utility model when the data carrier is used in the processing device. Examples of electronically readable data carriers are DVDs, magnetic tapes or USB sticks, on which electronically readable control information, in particular software, is stored. All of the above-described methods can be performed according to embodiments of the present invention when the control information is read from the data carrier and stored in the processing means. The utility model can therefore also be based on the computer-readable medium and/or the electronically readable data carrier. The advantages of the proposed computer program product substantially correspond to the advantages of the proposed method.

Drawings

Further features and advantages of the utility model will be apparent from the following description of embodiments thereof, which is given by way of illustration. The variants mentioned in this context can each be combined with one another in order to form new embodiments. The same reference numerals are used in different figures for the same features.

The figures show:

fig. 1 shows a schematic top view of a system for performing an integrated imaging and interventional and/or therapeutic medical procedure according to an embodiment;

fig. 2 shows a schematic representation of a patient receiving device according to an embodiment in a top view;

FIG. 3 shows a schematic diagram of a positioning apparatus according to an embodiment;

FIG. 4 shows a schematic view of a positioning apparatus according to another embodiment;

fig. 5 shows a schematic view of the positioning device in an installed position at the patient accommodation device according to an embodiment;

FIG. 6 shows a schematic flow diagram of a method of utilizing a positioning apparatus in accordance with an embodiment;

FIG. 7 shows a schematic flow diagram of a method of utilizing a positioning apparatus in accordance with another embodiment; and

FIG. 8 shows a schematic flow diagram of a method of utilizing a positioning apparatus, according to another embodiment.

Detailed Description

Fig. 1 shows a schematic view of a system 1 for performing an integrated or combined imaging and interventional and/or therapeutic medical procedure according to an embodiment in a top view from above. The system 1 has a first imaging modality 200 and an interventional and/or therapeutic device 400.

The first imaging modality 200 can generally be configured to delineate an anatomical region of a patient P when the anatomical region of the patient P is placed in a detection region of the first imaging modality 200. Delineating the anatomical region by the first imaging modality 200 can be adapted to make identifiable or detectable one or more possible therapeutic and/or interventional targets in the anatomical region. The therapeutic and/or interventional target is also referred to as target object in the following. The target object can be, in particular, a pathological change in an anatomical region, such as, for example, a lesion or a tumor, a space requirement, a narrowing of a blood vessel, an aneurysm, etc. The target object can also comprise a region, such as for example a three-dimensional volume. The anatomical region and the target object contained therein can be arranged in particular in the body of the patient P and in particular comprise a volume in the body of the patient P. According to an exemplary embodiment, the first imaging modality 200 can have a magnetic resonance apparatus.

The interventional and/or therapeutic device 400 can generally constitute a medical procedure for performing an interventional and/or therapeutic procedure at one or more target objects in an anatomical region of a patient P. The interventional and/or therapeutic device 400 can be, for example, a biopsy device for extracting a tissue sample of the target object, a radiotherapy or radiotherapy device for irradiating the target object, and/or a surgical device for performing, in particular, a minimally invasive procedure at the target object. The anatomical regions can in particular each be located in the body of the patient P. According to an embodiment of the utility model, the interventional and/or therapeutic device 400 can be automated or at least semi-automated and in particular robotically controlled. The radiotherapy or radiotherapy apparatus can have, for example, a medical linear accelerator or other beam source. The surgical device can have, for example, a catheter robot, a minimally invasive surgical robot, an endoscopic robot, or the like.

According to some embodiments, the combined imaging and interventional and/or therapeutic procedure imaging portion can be performed by means of the first imaging modality 200. Correspondingly, the interventional and/or therapeutic part of the combined imaging and interventional and/or therapeutic procedure can be performed by means of the interventional and/or therapeutic device 400.

Optionally, the system 1 also has a second imaging modality 300. The second imaging modality 300 can preferably be primarily set to accompany the interventional and/or therapeutic portion of the combination of imaging and interventional and/or therapeutic procedure in an imaging manner so that a visual monitoring of the performance can be achieved for the user. The second imaging modality 300 can be based on or implement a different rendering method than the first imaging modality 200, among other things. The second imaging modality 300 can, for example, carry out ultrasound imaging methods or X-ray-based imaging methods, such as, for example, computed tomography methods or X-ray fluoroscopy methods. According to some embodiments, the second imaging modality 300 can have an ultrasound device, a computed tomography scanner and/or an X-ray device, such as for example a C-arm X-ray device.

Furthermore, the system 1 has a patient support device 100 on which the patient P is supported during the integrated imaging and interventional and/or therapeutic medical procedure. The patient accommodating device 100 can be at least partially movable. For this purpose, the patient accommodation device 100 can have a movement device (not shown). The movement device can be designed in particular such that a patient P accommodated on the patient accommodating device 100 can be placed from the first imaging modality 200 onto the interventional and/or therapeutic device 400. In other words, the anatomical region of the patient P can thereby be placed from the detection region of the first imaging modality 200 into the region of action of the interventional and/or therapeutic device 400.

According to some embodiments, the patient accommodating apparatus 100 has a defined positional relationship with respect to the first imaging modality 200. Each coordinate in the coordinate system of the patient receiving apparatus 100 can thereby be translated to a coordinate in the coordinate system of the first imaging modality 200 in a one-to-one correspondence, and vice versa. Thus, the patient accommodating device 100 is registered with the first imaging modality 200. In a similar manner, the optional second imaging modality 300 can be registered with the interventional and/or therapeutic device 400. In other similar ways, the patient accommodating device 100 can be registered with the interventional and/or therapeutic device 400.

Furthermore, the system has a processing device 500 which is in data connection with at least the first imaging modality 200 and the interventional and/or therapeutic device 400 and optionally with the patient accommodating device 100 and the second imaging modality 300. The processing device 500 can also have a user interface that can have input elements and/or display elements. Via the user interface, the user can, for example, see the image data obtained by the first imaging modality 200, identify and determine one or more target objects for a therapeutic and/or interventional procedure, control the therapeutic and/or interventional procedure and/or monitor the performance of the therapeutic and/or interventional procedure as necessary from the image data generated by the second imaging modality 300.

One embodiment of a patient support device 100 is shown in a top view in fig. 2. The patient accommodation apparatus 100 has a bed 101. The examination table 101 can be removed from the movement apparatus of the patient accommodation apparatus 100. In order to carry out the interventional and/or therapeutic part of the integrated imaging and interventional and/or therapeutic procedure, the examination table 101 (with or without the patient P) can be removed from the patient receiving device 100 and set onto a corresponding receiving means of the interventional and/or therapeutic device 400, in particular.

In order to be able to determine or verify the position of the patient P on the table 101 during the entire medical procedure, the table 101 can be provided with markings 102. The markings 102 can substantially comprise optical markings, such as, for example, lines. Furthermore, the marking 102 can also have functional markings, such as protruding guide elements. The markers 102 can be designed in particular for reversible coupling with a portable positioning device 10 described below in order to mount or orient the portable positioning device 10 in a defined positional relationship with respect to the examination table 101.

In order to be able to additionally physically determine the position of the patient on the patient table 101, the patient support apparatus 100 can also have a positioning aid 103, by means of which one or more body parts of the patient P can be clamped and physically fixed. The placement aid 103 can have, for example, one or more blocks that are adapted in particular to the respective anatomy of the patient P, against which blocks corresponding body parts of the patient P can rest. By means of the positioning aid 103, the patient support device 100 or the examination table 101 is designed such that the relative position of the patient P with respect to the patient support device 100 or the examination table 101 can be determined physically.

Typically, the target object for the therapeutic and/or interventional procedure is determined and determined by means of the first imaging modality 200. Furthermore, the planning of the procedure, i.e. for example the trajectory of the biopsy needle or the duration and spatial position of the irradiation, is also performed by means of the image data obtained by the first imaging modality 200. Thus, the information is defined with respect to the coordinate system of the first imaging modality 200. In order to translate this information into the coordinate system of the interventional and/or therapeutic device 400 when displacing the patient P towards the interventional and/or therapeutic device 400, a portable positioning device 10 is used according to an embodiment. The portable positioning device can be installed at the patient receiving device 100 or at the examination table 101 and can be understood as a geometric reference frame for transmitting information from the imaging procedure to the therapeutic and/or interventional procedure.

Fig. 3 shows a first embodiment of a portable locating device 10. The portable positioning apparatus 10 has a mounting section 50. The positioning device 10 can be detachably mounted by means of the mounting section 50 at the patient receiving device 100 or at the examination table 101. The "disengageable" means in this context, in particular, that the positioning device 10 can be installed quickly and, in particular, without installation tools during operation of the system 1. The mounting section 50 can, for example, be designed to interact appropriately with a possible guide element 102 of the examination table 101 in order to realize a releasable connection. The guide element 102 can have, for example, a recess into which a corresponding counterpart of the mounting section 50 can be inserted. Instead, the guide element 102 can have a bolt-like projection which can engage with a corresponding recess of the mounting section 50. Furthermore, solutions with push buttons are conceivable, wherein one or more push button elements can be provided at the mounting section 50 and a corresponding counterpart can be provided at the examination table 101 (for example in the form of the above-described guide).

The positioning section 20 is placed at the mounting section 50. The positioning segment serves as a true reference frame for the interventional and/or therapeutic procedure. The positioning section 20 is designed such that it can be placed in the examination area of the first imaging modality 200 when the positioning device 10 is mounted on the patient receiving device 100. For this purpose, the positioning section 20 has a correspondingly adapted shape or size. The shape and size of the positioning section 20 can be adapted in particular to the size of a patient tunnel of a magnetic resonance apparatus as the first imaging modality 200. The positioning portion 20 is in particular designed in a planar manner. In the embodiment shown, the positioning section 20 has a positioning surface 21.

Furthermore, the positioning portion 20 in the embodiment shown has a guide portion 40 which can be placed in the positioning surface 21. The guide section 40 can be used to mechanically determine a reference position for an interventional and/or therapeutic procedure independently of the patient. Thus, for example, a reference position can be determined or determined from the image data determined by means of the first imaging modality 200. The reference position can then be used in a subsequent interventional and/or therapeutic procedure by mechanically determining the reference position by means of the guide section 40.

For this purpose, the guide section 40 can form a medical instrument for guiding an intervention, for example. The guide section 40 can be designed in particular such that the guidance in the presetting of the position and/or the feed direction is present in the plane of the positioning surface 21. By means of such a guidance section 40, a procedure planning which is carried out on the basis of the image data of the first imaging modality 200 can be directly carried out. Then, during the interventional medical procedure, only the interventional medical instrument has to be properly placed at the guide section 40.

This is advantageously supported by: the patient P is physically fixed in its position in relation to the patient accommodating apparatus 100 and thus also in relation to the positioning apparatus 10 mounted thereon by the positioning aid 103 according to an embodiment. If this cannot be ensured, the guide element 40 can have a marking device which projects optical markers onto the skin surface of the patient P. Such a marking device can be designed, for example, as a laser marking device. The optical markers can then be marked by the user on the skin surface of the patient P, for example by means of colour markers. The patient P can then be set in the correct position again during the ongoing intervention and/or treatment, so that the color markings coincide with the projected optical markings.

If the second imaging modality 300 is used during an interventional and/or therapeutic procedure, the guide section 40 can have a marking element 41, so that it can be detected, in particular, in a one-to-one correspondence, by means of the second imaging modality 300. Alternatively, the guide section 40 can also be designed such that it can be detected, in particular, in a one-to-one correspondence, by means of the second imaging modality 300. A one-to-one detectability can generally mean that, by the representation by the respective imaging modality, a marking is obtained, which is associated with the respective element (i.e., for example, the marking element 41 or the guide element 40 or the marking section 30) in a one-to-one correspondence. The relative position of the locating device 10 with respect to the image data determined by means of the second imaging modality 300 can thus be detected. Since the reference position of the guide section 40 is determined on the basis of the image data determined by means of the first imaging modality 200, a relationship between the coordinates of the first imaging modality 200 and the coordinates of the second imaging modality 300 can be established or a determination made by the first imaging modality 200 can be checked.

Additionally, the guide element 40 or the marking element 41 can also be designed such that they can also be detected, in particular in a one-to-one correspondence, by means of the first imaging modality 200. Thereby, the guide element 40 or the marker element 41 can be used, for example, to determine and/or correct a possible delineation error of one of the two

imaging modalities

200, 300. Therefore, spatial distortions can occur in magnetic resonance imaging, for example, due to inhomogeneities in the magnetic field. The spatial distortion can then be identified or corrected, or existing corrections can be adjusted, for example by comparative delineation with the X-ray device as the second imaging modality 300.

This can also be used for quality control if the guide element 40 or the marker element 41 can be detected by means of the first imaging modality 200. Thus, it can be simply checked that: when the guide section 40 is placed at a reference position in the positioning surface 21, it is also true whether the guide element 40 or the marking element 41 is present at the determined reference position.

Since the positioning section 20 or the positioning surface 21 is intended to serve as a reference frame for marking a reference position for performing a medical procedure which is directed to a target object in the anatomical region of the patient P, it is advantageous if the positioning device 10 at least partially covers the anatomical region by means of the positioning surface 21. This has the following effect when delineating an anatomical region by the first or second imaging modality 200, 300: at least partially together depicting the positioning section 20 or the positioning face 21 of the positioning apparatus 10. In other words, the positioning section 20 with the positioning face 21 defines an examination volume UV in which an anatomical region of the patient P can be arranged for imaging. If the examination volume UV is depicted, the anatomical region of the patient P accommodated therein is thus depicted.

The positioning surface 21 can have a frame element 21a and a face element 21 b. The locating surface 21 can be composed of a material that is not detectable by the first and/or

second imaging modalities

200, 300. Alternatively, the frame element 21a and/or the surface element 21b can be composed of a material that is detectable by means of the first and/or

second imaging modalities

200, 300. The surface elements 21b can be designed as grid elements. The grid element and/or the guide element 40 can be designed such that the guide element 40 can be inserted into the grid space to determine the reference position. Alternatively, the positioning surface 21 and the guide element 40 can also be designed in addition such that the guide element 40 can be placed and fixed in the positioning surface 21 to determine the reference position. The positioning surface 21 can also have a position detection module, by means of which the current setting position of the guide element 40 can be automatically detected.

The positioning section 20 can be designed such that it additionally, possibly in cooperation with the placement aid 103, physically determines the position of the patient P and thus of the anatomical region. For this purpose, the patient P can be placed against the positioning section 20. For this purpose, the mounting section 50 and/or the frame element 21b can be designed in a correspondingly stable manner, whereby the positioning section 20 can suitably support the respective body part of the patient P.

In order to be able to use the positioning device 10 as a reference frame for combined imaging and interventional and/or therapeutic procedures, according to some embodiments, the relative positional relationship between the positioning device 10 and the anatomical region or target object to be delineated should be known or derivable. For this purpose, the inventors have proposed two alternative possibilities which can, however, also be combined with one another.

On the one hand, the relative position between the anatomical region and the positioning device 10 can be determined indirectly via the patient receiving device 100 or the examination table 101. The protocol is based on the patient P always being arranged on the table 101 in a defined position. This can be achieved, for example, by means of the placement aid 103. Then, if the positioning device 10 is also mounted at the examination table 101 in a defined positional relationship, a relative positional relationship between the anatomical region and the positioning device 10 is determined. For this purpose, the mounting section 50 can be configured such that the positional relationship between the examination couch 101 and the positioning apparatus 10 is determined during mounting.

Alternatively, the locating device 10 can have marking sections 30 which are integrated into the locating device 10 and can be detected, in particular, in a one-to-one correspondence, by means of the first imaging modality 200. Thereby, the positioning device 10 and the anatomical region or target object can be co-located in the delineation of the examination volume UV. Advantageously, the marking section 30 is also designed such that it can additionally be detected by means of the second imaging modality 300. As explained, for example, in connection with the marking element 41, additional quality monitoring is thus possible. In particular, possible delineation errors of one of the two

imaging modalities

200, 300 can be compensated. The marking section 30 can, for example, be incorporated into the mounting section 50 or into or mounted on the positioning section 20. The marking section 30 can in particular be incorporated into or mounted on the frame element 21a and/or the surface element 21 b. The cell shown in fig. 3 can be designed, for example, as a marking section 30.

In fig. 3, only one guide element 40 is shown for a better overview. However, the positioning device 10 can also have more than one guide element 40 and in particular at least two guide elements 40. The use of a plurality of guide elements 40 increases the flexibility in determining a feasible reference position. In particular, more than two reference positions can be determined for different target objects in the anatomical region, if necessary. If the guide elements 40 each have a marker element 41 or are themselves detectable by the first and/or

second imaging modality

200, 300, the feasibility of quality monitoring is further extended, since possible spatial distortions can be directly checked during imaging by the first imaging modality 200, for example, by means of a known distance between the two guide elements 40 or marker elements 41 and the imaging by the first imaging modality 200, for example. Furthermore, by using a plurality of guide elements 40, the position of the target object in the anatomical region can be determined more accurately from different directions. When three guide elements 40 are used, triangulation can be performed here, for example.

Another embodiment of the positioning device 10 is shown in fig. 4. For better illustration, fig. 5 shows a schematic illustration of the positioning device 10 from fig. 4 in the installed position on the patient receiving device 100 or on the table 101.

In contrast to the positioning device 10 shown in fig. 3, the positioning section 20 has three

positioning surfaces

22, 23 and 24. The positioning surfaces 22, 23 and 24 are essentially designed as the positioning surface 21 in fig. 3. The positioning surfaces 22, 23 and 24 are arranged such that they span the patient P accommodated on the patient accommodating apparatus 100 in the transverse direction L of the patient P. The examination volume UV expanded by the positioning section 20 is bounded on three sides by in each case one of the positioning surfaces 22, 23 and 24. On the fourth side, the examination volume UV is then delimited by the patient receiving device 100. If the anatomical region of the patient P is, for example, the chest region, the positioning section 20 can span the chest region of the patient P. The mounting section 50 is then expediently designed such that the positioning device 10 can be mounted on the patient support device 100 at two locations, which can be arranged, for example, at two opposite longitudinal sides of the patient support device 100 or the examination table 101. Each

positioning surface

22, 23 and 24 can have one or more guide sections 40.

Other forms besides the illustrated embodiment are also contemplated. For example, the positioning section 20 can also have a further positioning surface and/or be formed in an arcuate or portal shape. Furthermore, the positioning section 20 can be adapted to the anatomy of the body region of the patient P to be subjected to the procedure, for example to the female breast or thigh.

In the following figures, a method for using the positioning apparatus 10 in an integrated imaging and interventional and/or therapeutic medical procedure is presented. The method is suitable here for locating the target object in the examination volume UV or for quality assurance (but not for the intervention or the treatment itself).

Fig. 6 shows a schematic view of an embodiment of the proposed method for localizing a target object in an anatomical region of a patient P during an integrated imaging and interventional and/or therapeutic medical procedure. The order of the method steps is not limited by the order shown or by the number selected. Therefore, the order of steps can be interchanged and individual steps can be omitted, if necessary.

In a first step S10, the positioning device 10 can be mounted on the patient accommodating device 100 or on the examination table 101. For this purpose, the mounting section 50 can be engaged with the patient accommodation device 100 or the examination table 101, for example. The configuration shown in fig. 5 can then be produced, for example. By means of the mounting, an examination volume UV, in which the anatomical region of the patient P to be examined and/or treated can be set or accommodated, is spread on the examination table 101 by means of the positioning section 20. Thereby, when the examination volume UV is delineated by means of the first or

second imaging modality

200, 300, the anatomical region and the positioning apparatus 10 or the positioning section 20 thereof can be detected at least partially from the detection region of the first or

second imaging modality

200, 300. Step S10 can be performed, for example, by a user of the positioning device 10, such as, for example, a doctor or a medical assistant.

In a second step S20, the patient P can be arranged on the patient support apparatus 100 or on the examination table 101, to be precise in particular such that the relevant anatomical region of the patient P is arranged in the examination volume UV expanded by the positioning section 20. In other words, the positioning section 20 then at least partially covers the anatomical region of the patient P in a top view of the positioning section 20 and the patient P lying behind it. Preferably, the patient is physically secured in said position with the placement aid 103. Step S20 can in turn be performed, for example, by the user of the positioning device 10.

In a further step S30, image data of the first imaging modality 200 is received, the image data showing an anatomical region of the patient P. To create the image data, the examination volume UV is placed in the examination area of the first imaging modality 200, for example by suitably moving the patient accommodating apparatus 100. Thus, the anatomical region of the patient P and the positioning apparatus 10 or the positioning section 20 thereof are at least partially accommodated in the detection region of the first imaging modality 200. Thus, the image data obtained from the examination region by the first imaging modality 200 can display the anatomical region of the patient P and optionally at least partially the positioning section 20 (depending on whether the positioning section 20 contains material detectable by the first imaging modality 200, for example in the form of one of the

elements

30, 40 or 41). The image data can be received, for example, by a processing device 500 (which is thus correspondingly configured). The image data received in this way can be provided to the user by the processing device 500 (which is then correspondingly configured) via a user interface.

In a further step S40, the localization object 10 is registered with the coordinate system of the first imaging modality 200. In other words, the relative position of the mapped anatomical region with respect to the positioning device 10 is determined. For this purpose, different possibilities can be used in step S40, which can however also be combined with one another. On the one hand, such a relative position can be derived from geometric or mechanical conditions of the system 1, in particular if, for example, the relative position of the patient P on the patient support device 100 can be determined sufficiently by the positioning aid 103. If the patient support device 100 is also registered with the first imaging modality 200 and the relative installation position of the positioning device 10 at the patient support device 100 is known, the positional relationship between the image data and the positioning device 10 can be derived therefrom. Alternatively or additionally, for registering the locating device 10 with the image data, a marker section 30 integrated into the locating device 10 according to some embodiments can be used, which can be detected by means of the first imaging modality 200. By delineating the examination volume UV, detection signals corresponding to the marker segments 30 are then obtained, from which detection signals the relative position of the marker segments 30 and thus of the positioning device 10 in the image data with respect to the accommodated anatomical region can be derived. The registration of the positioning device 10 according to step S40 with the first imaging modality 200 or with the image data can preferably be carried out automatically by the (thus correspondingly constructed) processing means 500.

In a further step S50, user input regarding one or more target objects for the interventional and/or therapeutic procedure can be received based on the image data. For this purpose, the user can mark the target object in the image data, for example by means of a user interface. User input is preferably received by the processing means 500 (which is accordingly correspondingly configured).

In step S60, a path or treatment plan is created based on the user input. The path or treatment plan can, for example, preset how the interventional instrument has to be guided to the target object or how the radiotherapy device has to be set up in order to perform the desired action in the target object. Based on the user input and/or the path or treatment plan, a reference position placed outside the patient P can also be calculated, which is a reference position for performing an interventional or therapeutic treatment. The reference position is thus determined such that it is provided in, on or at the positioning section 20. Therefore, the calculation of the reference position is preferably based on the registration determined in step S40 between the image data and the positioning device 10. Thus, if no imaging monitoring is provided by the

imaging modalities

200, 300 or the target object cannot or cannot be optimally detected by means of the second imaging modality 300 used, the target object for the interventional or therapeutic procedure can also be located by means of the reference position. The calculation of the reference position based on the user input and the registration of the positioning device 10 with the image data can preferably be performed automatically by the processing means 500 (which is then correspondingly constructed).

In step S70, the reference position calculated in step S60 can be output to the user via the user interface. This can therefore be understood as an instruction to the user: where and how the guide section 40 must be arranged on the positioning section 20 in order to indicate the reference position and, if necessary, to preset the setpoint for the interventional and/or therapeutic procedure. Step S70 is preferably executed by the processing means 500 (which is accordingly correspondingly configured).

Finally, the guide section 40 is set by the user at the reference position in step S80. Subsequently, the patient P can be transferred by means of the patient accommodation device 100 to the interventional and/or therapeutic device 400, where the interventional or therapeutic procedure is then carried out. The coordinates and/or the path of the calculated reference position or the treatment plan can be provided here by the processing means 500 (thus correspondingly constructed) to the interventional and/or therapeutic device 400.

The method of fig. 6 is described for simplicity with respect to the guide section 40. However, it is also possible to use several guide sections 40, for which separate reference positions can be preset in each case. This can improve the accuracy of the reference position preset for the interventional or therapeutic procedure and also opens up further possibilities in terms of quality assurance.

The steps illustrated in fig. 6 do not necessarily require that one or more guide sections 40 can be detected or have a marking element 41 by the first and/or

second imaging modalities

200, 300. If this is the case, this design can nevertheless open up further possibilities in terms of quality assurance and/or path or therapy planning. This is exemplarily shown in some of the following embodiments.

Fig. 7 shows a schematic view of an embodiment of the proposed method for locating a target object in an anatomical region of a patient P during an integrated imaging and interventional and/or therapeutic medical procedure. The order of the method steps is not limited by the order shown or by the selected numbering. Thus, the order of steps can be interchanged and individual steps can be omitted if desired. The step illustrated in fig. 7 can follow step S80 of fig. 6.

In step S110, an anatomical region of the patient P is first set into the region of action of the interventional and/or therapeutic device 400, so that one or more target objects can undergo interventional and/or therapeutic treatment by means of the interventional and/or therapeutic device 400. For this purpose, the patient receiving device 100 can be moved appropriately, for example, or the table 101 can be placed on a corresponding receiving means of the interventional and/or therapeutic device 400. The positioning device 10 remains mounted in the position set and used in steps S10 to S80 on the patient support device 10 and/or on the table 101.

Image data is received in step S120, in which an anatomical region of a patient is depicted by a second imaging modality 300. The image data can be received, for example, by a processing device 500 (which is thus correspondingly configured). For this purpose, it can be performed substantially as described in step S30. Thus, the image data thus obtained by the second imaging modality 300 enables the display of the anatomical region of the patient P and in particular of the marker element 41.

In step S130, the localization object 10 is registered with the coordinate system of the second imaging modality 300. For this purpose, it can be performed substantially as described in step S40. Step S130 can preferably be performed by the processing means 500 (which is accordingly correspondingly configured).

In step S140, the actual position of the marking element 41 and thus of the guide section 40 on the positioning section 20 is determined on the basis of the image data registering and displaying the marking element 41. Step S140 can preferably be executed by the processing means 500 (which is accordingly correspondingly configured).

Then, in step S150, the actual position can be compared with the reference position calculated in step S60. Then, in step S150, based on the comparison, a deviation between the actual position and the calculated reference position can be determined and/or corrected. Such deviations can be caused, for example, by delineation errors of the first imaging modality 200, by misalignments of the positioning device 10 by bringing the patient P to the interventional and/or therapeutic device 400, and/or by incorrect initial registration. If such deviations are determined, either the path or the treatment plan can be adjusted or the user can be prompted to correct the setting position of the guide section 40 by means of a corresponding output via the user interface. Alternatively, the initial registration can be corrected and/or the path or treatment plan can be adjusted. Step S150 is preferably executed by the processing means 500 (which is accordingly correspondingly configured).

The interventional or therapeutic procedure can then be carried out according to the adjusted path or therapy plan or the corrected set position of the guide section 40.

The method of fig. 7 is described for the guide section 40 for the sake of simplicity. However, it is of course also possible to use a plurality of guide segments 40, for which separate checking of the setting positions can then be carried out in each case. This can improve the accuracy of the reference position preset for the interventional or therapeutic procedure.

Fig. 8 shows a schematic view of an embodiment of the proposed method for locating a target object in an anatomical region of a patient P during an integrated imaging and interventional and/or therapeutic medical procedure. The order of the method steps is not limited by the order shown or by the number selected. Therefore, the order of steps can be interchanged and individual steps can be omitted, if necessary. The step shown in fig. 8 can follow step S80 of fig. 6.

In step S210, image data is received in which an anatomical region of a patient P is delineated by a first imaging modality 200. The re-drawing in step S210 can be performed some time after the first drawing. In principle, this can be done as in step S30. Since the guide section 40 in the embodiment described has the marking element 41 or is detectable by the first imaging modality, the guide section 40 is visible in the image data. The image data can be received, for example, by the processing device 500 (which is correspondingly configured).

In step S220, the position of the marker element 41 and thus of the guide element 40 on the positioning section 20 is calculated on the basis of the image data and the registration found in step S40. Step S220 is preferably performed by the processing means 500 (which is accordingly correspondingly configured).

Then, in step S230, the calculated position can be compared with the reference position calculated in step S60. Step S230 is preferably performed by the processing means 500 (which is accordingly correspondingly configured).

Then, in step S240, based on the comparison, a deviation can be determined and/or corrected. Such deviations can be caused, for example, by a delineation error of the first imaging modality 200, a misalignment of the positioning device 10, or an overly inaccurate registration. Based on this, a user output can then be provided to the user via the user interface, which informs the user about possible quality problems. Further, other measures can be arranged based on the comparison result. For example, interventional or therapeutic procedures can be prohibited. Furthermore, an adjustment of the recalibration or registration of the positioning device 10 or an adjustment of the path or the treatment plan can be arranged. Step S240 is preferably performed by the processing means 500 (which is accordingly correspondingly configured).

The method of fig. 8 is described for the guide section 40 for simplicity. However, it is of course also possible to use a plurality of guide sections 40, for which separate tests can then be carried out for the setting positions. This can improve the accuracy of the reference position preset for the interventional or therapeutic procedure.

It is not expressly stated, but rather reasonable, that the various embodiments, sub-aspects or features thereof may be combined or interchanged with one another without departing from the scope of the utility model. Where applicable, the advantages of the utility model described with reference to the embodiments apply also to other embodiments, without explicit mention.

The following are also part of the disclosure:

1. a localization device (10) for localizing one or more target objects in an anatomical region of a patient (P) during an integrated imaging and interventional and/or therapeutic medical procedure; wherein:

a patient is disposed on a patient containment device (100) during a medical procedure;

during a medical procedure, an anatomical region of a patient (P) is placed in a detection region of a first imaging modality (200) by suitably positioning the patient receiving device (100) and delineated by means of the first imaging modality (200) to detect one or more target objects; and

a positioning device (10) is provided with:

a mounting section (50) which is designed such that the positioning device (10) can be detachably mounted on the patient-receiving device (100) and can be positioned relative to the patient-receiving device (100);

a positioning section (20) which is designed such that it can be arranged at least partially in a detection region of the first imaging modality (200) by means of a suitable mounting of the positioning device (10) on the patient receiving device (100); and

a guiding section (40) which can be arranged in and relative to the positioning section (20) for indicating a reference position relative to the positioning section (20), which serves as a reference position for performing an interventional and/or therapeutic procedure facing one or more target objects.

2. The positioning apparatus of claim 1, wherein:

the positioning section (20) is designed in such a way that the positioning section (20) expands an examination volume (UV) for receiving an anatomical region to be delineated; and is

The mounting section (50) is designed such that the positioning device (10) can be detachably mounted on the patient receiving device (100) such that the positioning device (10) can be positioned relative to the patient receiving device (100) such that the anatomical region to be delineated is accommodated in the examination volume (UV) when the patient is arranged on the patient receiving device (100).

3. Positioning device (10) according to any one of the above points, wherein

The positioning section (20) and/or the guide section (40) are designed such that the guide section (40) can be arranged in a reference position in the positioning section (20) and is in particular fixed in the reference position.

4. A positioning device (10) according to any one of the above points, wherein

The guiding section (40) is designed for guiding the interventional device during an interventional procedure.

5. Positioning device (10) according to any one of the above points, wherein

The guide section (40) is designed as a placement aid for the treatment device during the treatment process.

6. Positioning device (10) according to any one of the above points, wherein

The positioning section (20) is designed such that it spans the patient (P) accommodated on the patient accommodating device (100) in the transverse direction (L) of the patient (P) when the positioning device (10) is mounted on the patient accommodating device (100).

7. A positioning device (10) according to any one of the above points, wherein

The positioning section (20) has three positioning surfaces (22, 23, 24) which are designed such that, when the positioning device (10) is mounted on the patient-receiving device (100), the positioning section (20) spans the patient (P) received on the patient-receiving device (100) in the transverse direction (L) of the patient (P).

8. Positioning device (10) according to point 7, wherein

Each positioning surface (22, 23, 24) has associated therewith at least one guide section (40) which can be placed in the respective positioning surface (22, 23, 24).

9. A positioning device (10) according to any one of the above points, wherein

The positioning section (20) is designed to physically fix the setting position of the patient (P) relative to the positioning device (10), in particular by means of at least partial contact with the patient (P).

10. A positioning device (10) according to any one of the above points, wherein

The positioning section (20) has a grid, in particular grid-shaped, for supporting the arrangement of the guide element (40) in the positioning section (20).

11. A localization system for localizing one or more target objects in an anatomical region of a patient (P) during an integrated imaging and interventional and/or therapeutic medical procedure, the localization system having:

-a positioning device (10) according to any one of the above points; and

a patient accommodating device (100).

12. A positioning system according to point 11, wherein

The patient accommodating device (100) is designed such that the installation position of the patient (P) relative to the patient accommodating device (100) can be physically fixed.

Claims

1. A localization device (10) configured for localizing one or more target objects in an anatomical region of a patient (P) during an integrated imaging and interventional and/or therapeutic medical procedure; wherein:

during the medical procedure, the patient (P) is positioned in a patient accommodation device (100);

during a medical procedure, placing an anatomical region of the patient (P) in a detection region of a first imaging modality (200) by placing the patient accommodating apparatus (100) in position and delineating by means of the first imaging modality (200) to detect the one or more target objects;

the positioning device (10) has:

a mounting section (50), the mounting section (50) being designed such that the positioning device (10) can be detachably mounted on the patient receiving device (100) and is positioned relative to the patient receiving device (100);

a positioning section (20), the positioning section (20) being designed such that it can be arranged at least partially in a detection region of the first imaging modality (200) by means of a suitable mounting of the positioning device (10) on the patient receiving device (100);

a guiding section (40) that can be arranged in and relative to the positioning section (20) for marking a reference position relative to the positioning section (20), the reference position being used as a reference position for performing an interventional and/or therapeutic procedure facing the one or more target objects; and

a marker section (30), the marker section (30) being designed such that it can be detected by means of the first imaging modality (200), wherein

The marking section (30) is also designed such that it can be detected by means of a second imaging modality (300); wherein

The second imaging modality (300) implements a different imaging method than the first imaging modality (200).

2. Positioning device (10) according to claim 1, wherein

The marking section (30) is integrated into the positioning section (20).

3. Positioning device (10) according to claim 1 or 2, wherein

The guide section (40) is designed such that it can be detected by means of the first imaging modality.

4. Positioning device (10) according to claim 3, wherein

The guide section (40) is designed such that it can be detected by a second imaging modality (300).

5. Positioning device (10) according to claim 4, wherein

The second imaging modality (300) is used during an interventional and/or therapeutic procedure.

6. Positioning device (10) according to claim 1 or 2, wherein

The positioning device (10) has a plurality of guide sections (40), wherein the plurality of guide sections (40) can be arranged independently of one another in the positioning section (20) in order to indicate a plurality of different reference positions.

7. Positioning device (10) according to any of claims 1 or 2, wherein

The positioning section (20) has a plurality of positioning surfaces (22, 23, 24) which are designed in such a way that they enclose the anatomical region of the patient (P) on different sides when the patient (P) is accommodated on the patient-accommodating device (100) and the positioning device (10) is mounted on the patient-accommodating device (100).

8. Positioning device (10) according to claim 7, wherein

At least one guide section (40) is associated with each positioning surface (22, 23, 24), wherein the at least one guide section (40) can be placed in the respective positioning surface (22, 23, 24).

9. A localization system configured for localizing one or more target objects in an anatomical region of a patient (P) during an integrated imaging and interventional and/or therapeutic medical procedure, the localization system having:

the positioning device (10) according to any one of claims 1 to 8; and

a patient accommodating device (100).