DE102007043729A1 - Medical system for e.g. endoscopic surgery, has X-ray window arranged in magnetic coil system, and X-ray diagnostic system with X-ray emitter emitting X-ray radiation that is irradiated into three-dimensional work space through window - Google Patents

Abstract

The system has a magnetic coil system (1) with a three-dimensional work space (3) into which a study object (4) is partially inserted. Controllable single coils (2) of the coil system generate base magnetic field for non-contact force exertion on a miniaturized medical instrument (6). An X-ray diagnostic system (10) includes an X-ray detector (13) arranged in an inner side of the work space. An X-ray window (8) is arranged in the coil system. An X-ray radiation emitted by an X-ray emitter (11) of the diagnostic system is irradiated into the work space through the window.

Description

The The invention relates to a medical system.

surgical Operations today require one in most cases large opening of the body to with the surgical instruments to reach the target area and in the target area the necessary measures with the to perform surgical instruments. Minimally invasive surgical techniques are mostly targeted in the outer areas of the body and on relative limited to simple procedures.

Around to expand the scope of minimally invasive therapies and new applications for minimally invasive therapies The EURO-NOTES research fund was founded. NOTES (Natural Orifice Translumenal Endoscopic Surgery - translumenal endoscopic surgery over natural orifices) for a new type of multidisciplinary procedure with great potential for future minimally invasive Therapies that reduce the burden on the patients and the Convalescence shortens.

An endoscopy system with a magnetic coil system is z. B. from the DE 101 42 253 C1 known. The magnet coil system has a working space into which a patient is at least partially insertable. With this magnet coil system, an endoscopy capsule, which is termed an "endorobot" and has a magnetic moment, can be magnetically navigated within the working space to a selectable position in a hollow organ of the patient. For this purpose, a force and / or a torque is exerted on the endoscopy capsule (endorobot, endocapsule) without contact, in a predeterminable direction and strength. Thus, a so-called capsule endoscopy (Magnetically Guided Capsule Endoscopy - MGCE) can be performed on the patient, in which the endocapsule in the patient is targeted and arbitrarily be moved. The endocapsule has at least one camera for imaging.

For a MGCE suitable magnetic coil systems are also, for example, in the DE 103 40 925 B3 and in the DE 10 2005 007 631 A1 as well as in the DE 10 2005 032 289 A1 and in the DE 10 2005 010 489 B4 disclosed.

In the filed on 02.08.2007 German patent application with the file number 10 2007 036 242.2 a medical system is described whose magnetic coil system can be used both for MR imaging (magnetic resonance imaging) and for magnetic navigation of an endoscopy capsule. In this technically demanding and thus expensive medical system, MR imaging can not take place in the vicinity of the endoscopy capsule, if it is designed as an endo-robot, that is to say has a permanent magnet. The reason for this is the near field of the permanent magnet. Thus, only one passive endoscopy capsule may be used for simultaneous MR imaging. When using a magnetically navigable endoscopic capsule, it must be removed from the body prior to MR imaging.

From the via the URL " http://www.priorartdatabase.com / retrievable "publication "Apparatus and method for navigation of capsules in the body under ultrasound control" There is described a medical system comprising an MGCE system and an ultrasound system. The ultrasonic head of the ultrasound system is equipped with markers that enable detection of the 3D location and the solid angle in the MGCE system. The magnet coils of the MGCE system exert forces on the endoscopy capsule so that it always remains at a fixed point to the ultrasound image or is carried along according to the movement of the ultrasound head. The movement of the ultrasound head is done by hand or by a robot arm. Due to the limited working space, this is problematic.

The DE 10 2005 032 370 A1 A medical system is known which comprises a magnet coil system for navigating an endoscopy capsule and an X-ray system for radiographically measuring the position (location and solid angle) of this endoscopy capsule. In the known medical system, a position detection of the endoscopy capsule is enabled, which is not influenced by the navigation magnetic fields of the magnetic coil system.

task the present invention is to provide a medical system which allows for improved diagnosis and / or therapy.

The The object is achieved by a medical System solved with the features of claim 1. advantageous Embodiments of the invention are each the subject of further Claims.

• – ein Magnetspulensystem mit einem dreidimensionalen Arbeitsraum, in den ein Untersuchungsobjekt zumindest teilweise einbringbar ist, und mehreren, einzeln ansteuerbaren Einzelspulen zur Erzeugung mindestens eines Grundmagnetfeldes zur vorgebbaren berührungsfreien Kraftausübung auf ein miniaturisiertes medizinisches Gerät, das ein magnetisches Moment aufweist und innerhalb des Arbeitsraumes an eine wählbare Stelle in einem Hohlorgan des Untersuchungsobjektes magnetisch navigierbar ist,
• – ein Röntgendiagnosesystem mit wenigstens einem Röntgenstrahler und wenigstens einem Röntgendetektor, der innerhalb des Arbeitsraumes angeordnet ist, wobei
• – im Magnetspulensystem wenigstens ein Röntgenfenster angeordnet ist, durch das die von dem wenigstens einen Röntgenstrahler emittierte Röntgenstrahlung in den Arbeitsraum einstrahlbar ist.

The medical system of claim 1 comprises

• - A magnetic coil system with a three-dimensional workspace into which an examination object is at least partially introduced, and a plurality of individually controllable individual coils for generating at least one basic magnetic field for specifiable non-contact force on a miniaturized medical device having a magnetic moment and within the working space to a selectable Place in egg a hollow organ of the examination subject is magnetically navigable,
• - An X-ray diagnostic system with at least one X-ray source and at least one X-ray detector, which is disposed within the working space, wherein
• - In the magnetic coil system, at least one X-ray window is arranged, through which the X-radiation emitted by the at least one X-ray source can be irradiated into the working space.

Within the scope of the invention, the miniaturized medical device which has a magnetic moment can be, for example, a flexible endoscope or a catheter. The endoscope or the catheter can be magnetically navigated to a selectable position in a hollow organ of the examination subject. Such an endoscope is z. B. from the WO 2007/081039 A2 known. A suitable catheter for the medical system according to the invention has an integrated magnetic moment in the region of its tip and is thereby magnetically navigable. In addition, both push and pull forces can be exerted on the catheter through a catheter guidewire. Preferably, the miniaturized medical device, which has a magnetic moment, is designed as a magnetically navigable endoscopy capsule. Such endoscopy capsules are described for example in the publications mentioned above.

in the The following is for the notes to the medical System according to the invention always the term "endoscopy capsule" used. However, it will be understood by those skilled in the art itself that the invention also other miniaturized medical Devices that are magnetic in the hollow organ of an examination object navigable includes.

With The medical system according to claim 1 may be endoscopic Investigation by means of a magnetically navigable endoscopy capsule and an X-ray examination without rearrangement of the patient be carried out in parallel. This can be endoscopic and radiographic findings are created in parallel. Compared to an endoscopy and an x-ray examination, the spatially separated and thus carried out sequentially the diagnostic safety is significantly increased and In addition, the diagnostic time significantly reduced.

With the medical system according to the invention the endoscopic examination and the X-ray examination be carried out in succession without any rearrangement of the Patients is required. For example, in one first X-ray examination determined position of a closer to be examined area in the X-ray image or in the x-rays are entered and the endoscopy capsule then be navigated to this position. Vice versa may also be recognized by the endoscopy capsule vascular problem subjected to a subsequent X-ray examination become. The position of the vascular problematic Area can in the X-ray image or in the X-ray images be registered.

About that In addition, the medical system according to the Invention also for a standardized X-ray examination, So for a medical examination without endoscopy capsule, be used.

All endoscopic and radiographic examinations If necessary, with a contrast agent.

at a particularly preferred embodiment of the invention, in which the X-ray system comprises two X-ray sources, with their associated x-ray detectors in arranged at an angle of 90 °, can simultaneously radiographed from two directions (two-plane x-ray imaging, biplan). This may cause a possible vascular problem be detected faster and localized more accurately (quasi-3D imaging) and the endoscopy capsule may be targeted to this problematic area to be navigated. Furthermore will also be the navigation of the endoscopy capsule in this area improved by the biplane X-ray images. Farther can be positions of vascular problematic Areas in the X-ray image or in the X-ray images including their spatial allocation.

at corresponding embodiment of the magnetic coil system can the X-ray source and the associated X-ray detector around the workspace and thus around the patient (object under examination) to move around. This is a 3D imaging analogous to computed tomography possible.

following is a schematically illustrated embodiment of a medical system according to the invention in the Drawing explained in more detail, but without it to be limited. The only figure shows the medical System in a cross section.

The exemplary embodiment of a medical system according to the invention explained below comprises a magnet coil system 1 with several, individually controllable individual coils for generating at least one basic magnetic field.

The magnet coil system 1 corresponds essentially to that from the DE 103 40 925 B3 be knew magnet coil system of fourteen controllable single coils.

Due to the selected representation of the individual coils in the drawing, only the single coil 2 visible in cross section.

The magnet coil system 1 forms a three-dimensional working space 3 , into an object under investigation 4 (Patient) is at least partially recoverable. The patient 4 is this on an examination table 5 stored.

That of the single coils 2 The basic magnetic field generated serves for the specifiable non-contact exertion of force on a miniaturized medical device 6 , which is formed in the illustrated embodiment as an endoscopy capsule. The endoscopy capsule 6 indicates due to an integrated permanent magnet 7 a magnetic moment and is within the working space 3 to a selectable location in a hollow organ of the patient 4 magnetically navigable.

Such an endoscopy capsule is for example from the DE 101 42 253 C1 known. This endoscopy capsule has funcionalities of a conventional endoscope, z. B. Video recording, biopsy, drug administration. With such an endoscopy capsule, a medical procedure can be carried out independently, ie wirelessly or catheter-free.

Furthermore, in the filed on 28.03.2006 German patent application 10 2006 014 339.6 a magnetically navigable endoscopy capsule described, in whose housing a radiation source is arranged.

At the time of the DE 10 2005 032 368 A1 known Endoskopiekapsel, also called "Endoratte", the permanent magnet is arranged in a decoupled from the rest of the capsule housing portion. The disconnectable housing section is connected to an extension extending outside the patient (hose). If necessary, the detachable housing portion containing the permanent magnet can be separated from the rest of the capsule housing and pulled together with extension of the patient. Thus, the endoscopy capsule no longer has a magnetic moment.

The endoscopy capsule 6 is in the cavity at the selected location, which has a vascular problem, for example by means of a in the DE 103 36 734 A1 can be fixed and remains there, even if the magnet system 1 switched off and so that the magnetic moment is removed.

In the magnet coil system 2 In the illustrated embodiment, two further X-ray windows 8th and 9 arranged. According to the invention, at least one X-ray window must be provided. In the context of the invention, however, more than two X-ray windows are possible.

The medical system shown in the drawing further comprises an X-ray diagnostic system 10 with two x-ray tubes 11 and 12 and in each case one associated X-ray detector 13 respectively. 14 , The X-ray source 11 and 12 are in the embodiment shown in the drawing outside of the magnet coil system 1 arranged. The X-ray source 11 and 12 as well as the x-ray detectors 13 and 14 can be manually or automatically moved to the required position.

The X-ray source 11 and 12 can be equipped with manually or automatically movable panels. This allows the X-ray dose to a limited volume, z. B. the current location of the endoscopy capsule 6 to be restricted.

Both x-ray detectors 13 and 14 are inside the workroom 3 each in the beam path of the X-ray source 11 respectively. 12 arranged. The beam path is symbolized by dashed lines. The beam path of the X-ray source 11 passes through the X-ray window 8th whereas the beam path of the X-ray source 12 through the X-ray window 9 runs. In the context of the invention, the X-ray diagnostic system 10 also comprise more than two X-ray emitters and more than two X-ray detectors.

The X-ray detectors 13 and 14 are formed in the illustrated embodiment as space and space-saving flat panel detectors.

In the drawing, two possible shapes for the X-ray detectors are shown. The x-ray detector 13 is arcuate in shape and the curvature of the single coil 2 customized. In contrast, the X-ray detector 14 executed plan. The x-ray detector 14 can thus also be used for other X-ray systems, for example C-arm X-ray systems.

According to an advantageous embodiment, the magnetic coil system 1 at least one mechanical holding element for at least one of the x-ray detectors 13 and 14 be arranged, wherein advantageously the mechanical holding element in each case of a GRP material (GFK - glass fiber reinforced plastic) or an AFK material (AFK - aramid fiber reinforced plastic) consists. This allows the preferably designed as flat panel detectors X-ray detectors 13 and 14 at the optimal for the particular application Positions within the workspace 3 be installed. The retaining elements are not shown in the drawing for reasons of clarity.

in the illustrated embodiment, two X-ray source used simultaneously. However, it is also within the scope of the invention possible to use only an x-ray source is, which is then arranged pivotally expedient, so he at least before another x-ray window can be positioned.

In the context of the invention, the X-ray detectors 13 and 14 not permanently installed. Rather, variants are possible in which the X-ray detectors 13 and 14 can be pulled out and / or movable, so that the X-ray detector or the X-ray detectors can be positioned depending on the clinical issue.

According to a further variant, at least one of the X-ray detectors 13 and 14 along the longitudinal axis of the magnet coil system 1 (in the selected representation into the plane of the drawing into) displaceable, so that tomosynthesis is possible. For this at least an X-ray window must be 8th respectively. 9 extend parallel to the longitudinal axis of the magnetic coil system.

In the illustrated, particularly preferred embodiment of the invention, the X-ray system comprises 10 two x-ray tubes 11 and 12 using their associated x-ray detectors 13 and 14 are arranged at an angle of 90 °, so that can be X-rayed simultaneously from two directions (two-plane x-ray imaging, biplan). This allows a possible vascular problem to be detected more quickly and localized more accurately (quasi-3D imaging) and the endoscopy capsule 6 be specifically navigated to this potentially problematic area. In addition, also the navigation of the endoscopy capsule 6 improved in this area by the biplane Rönt genbilder. Furthermore, positions of vascular problematic areas in the X-ray image or in the X-ray images can be entered including their spatial allocation.

The biplane X-ray possible with the medical system shown in the drawing can also simply be used for exact position and orientation determination. The required X-ray dose can be kept low by the use of a fluoroscopic dose and a small frame rate (<5 Hz), since the detection of the endoscopy capsule 6 in the two fluoroscopic images is easily possible. The position is then determined simply by an automatic detection of the endoscopy capsule 6 simultaneously in both X-ray images and combined with the knowledge of the recording geometries of the two emitter detector systems (each consisting of one X-ray emitter 11 respectively. 12 and an X-ray detector 13 respectively. 14 ). Because the geometry of the endoscopy capsule 6 exactly known is the automatic detection in "real-time" (eg by means of correlation method). The endoscopy capsule 6 only moves relatively slowly, so to the X-ray source 11 and 12 Also automatically controllable collimators can be used, which are only the endoscopy capsule 6 and illuminate the surrounding area. This leads to a significant reduction of the X-ray dose. In this case, the movement of the endoscopy capsule 6 even prediction, which leads to a simplification of the collimator movement. To improve the detectability of the endoscopy capsule 6 in the X-ray images could either the permanent magnet 7 be used or it could be additionally attached two small permanent magnetic metal beads.

In addition, this method can also be used to calibrate the electromagnetic position detection of the endoscopy capsule required for navigation 6 be made. Alternatively or additionally, this method can also serve for quality control of the position determination. If necessary, a correction of the position (location and solid angle) of the endoscopy capsule 6 and / or a correction of the control of the individual coils 2 of the magnetic coil system 1 be made.

The two x-ray detectors 13 and 14 can (according to a variant not shown in the drawing) in the geometry of the individual coils 2 to get integrated. Is at least one of the X-ray detectors 13 and 14 removable, then this X-ray detector can be used in conjunction with other X-ray systems (eg C-arm X-ray system). This would significantly improve the cost position of the medical systems concerned.

To switch off when magnetic coil system 1 and with the X-ray diagnostic system switched off 10 the patient 4 Without being able to administer medications or to be able to intervene, the embodiment shown in the drawing has a working window 15 on.

With the medical system according to the invention also the use of integrated manipulators for intervention assistance possible. This includes, for example, the use from in vivo cameras (fiber optic tube with optics) and percutaneously flexible Instruments.

Furthermore, it is also possible, thin and flexible le instruments regarding placement, positioning and movement control. In addition, the control of actuators (actuators) via magnetic fields (for example, μ-forceps movements, cutting, coagulation, grasping, laser also in combination with endoscopy capsules) can be realized.

• – Behandlungen von Knorpeldefekten in Kombination mit der Arthroskopie,
• – Behandlungen von Bandscheibenschäden,
• – gezieltes Einbringen von flexiblen Instrumenten bei NOTES (Natural Orifice Translumenal Endoscopic Surgery),
• – endoskopische Eingriffe mit gleichzeitiger Überwachung durch die Kamera einer Endoskopiekapsel 6,
• – endoskopische Chirurgie,
• – Behandlungen von früh erkannten Erkrankungen,
• – Kombinationseingriffe (zunächst Zielpunkt durch Endoskopiekapsel 6 positionieren und anschließend perkutan behandeln),
• – lokale Erwärmung zur Formveränderung von Implantaten aus einer Gedächtnislegierung.

Thus, a variety of medical options can be realized. Examples are:

• - Treatments of cartilage defects in combination with arthroscopy,
• - Treatments of disc damage,
• - targeted insertion of flexible instruments in NOTES (Natural Orifice Translumenal Endoscopic Surgery),
• - Endoscopic surgery with simultaneous surveillance by the camera of an endoscopy capsule 6 .
• - endoscopic surgery,
• - Treatments of early recognized diseases,
• - Combination procedures (initially target point through endoscopy capsule 6 position and then treat percutaneously),
• - Local heating to change the shape of implants from a memory alloy.

• – Kombination von Röntgen-Bildgebung und endoskopischer Bildgebung, aber auch reine Röntgen-Bildgebung oder reine endoskopische Bildgebung möglich,
• – Kombination aller Diagnosemöglichkeiten (Röntgendiagnose und/oder endoskopische Diagnose) mit verschiedenen Therapiemöglichkeiten und/oder mit operativen Maßnahmen (z. B. Biopsie),
• – Verwendung prä-operativer Bildgebung einschließlich Bildfusion möglich,
• – Exakte Positionsbestimmung mit einer reduzierten Röntgendosis oder gelegentliche Kontrolle der Qualität einer elektro-magnetischen Positionsbestimmung,
• – Reporting und Befundeintragung in Röntgenbilder.

Compared with the standard applications known from the prior art, the essential advantages of the solution according to the invention and of its advantageous embodiments can be summarized as follows:

• Combination of X-ray imaging and endoscopic imaging, but also pure X-ray imaging or pure endoscopic imaging,
• Combination of all diagnostic options (X-ray diagnosis and / or endoscopic diagnosis) with different therapeutic options and / or with operative measures (eg biopsy),
• - use of pre-operative imaging including image fusion possible,
• Exact position determination with a reduced X-ray dose or occasional check of the quality of an electro-magnetic position determination,
• - Reporting and findings in X-rays.

The inventive medical system allows thus an improved diagnosis and / or therapy.

QUOTES INCLUDE IN THE DESCRIPTION

This list The documents listed by the applicant have been automated generated and is solely for better information recorded by the reader. The list is not part of the German Patent or utility model application. The DPMA takes over no liability for any errors or omissions.

Cited patent literature

• - DE 10142253 C1 [0004, 0026]
• - DE 10340925 B3 [0005, 0022]
• DE 102005007631 A1 [0005]
• DE 102005032289 A1 [0005]
• DE 102005010489 B4 [0005]
• - DE 102007036242 [0006]
• - DE 102005032370 A1 [0008]
• WO 2007/081039 A2 [0012]
• - DE 102006014339 [0027]
• - DE 102005032368 A1 [0028]
• - DE 10336734 A1 [0029]

Cited non-patent literature

• - http://www.priorartdatabase.com [0007]
• - "Apparatus and method for navigation of capsules in the body under ultrasound control" [0007]

Claims (14)

Medical system comprising - a magnetic coil system ( 1 ) with a three-dimensional work space ( 3 ) into which an examination object ( 4 ) is at least partially einbringbar, and a plurality of individually controllable individual coils ( 2 ) for generating at least one basic magnetic field for predeterminable contactless application of force to a miniaturized medical device ( 6 ), which is a magnetic moment ( 7 ) and within the working space ( 3 ) to a selectable location in a hollow organ of the examination subject ( 4 ) is magnetically navigable, - an X-ray diagnostic system ( 10 ) with at least one X-ray source ( 11 . 12 ) and at least one X-ray detector ( 13 . 14 ) within the workspace ( 3 ), wherein - in the magnet coil system ( 1 ) at least one X-ray window ( 8th . 9 ) is arranged, through which the of the at least one X-ray source ( 11 . 12 ) emitted X-radiation into the working space ( 3 ) is einstrahlbar. The medical system of claim 1, wherein the miniaturized medical device ( 6 ), which is a magnetic moment ( 7 ), is designed as a magnetically navigable endoscopy capsule. A medical system according to claim 1 or 2, wherein each X-ray source ( 11 . 12 ) at least one X-ray detector ( 13 . 14 ) assigned. A medical system according to any one of claims 1 to 3, wherein the x-ray system comprises two x-ray emitters ( 11 . 12 ) with an associated x-ray detector ( 13 . 14 ), which are arranged at an angle of 90 ° to each other. A medical system according to any one of claims 1 to 4, wherein at least one X-ray source ( 11 . 12 ) outside of the magnet coil system ( 1 ) is arranged. Medical system according to one of the claims 1 to 5, wherein at least one X-ray source in a X-ray window is arranged. Medical system according to one of claims 1 to 6, wherein at least one X-ray window ( 8th . 9 ) in the circumferential direction of the magnetic coil system ( 1 ). Medical system according to one of claims 1 to 7, wherein at least one X-ray window ( 8th . 9 ) parallel to the longitudinal axis of the magnetic coil system ( 1 ). Medical system according to one of claims 1 to 8, wherein in the magnet coil system ( 1 ) at least one working window ( 15 ) is arranged. Medical system according to one of claims 1 to 9, wherein at least one X-ray detector ( 13 . 14 ) is designed as a flat-panel detector. Medical system according to one of the claims 1 to 10, wherein at least one X-ray detector in the magnetic coil system is integrated. Medical system according to one of the claims 1 to 11, wherein at least one X-ray detector removable is. Medical system according to one of claims 1 to 12, wherein on the magnetic coil system ( 1 ) at least one mechanical holding element for an x-ray detector ( 13 . 14 ) is arranged. The medical system of claim 13, wherein the mechanical mounting made of a GRP material or an AFK material consists.