DE102007044213A1 - Medical implant i.e. stent, image representation method for examination or treatment device, involves overlaying representation with X-ray-transillumination at position, and optically representing overlaid representation on monitor - Google Patents

Abstract

The method involves receiving an image sequence in X-ray-transillumination of a body region of a patient (5). A three dimensional volume pattern of the body region is produced from the image sequence. A position of an inserted medical implant is determined in the body region. A visual or symbolic representation of the implant is generated. The X-ray-transillumination is optically represented. The representation is overlaid with the X-ray-transillumination at the determined position. The overlaid representation is optically represented on a visualizing section i.e. monitor. An independent claim is also included for a medical device including a unit for communicating with a computer system.

Description

The The invention relates to a method and a device for coupled Image representation of at least one in a body region of interest of a patient to be implanted medical implant, in particular at least one stent, as part of a medical examination or treatment.

in the Case of stenosis or aneurysm, for example, in one Blood vessel or in other vessels, such as As gallbladder, urinary tract, bronchi, can Treatment of a diseased site implants, especially so-called Stents are introduced. Likewise, new ones Channels for blood flow by using a stent in an organ tissue, z. B. Liver be created. In a preliminary investigation Suitable implants are determined and selected. Possibly it is necessary to make several implants overlapping, to treat larger diseased areas.

Currently can vascular disease through an imaging System z. B. by generating a three-dimensional volume data set be visualized from a Rotationsangiographie. Therefor usually become so-called C-arm X-ray systems used in which X-ray tube and detector attached to a C-arm that moves freely around the patient is. Such systems enable real-time control interventional procedures such as angiography or catheter surgery by taking fluoroscopic images. From the thus obtained two-dimensional X-ray fluoroscopic images or projection images a three-dimensional volume image can be reconstructed.

With such an imaging system, a vascular analysis for stent planning can be performed, such as in US 2006/0184066 A1 is described. Furthermore, on a computer system or workstation, for. B. Siemens Leonardo generated a virtual image of a fully deployed stent, which can be used in a blood vessel. This is for example in Karmonik C. et al. "Stent-assisted coiling of intracranial aneurysms aided by virtual parent artery reconstruction", AJNR Am J Neuroradiol 2005, 26, pp. 2368-2370 described.

These Measures take place as part of a preliminary examination of the patient instead of. During the treatment it is for the doctor however difficult to use the stent deployment planned from the pre-examination possibly changed conditions, for example a patient movement and / or an anatomical change the body area of the patient to be treated and / or from a projection geometry change of the X-ray system (eg by changing the recording angle to produce the live x-ray fluoroscopic image), to adjust during the treatment.

It It is an object of the invention to provide the method and to design the device mentioned above in such a way to provide the best possible support during the treatment.

These The object is achieved by the features of the independent claims solved. Advantageous developments of the invention will become characterized in the dependent claims.

• a) Aufnahme einer Bildfolge von Röntgen-Durchleuchtungsbildern des interessierenden Körperbereichs,
• b) Erstellung eines dreidimensionalen Volumenbildes des interessierenden Körperbereiches aus der Bildfolge,
• c) Ermittlung einer geeigneten Position des einzubringenden Implantats im interessierenden Körperbereich,
• d) Erzeugung einer bildlichen oder symbolischen Darstellung des mindestens einen einzubringenden Implantats,
• e) Optische Darstellung zumindest eines aufgenommenen Röntgen-Durchleuchtungsbildes,
• f) Überlagerung der Darstellung aus Schritt d) mit dem zumindest einen Röntgen-Durchleuchtungsbildes aus Schritt e) an der in zumindest einen Röntgen-Durchleuchtungsbild entsprechenden ermittelten Position und
• g) optische Darstellung der Überlagerung auf zumindest einer Visualisierungsebene, insbesondere an einem Bildschirm.

According to the invention, a method is used for coupled imaging of at least one medical implant to be introduced into a body region of interest of a patient, in particular at least one stent, in the context of a medical examination or treatment, comprising the following steps:

• a) taking an image sequence of X-ray fluoroscopic images of the body region of interest,
• b) creation of a three-dimensional volume image of the body region of interest from the image sequence,
• c) determination of a suitable position of the implant to be introduced in the body region of interest,
• d) generating a pictorial or symbolic representation of the at least one implant to be introduced;
• e) optical representation of at least one recorded x-ray fluoroscopic image,
• f) superposition of the representation from step d) with the at least one x-ray fluoroscopy image from step e) at the determined position in at least one X-ray fluoroscopic image and
• g) optical representation of the superimposition on at least one visualization plane, in particular on a screen.

alternative For example, the above-mentioned step e) may be carried out after step a) or b) become.

Preferably be at least the above-mentioned steps e) to g) in real time, especially intraoperatively.

In the pictorial representation of the implant to be introduced or of several implants to be inserted, optionally assembled in an overlapping manner, a virtual image of the implant or of the implants already created during the preliminary examination can be used. In a symbolic representation of the at least one implant to be introduced, for example, so-called graphical markers can be used.

According to one advantageous development of the invention may instead of the above said volume image of the body region of interest at least in the above steps b) to d) one or more X-ray fluoroscopy images are used. These x-ray fluoroscopic images are usually a two-dimensional representation of the one of interest Body region.

Conveniently, can be from the volume image or the X-ray fluoroscopic image of the body region of interest at least a part of body region of interest, e.g. B. only the sick Vascular site, to be segmented.

As previously mentioned, an implant can be made of at least two overlapping partial implants exist in the body region of interest, in particular a vessel are introduced should.

in the Case of multiple overlapping partial implants can these either scheduled consecutively or simultaneously become.

It is advantageous, the pictorial or symbolic representation of at least one implant to be inserted with a beginning and / or to mark one end and / or the middle thereof. Also can be at least one overlapping area the partial implants are displayed graphically. Preferably used for this graphic object or marker.

additionally overlapping partial implants may be colored can be shown differently, it can also be in the case several overlapping partial implants only a specific one Number of these are displayed, d. H. partial implants can be inserted or hidden.

Conveniently, the entire geometry of an implant can be adjusted, eg. As the length, width or the diameter, as well as overlapping Areas with other partial implants. For this it is advantageous if this geometry adjustment using a mouse on a screen through Change of positions, length, width, diameter or overlapping areas can.

It is also beneficial if changes in the intake at least one X-ray fluoroscopic image, in particular by a patient's movement or by anatomical changes in the body region of interest, at least individual or all of the above steps from a) to g) are repeated.

Usually There will be a registration between the coordinates of the patient the patient bed and the three-dimensional volume data set to be generated carried out.

Therefore can patient movements during admission at least one x-ray fluoroscopic image normally be compensated by a 2D-3D or 3D-3D registration.

Should a change in the projection geometry of the X-ray machine, especially with a change in the recording angle, when taking at least one X-ray fluoroscopic image result, the position of the implant to be inserted is adjusted and this possibly at least in the above-mentioned steps d) to g) considered. Optionally, this will be at least one implant in the superimposed visualization on the visualization level displayed again, its size (eg width, Length, if necessary depth and diameter) and position adjusted could be.

One Another aspect of the invention is a medical device, in particular an examination and / or treatment device, which is designed to carry out the above-mentioned method.

Also may be a medical examination and / or treatment device for carrying out at least the above-mentioned step a) and / or the above-mentioned developments of the method used Be that additional means of communication with at least a computer system having at least the above steps b), c), d), e), f) and g) is formed. On the other hand, a computer system can be used, that to carry out at least the above steps b), c), d), e), f) and g), and additionally Means for communicating with at least one of the aforementioned medical Device or examination and / or treatment device.

• – Virtuelle (ggf. sich überlappende) Implantate können in ein Live-Röntgen-Durchleuchtungsbild während einer Behandlung auf einer Visualisierungsebene, vorzugsweise an einem Bildschirm eingeblendet werden. Dadurch können zusätzliche Markierungsgeräte, wie z. B. Führungsdrähte vermieden werden.
• – Die Umgebung der erkrankten Stelle, in der das mindestens eine Implantat eingebracht werden soll, bleibt sichtbar. Gegebenenfalls kann die bildliche und/oder symbolische Darstellung des zumindest einen Implantats hierfür ein- und ausgeblendet werden.

The invention has the following advantages:

• - Virtual (possibly overlapping) implants can be displayed in a live X-ray fluoroscopic image during a treatment on a visualization level, preferably on a screen. This allows additional marking devices, such. B. guidewires can be avoided.
• - The environment of the diseased site in which the at least one implant is to be introduced remains visible. If necessary, the picture Liche and / or symbolic representation of the at least one implant for this purpose and hidden.

Should change conditions during the treatment, can implant planning or planning the overlapping Areas of partial implants slightly changed and adapted become.

below The invention is based on one or more embodiments explained in more detail by reference to a drawing.

there shows the drawing:

In 1 a schematic representation of a C-arm system with evaluation computer,

in 2 an exemplary three-dimensional visualization or representation of a virtual stent, which is superimposed in a live X-ray fluoroscopic image and

in 3 an X-ray fluoroscopic image in which graphical objects for marking the position of the stent to be introduced.

In 1 is schematically a C-arm system 1 shown, which is a C-arm 2 having, opposite to each other, an x-ray tube 3 and an x-ray detector 4 are attached. The angular position of the C-arm may be around a couch 6 with a patient on it 5 or a body region of interest are rotated (angulated) in order to obtain X-ray fluoroscopy images from different projection directions. Such recorded projection images are sent to an evaluation unit or computer system 7 , z. As a Leonardo workstation, forwarded, for example, a data storage 8th and a calculation module 9 with a processor or the like. The recorded projection images as well as the reconstructed three-dimensional volume images can be displayed on one screen 10 considered and possibly manipulated with a mouse.

2 shows an X-ray fluoroscopic image on which a vessel G can be seen. In the diseased part of the vessel, a three-dimensional virtual image of a stent S is superimposed or superimposed. It is also conceivable that instead of the one stent, several partial implants that overlap are superimposed at this point. Thus, during a real-time treatment, the physician is presented with the position of the implant to be inserted on a screen 10 visually displayed.

In 3 Instead of the virtual stent image, graphic objects or markers M1 and M2 are displayed, which show the beginning and the end of the position of the implant or partial implants to be inserted. Likewise, the center of the position of the implant to be introduced or partial implants can be shown. It is also conceivable to use the markers in addition to the virtually displayed stent 2 display. In the same way, the virtual stents or graphic markers can be displayed differently in color.

A Patient movement or an anatomical change of the shown vessel (eg., By vessel position changes due to a heart movement) during the recording of the projection images can normally - as already mentioned - through a 2D-3D or 3D-3D registration are compensated.

In the case of a projection geometry change of the used C-arm X-ray system (eg by changing the recording angle in the live X-ray fluoroscopic image generation), the position or size of the virtual stent or the graphical markers according to these changes recalculated and displayed. Looking at 2 For example, the view of the curvature of the stent shown could change. So z. B. at a change in the angular position of the C-arm to about 90 °, the curvature of the stent "disappear". The stent shown would then be displayed close to "straight" and possibly somewhat "shortened".

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

• US 2006/0184066 A1 [0004]

Cited non-patent literature

• "Stent-assisted coiling of intracranial aneurysms aided by virtual parent artery reconstruction", AJNR Am J Neuroradiol 2005, 26, pp. 2368-2370 [0004]

Claims (16)

Method for the coupled image representation of at least one body region of interest of a patient ( 5 ) to be introduced medical implant, in particular at least one stent (S), in the context of a medical examination or treatment, comprising the following steps: a) recording an image sequence of X-ray fluoroscopic images of the body region of interest, b) creating a three-dimensional volume image of the body region of interest from the image sequence c) determination of a suitable position of the implant to be introduced in the body region of interest, d) generation of a pictorial or symbolic representation of the at least one implant to be introduced, e) optical representation of at least one recorded x-ray fluoroscopy image, f) superposition of the representation from step d) with the at least one X-ray fluoroscopy image from step e) at the determined position corresponding to the at least one x-ray fluoroscopic image, and g) optical representation of the overlay on at least one visualization plane, in particular at one Screen ( 10 ). Method according to the preceding claim, characterized in that step e) is carried out after step a) or b) can be. Method according to one of the preceding claims, characterized in that at least steps e) to g) of Claim 1 are carried out in real time. Method according to one of the preceding claims, characterized in that one or more x-ray fluoroscopic images instead of the volume image of the body region of interest at least in steps b) to d) of claim 1 are used. Method according to one of the preceding claims, characterized in that at least a part of the one of interest Body area from the volume image or X-ray fluoroscopic image of the body region of interest is segmented. Method according to one of the preceding claims, characterized in that the at least one implant in a Vessel (G) of the body region of interest should be introduced. Method according to one of the preceding claims, characterized in that an implant of at least two overlapping Partial implants may exist. Method according to one of the preceding claims, characterized in that in the representation of at least an implant to be inserted the beginning (M1) and / or the end (M2) and / or the center thereof and optionally at least an overlapping area of partial implants graphically being represented. Method according to one of the preceding claims, characterized in that overlapping in the case of several to be displayed Partial implants these are shown in different colors. Method according to one of the preceding claims, characterized in that in the case of several overlapping Partial implants represented a certain number of partial implants become. Method according to one of the preceding claims, characterized in that the at least one overlapping Area of partial implants adjusted by adjusting their geometry can be. Method according to one of the preceding claims, characterized in that by a patient movement or at anatomical changes in the body region of interest when taking at least one X-ray fluoroscopic image at least one or all steps from a) to g) of the claim 1 repeated. Method according to one of the preceding claims, characterized in that in the case of a change the projection geometry in the recording of at least one X-ray fluoroscopic image the position of the implant to be inserted is adjusted and if necessary the adjusted position at least in steps d) to g) of Claim 1 is taken into account. Medical device, in particular an examination device and / or treatment device, designed for implementation the method according to any one of the preceding claims. Medical examination and / or treatment device ( 1 ), which is designed to carry out at least step a) of claim 1 and / or a method according to one of claims 2 to 13, comprising means for communicating with at least one computer system ( 7 ), which is designed to carry out at least steps b), c), d), e), f) and g) of claim 1. Computer system ( 7 ), which is designed to carry out at least steps b), c), d), e), f) and g) of claim 1, comprising means for communicating with at least one medical device according to claim 14 or at least one medical examination and / or treatment device ( 1 ) according to claim 15.