DE102008032312A1 - Patient supporting unit e.g. patient supporting plate, for positioning catheter, into body of patient, during percutaneous transluminal coronary angioplasty, has markers integrated fixedly into unit - Google Patents

Abstract

The unit i.e. vacuum-based patient adjustment support (1), has an X-ray marker (5) and an electromagnetic marker (6) provided in an imaging system and a positioning system and integrated fixedly into the unit. The markers are surrounded by a soft material i.e. foam material (3), and the unit is made of sterilizable material. A recess and/or cavity are provided in the plate, and the markers are removably inserted in the recess and/or cavity. The markers arranged at a rod or needle like insertion device are removably inserted in a blind hole.

Description

The The invention relates to a patient support means.

Patient support means are always needed when a patient is for an examination and / or treatment as calm as possible and / or should be stored conveniently. The term is patient restraint In the context of this invention, it is to be understood that all indirect and include direct storage means, so for example both a Patient table as well as its circulation or other documents, on or in which a patient can be bedded.

Such For example, patient support products are also becoming more and more popular Significant field of minimally invasive medical therapies or examinations needed. As examples of For example, minimally invasive medical procedures balloon dilatation (percutaneous transluminal coronary angioplasty), the use of a stants, biopsies and the like. At all It is necessary to use this method as precisely as possible Position of minimally invasive instruments, such as one Catheter, especially its tip, in the body of the patient to locate. Advances in three-dimensional imaging With the X-ray technique meanwhile allow the three-dimensional Illustration of organs and instruments, but on the one hand still difficult in X-ray image between instrument, Organ and bones to distinguish, on the other hand a patient one exposed to very strong radiation exposure.

Recently, other methods for determining the location of medical instruments in a patient's body have been presented. In particular, the use of electromagnetic positioning systems should be mentioned here. Another option is a method that takes a biplan projections, so for example, two-dimensional X-ray images, a positi onsbestimmung on the triangulation of a catheter or instrument tip and using "template matching" between catheter or instrument and organs and bones differs. Such a method is for example from the DE 10 2005 028 746 A1 known.

at However, these solutions mentioned has the disadvantage that to improve the positioning and registration different coordinate systems special markers under the patient must be arranged. Especially often need Markers for imaging systems and markers for positioning systems used simultaneously in a fixed location relationship to both a registration of the individual systems as well as both systems to enable each other.

To It is known to use a marker plate in which solid Arrangement markers for an imaging system and / or markers are embedded for a position determination system. This plate, the most, in order to obtain the fixed local relationship, from a hard, inflexible material is placed under the patient. However, this has some disadvantages. First the lying comfort of the patient is greatly impaired and It can cause injury from protruding edges or the hard ones Come surface, especially to pressure injuries. To the another may be such a marker plate placed under the patient Slightly shift, prompting the comparison of captured images is no longer possible and the position determination inaccurate becomes.

Of the The invention is therefore based on the object, a possibility specify as possible while avoiding the disadvantages mentioned non-slip and not impairing or endangering the patient Positioning of markers.

to Solution to this problem is in accordance with the invention Patient support means by at least one particular stationary in the patient support agent integrated marker for an imaging system and / or at least one particular stationary in the patient support agent integrated marker for a positioning system characterized.

According to the invention that is, it is proposed to form a patient restraint that needed markers in the patient support agent are integrated. This eliminates the need for the markers alone or in a special device in addition to be arranged under the patient. Preferably, the markers are included at least for the time of image acquisition and / or position determination fixedly arranged in the patient support means, so that no Risk of slippage exists. Also, the patient is faced with discomfort or injuries, especially pressure injuries.

It is also particularly advantageous if at least one marker for an imaging system and at least one marker for a position determination system are integrated in fixed positional relationship to one another in the patient support means. For example, x-ray markers for an x-ray imaging system and an electromagnetic marker for a position determination system may be provided, which are arranged in fixed positional relationship to each other. Such a constellation will This is particularly often needed because the X-ray image is combined with the electromagnetic positioning systems. The fixed location relationship of the markers can be used to derive a relationship between the coordinate systems of the imaging system and the positioning system.

As already explained, is the term of the patient support means far to understand. However, it should be provided that the marker (s) as close as possible to the patient are definitely within the scope of the imaging system and / or the position determination system to be arranged.

In a first embodiment, the patient support means may be a vacuum-based patient fixation support. In such a patient fixation storage, the pad is formed by a vacuum pump according to the surface of the patient exactly so that it adapts to the surface of the patient and the patient can be kept immobile at least in the areas relevant for the examination or treatment. The mechanism of action of such a vacuum-based patient fixation storage is for example in the US 6,656,143 described.

In a second embodiment may also be provided that the Patient support means a support for a patient table is. Such requirements are well known. They are supposed to be a softer and Allow patient pressure-resistant storage and are usually as with a soft material, for example foam, filled, from an outer protective cover formed surrounded mats. These are in their size adapted to the size of the patient table.

at Use of such a vacuum-based patient fixation storage or a support for a patient table, it is advantageous if the at least one marker or one or the marker bearing Device, in particular a plate, of a soft material, in particular of foam, is surrounded. This will prevent that the markers or devices carrying them harder Materials despite integration into the patient support agent Trigger pressure injuries or an uncomfortable storage.

As well it is in the case of the first or second embodiment with a Pad for a patient table or a vacuum-based Patient fixation storage advantageous when the surface the patient support means is designed non-slip and / or the patient support means fastening means, in particular Velcro and / or adhesive, for non-slip attachment to a substrate, in particular a patient table or a patient support. In this way, further protection against slippage of the Patient storage agent and thus given the marker or the.

One as a support for a patient table or as a vacuum-based Patient fixation storage trained patient support means may include an outer protective cover and / or consist of a sterilizable material. An outer protective cover prevents the ingress of air, foreign bodies and liquids into the inside of the patient pad while the sterilizable Material a sterilization with liquids or in an autoclave (Gas, pressure, temperature) allowed.

In A third aspect of the present invention can be provided be that the patient support means a patient support plate of a Patient table is. Such a patient support plate can for example made of glass fiber reinforced plastic (GRP) exist and is made particularly stable.

there can in the patient support plate at least one recess and / or a cavity may be provided in which or which of at least one marker is removably inserted. For integration the marker in the patient support plate is so in this case intended to use a recess or a cavity in the marker or a device or the marker bearing the device is used. The removability allows the marker (s) to remove if they are not needed. With special Advantage may be at least one fixed to the or at least one marker connected insertion device, in particular one at least a marker included plate, be provided in the recess and / or the cavity is removably inserted. Such Insertion device, for example, laterally in the patient support plate be inserted.

In a further advantageous embodiment it can be provided that the insertion device is in particular automatically movable within the recess and / or the cavity. In this way, it is possible to position the marker (s) in such a way that they are always located at an ideal location even if, for example, a changed field of view of the imaging system and / or the position determination system. During the actual procedure or the actual examination, the marker or markers are then arranged in a stationary manner, since there is no risk of slippage within the recess and / or the cavity. The mobility can be realized manually, for example via a rail system in which the Inserting device can be moved by externally arranged on the patient support plate lever. However, an automatic, in particular motor-driven mobility is just as well conceivable. In an automatic embodiment, it can be provided, in particular, that the at least one marker is always automatically positioned by a control device of the imaging system and / or the position determination system in such a way that it is located in the corresponding fields of view. For example, a carriage system may be provided in which one or more x-ray markers are tracked to the x-ray emitter. Any configurations are conceivable here.

In In another embodiment it can be provided that the patient support plate contains at least one blind hole, in which the or at least one of a particular rod or Needle-like insertion device arranged markers removable is used. In this way, a fixed location relationship can be found several markers can be achieved without this at a single Inserting device must be attached.

As already mentioned, the patient support agent can Capture X-ray markers. This may be made from a non-X-ray transparent Material, in particular of lead, consist and a diameter of 3-15 mm. Preferably, 3-6 are against each other staggered x-ray markers provided.

additionally or alternatively, the patient support means may be an electromagnetic Include marker and / or an ultrasound marker. In particular electromagnetic Markers are common in positioning systems and can be electromagnetic receiving coils with at least 4, in particular 6 degrees of freedom. When using Reception coils electrical leads are provided, in particular with the simultaneous use of x-ray markers, provided can be that electrical leads to the receiver coils off thin and / or X-ray transparent material consist. The diameter of the feed line can be in the range of 0.5-1 mm are selected. Such leads are in X-ray technology already in the context of connections of ionization chambers the automatic exposure system known.

Further Advantages and details of the present invention will become apparent from the embodiments described below as well as from the drawings. Showing:

1 a schematic diagram of a vacuum-based patient fixation storage according to the invention,

2 a section through a support for a patient table according to the invention,

3 A first embodiment of a patient support plate according to the invention,

4 a section through a second embodiment of a patient support plate according to the invention,

5 a view of the patient support plate off 4 used insertion device,

6 a section through a third embodiment of a patient support plate according to the invention,

7 a section through a fourth embodiment of a patient support plate according to the invention, and

8th a section through a fifth embodiment of a patient support plate according to the invention.

1 shows as a vacuum-based patient fixation storage 1 trained inventive patient support means in a schematic diagram. The section shown is a horizontal section. The patient fixation storage 1 is from an outer protective cover 2 surrounded, which is formed in this case, in particular, airtight. Inside the protective cover 2 is a soft filler 3 intended. At a certain position within the filling material 3 so that the soft filling material 3 she surrounds is a plate 4 , For example, plastic, arranged. In this plate 4 let in are five x-ray markers 5 as well as an electromagnetic marker 6 , which includes electromagnetic receiver coils for six degrees of freedom. The x-ray markers 5 are made of lead and have a diameter of 8 mm. The x-ray markers 5 and the electromagnetic marker 6 are in a fixed spatial relationship with each other in the plate 4 arranged. About leads 7 , which have a diameter of 0.7 mm and are made of X-ray transparent material, are the receiving coil of the electromagnetic marker 6 with a connection 8th connected to the outer protective cover 2 is arranged. There, a corresponding control device for a positioning system, which is not shown here, are connected.

Furthermore, a vacuum pump 9 provided by a hose 10 to the interior of the patient fixation storage 1 is connected to optimally adapt the patient fixation support in shape to the surface of a patient supported thereon, as known to those skilled in the art.

The patient fixation storage 1 may have a length of 1,800-2,500 mm, a width of 400-900 mm and a height of 40-100 mm. It is either placed directly on the patient support plate of a patient table or on a lying on the patient support plate patient support. Thus the patient fixation storage 1 does not slip, there is the protective cover 2 made of a non-slip material. In addition, only schematically indicated fasteners are at her here 11 provided, in particular Velcro or adhesive, to enable a further slip resistance.

The patient fixation storage 1 is also made of sterilizable materials.

Of the better comprehensibility because are in the following representations provide the same elements with the same reference numerals.

2 shows another, as an edition 12 for a patient table trained inventive patient support means. The edition 12 is substantially rectangular, particularly adapted to the shape of the patient table, may be about 1,800-2,500 mm long, 40-100 mm high and 400-900 mm wide. It includes an outer protective cover 2 , which prevents the ingress of liquids and solids into the interior and consists of a sterilizable and non-slip material to allow sterilization or avoid slipping on the patient table as possible. In addition, in the in 2 illustrated longitudinal section fastening means 11 , in particular Velcro or adhesive agent, indicated that allow the non-slip attachment to the patient table.

Inside the protective cover 2 in the present case is a soft, single or multilayer foam 13 provided, a plate 4 surrounds, in the five x-ray markers 5 as well as an electromagnetic marker 6 are incorporated with receiving coils for six degrees of freedom so that they have a fixed spatial relationship against each other. Of the five x-ray markers 5 only three can be seen in this cross section. The plate 4 is flush with the foam on all sides 13 surrounded so that it is stationary.

To connect the electromagnetic marker 6 with connection means 8th are again thin and X-ray-transparent supply lines 7 intended.

3 shows a patient support plate according to the invention 14 a patient table 15 , which are movable on a pedestal 16 is arranged. The patient support plate 14 consists of fiberglass. In the patient support plate 14 integrated are five x-ray markers 5 made of lead with a diameter of 3-15 mm and an electromagnetic marker 6 with reception coils for six degrees of freedom. The markers 5 and 6 are stationarily embedded in the glass fiber plastic and accordingly have a fixed spatial relationship with each other. Over the first through the fiberglass, then outside of the patient support plate 14 along guided thin, X-ray-transparent leads 7 is the electromagnetic marker 6 with connection means 8th connected.

4 shows a second embodiment of a turn of GFK existing patient support plate according to the invention 14 ' in a horizontal section. In a recess 17 inserted is a plate 4 , the five lead-based x-ray markers, 3-7 mm in diameter 5 and an electromagnetic marker 6 with reception coils for six degrees of freedom, as already explained in previous embodiments Ausfüh. Over thin and X-ray-transparent supply lines 7 is the electromagnetic marker 6 with connection means 8th connected, which in this case in a cover 18 find the cavity 17 closes to the outside. The cover element 18 as well as the plate 6 are removable, if no markers 5 . 6 needed. Then the opening of the recess 17 be closed with another cover. The plate 6 and the cover 18 thus form an insertion device 19 , in the 5 is shown in more detail. There is particularly well the stationary staggered arrangement of the x-ray marker 5 or the fixed relative arrangement of the x-ray markers 5 and the electromagnetic marker 6 to recognize. Likewise, two receiving coils 20 of the electromagnetic marker 6 indicated.

For guiding the supply lines 7 can also be provided a rigid element, such as a pipe.

6 shows a vertical section through a further embodiment of a patient support plate according to the invention 14 which in turn consists of fiberglass. It has a cavity 21 in which the inserting device forming plate 4 with x-ray markers 5 and an electromagnetic marker 6 this time is not fit to use, but is movable. This is a schematically indicated only slide system 22 provided on which the plate 4 is guided and automatically controlled, for example via a control device 23 and a motor drive (not shown in detail), can be moved. Thus, it can be achieved that the marker is always in the field of view of a schematic at 24 indicated imaging system, the X-ray marker 5 are assigned, or one at 25 indicated position determination system, are located. Such mobility according to the position, for example, a Rönt Genstrahlers is known for example from the mobility of an X-ray cassette in a so-called Bucky table.

The supply lines 7 of the electromagnetic sensor 6 to the connection 8th are performed in this embodiment together with the required for the automatic handling cables.

alternative to the automatic movability of an insertion device can also a manual mobility, for example via levers in a rail system, be provided.

This in 7 via a horizontal section shown fourth embodiment of a patient support plate according to the invention 14 ''' shows another possibility for the fixed integration of x-ray markers 5 and an electromagnetic marker 6 in the CSF of the patient support plate 14 Here are the connections 8th directly on the edge of the here rectangular patient support plate 14 ''' intended.

8th finally shows a horizontal section through a fifth embodiment of a patient support plate according to the invention 14 '''' , In the patient support plate 14 '''' are blind holes 26 provided in the needle-like insertion devices 27 can be inserted. At the insertion devices 27 is each an x-ray marker 5 or an electromagnetic marker 6 attached at the top, in case of the arrangement of an electromagnetic marker 6 the supply lines 7 within the needle-like insertion device 27 run and arranged at the opposite end connecting means 8th lead, which then outside the patient support plate 14 '''' are located.

Anyway about the volume of the patient support plate 14 '' distributed are more blind holes 26 of which only two are represented here representatively. This allows markers to be fixed in many different positions. For closing unused blind holes 26 are cover elements 28 intended.

It should finally be pointed out that even if some elements, such as the markers 5 . 6 or the supply lines 7 are no longer explicitly described in the later embodiments, yet all mentioned in the preceding embodiments embodiments are just as possible as completely different, within the scope of the present invention embodiments. For example, ultrasound markers can also be provided in the patient support means according to the invention or other markers of the imaging systems or position determination systems.

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 102005028746 A1 [0004]
• - US 6656143 [0012]

Claims (19)

Patient storage means, characterized by at least one in particular stationary in the patient support means integrated marker ( 5 . 6 ) for an imaging system ( 24 ) and / or at least one in particular stationary in the patient support means integrated marker ( 5 . 6 ) for a position determination system ( 25 ). Patient support means according to claim 1, characterized in that it comprises a vacuum-based patient fixation ( 1 ). Patient support means according to claim 1 or 2, characterized in that it has a support ( 12 ) is for a patient table. Patient support means according to claim 2 or 3, characterized in that the at least one marker ( 5 . 6 ) of a soft material, in particular of foam ( 3 ) is surrounded. Patient support means according to one of claims 2 to 4, characterized in that its surface is configured non-slip and / or the patient support means fastening means ( 3 ), in particular Velcro and / or adhesive, for non-slip attachment to a pad, in particular a patient table or a patient support having. Patient support means according to one of claims 2 to 5, characterized in that it has an outer protective cover ( 2 ). Patient support means according to one of the claims 2 to 6, characterized in that it consists of a sterilizable Material exists. Patient support means according to claim 1, characterized in that it has a patient support plate ( 14 . 14 ' . 14 '' . 14 ''' . 14 '''' ) of a patient table ( 15 ). Patient support means according to claim 8, characterized in that in the patient support plate ( 14 . 14 ' . 14 '' . 14 ''' . 14 '''' ) at least one recess ( 17 ) and / or a cavity ( 21 ) into which and / or which of the at least one marker ( 5 . 6 ) is removably inserted. Patient support means according to claim 9, characterized in that at least one of the at least one stationary with the or at least one marker ( 5 . 6 ) associated insertion device ( 19 . 27 ), in particular a the at least one marker ( 5 . 6 ) containing plate ( 4 ), which is provided in the recess ( 17 ) and / or the cavity ( 21 ) is removably inserted. Patient support means according to claim 10, characterized in that the insertion device ( 19 . 27 ) within the recess ( 17 ) and / or the cavity ( 21 ) is in particular automatically movable. Patient support means according to claim 10 or 11, characterized in that the patient support plate at least one blind hole ( 26 ), in which the or at least one on a particular rod or needle-like insertion device ( 27 ) ( 5 . 6 ) is removably inserted. Patient support means according to one of the preceding claims, characterized in that it has an X-ray marker ( 5 ). Patient support means according to claim 13, characterized in that the from a non-X-ray transparent material, in particular lead, existing X-ray marker ( 5 ) has a diameter of 3 to 15 mm. Patient support means according to claim 13 or 14, characterized in that three to six staggered X-ray markers ( 5 ) are provided. Patient restraint according to one of the preceding claims, characterized in that it contains an electromagnetic marker ( 6 ) and / or comprises an ultrasound marker. Patient support means according to claim 16, characterized in that the electromagnetic marker ( 6 ) electromagnetic receiving coils ( 20 ) comprising at least 4, in particular 6 degrees of freedom. Patient support means according to claim 17, characterized in that electrical supply lines ( 7 ) to the receiving coils ( 20 ) consist of thin and / or X-ray transparent material. Patient support means according to one of the preceding claims, characterized in that at least one X-ray marker ( 5 ) and at least one electromagnetic marker ( 6 ) are provided, which are arranged to each other in fixed location relationship.