FR2671507A1 - Device for the remote manipulation of medical appliances - Google Patents

Abstract

For controlling a biomedical diagnostic or treatment appliance mounted on a bed cradle, an ergonomic control arm 4, 3 is proposed, the movements of which are faithfully reproduced by the member to be positioned, regardless of the configuration of the bed cradle. Use is very simple, intuitive and can easily be learnt by a non-specialist. Inversion of the bed cradle is controlled by rotating a control stand 46 and requires only a single switch-over in the other controls. Total safety is provided by individually locking all the non-used functions.

Description

"Remote handling device for medical devices"
The present invention relates to a device for the remote handling of medical devices of the type comprising a treatment or diagnostic head generally mounted on a support arch associated with a support in a configuration comprising means for guiding and driving the support in translational movements. , as well as means for guiding and driving the roll bar in rotation on its support.

 The translational movements can conveniently take place along three octhogonal axes, respectively transverse (X), longitudinal (Y) and vertical (Z) with reference to a patient support table, while two rotational movements allow respectively a displacement of the rollbar in its plane and a rotation of this plane around a generally horizontal axis, either to vary the inclination of the plane of the rollbar with a limited clearance on either side of a vertical plane, or to cause a complete reversal.

The devices thus designed can be structured around a central element comprising
- either an imaging or diagnostic instrument:
radiological generator
image intensifier
ultrasonic probe
gamma camera
optical or video player
- either a therapeutic agent or treatment tip
piezoelectric lithotriptic dish
electrohydraulic generator
electromagnetic generator
heat treatment source
gamma transmitter
This central element must be controlled and positioned in space with great precision around the patient's body. In addition, the energies often used make absolute security of controls absolutely imperative, with automatic locks and validation control.

The mechanical arrangements vary greatly from one device to another, and are mainly a function of the weight and the size of the "head" to be moved. However, the most common configuration with a roll bar has many advantages
- reduction in space and size of the
machine, "containing" the patient lying in position
central.

- better distribution of masses and
counterweight.

- possibility of complete reversal by reversing
the roll bar.

 - displacements centered on the "focal point".

To ensure the various displacements required, there is currently a set of commands according to several provisions
- separate orders most often, as on the
image intensifier console,
slave maneuvers being positioned close to
their place of effect (axis of rotation), without any
centralized control.

- commands grouped on console in the devices of
radio or high energy therapy
the movements are generally controlled by
juxtaposed inverters. Sometimes controllers group
2 or 4 movements.

- computerized or computer-assisted control, on
help menus or programs using or not
graphic assistance. These systems borrow
usually computer controls (joystick
dedicated or trackball).

- ergonomic console in the best cases, with a
start of movement integration (but at least 3
commands including 2 joysticks).

These provisions have a number of drawbacks which make them ill-suited to current technological developments
- They are relatively complex and most often require learning and habituation. This aspect is tempered by the fact of fixed or few users for the same machine.

 - However, the new devices tend towards multidisciplinary use or towards use by less accustomed practitioners, such as surgeons who find in their use a substitution for their reference techniques. In addition, new machines often present greater complexity in movement. Another important element is the increasingly frequent use in therapy, with the use of high energies. This requires positioning that is both very precise, quick and secure.

 - Current methods of ordering do not meet these criteria well, or do so at the cost of a flagrant lack of uniqueness and ergonomics. We do not find in biomedical matters the fruits of progress made in this area in the aeronautical industry or in the manipulators of current robotics.

 - For example the reversal of a hoop (up-down) implies the inversion of a certain number of commands which it is not easy to manage.

 - The rotation controls are generally designed around a lower center (the plane of the console) and therefore do not reproduce movements of a head supported by an arch above a focal point.

 - Finally, the current means of control are often devoid of security and locking devices made compulsory by the dangers of new therapeutic agents.

 The object of the present invention is to group together, in a remote handling device, all of the commands for moving a hoop, taking into account the imperatives of turning and inversion of the assembly with perfect ergonomics and immediate ease of use by its logical and intuitive aspect.

 The device is intended for any system comprising a diagnostic or treatment head requiring precise spatial positioning. The user will have at his disposal a real robotic arm faithfully reproducing the exact movements of the head, whatever its starting position; handling will be logical, easy, precise and intuitive at the same time.

 Finally, the device provides permanent locking of unused functions and provides total and simplified security.

 The device proposed for this purpose according to the invention comprises a console arranged facing the operator, an arm having an axis extending substantially horizontally from the console towards the operator; at the end of this arm a base carrying a handle for controlling horizontal translations, disposed on a first face, a handle for controlling rotations on a second face opposite to the previous one, said base being adapted to rotate about said axis, this rotation causing the control of the inclination rotations of the arch and a sign reverser associated with a horizontal translation control being adapted to change state depending on whether the second face of the base is oriented upwards or downwards.

 It is this faculty of orientation of the second face of the base upwards and downwards which seems to constitute a dominant aspect of the invention by bringing the control lever for the rotations upwards, above its axis of pivoting, when the central element, treatment or diagnostic head, is above the patient support table, while said rotation control handle is oriented downwards, above its center of rotation , when the head is under the table.

 Thanks to this concordance of the relative positions of the rotation control handle relative to its pivot point, on the one hand, and of the treatment or diagnostic head relative to the target area, on the other hand, the control will in all cases retain the intuitive character desirable to facilitate the work of the practitioner.

 The conformity of the translational movements remains ensured at the cost of a simple change in the direction of the control of the translational movements likely to be affected by the reversal of the base.

The characteristics and advantages of the invention will emerge from the description which follows by way of example, with reference to the accompanying drawings, or FIG. 1 is a schematic perspective view of a treatment and / or diagnostic installation.
Figure 2 is a schematic view on a larger scale of the remote handling device
Figure 3 is a similar view of a simplified embodiment.

Depending on the embodiment chosen and shown
Figure 1, a processing device is constituted around a central element 10 source of radiation, mounted on a support arch 11 in a position diametrically opposite to a detector element 12. The arch is mounted in a sheath 13 extending from and on the other side of a patient support table 14.

 The hoop 11 is adapted to move along its guide constituted by the sheath 13 under the action of a first drive shown diagrammatically by a motor 15 acting by means of a pinion 16 on a rack 17 carried by the 'arch: This is therefore a rotational movement of the arch in its plane.

 The sheath 13 of the hoop is carried on its side by an axis 20 of horizontal orientation journalled in a bearing support 21 disposed at the top of a vertical column 22 and adapted to be driven in rotation by a controlled motor indicated schematically at 23 This second rotational movement therefore has the effect of rotating the median plane of the arch around the horizontal axis 20.

 The column 22 is itself adapted to move by sliding in a suitable vertical guide 24 under the action of a drive illustrated schematically at 25 with a reversible motor 26. A vertical translational movement is thus thus produced.

The vertical guide 24 rests on a platform 27 adapted to move in a horizontal direction known as longitudinal Y, being carried for this purpose by two screws 28, 29 oriented in this direction and intended to be driven in rotation by a servo-motor 30; these screws are journalled in slides 31, 32 carried by a pair of guide rods 33 oriented in an orthogonal direction
X.

 The assembly formed by the platform 27 and its slides 31, 32 therefore constitutes a carriage adapted to move in the so-called transverse direction X, this displacement being produced by means of two screws 35,36 journalled in slides 37,38 carried by a pair of guide rods 39 and adapted to be driven in rotation by a servo-motor 40.

Thus, in a manner known per se, five independent movements of the arch were made, namely
the two movements of horizontal translation in the directions X and Y, that is to say TX and TY which can respectively be qualified as transverse -and longitudinal with reference to a patient normally installed on the table 14,
- the vertical translational movement, ie TZ,
- the rotational movement of the arch in its plane, ie Rx; and
the rotational movement in inclination of the plane around its axis 20, ie Ry.

 We have seen that each of these five movements includes a motor assigned to control this movement; arrangements are also made for each of the movements to be automatically locked in the absence of a corresponding command.

 The realization of this automatic locking condition results from the irreversibility of the screw control in the case of TX and TY translations. It involves the use of brake motors or pulse motors, for example in the case of vertical translation TZ and rotations Rx and Ry.

Each of the five movements naturally has limitations through an appropriate system of stops; the horizontal translations TX and TY are limited by the deflections of the slides 31, 32 and 37, 38 on their respective guides; the vertical translations TZ naturally include upper and lower limit stops; the rotation Tx of the arch in its plane, are normally limited to + 45; finally regarding rotation
Ry of the hoop on its horizontal axis 20, the possibility is provided of a complete reversal, therefore capable of causing the central element 10 to pass over the table. There are therefore naturally two privileged and locked positions of the hoop in the vertical plane with possibilities of limited angular deflections, for example of + 15 on either side of each of these two privileged positions.

 The remote handling device according to the invention for controlling the five movements thus organized generally comprises a console 41 placed within the operator's convenient reach next to the bed 14 substantially opposite the average position of the column 22 , therefore of the arch.

 As can be seen in FIG. 2, the console here having the general shape of a desk has projecting on its face 42 facing the operator an arm 43 extending substantially horizontally through a slot 44, this arm having a axis 45 adapted to journal in the body of said arm. This axis carries opposite the external end of the arm a base 46, while inside the console it passes through a transmitter 50 for controlling inclinations to arrive at a bearing (not detailed) secured to a carriage 51 for controlling horizontal translations.

Benefiting from two degrees of freedom by sliding along the guide rods 52, 53 respectively oriented in the directions X and Y, this carriage controls by its respective displacements two control transmitters 54 of position X and 55 of position Y, transmitters represented diagrammatically in the form of potentiometers. It is also in the form of a potentiometer that the transmitter 50 for controlling tilt rotations has been shown. To this transmitter is also coupled, as indicated at 50 ′, a sign reverser associated with the transmitter 55.

 The base 46 disposed at the end of the arm 43, secured in rotation with the axis 45, carries on a first face 56, which is turned upwards in the illustrated position, a so-called translation handle 57. This handle being secured to the body base allows, by movement of the arm along its axis, to move the cursor of the transmitter 54 of transverse translation, and by movement of the arm in a direction perpendicular to said axis, to move the cursor of the transmitter 55 of horizontal translation.

 The horizontal translation movements of the carriage 51 are constantly locked by an immobilization means (not detailed) and the lever 57 is equipped with a means for releasing this locking by simple touch.

 On a second face 58, opposite the first, the base carries a lever 60 for controlling rotations articulated on an axis 61 parallel to the longitudinal axis Y and secured to the cursor of a potentiometer 62 incorporated in the base and representing a transmitter for controlling the rotations x of the rollbar in its plane.

 On a third face, here on the rear face, of the base, there is finally a three-position switch 63 constituting the vertical translation control member (TZ): it is a simple inverter with two positions on either side. '' a central stop and locking position by switching the button of this switch on either side of this central position, the vertical drive motor 26 is powered in the direction of ascent or descent of the roll bar.

 The joystick 60 for controlling the rotations finally comprises two push buttons 65, 66 mounted electrically in parallel and adapted to cause one or the other to release the locking of the movements of horizontal translation.

 In the present embodiment, the two horizontal translation commands TX and TY, on the one hand, and the two rotation commands Rx and Ry on the other hand, are therefore produced by position controls using actuators. slaved to respective position issuers.

 Only the vertical translation is carried out here by a simple movement command.

 In any case, all the controls remain permanently locked so as to be released only on positive intervention by the operator.

 Furthermore, the deflections of the emitting members of positions 50 and 62 for the rotations and 54.55 for the horizontal translations are advantageously equipped with limit stop stops (not detailed) corresponding to the limitations of the real movements imposed on the arch.

 We will now consider in detail the commands of the various movements, translations, of one, and rotations, on the other hand.

 The horizontal translations are slaved to the movements of the entire arm 43 relative to the console 41 in the horizontal plane. Normally this arm is locked in translation and to authorize an X or Y translation movement, it is necessary either to touch the handle 57 for controlling the translations, or to press one or other of the push buttons 65, 66 formed on the handle 60 of rotation control.

 Since the base 46 is normally locked in rotation, the translation X is obtained by movement of the arm 43 along its major axis: the action on the potentiometer 54 controls the movement of the arch in its plane by the motor 40.

 The translation Y is obtained by moving the arm 43 perpendicularly to its major axis: the action on the potentiometer 55 controls the movements of the arch in the direction perpendicular to its plane by the motor 30.

 The translation in elevation (Z) is controlled by the reverser 63 which can be actuated by the thumb of the operator, whether he uses one or the other of the two joysticks 57 or 60. A push upwards of the inverter causes the roll bar to rise, a push down causes the lowering, while the release of the inverter automatically re-establishes the locking in the new position reached.

 The rotations are controlled by the lever 60 and these controls remain very simple and intuitive. The rotation x around the axis 61, therefore in the vertical plane of the arm, controls the similar movement of rotation of the arch in its plane. On the other hand, the rotation drive of the base 46 with its axis 45 controls by the position transmitter 50, the same tilting movement (rotation y) of the arch around its horizontal axis 20.

 As for translations, these two movements are unlocked in contact with the handle 60, the release of which causes locking in the new position.

 It is possible to combine the various movements of translation and rotation.

 For a simple X or Y or X + Y translation, only the handle 57 of the horizontal translations is requested with the possibility of acting in X or in Y either individually or simultaneously. The device remains locked in rotation (handle 60 not touched).

 For a simple rotation x or y or x + y, the lever 60 of the rotations is the only one solicited with the possibility of acting in x and in y in isolation or simultaneously. The device remains blocked in translations (handle 57 not touched).

 For a combined control in rotation and translation the operator uses the handle 60 of the rotations by pressing the push button 65 (FIG. 2) which unlocks the translations. It can therefore drive in the same movement the handle 60 by imparting to it a desired inclination, while moving its center of rotation, therefore the arm 43, in the horizontal plane. A trained operator can thus combine four simultaneous movements.

 Starting from the situation illustrated in FIGS. 1 and 2, where the diagnostic or treatment head 18 is in the lower position below the table 16, it will be possible for many applications to decide the turning operation consisting in placing said head in position superior: this will be the case for example in extracorporeal lithotripters in biliary use.

 In the device according to the invention, this reversal is obtained by reversing the base 46 with corresponding rotation of the axis 45 which passes through the arm 43. Due to the very large amplitude of the movement of the arch, this maneuver is subject to a clearly validated authorization which will generally take place in a more complex sequence, outside of normal use, involving for example a retraction of the support of the roll bar, withdrawal of the patient, etc.

 Following such a turning maneuver the handle 60 of the rotations has therefore come to be placed in the upper position, and the handle 57 of the translations in the lower position: the head to be piloted has therefore followed its control member in rotation.

 The other commands keep their functions unchanged except for that of the longitudinal translation Y which was reversed in 50 '. The push button 65 is no longer accessible under the thumb, but it is replaced by the second button 66, which, now placed below the lever 60, comes naturally in hand.

 FIG. 3 illustrates a simplified embodiment of the invention, avoiding the installation of translation potentiometers in the console: the latter being reduced to a simple box 70 mounted on a stand 71, contains only the potentiometer 50, transmitter rotational position coupled to the inverter 50 'with an arm reducing to the axis 45 which carries at its free end a base 46' containing all the rest of the equipment.

The base thus becomes a remote control unit containing, in addition to the potentiometer 62 for controlling the rotations x which we find unchanged in association with the handle 60 for controlling the rotations, a set of potentiometers for controlling the horizontal translations X and
Y schematically in 54 ', 55' under the action of the lever 57 'articulated in 57 ".

 The function of controlling the horizontal translations remains unchanged except that it operates here by angular movements and no longer by translation movements of the lever 57 '.

The command for vertical translations (not detailed in Figure 3) remains unchanged
In this simplified embodiment it is no longer possible to simultaneously control with one hand the rotations and the translations: the two levers must in this case be manipulated simultaneously. The push buttons 65, 66, no longer required, are deleted.

All the other aspects are however preserved:
- total ergonomics
- conservation of functions in reverse position;
- security of locks and validations.

Claims (9)

 1. Device for the remote handling of medical devices of the type comprising a treatment or diagnostic head on a support arch associated with a support in a configuration comprising means for guiding and driving the support in translational movements along three respectively transverse orthogonal axes (X), longitudinal (Y) and vertical (Z), as well as means for guiding and driving the arch on its rotational support, on the one hand, of the type known as x in its plane and, on the other hand, of the type known as inclinations of this plane, an independent control being provided for each of these five types of movements  characterized in that it comprises a console (41) disposed facing the operator, an arm (43) having an axis (45) extending substantially horizontally from the console towards the operator, at the end of this arm a base (46) carrying a handle (57) for controlling horizontal translations X and Y disposed on a first face (56), a handle (60) for controlling x and y rotations on a second face opposite to the previous one and means ( 63) for controlling vertical translations Z on a third face, said base being adapted to rotate about said axis, this rotation causing the control (50) of the inclination rotations y and a sign reverser (50 ') for controlling the horizontal longitudinal translations Y being adapted to change state depending on whether the second face of the base is oriented upwards or downwards.  2. Device according to claim 1, characterized in that the control of rotations y at least comprises a position control.  3. Device according to claim 1, characterized in that the arm (43) is oriented along the transverse axis of the translational movements X of the hoop support.  4. Device according to claim 3, characterized in that the arm (43) is movable relative to the console with two degrees of freedom along the two axes of horizontal translations X and Y.  5. Device according to claim 4, characterized in that the controls (54,55) in horizontal translation are of the type with position control with transmitters arranged inside the console.  6. Device according to any one of claims 1 to 5, characterized in that the control (63) in vertical translation Z is of the movement control type.  7. Device according to any one of the preceding claims, characterized by an individual automatic locking of each of the five movements, each of these locks being releasable by the contact of the corresponding control lever.  8. Device according to any one of the preceding claims, characterized in that the movements of the control levers are limited by stops corresponding to the limitations of the real movements imposed on the roll bar.  9. Device according to any one of the preceding claims, characterized by the association with the rotation control handle of a button (65,66) for unlocking the translational movements.