JP2007307399A - 定位手術処置装置および方法 - Google Patents
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Abstract
【解決手段】患者の身体と身体に隣接して配置された基準点を異なる方向から撮った第1、第2の透視画像をディスプレイする手段と、第1、第2透視画像における基準点の二次元座標を識別する手段と、既知の座標フレームから第1および第2透視画像内の二次元ポイントに三次元座標をそれぞれ投影する第1変換マトリクスおよび第2変換マトリクスを含む幾何学的モデルを作成する手段と、既知の座標系で手術器具の線状軌道を少なくとも部分的に指定する手段と、手術器具の線状軌道を第1および第2変換マトリクスを用いて第1および第2透視画像にそれぞれ投影する手段とを備える。
【選択図】図1
Description
米国政府は本発明に所定の権利を有する。
本発明は、線状軌道に沿って身体内に物体を挿入することをプラニングし、ガイドするための装置および方法に関する。より詳細には、二次元画像しか使用しないで軌道の有効な三次元プラニングを可能にするよう、2つの捕捉された透視画像をコーディネイトさせるための方法および装置に関する。
位置合わせは画像によりガイドされる手術システムにおけるキーとなる工程である。位置合わせとは手術プランを策定する画像のポイント間、および患者の近く(およびその内部)における作業空間のポイント間の対応性を決定することである。数値制御された器具(ロボットまたはマニュアルのいずれかである)を使用すべき場合、装置のコーディネートシステムも画像に一致させなければならない。
手術プランニングも画像でガイドされる手術におけるキーとなる工程である。三次元手術方法のプランニングは、例えばコンピュータトモグラフィー技術(CT)データから再構成できる三次元データセットで行うことができると予想できる。しかしながら、外科医は二次元画像、すなわちラジオグラフまたは透視画像でのプランニングすることに慣れている。CTデータが利用できる場合でも、プランニングは三次元状の再構成画像ではなく、むしろ個々の二次元状のCTスライスで行われる。
1)外科医が一旦、2つの画像上のポイントまたは線分を選択すると、この選択に対応する三次元のポイントまたは線分を完全に定義し、すぐに実行することができる。
2)CTスライスから得られるような軸方向の図は、一般に透視測定方法では得られない。軸方向の図内で最も容易に可視化できる角度は、横断角度として知られており、よってこの角度は透視測定方法では選択または実施が困難である。コーディネートされた透視測定技術ではこの横断角度は2つの画像上で線分を選択することによって外科医に暗黙のうちに指定される。これにより外科医は手術のための横断角度を可視化し、プランニングすることを助けることができる。
3)従来の透視測定技術では、ビーム発散に起因する画像の拡大は未知の大きさであり、これにより解剖学的距離を正確に測定するが困難となっている。コーディネートされた透視測定技術では、予定する線分の実際の場所での長さをソフトウェアで決定できる。このことは、適当なネジの長さを選択したり、それ以外の他の目的に有効である。
フランスのグルノーブル在住のラバール氏外は、画像ソースとしてコンピュータトモグラフィーを使用する椎間手術のためのシステムを開発した。CTデータを三次元データの組に組み立て、次にこの三次元データの組を直交平面で意図的にスライスし直すことができる。同時に3つの相互に直交する平面で手術プランニングが進められる。椎間板の任意の表面のポイントをデジタル化するのに、光学的なトラッキング装置を使用することによって位置合わせによりその表面のポイントがCTデータの組に一致される。
本発明によれば、身体の画像を発生するよう、透視装置を使って身体の手術器具の線上軌道に沿った挿入を行うための定位手術方法のプランを策定するための方法が提供される。この方法は、位置合わせアーティファクトの既知の座標フレームに対し既知の位置に複数の基準点を含む位置合わせアーティファクトを身体に隣接するように設置する工程と、患者の身体および位置合わせアーティファクトから撮られた画像をコンピュータのモニタにディスプレイする工程と、画像にディスプレイされた位置合わせアーティファクトの基準点の二次元座標を識別するための入力信号を受信する工程と、画像ポイントに三次元座標を投影するパラメータを有する幾何学的モデルを作成し、基準点の既知の三次元座標の投影が画像内の識別された二次元座標に最良に適合するように、幾何学的モデルのパラメータを数値的に最適化することにより、画像の位置合わせを行う工程とを備える。
添付した付属書には注釈、添え字および数式、公式および説明のすべてが記載されている。図4〜18に示された全フローチャートにわたり、付属書および付属書に記載された番号の付いた章[1]〜[15]を参照する。
フローチャート全体で使用する注釈
WCS 世界座標系
CCS Cアーム座標系
(x,y,z) WCSおよびCCSにおける三次元座標に使用
(x,y) 較正された画像座標に使用
(u,v) 実画像座標に使用
α サジタル角
β 横断角
γ アプローチ角
添え字
w=WCS 座標系を指定。三次元座標系に対してのみ使用
c=CCS
t=頂部 仮想ガイドワイヤー上のポイントを指定
b=底部
a=A/P 情報がどの画像に対応するかを指定
s=サジタル
[1] J.カニー、「エッジ検出への計算アプローチ」;パターン分析マシンインテリジェンスに関するIEEEトランザクション;第8巻、1986年11月、679〜698ページ
ここでxi=[x,y,z]は基準点の三次元座標であり、(u,v)は基準点の中心の二次元座標であり、α=[φ,θ,Ψ,tx,ty ,tz]は自由度が6のポーズを定める6つのパラメータである。
[3] 一旦適合を実行すると、次のように最適化されたパラメータ(α=[φ,θ,Ψ,tx ,ty ,tz ])に対応する一様変換マトリックスを構成する。
[4] 一旦適合を実行すると、次のように最適化されたパラメータ(α=[φ,θ,Ψ,tx,ty,tz])に対応する一様変換マトリックスを構成する。
[5] 視線は次のように計算する。
CCCでは視線は(0,0,0)および(uc ,vc ,f)で境界が定められる。
注:(uc ,vc )は(u,v)の較正された等価値である。[13]参照。
透視画像における固有の歪みにより、視線は湾曲した画像として描かれる。これは[15]のように(u1 ,v1 )および(u2 ,v2 )によって境界が定められたライン上で50のポイントをアンキャブレートし、これらを通るポリラインを描くことによって視線を描く。
[7] (Vxwt,Vywt,Vzwt)および(Vxwb,Vywb,Vzwb)の場合、次の式を使ってA/Pおよびサジタル画像の双方に仮想ガイドワイヤーの投影を描く。
[8] 仮想ガイドワイヤーの投影を描くには視線上に頂部ポイント(0,0,0)が位置するようにWCSにおける2つのポイント(0,0,0)および(0,0,−ネジ長さ)を変換する。仮想ガイドワイヤーは最初に30mmに設定される。次の式を用いて投影されたガイドワイヤーを描く。
最初、
深さ=0.2
ネジ長さ=30mm
α=0、β=0
(tx,ty,tz)は(LSxw1,LSyw1,LSzw1)および(LSxw2,LSyw2,LSzw2)によって境界が定められた視線上に位置するように制限されるので、次のようになる。
Tは次の変換式から成る:
画像上に投影されたガイドワイヤーを描くために、[7]と共に、ポイント(Vxwt,Vywt,Vzwt)および(Vxwb,Vywb,Vzwb)を使用する。
[10] 仮想ガイドワイヤーは(0wt,0wt,0wt)および(0wb,0wb,−ネジ長さ )によって境界が定められた三次元物体であることを思い出していただきたい。α=α+0.1*(トラックボールによって移動されるピクセル数)
[12] 次を式を仮定する。
次の制限式を使って完全[FP]となる他の2つのベクトルを決定する。
注:第1ベクトル(N)はドリルガイド軸であるので、[Plan]から維持される。
これらマトリックスは次のフォームである。
PUMA560ロボットは配置を指定するのにオイラー表示式を使用しているので、[FP]の逆解は次のように決定される。
従って、[i]からオイラー表示=Rot(z,φ)Rot(y,θ)Rot(z,Ψ)
最終ポーズ=(φ+90,θ−90,Ψ,tx,ty,tz)
[13] 次のような4次多項式を使ってエッジピクセル(u,v)の較正された座標(x,y)を決定する。
画像較正プログラムを使って予めパラメータaおよびbの組を決定する。
[14] 疑似逆関数アプローチを使ってエッジピクセルに円の式を適合させることにより、基準点のシャドーの中心を見つける。
疑似逆関数を使用すると、
Pが定められると次のように基準点(h,k)の中心が決定される。
Claims (5)
- 既知の座標フレームに対して既知の三次元座標に位置する複数の基準点を含む、身体に隣接して設置された位置合わせアーティファクトと、
少なくとも、身体および基準点の第1透視画像を少なくとも1つのコンピュータのモニタ上にディスプレイし、前記第1透視画像のそれとは異なる角度から撮られた、前記身体および前記基準点の第2透視画像をディスプレイする手段と、
前記ディスプレイされた第1透視画像および第2透視画像における前記基準点の二次元座標を識別する手段と、
前記基準点の既知の三次元座標の投影と画像内の識別された二次元座標との間の偏差が最小となるように、前記既知の座標フレームから前記第1透視画像内の二次元ポイントに三次元座標を投影するように適合されている、最適化されたパラメータを有する第1変換マトリクスと、前記既知の座標フレームから前記第2透視画像内の二次元ポイントに三次元座標を投影する第2変換マトリクスとを含む幾何学的モデルを作成する手段と、
前記既知の座標系において、手術器具の線状軌道を少なくとも部分的に指定する手段と、
前記既知の座標フレームから前記線状軌道を、前記第1変換マトリクスを用いて前記ディスプレイされた第1透視画像に投影し、前記第2変換マトリクスを用いて前記ディスプレイされた第2透視画像に投影する手段
とを備えた、身体の画像を発生するための透視装置を使用して身体へ手術器具を線状軌道に沿って挿入するための定位手術方法のプランを策定するための装置。 - 前記既知の座標フレームにおいて前記線状軌道を指定するポイントを前記第1および第2透視画像上でユーザが選択する入力手段をさらに含む、請求項1記載の装置。
- 前記既知の三次元座標フレームにおいて前記軌道を修正するために前記第1および第2透視画像内で前記ディスプレイされた軌道を動かすユーザ入力手段をさらに含む、請求項2記載の装置。
- 患者の身体と該身体に隣接する既知の位置に置かれた放射線に不透明な複数の基準点を異なる方向から撮った二次元の第1および第2透視画像を受け取るステップと、
前記基準点の位置の三次元座標の前記第1および第2透視画像への投影と前記第1および第2透視画像内の前記複数の基準点の位置との間の偏差が最小となるように、最適化されたパラメータを有する第1および第2変換マトリクスを含む幾何学的モデルを作成することにより前記第1および第2透視画像の位置合わせを行なうステップと、
前記身体内に置かれる三次元仮想物体を表現したものを前記第1および第2透視画像内に表示するステップ
とを含む方法。 - コンピュータにより読み取られた時に、請求項4の方法をコンピュータが実行できるようにする命令でコード化された、コンピュータにより読み取り可能な記憶媒体。
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US08/649,798 US5799055A (en) | 1996-05-15 | 1996-05-17 | Apparatus and method for planning a stereotactic surgical procedure using coordinated fluoroscopy |
US08/649,798 | 1996-05-17 |
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AU3066497A (en) | 1997-12-05 |
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JP2000510730A (ja) | 2000-08-22 |
TW384217B (en) | 2000-03-11 |
JP4469423B2 (ja) | 2010-05-26 |
EP0955935A1 (en) | 1999-11-17 |
CA2255041C (en) | 2006-11-21 |
US6069932A (en) | 2000-05-30 |
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