JP6009151B2 - マルチアーム・カテーテルのための圧力検知 - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0082—Catheter tip comprising a tool
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0127—Magnetic means; Magnetic markers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
- A61B2017/00044—Sensing electrocardiography, i.e. ECG
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- A61B2018/00345—Vascular system
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- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00577—Ablation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2051—Electromagnetic tracking systems
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2059—Mechanical position encoders
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
- A61B2090/065—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring contact or contact pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M2025/0001—Catheters; Hollow probes for pressure measurement
- A61M2025/0002—Catheters; Hollow probes for pressure measurement with a pressure sensor at the distal end
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M2025/0166—Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
Description
中心軸から外向きに斜めに延伸し、それぞれの位置変換器が連結された1つ又は2つ以上のアームを含む医療用プローブの遠位端を体内の表面に押し当て、アームが表面に圧力を加え、その圧力に応答して中心軸に対してアームが曲がるようにすることと、
アームに連結されたそれぞれの位置変換器の位置を測定することと、
アームによって加えられた圧力を、測定された位置に応答可能に推定することと、
を含む医療用プローブの操作方法を提供する。
中心軸から外向きに斜めに延伸し、それぞれの位置変換器が連結された1つ又は2つのアームを含む遠位端を有する医療用プローブであって、これらのアームが体内の表面に押し当てられ、その表面に圧力を加え、その圧力に応答して中心軸に対して曲がるように構成された、医療用プローブと、
アームに連結されたそれぞれの位置変換器の位置を測定し、アームによって加えられた圧力を、測定された位置に応答可能に推定するように構成されたプロセッサと、
が提供される。
心内心電図又は心臓アブレーションなど様々な診断及び治療手技において、その遠位先端部に少なくとも1つの電極を取付けた侵襲性プローブが使用される。この電極は、通常、プローブが体内組織に押し付けられたときに動作する。通常、これらの手技において、プローブと問題になっている組織との間に十分な接触圧を維持することが重要である。一方、過剰な圧力は手技に好ましくない効果を有することがあり、極端な場合には、組織に物理的な損傷を与えることさえある。
図1は、本発明の開示の実施形態に従って構成され、動作可能な、マルチアーム・カテーテルを使用した医療システム20の図である。システム20は例えば、カリフォルニア州ダイアモンド・バー(Diamond Bar, California)のバイオセンスウェブスター社(Biosense Webster Inc.)製造のCARTO(商標)システムに基づくことができる。システム20は、カテーテルなどのマルチアーム・プローブ22、及び制御卓24を備える。以下に述べる実施形態において、プローブ22は、心臓26内の電位のマッピングのような診断若しくは治療処置のために、又は心臓組織のアブレーションを行うために使用されるものと想定される。あるいは、プローブ22を心臓又はその他の体内器官において、その他の治療及び/又は診断目的のために準用してもよい。
上述のように、本発明の実施形態は、遠位端31と体内組織との間の接触圧を測定する方法及びシステムを提供する。実施形態によっては、プロセッサ40は、位置変換器56からの信号を処理して、アーム32の、一般的には位置座標及び向き座標の両方を含む位置座標を決定する。実施形態によっては、プロセッサ40は、収集した測定値を使用してアーム32間の1つ又は2つ以上の角度を計算することができる。図2を参照して、プロセッサ40は、アーム32の長手方向軸62のそれぞれの対の間の1つ又は2つ以上の角度60を計算することができる。別の方法として又は追加的に、プロセッサ40は、位置センサ56の対の間の1つ又は2つ以上の距離64を計算することができる。
(1) 医療用プローブを操作する方法であって、
中心軸から外向きに斜めに延伸し、それぞれの位置変換器が連結された1つ又は2つ以上のアームを含む前記医療用プローブの遠位端を体内の表面に押し当て、前記アームが前記表面に圧力を加え、前記圧力に応答して前記中心軸に対して曲がるようにすることと、
前記アームに連結された前記それぞれの位置変換器の位置を測定することと、
前記アームによって加えられた前記圧力を、前記測定された位置に応答可能に推定することと、
を含む、方法。
(2) 前記医療用プローブがカテーテルを含む、実施態様1に記載の方法。
(3) 前記圧力を推定することが、前記アームと前記表面との間の物理的接触を検証することを含む、実施態様1に記載の方法。
(4) 前記圧力を推定することが、前記測定された位置を利用して所定のアームの曲率の変化を検出することにより、前記所定のアームが前記表面と物理的に接触することを確認することを含む、実施態様1に記載の方法。
(5) 前記位置を測定することが、前記プローブの近傍に1つ又は2つ以上の磁界を印加すること、前記位置変換器によって前記磁界に応答可能に生成され、前記位置変換器のそれぞれの前記位置を示す、それぞれの信号を前記位置変換器から受信すること、及び前記受信した信号に基づいて前記位置を計算することを含む、実施態様1に記載の方法。
(6) 前記圧力を推定することが、少なくとも1対の前記位置変換器のそれぞれの間の少なくとも1つの距離を計算すること、及び前記圧力を前記距離に応答可能に推定することを含む、実施態様1に記載の方法。
(7) 前記圧力を推定することが、少なくとも1対の前記アームのそれぞれの間の少なくとも1つの角度を計算すること、及び前記圧力を前記角度に応答可能に推定することを含む、実施態様1に記載の方法。
(8) 前記圧力を推定することが、前記中心軸と前記アームのうちの少なくとも1つとの間の少なくとも1つの角度をそれぞれ計算すること、及び前記圧力を前記角度に応答可能に推定することを含む、実施態様1に記載の方法。
(9) 前記圧力を推定することが、前記測定された位置に前記圧力と前記位置との間の事前に較正された関係を適用することを含む、実施態様1に記載の方法。
(10) 前記位置を測定することは、前記中心軸に連結された追加の位置変換器の位置を測定することを含み、前記圧力を推定することは、前記圧力を前記追加の位置変換器の前記測定された位置に応答可能に評価することを含む、実施態様1に記載の方法。
(12) 前記圧力を推定することは、前記中心軸と前記アームのうちの少なくとも1つのそれぞれとの間の少なくとも1つの角度を計算すること、及び前記圧力を前記角度に応答可能に推定することを含む、実施態様10に記載の方法。
(13) 前記アーム及び前記表面の影像をオペレータに表示すること、及び前記推定された圧力に応答可能に前記影像内に前記アームを表示するために使用される画像的特徴を選択することを含む、実施態様1に記載の方法。
(14) 前記アームのうちの少なくとも1つに連結された1つ又は2つ以上の電極による信号の検知を、前記推定された圧力に応答可能に選択的に可能とすることを含む、実施態様1に記載の方法。
(15) 中心軸から外向きに斜めに延伸し、それぞれの位置変換器が連結された1つ又は2つ以上のアームを含む遠位端を有する医療用プローブであって、前記アームが体内の表面に押し当てられ、前記表面に圧力を加え、前記圧力に応答して前記中心軸に対して曲がるように構成された、医療用プローブと、
前記アームに連結された前記それぞれの位置変換器の位置を測定し、前記アームによって加えられた前記圧力を、前記測定された位置に応答可能に推定するように構成された、プロセッサと、
を含む、装置。
(16) 前記医療用プローブがカテーテルを含む、実施態様15に記載の装置。
(17) 前記プロセッサが、前記アームと前記表面との間の物理的接触を検証するように構成された、実施態様15に記載の装置。
(18) 前記プロセッサが、前記測定された位置を利用して所定のアームの曲率の変化を検出することにより、前記所定のアームが前記表面と物理的に接触することを確認するように構成された、実施態様15に記載の装置。
(19) 前記プロセッサが、前記プローブ近傍で1つ又は2つ以上の磁界を1つ又は2つ以上の磁界発生器に印加させ、前記位置変換器によって前記磁界に応答可能に生成された、前記位置変換器のそれぞれの前記位置を示すそれぞれの信号を前記位置変換器から受信し、前記受信した信号に基づいて前記位置を計算するように構成された、実施態様15に記載の装置。
(20) 前記プロセッサが、少なくとも1対の前記位置変換器のそれぞれの間の少なくとも1つの距離を計算し、前記圧力を前記距離に応答可能に推定するように構成された、実施態様15に記載の装置。
(22) 前記プロセッサが、前記中心軸と前記アームのうちの少なくとも1つとの間の少なくとも1つの角度をそれぞれ計算し、前記圧力を前記角度に応答可能に推定するように構成された、実施態様15に記載の装置。
(23) 前記プロセッサが、前記測定された位置に、前記圧力と前記位置との間の事前に較正された関係を適用することにより、前記圧力を推定するように構成された、実施態様15に記載の装置。
(24) 前記中心軸に連結された追加の位置変換器を含み、前記プロセッサが、前記追加の位置変換器の位置を測定し、前記圧力を前記追加の位置変換器の前記測定された位置に応答可能に推定するように構成された、実施態様15に記載の装置。
(25) 前記プロセッサが、前記追加の位置変換器と前記位置変換器のうちの少なくとも1つのそれぞれとの間の少なくとも1つの距離を計算し、前記圧力を前記距離に応答可能に推定するように構成された、実施態様24に記載の装置。
(26) 前記プロセッサが、前記中心軸と前記アームのうちの少なくとも1つのそれぞれとの間の少なくとも1つの角度を計算し、前記圧力を前記角度に応答可能に推定するように構成された、実施態様24に記載の装置。
(27) 前記プロセッサが、前記アーム及び前記表面の影像をオペレータに表示して、前記影像内に前記アームを前記推定された圧力に応答可能に表示するために使用する画像的特徴を選択するように連結された、実施態様15に記載の装置。
(28) 前記プローブが、前記アームの内の少なくとも1つに連結された1つ又は2つ以上の電極を含み、前記プロセッサが、前記電極による信号の検知を、前記推定された圧力に応答可能に選択的に可能にするように構成された、実施態様15に記載の装置。
(29) 中心軸から外向きに斜めに延伸し、それぞれの位置変換器が連結された1つ又は2つ以上のアームを含む医療用プローブと協働して動作する、コンピュータ・ソフトウェア・プロダクトであって、このプロダクトは、コンピュータによって読み出されたときに、前記アームに連結された前記それぞれの位置変換器の位置を前記コンピュータに測定させ、前記アームによって加えられた圧力を、前記測定された位置に応答可能に推定させる、プログラム命令を格納したコンピュータ読取り可能媒体を含む、コンピュータ・ソフトウェア・プロダクト。
Claims (15)
- 中心軸から外向きに斜めに延伸し、それぞれの位置変換器が連結された複数のアームを含む遠位端を有する医療用プローブであって、前記アームが体内の表面に押し当てられ、前記表面に圧力を加え、前記圧力に応じて前記中心軸に対して曲がるように構成された、医療用プローブと、
前記アームに連結された前記それぞれの位置変換器の位置を測定し、前記アームによって加えられた前記圧力を、少なくとも1対の前記それぞれの位置変換器の前記測定された位置に応じて推定するように構成された、プロセッサと、
を含む、装置。 - 前記医療用プローブがカテーテルを含む、請求項1に記載の装置。
- 前記プロセッサが、前記アームと前記表面との間の物理的接触を検証するように構成された、請求項1に記載の装置。
- 前記プロセッサが、前記測定された位置を利用して所定のアームの曲率の変化を検出することにより、前記所定のアームが前記表面と物理的に接触することを確認するように構成された、請求項1に記載の装置。
- 前記プロセッサが、前記プローブ近傍で1つ又は2つ以上の磁界を1つ又は2つ以上の磁界発生器に印加させ、前記位置変換器によって前記磁界に応じて生成された、前記位置変換器のそれぞれの前記位置を示すそれぞれの信号を前記位置変換器から受信し、前記受信した信号に基づいて前記位置を計算するように構成された、請求項1に記載の装置。
- 前記プロセッサが、少なくとも1対の前記位置変換器のそれぞれの間の少なくとも1つの距離を計算し、前記圧力を前記距離に応じて推定するように構成された、請求項1に記載の装置。
- 前記プロセッサが、少なくとも1対の前記アームのそれぞれの間の少なくとも1つの角度を計算し、前記圧力を前記角度に応じて推定するように構成された、請求項1に記載の装置。
- 前記中心軸に連結された追加の位置変換器を含み、前記プロセッサが、前記中心軸と前記アームのうちの少なくとも1つとの間の少なくとも1つの角度をそれぞれ計算し、前記圧力を前記角度に応じて推定するように構成された、請求項1に記載の装置。
- 前記プロセッサが、前記測定された位置に、前記圧力と前記位置との間の事前に較正された関係を適用することにより、前記圧力を推定するように構成された、請求項1に記載の装置。
- 前記中心軸に連結された追加の位置変換器を含み、前記プロセッサが、前記追加の位置変換器の位置を測定し、前記圧力を前記追加の位置変換器の前記測定された位置と、前記アームに連結された前記位置変換器のうちの少なくとも1つの位置と、に応じて推定するようにも構成された、請求項1に記載の装置。
- 前記プロセッサが、前記追加の位置変換器と前記位置変換器のうちの少なくとも1つのそれぞれとの間の少なくとも1つの距離を計算し、前記圧力を前記距離に応じて推定するように構成された、請求項10に記載の装置。
- 前記プロセッサが、前記中心軸と前記アームのうちの少なくとも1つのそれぞれとの間の少なくとも1つの角度を計算し、前記圧力を前記角度に応じて推定するように構成された、請求項10に記載の装置。
- 前記プロセッサが、前記アーム及び前記表面の影像をオペレータに表示して、前記影像内に前記アームを前記推定された圧力に応じて表示するために使用する画像的特徴を選択するように連結された、請求項1に記載の装置。
- 前記プローブが、前記アームの内の少なくとも1つに連結された1つ又は2つ以上の電極を含み、前記プロセッサが、前記電極による信号の検知を、前記推定された圧力に応じて選択的に可能にするように構成された、請求項1に記載の装置。
- 中心軸から外向きに斜めに延伸し、それぞれの位置変換器が連結された複数のアームを含む医療用プローブと協働して動作する、コンピュータ・ソフトウェア・プロダクトであって、このプロダクトは、コンピュータによって読み出されたときに、前記アームに連結された前記それぞれの位置変換器の位置を前記コンピュータに測定させ、前記アームによって加えられた圧力を、少なくとも1対の前記それぞれの位置変換器の前記測定された位置に応じて推定させる、プログラム命令を格納したコンピュータ読取り可能媒体を含む、コンピュータ・ソフトウェア・プロダクト。
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CN102327118B (zh) | 2015-04-01 |
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CA2745018C (en) | 2019-10-01 |
AU2011202668B2 (en) | 2015-06-04 |
AU2011202668A1 (en) | 2012-01-19 |
CN102327118A (zh) | 2012-01-25 |
US9101396B2 (en) | 2015-08-11 |
US20120004576A1 (en) | 2012-01-05 |
JP2012011197A (ja) | 2012-01-19 |
DK2401980T3 (en) | 2015-11-16 |
IL213367A0 (en) | 2011-07-31 |
CA2745018A1 (en) | 2011-12-30 |
US20150342700A1 (en) | 2015-12-03 |
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