KR101556725B1 - Method for generating insertion trajectory of medical device - Google Patents

Abstract

The present disclosure relates to a method of generating an insertion path of a medical device from an entry point to a target, comprising: preparing an image to be treated including a target and an uninvited area; Designating an initial insertion region including a insertion path, the initial insertion region having a three-dimensional columnar shape whose cross-sectional area decreases as the target becomes closer to the target; Determining whether an initial insertion region intersects with an uninfected area; And generating a safe insertion region by reducing an initial insertion region to avoid crossing.

Description

[0001] METHOD FOR GENERATING INSERTION TRAJECTORY OF MEDICAL DEVICE [0002]

Disclosure relates generally to a method of generating an insertion path of a medical device, and more particularly to a method of generating an insertion path of a medical device that automatically generates an insertion path.

Herein, the background art relating to the present disclosure is provided, and these are not necessarily meant to be known arts.

A medical device, such as a lead (eg, a lead for deep brain stimulation), a biopsy needle (eg, biopsy needle), a probe, a catheter, It is important that the implantation or implantation is performed so that vessels or anatomically important structures are not damaged or minimally invasive.

For example, in the case of the brain, such procedures include neurosurgical operations that affect various functions of the brain. Neurosurgical surgery may include surgery to remove tumors from the brain as well as deep brain stimulation (DBS) that stimulates specific areas of the brain that are functioning. For example, neurosurgeons perform deep brain stimulation (DBS) to treat serious illnesses such as Parkinson's disease, obsessive-compulsive disorder and depression. In deep brain stimulation, it is necessary to transplant an electrode capable of suppressing or stimulating a certain part of the brain to the deep part of the brain to normalize the brain function of the patient. The electrode may be provided at the end of the lead, and the lead is inserted along the insertion path of the brain.

The insertion or implantation of the medical device described above requires insertion of a medical tool, for example, a lead that does not damage the major structure, such as the blood vessels of the brain, while allowing the electrodes of the DBS to reach the target precisely, It is important to find the route. In the planning of the insertion path, the angle of entry of the lead into the brain is important, and the insertion path is planned by defining the entry angle and insertion point. However, the existing planning of the insertion route depends heavily on the physician's experience and knowledge rather than on the objective and quantitative basis of the degree of invasion of the insertion route to the critical anatomical structure of the blood vessel or brain. Therefore, different physicians may have different insertion routes for the same patient. U.S. Patent Application Publication No. 2012/0184844 discloses a method of generating a plurality of insertion paths in DBS. However, a specific method of evaluating the degree of invasion of the insertion path itself and planning the insertion route by avoiding blood vessels and the like is not disclosed I can not.

This will be described later in the Specification for Implementation of the Invention.

SUMMARY OF THE INVENTION Herein, a general summary of the present disclosure is provided, which should not be construed as limiting the scope of the present disclosure. of its features).

In a method of generating an insertion path of a medical device from an entry point to a target according to one aspect of the present disclosure, A step of preparing an image to be treated; Designating an initial insertion region including a insertion path, the initial insertion region having a three-dimensional columnar shape whose cross-sectional area decreases as the target becomes closer to the target; Determining whether an initial insertion region intersects with an uninfected area; And generating a safe insertion region by reducing an initial insertion region so as to avoid a crossing; and a method of generating an insertion path of the medical device.

This will be described later in the Specification for Implementation of the Invention.

1 is a diagram illustrating an example of a method of generating an insertion path of a medical device according to the present disclosure,
FIGS. 2 to 5 are views for explaining an example of a process of preparing a brain image including target and non-invasive areas,
FIGS. 6 and 7 are diagrams illustrating an example of brain images that are volume image-aligned,
FIG. 8 is a drawing showing an example of an interface of a software that performs insertion path planning;
9 is a view for explaining an example of a method in which an insertion range is specified,
FIG. 10 is a partially enlarged view of FIG. 9,
11 is a view for explaining an example of a process of creating a safe insertion area from an initial insertion area,
12 is a view for explaining an example of a sagittal, axial, coronal views, and an insertion path shown in a 3D image;
13 is a view showing an example of an image of the brain by the surgeon's eye view;

The present disclosure will now be described in detail with reference to the accompanying drawings.

1 is a diagram illustrating an example of a method of generating an insertion path of a medical device according to the present disclosure;

In a method of generating an insertion path of a medical device from an entry point to a target, a brain image including a target and a non-invasive area is first prepared (S11). For example, the Sagittal view, the axial view, and the coronal view brain images obtained from the medical imaging device are segmented to obtain a non-invasive area including the blood vessel and a target as a set of three-dimensional voxels (S11) The divided brain images are volume aligned with respect to the anterior commissure-posterior commissure line (S21). Next, an initial insertion area including the insertion path is designated (S31). The initial insertion area has a truncated column shape (for example, a truncated column) whose cross-sectional area decreases as it approaches the target. For example, an initial insertion area is defined from the insertion range to the target by designating an entry range on the surface of the object shown in the image of the object. Subsequently, it is judged whether or not the intersection between the initial insertion area and the non-invasive area is intersected. For example, the distance from the boundary of the initial insertion region to the non-invasive region is calculated using the distance map (S41). Thereafter, the initial insertion region is reduced so as to avoid the intersection, thereby creating the safe insertion region (S51). The insertion point can be extracted from the center line of the safe insertion area (S61). Since the insertion path can be changed within the safe insertion region, the safe insertion region is allowed in the insertion path. That is, according to the method of generating an insertion path of a medical device according to the present disclosure, an insertion region is extracted as a three-dimensional space, unlike extracting a single or a plurality of insertion paths individually. A method of generating an insertion path of a medical device according to the present disclosure is a method of creating a path of insertion of a medical device such as a biopsy needle, a lead for Deep Brain Stimulation, a probe, a catheter, It can be applied to various procedures, and can be applied to automatically generating a non-invasive insertion path in DBS (Deep Brain Stimulation). Hereinafter, the description will be focused on DBS.

Hereinafter, each process will be described in detail.

FIGS. 2 to 5 are views for explaining an example of a process of preparing a brain image including target and non-invasive areas.

First, various MRI brain images (eg, Vessel angiography, T1, etc.) are generated by MRI. Thereafter, the target (see 100 in FIGS. 9 and 11) and the non-invasive area (see 120 and 140 in FIG. 11) can be segmented (S11 in FIG. 1). For example, a software rendering method on a T1 image generates masks of regions (non-invasive areas) that should not be hurt such as vessels of the brain, ventricles, etc., and the target can be determined by the user have. The target is the part of the DBS that performs a specific function of the brain and becomes a target of stimulation. The DBS lead may be provided with an electrode (e.g., three electrodes) for stimulating the target. The brain images generated from the MRI include, for example, a sagittal view (see upper right), an axial view (see upper left), and a coronal view (see lower left) brain images, for example, as shown in FIG. In the case of blood vessels, blood vessels can be divided as shown in FIG. 3 (b) by a segmentation technique (for example, adaptive region growing) using an MRI Brain Angiography image in an axial view as shown in FIG. By such a segmentation, the target can be obtained as a three-dimensional set of voxels, and the non-invasive area such as blood vessels and ventricles such as arteries and veins. Likewise, the safe area excluding the non-invasive area can be obtained as a three-dimensional set of voxels. In FIG. 4, the non-invasive area and the safe area are not color-coded, but the non-invasive area and the safe area may be displayed in colors. The medical image software can be used to generate 3D volume rendering (FIG. 5 (a)) or 3D surface rendering (FIG. 5 (b)) from the divided blood vessels.

The non-invasive region extraction is a process of analyzing based on the brain image and storing the result as a mask. As a method of extracting the non-invasive area, a method of dividing the blood vessel by using the vascular emphasized image (thresholding, etc.) is applied as described above. A control program should be implemented that uses information such as masks, etc. to prevent the procedure tool from reaching the non-invasive area. In this case, if the accuracy is larger than the size of one voxel, the mask is sufficient. However, It is possible to apply the algorithm to create the surface model of this area and obtain the 3D modeled procedure tool and the intersection. That is, it implements mask intersection or 3D model intersection. Volume Rendering, Surface Rendering is a visualization of each piece of information that may need to be confirmed by the human eye.

FIGS. 6 and 7 are diagrams illustrating an example of brain images arranged in volume images.

Subsequently, the divided brain images are volume aligned based on anterior commissure-posterior commissure line (AC-PC line) (S21 in FIG. 1).

For example, two points AC and PC can be selected by the user using the sagittal view (see the upper right of FIG. 6 and FIG. 7) brain image, and the axial view (see upper left in FIG. 7) and the coronal view It is possible to select the two points AC and PC in the same manner. The sagittal view, axial view, and coronal view are volume aligned with respect to the AC-PC line (refer to the bottom right of FIG. 7).

FIG. 8 is a view showing an example of an interface of software for planning an insertion path, FIG. 9 is a view for explaining an example of a method of specifying an insertion range, and FIG. 10 is a partially enlarged view of FIG.

Subsequently, an initial insertion region (see Fig. 11 (a) 240) is designated by the user (S31 in Fig. 1). In this example, the insertion path can eventually be extracted as a single line, but first, the possible range of this final insertion path is specified by the user. For example, the possible range of such an insertion path is designated as a constant region of a three-dimensional columnar shape leading to the target. The insertion path specified by the user is defined as the initial insertion path.

Referring to FIG. 8, the user can select information or values related to AC-PC alignment, target position, entry range, and the like through an interface of software for planning an insertion path. Through these interfaces, it is possible to insert an insertion range (entry) on the surface of the brain, for example, in the sagittal view (see upper right in Fig. 9 and Fig. 10 (a)) and coronal view (lower left in Fig. 9 and Fig. range 211, 215) may be designated as a line. Therefore, the insertion range specified by the lines in the orthogonal sagittal view and the coronal view can be designated as the curved surface in the three-dimensional volume (see FIG. 11 (b) 210).

11 is a view for explaining an example of a process of generating a safe insertion area from an initial insertion area.

By designating the insertion range 210 described above, an initial insertion region 240 of a three-dimensional columnar shape is defined from the insertion range 210 to the target 100 as shown in Fig. 11 (a). In this example, the initial insertion area 240 has a truncated cone shape with a reduced cross-sectional area as it approaches the target 100. When the insertion range 210 is not circular, a cone fitting process can be performed, so that the initial insertion area 240 of the truncated cone shape is defined. The structure of the blood vessel 140 including the arteries and veins of the brain is simpler than that of the lung having a complicated vascular structure, and designating the initial insertion region 240 by avoiding the non-invasive regions 120 and 140 including the blood vessels It is possible for a doctor. Since the initial insertion region 240 is not forced to avoid the completely uninfected regions 120 and 140 and the process of extracting the safe insertion region 280 to be described later proceeds, Or may partially intersect with the regions 120 and 140 (see Fig. 11 (a)). However, the initial insertion area 240 is the one that minimizes the invasion by the user's experience and knowledge, and designates an area suitable for the insertion path for the subsequent process.

Then, it is determined whether or not the initial insertion area 240 intersects with the uninfected areas 120 and 140. For this, the distance from the boundary of the initial insertion area to the non-invasive area can be calculated. For example, as shown in FIG. 11 (a), a ray casting method from a target 100 may be used to move from the boundary of the initial insertion region 240 to the voxels of the non-invasive regions 120 and 140 A distance map of the distance map may be generated (S41 in FIG. 1).

The process of generating the distance map includes calculating the distance from the boundary to all the voxels based on the boundary on the mask of the non-invasive area. It is advantageous to calculate the distance of the insertion of the DBS lead or to calculate the safety distance in real time when the robot punches the medical needle.

Voxels in non-invasive areas 120 and 140 such as blood vessels located in the initial insertion area 240 can be found using the distance map. In addition, the distance between the boundary of the non-invasive areas 120 and 140 and the boundary of the initial insertion area 240 can be obtained. 11 (a), it can be seen that the initial insertion region 240, the blood vessel 140, and other important structures 120 (e.g., hippocampus, amygdala, etc.) of the brain partially cross each other.

Next, as shown in Fig. 11 (b), the initial insertion area 240 is reduced so as to avoid the intersection to generate the safe insertion area 280 (S51 in Fig. 1). The initial insertion area 240 may be reduced so that the initial insertion area 240 may intersect with the uninfected areas 120 and 140 or may be separated from the boundary of the uninfected areas 120 and 140 by a safety distance do. That is, the secure insertion area 280 is an area included in the initial insertion area 240. For example, by using the distance map, the initial insertion area 240 is reduced to a safe insertion area 280 outside the safety distance from the uninvited area 120, 140, And may be cone fitting. The thus generated safe insertion region 280 may indicate the range of the insertion path that can be applied to the actual procedure. If the created secure insertion area 280 is too small or another inappropriate reason is found, another initial insertion area may be specified and another safe insertion area may be obtained.

FIG. 12 is a view for explaining an example of insertion paths shown in sagittal, axial, coronal views and 3D images. 13 is a view showing an example of an image of the brain by the surgeon's eye view.

The intersection point between the center line of the cone-shaped safe insertion region 280 (see FIG. 11 (b) 250) and the head surface of the brain image is extracted as an insertion point 270 (See Fig. 11 (b) and Fig. 12). Thus, an insertion path is extracted from the insertion point 270 to the target 100 (e.g., to the center of the target). The insertion path in the safe insertion region 280 can be all insertion paths applicable to the procedure, and not necessarily the insertion path along the center line 250.

In this example, a method of generating an insertion path of a medical device may include displaying an image of the brain along an insertion path. For example, an image of the brain (e.g., a 2D MPR image) projected from the viewpoint of the virtual camera 5 located at the medical device (e.g. DBS lead) 7 along the insertion path from the insertion point 270 to the target 100 path) or a 3D surface view display may be displayed (see FIG. 13). The view of the virtual camera 5 shows an image of the brain through which the medical device will pass along the insertion path in the surgeon's eye view. This allows the appropriateness of the insertion path to be reevaluated and, if necessary, the insertion path can be modified. The modification process can be simply performed by directly inputting parameters or adjusting the insertion point 270 with a mouse, moving the insertion path, or the like, as shown in FIG.

The process of specifying the insertion range 210 described above, generating the initial insertion area 240, generating the distance map, generating the safe insertion area 280, and extracting the insertion path along the center line 250, Under the control of a computer. In addition, a specific method of objectively evaluating whether the invasion of the uninfected areas 120 and 140 by the insertion path of the medical device is invasive using a brain image and generating an insertion path by avoiding the uninfected areas 120 and 140 .

Various embodiments of the present disclosure will be described below.

(1) the step of designating an initial insertion region includes the steps of: defining an initial insertion region from an insertion range to a target by designating an entry range on a surface of an object displayed in an image of the object; Wherein the method comprises the steps of:

(2) The step of determining the intersection may include: calculating a distance from the boundary of the initial insertion region to the non-invasive region.

(3) The step of preparing the target image includes: a process in which the non-invasive region including the blood vessel is segmented using the Sagittal, axial, and coronal view images of the target acquired from the medical imaging apparatus; Wherein the step of generating the insertion path comprises:

(4) The target is a stimulation target in Deep Brain Stimulation (DBS).

(5) The step of preparing the image to be treated includes: a process in which the non-invasive area including the blood vessel is segmented using the sagittal, axial and coronal view images acquired from the medical imaging apparatus; and a step of volume alignment based on a commissure-posterior commissure line, the step of designating an initial insertion region comprises: using at least two of the aligned Sagittal, Axial and Coronal view brain images, and defining an initial insertion area of a truncated cone shape from the insertion range to the target by designating an entry range of the surface shape of the insertion path, .

(6) The step of preparing an image of a subject is: a process in which a non-invasive region including a blood vessel is segmented into a set of three-dimensional voxels using Sagittal, Axial, and Coronal view brain images obtained from a medical imaging apparatus; And a volume alignment of the divided brain images based on anterior commissure-posterior commissure line. The step of determining the intersection is performed by: ray casting from the boundary of the initial insertion region, and generating a distance map from the boundary to the voxel of the non-invasive area by a casting method.

(7) The step of creating a safe insertion area includes: a process of cone fitting a safety insertion area in which an initial insertion area is reduced from an uninvited area using a distance map outside a safety margin; And a process of extracting an intersection point between a center line of the safe insertion region and a head surface of a brain image as an entry point.

(8) displaying an image of the brain at a viewpoint of the virtual camera located at the medical device along the insertion path from the insertion point to the target.

(9) The step of preparation of the brain image is performed by: using the Sagittal, Axial and Coronal view brain images obtained from the medical imaging device, the non-invasive area including the blood vessel and the DBS target are segmented into a set of three-dimensional voxels The process includes the following steps: volume alignment of brain images based on anterior commissure-posterior commissure line. The step of designating an initial insertion region includes: using sagittal and coronal view brain images, defining an initial insertion region of a truncated cone shape from an insertion range to a target by designating an entry range of a surface shape, The distance map from the boundary to the voxel in the non-invasive region is generated by the ray casting method from the boundary of the non- ; Step which includes, the inserted safety zone is created: a distance map using the initial insertion area reduction in the safety margin from the outer area not allowed invasion safety fitting insertion region is cone (cone fitting) process; And designating an intersection point between a center line of the safe insertion region and a head surface of the brain image as an entry point.

According to the method of generating an insertion path of one medical device according to the present disclosure, an insertion path having an objective and quantitative basis is created in avoiding a region where invasion is not permitted, such as a blood vessel or a ventricle.

According to the method of generating an insertion path of another medical device according to the present disclosure, the risk can be reduced by avoiding invasion of blood vessels and the like in a procedure of DBS using a medical device.

According to the method of generating an insertion path of another medical device according to the present disclosure, an insertion path avoiding an uninvoked area is automatically generated under a user setting condition and is convenient.

The method of generating an insertion path of another medical device according to the present disclosure creates an insertion path in 3D and thus overcomes the limitation of a method of planning and guiding an insertion path on a 2D section.

Claims (10)

In a method for generating a trajectory of a medical device from an entry point to a target,
Preparing an image of a treatment target including a target and a non-invasive area;
Designating an initial insertion region including a insertion path, the initial insertion region having a three-dimensional columnar shape whose cross-sectional area decreases as the target becomes closer to the target;
Determining whether an intersection between the initial insertion region and the non-invasion-inhibiting region is intersected; determining whether to include a voxel in an invasion-unallowable region located in the initial insertion region; And
And generating a safe insertion region by reducing an initial insertion region to avoid intersection. The method according to claim 1,
The steps in which the initial insert region is specified are:
And defining an initial insertion area from an insertion range to a target by designating an entry range on a surface of an object displayed in an image of the object. In a method for generating a trajectory of a medical device from an entry point to a target,
Preparing an image of a treatment target including a target and a non-invasive area;
Designating an initial insertion region including a insertion path, the initial insertion region having a three-dimensional columnar shape whose cross-sectional area decreases as the target becomes closer to the target;
Determining whether an intersection between an initial insertion area and an uninvited area is determined; calculating a distance from a boundary of the initial insertion area to an uninvited area; And
And generating a safe insertion region by reducing an initial insertion region to avoid intersection. The method according to claim 1,
The steps of preparing the image of the object include:
The process of segmentation of non-invasive areas containing blood vessels using Sagittal, axial and coronal view images of objects acquired from medical imaging devices:
And wherein the images are volume aligned with respect to the patient. The method according to claim 1,
Wherein the target is a stimulation target in Deep Brain Stimulation (DBS). The method according to claim 1,
The step of preparing the image to be treated includes:
Sagittal, Axial, and Coronal view acquired from a medical imaging device The process of segmentation of the non-invasive area containing blood vessels using brain images:
The process of volume alignment of brain images based on anterior commissure-posterior commissure line,
The steps in which the initial insert region is specified are:
By specifying an entry range of the surface shape using at least two of the aligned sagittal, axial and coronal view brain images, the initial insertion region of the truncated cone shape from the insertion range to the target The method comprising the steps of: (a) defining an insertion path of the medical device; The method according to claim 1,
The steps of preparing the image of the object include:
The process of segmentation of a non-invasive area containing blood vessels into a set of three-dimensional voxels using Sagittal, axial and coronal view brain images acquired from a medical imaging device:
The process of volume alignment of segmented brain images based on anterior commissure-posterior commissure line,
The step of determining the intersection is:
And generating a distance map from the boundary to the voxel in the non-invasive area by a ray casting method from a boundary of the initial insertion region. / RTI > The method of claim 7,
The steps in which a secure insert region is created are:
A process of cone fitting a safety insertion region in which an initial insertion area is reduced from a safety margin outside an uninvolved area using a distance map; And
And a step of extracting an intersection point between a center line of the safe insertion region and a head surface of the brain image as an entry point. The method of claim 8,
And displaying an image of the brain at a viewpoint of the virtual camera located at the medical device along the insertion path from the insertion point to the target. The method according to claim 1,
The steps of preparing the image of the object include:
The process of segmentation of a non-invasive area containing a blood vessel and a DBS target into a set of three-dimensional voxels using Sagittal, Axial and Coronal view brain images acquired from a medical imaging device:
The process of volume alignment of brain images based on anterior commissure-posterior commissure line,
The steps in which the initial insert region is specified are:
And defining an initial insertion region of a truncated cone shape from the insertion range to the target by designating an entry range of a surface type using aligned Sagittal and Coronal view brain images, ,
The step of determining the intersection is:
And generating a distance map from the boundary to the voxel of the non-invasive region by a ray casting method from the boundary of the initial insertion region,
The steps in which a secure insert region is created are:
A process of cone fitting a safety insertion region in which an initial insertion area is reduced from a safety margin outside an uninvolved area using a distance map; And
And a step of designating an intersection point between a center line of the safe insertion region and a head surface of the brain image as an entry point.

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