KR20100039315A - Medical instrument used in medical navigation and medical navigation method - Google Patents

Abstract

PURPOSE: An operation tool and a navigation for operation are provided to allow easy navigation by registering a fiducial mark with a elongated pin. CONSTITUTION: A probe(201) has at least three infrared reflection spheres on a knob. The probe has a groove(204) on the end and receives a long pin. Since the long pin is received in the groove stably, the position of a reference frame at the long pin is determined by an infrared camera accurately.

Description

Surgical Instruments and Surgical Navigation Methods {MEDICAL INSTRUMENT USED IN MEDICAL NAVIGATION AND MEDICAL NAVIGATION METHOD}

TECHNICAL FIELD The present invention relates to surgical instruments and surgical navigation methods, and more particularly, to a probe grooved to receive an elongated pin to be used as an indicator and a method of registering between a patient and an image using the probe.

1 is a view illustrating a conventional surgical navigation apparatus, a patient 101, a surgical navigation system 102 (medical navigation system), an infrared camera 103, a reference frame fixed to the patient in the operating room Reference Frame) is shown.

Surgical navigation device 102 stores a medical image such as MRI, CT, PET, and the image corresponding to the affected part of the patient 101 that the doctor wants to see during surgery (provided in the surgical navigation device 102) It serves to show through the monitor 105.

2 is a view showing an example of a probe used in a surgical navigation device, the probe 201 (Probe) is a tool for indicating the affected part of the patient 101 that the doctor wants to see, the doctor is affected by the affected part of the patient 101 When the probe 201 is taken to the surgical navigation apparatus 103, the surgical navigation apparatus 103 recognizes the position of the probe 201 through the infrared camera 103 based on the reference frame 104 (provided in the probe 201). The infrared reflector 202 recognizes the infrared camera 103 and informs the surgical navigation apparatus 102 of this position information, and displays an image corresponding to this position on the monitor 105. Here, the position of the reference frame 104 is also determined by the infrared camera 103 to recognize the infrared reflector 130 provided in the reference frame 104.

For this operation, the task of associating the image stored in the surgical navigation device 102 with the position of the patient 101 in the operating room (mapping the image coordinate system and the position coordinate system of the patient) must be preceded. This is called Registration. This registration can be made in various ways, but here, the registration method using the fiducial marks 106 will be described.

3 is a diagram conceptually illustrating a registration method using an index point, wherein registration is based on an image coordinate system 107 provided in an image, a camera coordinate system 108 provided in an infrared camera 103, and a reference provided in a reference frame 104. The frame coordinate system 109 is used.

The principle of this registration is that the index point 106 of the patient 101 and the index point 111 on the image are the same (the image was created with the patient attached to the index point 106, so that the index point 106 And the index point 111 must be in the same positional relationship.), Registration is made by finding a correlation between these points.

That is, the position (coordinate value or vector) of the ground point 106 on the reference frame coordinate system 109 is the same as the position (coordinate value or vector) of the ground point 111 on the image coordinate system 107.

The position of the index point 111 on the image coordinate system 107 is already given, and the position of the index point 106 on the reference frame coordinate system 109 can be known by placing the probe 201 at the index point 106. Since these are points in three-dimensional space, position information of at least three ground points is required. Strictly, the position of the ground point 106 on the reference frame coordinate system 109 recognizes the reference frame coordinate system 109 by allowing the infrared camera 103 to recognize the infrared reflector 130 provided in the reference frame 104. (Represents the reference frame coordinate system 109 with respect to the camera coordinate system 108), and recognizes the position of the ground point 106 by recognizing the infrared reflector 202 provided in the probe 201 (the camera coordinate system 108). By indicating the position of the index point 106 relative to the reference frame coordinate system 109. On the other hand, the position of the ground point 106 and the probe 201 are displayed relative to the reference frame coordinate system 109 so that the positional relationship between the reference frame coordinate system 109 and the patient 101 is dependent on the movement of the infrared camera 103. Will not be affected.

For the sake of understanding, the registration process is described in a mathematical manner: points (X _r1 , Y _r1 , Z _r1 ), (X _r2 , Y _r2 , Z _r2 ), (X _r3 , Y _r3 ) on the reference frame coordinate system 109. A matrix T that transforms, Z _r3 ) into points (X _i1 , Y _i1 , Z _i1 ), (X _i2 , Y _i2 , Z _i2 ), (X _i3 , Y _i3 , Z _i3 ) on the image coordinate system 107. It can be said that the process of finding.

As shown in FIG. 3, in the case of brain surgery, the fixing device 107 having the indicator point 106 is fixed to the head of the patient 101 prior to the operation, and then the indicator as shown in the monitor 105. After acquiring the image provided with the ground point 111 corresponding to the point 106, registration can be easily performed at the operating room.

However, in surgery such as knee surgery or bone tumor surgery, the fixation device 107 cannot be fixed near the affected part of the patient (in the case of the brain, the skin is directly enclosed by the skull, so it is fixed to the skull). The device 105 may be fixed, but in the case of bone tumor surgery, since a soft tissue such as muscle is present between the skin and the bone, the fixing device 107 cannot be fixed). The affected area was dissected at, and then enrolled or surface registered using anatomical fiducial marks.

An object of the present invention is to provide a surgical instrument and a surgical navigation method that can be easily navigated through the registration of the landmark.

In addition, an object of the present invention is to provide a surgical tool and a surgical navigation method that can be easily navigated through the registration of the landmark using the long pin.

It is also an object of the present invention to provide a surgical navigation method that can be easily navigated using the synthesized image.

It is another object of the present invention to provide a surgical navigation method that can prevent infection of a patient before surgery after image acquisition.

To this end, the present invention is a surgical navigation using an elongage pin that penetrates the skin and internal tissues underlying the epidermis, and is fixed to bones underlying the internal tissues. A surgical instrument for use in a method, wherein the surgical tool is located by the sensing means, comprising: a sensing object located by the sensing means; And it is fixed to the position to be detected, the end of the groove for receiving the elongated pin; provides a surgical tool comprising a. The sensing means is mainly an infrared camera, in which at least three infrared reflectors are used.

In another aspect, the present invention provides a surgical tool, characterized in that the sensing object is formed on the handle, the end having a groove is located on the opposite side of the sensing object.

The present invention also provides a surgical instrument, characterized in that the sensing object is at least three infrared reflectors.

In another aspect, the present invention provides a surgical tool characterized in that one end of the elongated pin is fixed to the bone, the other end of the elongated pin has a pointed shape that is received in the groove.

The present invention also provides a surgical tool, characterized in that formed when the length is adjusted so that the remaining end of the elongated pin does not interfere with the operation.

The present invention also provides information on bone, internal tissues that are relatively movable to bone and skin that covers the internal tissue, and information about elongate pins fixed to the bone through the epidermis and internal tissue. A first step of preparing an image containing a; And a second step of determining the positional relationship between the patient and the first step image by using an input from the sensing means that recognizes the surgical tool positioned by receiving one end of the elongated pin. Provided is a surgical navigation method. In this case, an infrared camera is mainly used, but a magnetic sensing means may be used when a magnetic field is used.

In another aspect, the present invention provides a surgical navigation method characterized in that it contains information about the elongated pin is adjusted so that the image of the first step does not interfere with the surgery. Cutting out the long pins will facilitate patient behavior and surgery in the operating room, while protecting the pinned areas with sterilized cotton to prevent infection of the patient through the pinned areas. Can be.

In another aspect, the present invention provides a surgical navigation method characterized in that the image of the first step is generated using a CT image reflecting the characteristics of bone and elongated pins. By using CT images, bone and elongated pins can be identified more effectively than using MRI images, while facilitating registration in the second stage.

In another aspect, the present invention provides a surgical navigation method characterized in that the image of the first step is generated by synthesizing the CT image and the MRI image reflecting the characteristics of the tumor. By using image fusion, the positional relationship between bone and tumor can be more clearly understood.

According to the surgical instrument and the surgical navigation method according to the present invention, it is possible to easily navigate through the registration of the landmark.

In addition, according to the surgical tool and the surgical navigation method according to the present invention, it is possible to easily navigate through the registration of the landmark using the long pin.

In addition, according to the surgical navigation method according to the present invention, it is possible to easily navigate using the synthesized image.

In addition, according to the surgical navigation method according to the invention, it is possible to prevent the infection of the patient before the operation after the image acquisition.

1 is a view for explaining a conventional surgical navigation device,
2 is a view showing an example of a probe used in a surgical navigation device,
3 is a view conceptually illustrating a registration method using an index point;
4 is a view for explaining an example of the operating room where surgery is performed according to the present invention,
5 is a view for explaining an example of a navigation according to the present invention;
6 is a view showing an example of a CT image according to the present invention;
7 is a diagram illustrating an example of an image matched according to the present invention;
8 is a view showing an example of a surgical tool or probe according to the present invention,
9 is a view showing an example of the shape of an elongated fin according to the present invention.

Hereinafter, the present invention will be described in more detail with reference to the drawings.

4 is a view illustrating an example of an operating room in which surgery is performed according to the present invention, and a surgical navigation device 102, an infrared camera 103, a reference frame 104, and a monitor 105 are provided in the operating room. It is. Meanwhile, as part of the patient, the bone (BN), the tumor (TM) that has metastasized into the bone (BN), the internal tissue (TS) relatively movable relative to the bone (BN) and the epidermis (S) covering the internal tissue (TS) Is shown. The reference frame 104 may be fixed to the bone BN after incision of the internal tissue TS at the operating room. In addition, at least three elongated pins 401, 402, 403 are embedded in the bone BN, which is used as an index in registration between the patient at the operating room and the image stored in the surgical navigation device 102. The pin has a material that can be identified in imaging such as CT, has a length that can be fixed to the bone BN through the internal tissue TS, and has a pointed end to be fixed to the bone BN. It is sufficient to have and does not have special limitations. For example, an elongated pin of stainless steel having a thickness of 1.5 mm and a length of 25 cm may be used. In this state of preparation, registration is made by designating each of the elongated pins 401, 402, 403 using a surgical tool or probe 201 with an infrared reflector 202. In securing the long pins 401, 402, 403 to the bone BN, pins longer than those shown in FIG. 4 may be used to facilitate fixation, which may be cut to a suitable size after fixation. This is for the convenience of the patient after fixing and to prevent the jam in the operating room. On the other hand, the patient may be infected through the point where the pins 401, 402, 403 and the skin or the epidermis S meet, and this can be solved by wrapping the part with sterilized cotton or the like.

FIG. 5 is a view illustrating an example of navigation according to the present invention. First, in operation S1, an MRI image including information of a tumor TM is obtained before surgery. MRI is used to obtain tumor (TM) information because MRI is suitable for obtaining soft tissue information.

In operation S2, a CT image of the long pins 401, 402, and 403 fixed is obtained before surgery. This is because CT is suitable for obtaining information of a hard object such as long pins 401, 402, 403 and bone BN.

In step S3, the MRI image of step S1 and the CT image of step S2 are fused. Image matching provides a basis for superimposing two images on one screen, and can be understood as a process of finding a linear transformation P representing a correspondence of two images. Through this registration, the information of the tumor (TM), which is shown in the MRI image, and the information of the bone (BN), which is shown in the CT image, can be seen in a state where the positional relationship between the two is aligned on one screen. Various methods apparent to those skilled in the art may be used for matching, and for example, a method using the following MI (Mutual Information) may be used.

P = arg max MI (P (A), B)

(Where MI is the mutual information between the images A and B)

The pre-operation preparation is completed by placing the image matched in step S3 in a state that the surgical navigation apparatus 102 can display on the monitor 105.

In step S4, registration of the patient entering the operating room is started. When the surgical navigation apparatus 102 is placed in the registration mode and the one-to-one correspondence of each of the long pins 401, 402, 403 and the corresponding points on the image displayed on the monitor 105 using the probe 201, the surgical navigation apparatus 102 is performed. Recognizes this. At this time, the matched image of step S3 may be used or a CT image may be used.

In step S5, the surgical navigation device 102 obtains the positional relationship T between the patient and the image in the operating room using the correspondence input in step S4, and registration is completed.

In step S6, the position of the surgical tool 201 is tracked through the infrared camera 103 and transferred to the surgical navigation device 102.

In step S7, the surgical navigation device 102 displays on the image the position of the surgical tool 201 tracked using the positional relationship T.

In the present embodiment, the process of step S4 to step S7 is a series of processes occurring in the surgical navigation device 102 located in the operating room.

6 is a view illustrating an example of a CT image according to the present invention, in which three elongated pins 401, 402, 403 are fixed to a side of a leg bone. Here pin 403 is volume rendered and displayed in a different color.

7 is a view showing an example of a matched image according to the present invention, in which the surgical tool 201 is displayed according to the positional relationship T on the matched image.

When the registration using the landmark is performed by using the landmark 106 and the surgical tool or probe 201 as shown in FIGS. 2 and 3, the probe 201 is formed in the concave groove formed in the landmark 106. By positioning the sharp end of the position of the ground point 106 through the infrared camera 103 was able to recognize. However, when using the long pin 401 as an index point as in the present invention, it is not easy to precisely position the long pin 401 using the probe 201.

8 is a view showing an example of a surgical tool or a probe according to the present invention, the probe 201 having at least three infrared reflector 202 in the handle 203 can accommodate the elongated pin 401. A groove 204 is formed at the end thereof. Therefore, by stably accommodating the end of the elongated pin 401, it is possible to precisely position the position of the elongated pin 401 with respect to the reference frame 104 through the infrared camera 103.

9 is a view showing an example of the shape of an elongated pin according to the present invention, the elongated pin 401 has a pointed shape so that one end 404 can be fixed to the bone (BN), the other end 405 It has a pointed shape to be accommodated in the groove 204 of the probe 201. The pointed shape may be formed in various ways, but when the elongated pin 401 is fixed to the bone BN and then the length is adjusted, it may be formed in the process of adjusting the length. At this time, it has a form inclined to one side as shown in FIG.

End 404 pin 401

Claims (9)

It is used in surgical navigation methods that use elongage pins as indicators that penetrate the skin and internal tissues underlying the epidermis and are fixed to bones underlying the internal tissues. In the surgical instrument that is located by the sensing means,
A sensing object recognized by the sensing means; And
Positioned relative to the sensing object, the end having a groove for receiving an elongated pin; surgical tool comprising a. The method of claim 1,
The sensing object is formed on the handle,
Surgical tool characterized in that the end having a groove is located on the opposite side of the sensing object. The method of claim 2,
Surgical object, characterized in that the at least three infrared reflector. The method of claim 1,
One end of the elongated pin is fixed to the bone,
Surgical tool is characterized in that the other end of the elongated pin has a pointed shape that is accommodated in the groove. The method of claim 5, wherein
Surgical tool is characterized in that the remaining end of the elongated pin is formed when the length is adjusted so as not to interfere with the surgery. Images containing information about bones, internal tissues that are relatively movable to bones and skin covering the internal tissues, and elongate pins fixed to the bones through the epidermis and internal tissues Preparing a first step; And,
And a second step of grasping the positional relationship between the patient and the first step image by using an input from the sensing means that recognizes the surgical tool positioned by receiving one end of the elongated pin. Navigation method. The method of claim 6,
Surgical navigation method characterized in that the image of the first step contains information about the elongated pin is adjusted so as not to interfere with the surgery. The method of claim 7, wherein
Surgical navigation method characterized in that the image of the first step is generated using a CT image reflecting the characteristics of the bone and the elongated pins. The method of claim 8,
Surgical navigation method, characterized in that the image of the first step is generated by synthesizing the CT image and the MRI image reflecting the characteristics of the tumor.

Images