US20130109957A1 - Flexible instrument channel insert for scope with real-time position tracking - Google Patents

Flexible instrument channel insert for scope with real-time position tracking Download PDF

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Publication number
US20130109957A1
US20130109957A1 US13/521,579 US201013521579A US2013109957A1 US 20130109957 A1 US20130109957 A1 US 20130109957A1 US 201013521579 A US201013521579 A US 201013521579A US 2013109957 A1 US2013109957 A1 US 2013109957A1
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instrument channel
optical fiber
recited
sheath
fiber
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US13/521,579
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Gert 'T Hooft
Adrien Emmanuel Desjardins
Raymond Chan
Guy Shechter
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Koninklijke Philips NV
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Koninklijke Philips Electronics NV
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Assigned to KONINKLIJKE PHILIPS ELECTRONICS N V reassignment KONINKLIJKE PHILIPS ELECTRONICS N V ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: SHECHTER, GUY, DESJARDINS, ADRIEN, CHAN, RAYMOND, 'T HOOFT, GERT
Publication of US20130109957A1 publication Critical patent/US20130109957A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00082—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/009—Flexible endoscopes with bending or curvature detection of the insertion part
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1076—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions inside body cavities, e.g. using catheters
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01D—MEASURING NOT SPECIALLY ADAPTED FOR A SPECIFIC VARIABLE; ARRANGEMENTS FOR MEASURING TWO OR MORE VARIABLES NOT COVERED IN A SINGLE OTHER SUBCLASS; TARIFF METERING APPARATUS; MEASURING OR TESTING NOT OTHERWISE PROVIDED FOR
    • G01D5/00—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable
    • G01D5/26—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light
    • G01D5/32—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light
    • G01D5/34—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells
    • G01D5/353—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells influencing the transmission properties of an optical fibre
    • G01D5/35306—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells influencing the transmission properties of an optical fibre using an interferometer arrangement
    • G01D5/35309—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells influencing the transmission properties of an optical fibre using an interferometer arrangement using multiple waves interferometer
    • G01D5/35316—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells influencing the transmission properties of an optical fibre using an interferometer arrangement using multiple waves interferometer using a Bragg gratings
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01D—MEASURING NOT SPECIALLY ADAPTED FOR A SPECIFIC VARIABLE; ARRANGEMENTS FOR MEASURING TWO OR MORE VARIABLES NOT COVERED IN A SINGLE OTHER SUBCLASS; TARIFF METERING APPARATUS; MEASURING OR TESTING NOT OTHERWISE PROVIDED FOR
    • G01D5/00—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable
    • G01D5/26—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light
    • G01D5/32—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light
    • G01D5/34—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells
    • G01D5/353—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells influencing the transmission properties of an optical fibre
    • G01D5/35383—Mechanical means for transferring the output of a sensing member; Means for converting the output of a sensing member to another variable where the form or nature of the sensing member does not constrain the means for converting; Transducers not specially adapted for a specific variable characterised by optical transfer means, i.e. using infrared, visible, or ultraviolet light with attenuation or whole or partial obturation of beams of light the beams of light being detected by photocells influencing the transmission properties of an optical fibre using multiple sensor devices using multiplexing techniques
    • 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
    • A61B2034/2061—Tracking techniques using shape-sensors, e.g. fiber shape sensors with Bragg gratings
    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B6/00—Light guides; Structural details of arrangements comprising light guides and other optical elements, e.g. couplings
    • G02B6/02—Optical fibres with cladding with or without a coating
    • G02B6/02057—Optical fibres with cladding with or without a coating comprising gratings
    • G02B6/02076—Refractive index modulation gratings, e.g. Bragg gratings
    • G02B6/02195—Refractive index modulation gratings, e.g. Bragg gratings characterised by means for tuning the grating
    • G02B6/022—Refractive index modulation gratings, e.g. Bragg gratings characterised by means for tuning the grating using mechanical stress, e.g. tuning by compression or elongation, special geometrical shapes such as "dog-bone" or taper

Definitions

  • This disclosure relates to medical devices, and more particularly to medical devices employing fiber optic technology for position tracking during procedures.
  • Navigating a bronchoscope to a target in a bronchial tree of the lungs can be very challenging, even for experienced physicians.
  • a target is typically identified by computed tomography (CT), and as follow-up, a biopsy is performed via an instrument channel of a bronchoscope.
  • CT computed tomography
  • bronchoscopy there is often a dearth of visual features for determining a direction to navigate at branch points and therefore physicians can get disoriented. The process of getting to the target can be very inefficient, which can result in increased procedure time or a tissue biopsy from an incorrect location.
  • a significant step forward for pulmonologists would be to have a robust method for correlating a position of the bronchoscope tip with a CT image volume.
  • Different methods have been proposed to achieve this, and each has its disadvantages.
  • One method includes electromagnetic (EM) navigation. In good cases, accuracy can be in the range of 1-2 mm, which is sufficient. This method involves a lengthy and complicated setup process in which EM sensors are positioned around the patient. Additionally, this method is sensitive to the presence of external fields which can significantly degrade accuracy.
  • Another method includes registration of visual features observed with the bronchoscope with 3D fly-through reconstructions obtained from pre-procedurally-acquired 3D datasets. This method has the disadvantage that often there are insufficient visual cues to provide robust registration.
  • an apparatus, system and method for determining a position of an instrument are provided.
  • a sheath is configured to fit within an instrument channel of a medical scope.
  • An optical fiber or fibers are disposed within the sheath and a plurality of sensors is integrated in optical fiber(s). The sensors are configured to measure deflections and bending in the optical fiber.
  • a fixing mechanism is sized to fit within the instrument channel in a first state and fixes the sheath within the instrument channel in a second state such that the fixing mechanism anchors the sheath and the optical fiber so that the deflections and bending in the optical fiber are employed to determine a position of the instrument.
  • a system for tracking of a portion of a medical device includes spatially distributed Fiber Bragg Gratings (FBGs) integrated on an optical fiber and disposed within a flexible insert, the flexible insert being positionable within an instrument channel of the medical device.
  • An optical system is configured to deliver light to the FBGs and receive light from the FBGs such that deflections of the optical fiber are measured.
  • a computer system includes a shape determination program configured to compute parameters related to the deflections of the optical fiber and determine a configuration of the flexible insert, and a map volume acquired from a pre-procedural scan such that based upon a comparison between the configuration of the flexible insert and the map volume a position of the medical device is determined.
  • a method for tracking of a portion of a medical device includes inserting a sheath into an instrument channel, the sheath including an optical fiber and a plurality of distributed sensors integrated with the optical fiber; anchoring the sheath within the instrument channel; determining a reference position within a patient using a pre-procedural volume of the patient, and determining a shape of the optical fiber using the sensors and correlating the shape with the pre-procedural volume to provide a location of the portion of the medical device.
  • FIG. 1 shows an optical fiber including a Fiber Bragg Grating (FBG), a plot of index of refraction versus distance and spectral response due to the FBG;
  • FBG Fiber Bragg Grating
  • FIG. 2 shows a fiber triplet deflected in three-dimensional space
  • FIG. 3 is a diagram showing a cross-sectioned view of a scope with an apparatus therein including a flexible insert having an optical fiber with FBGs and a balloon for anchoring an end portion of the flexible insert;
  • FIG. 3A is a diagram showing the cross-sectioned view of FIG. 3 with the balloon expanded for anchoring an end portion of the flexible insert;
  • FIG. 4 is a cross-sectional view taken as section line 4 - 4 of FIG. 3 ;
  • FIG. 5 is a cross-sectional view taken as section line 5 - 5 of FIG. 3 ;
  • FIG. 6 is a flow diagram showing an illustrative procedure for tracking a bronchoscope within a body in accordance with one embodiment.
  • the present disclosure describes an apparatus and method for real-time, markerless (no external markers are needed on a patient) tracking of a tip of a medical device, for example, a bronchoscope.
  • Sensors such as Fiber Bragg Gratings (FBGs) are integrated within a flexible insert that can be positioned within an instrument channel of the device.
  • FBGs Fiber Bragg Gratings
  • a system may include: (1) a bronchoscope or other instrument having at least one instrument channel, a light source, and an optical system for acquiring images (e.g., a CCD camera at the tip or a fiber bundle), (2) at least one optical fiber containing a plurality of FBG's to monitor, in a spatially distributed fashion, deflection or bending of the optical fiber, (3) an optical console that delivers light to the FBGs and receives light from them, with a corresponding shape determination program which computes parameters related to the deflection of the optical fibers, and (4) a computer system with a 3D volume of the bronchial tree acquired from a pre-procedural scan, preferably with, e.g., a segmentation of a bronchial tree.
  • images e.g., a CCD camera at the tip or a fiber bundle
  • an optical console that delivers light to the FBGs and receives light from them, with a corresponding shape determination program which computes parameters related to the deflection of the
  • the apparatus and method assist in orienting a physician or technician in navigating through branch points in a bronchial tree or other structure, make reaching a target more efficient, decrease the time required for a procedure and make it easier to assure that a biopsy is taken from a correct location.
  • a system for real-time, markerless tracking of the tip of a bronchoscope.
  • the system preferably utilizes Fiber Bragg Gratings (FBGs) integrated within a flexible sheath or insert that can be inserted into an instrument channel of the bronchoscope.
  • FBGs Fiber Bragg Gratings
  • One, two, three or more fibers may include integrated FBGs that can be utilized in conjunction with each other to track 3D shapes of the fibers in real-time.
  • the present invention will be described in terms of medical instruments; however, the teachings of the present invention are much broader and are applicable to any instruments employed in tracking or analyzing complex biological or mechanical systems.
  • the present principles are applicable to bronchoscopic procedures of the lung, as well as endoscopic procedures in other areas of the body such as the gastro-intestinal tract, blood vessels, etc.
  • the elements depicted in the FIGS. may be implemented in various combinations of hardware and software and provide functions which may be combined in a single element or multiple elements.
  • processor or “controller” should not be construed to refer exclusively to hardware capable of executing software, and can implicitly include, without limitation, digital signal processor (“DSP”) hardware, read-only memory (“ROM”) for storing software, random access memory (“RAM”), and non-volatile storage.
  • DSP digital signal processor
  • ROM read-only memory
  • RAM random access memory
  • embodiments of the present invention can take the form of a computer program product accessible from a computer-usable or computer-readable medium providing program code for use by or in connection with a computer or any instruction execution system.
  • a computer-usable or computer readable medium can be any apparatus that may include, store, communicate, propagate, or transport the program for use by or in connection with the instruction execution system, apparatus, or device.
  • the medium can be an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system (or apparatus or device) or a propagation medium.
  • Examples of a computer-readable medium include a semiconductor or solid state memory, magnetic tape, a removable computer diskette, a random access memory (RAM), a read-only memory (ROM), a rigid magnetic disk and an optical disk. Current examples of optical disks include compact disk—read only memory (CD-ROM), compact disk—read/write (CD-R/W) and DVD.
  • a Fiber Bragg grating (FBG) 10 is illustratively depicted.
  • the FBG 10 includes a short segment of an optical fiber 12 that reflects particular wavelengths of light and transmits all others. This is achieved by adding a periodic variation 14 of the refractive index in a fiber core 16 , which generates a wavelength-specific dielectric mirror.
  • a plot 20 of core refractive index versus distance is illustratively shown.
  • a fiber Bragg grating 10 can therefore be used as an inline optical filter to block certain wavelengths, or as a wavelength-specific reflector.
  • An input spectrum 22 and respective output spectrums 24 and 26 illustratively show a transmitted portion (spectrum 24 ) and a reflected portion (spectrum 26 ) of the input spectrum 22 .
  • the fundamental principle behind the operation of a fiber Bragg grating 10 is Fresnel reflection at each of the interfaces where the refractive index changes. For some wavelengths, the reflected light of the various periods is in phase so that constructive interference exists for reflection and consequently, destructive interference exists for transmission.
  • the Bragg wavelength is sensitive to strain as well as to temperature. This means that Bragg gratings can be used as sensing elements in fiber optical sensors.
  • the strain causes a shift in the Bragg wavelength, ⁇ B .
  • the relative shift in the Bragg wavelength, ⁇ B / ⁇ B due to an applied strain ( ⁇ ) and a change in temperature ( ⁇ T) is approximately given by:
  • the coefficient C s is called the coefficient of strain and its magnitude is usually around 0.8 ⁇ 10 ⁇ 6 / ⁇ or in absolute quantities about 1 pm/ ⁇ ).
  • the coefficient C T describes the temperature sensitivity of the sensor; it is made up of the thermal expansion coefficient and the thermo-optic effect. Its value is around 7 ⁇ 10 ⁇ 6 /K (or as an absolute quantity 13 pm/K). While FBGs are particularly suited for use in accordance with the present principles, other sensors may also be employed.
  • a fiber triplet 30 includes three fibers 34 and three FBGs 32 .
  • One advantage of employing the triplet 30 or a multiple fiber/FBG element is that various sensor elements can be distributed over the length of a fiber. E.g., incorporating three cores with various sensors (gauges) along the length of the fiber embedded in a structure, the three dimensional form of such a structure can be precisely determined Along a length of a fiber 34 at various positions, FBG sensors 32 are located. From the strain measurement of each FBG 32 , the curvature of the structure 30 can be inferred at that position in three dimensional space (x, y, z). From the multitude of measured positions, the total three dimensional form is determined.
  • the fibers 34 are preferably potted in a flexible material, such as medical grade polymers (e.g., PEEKTM). Fiber cores 35 are shown in an inset cross-sectional view. A sheath 36 surrounding the fibers may be constructed from medical grade polymers, silicone, or other suitable materials.
  • a flexible material such as medical grade polymers (e.g., PEEKTM).
  • Fiber cores 35 are shown in an inset cross-sectional view.
  • a sheath 36 surrounding the fibers may be constructed from medical grade polymers, silicone, or other suitable materials.
  • an apparatus or device 100 for real-time, markerless tracking of a tip of a medical instrument is illustratively depicted.
  • Apparatus 100 is depicted in cross-section to render portions of the device visible.
  • the device 100 may include a bronchoscope, a catheter, or similar device.
  • Device 100 includes at least one instrument channel 102 , which is configured to receive a sheath, insert or tube 104 having sensors 106 therein.
  • a light source 108 may be provided on an end of the device 100 or may be located on a proximal end and transmit light through optical fibers 112 .
  • An optical system 114 includes components for acquiring images. These components 110 may include, e.g.
  • At least one optical fiber 112 is provided in the sheath 104 including one or more of sensors 106 , which preferably include Fiber Bragg Gratings (FBGs) which monitor, in a spatially distributed fashion, the deflection or bending of the optical fiber 112 .
  • FBGs Fiber Bragg Gratings
  • the optical system 114 includes an optical console 116 that delivers light to the FBGs 106 and receives light from them.
  • Console 116 may be connected to computer system 130 which includes memory storage 118 and operating system 120 with a corresponding shape determination program 122 which calculates parameters related to the deflection of the optical fibers 112 .
  • Computer system 130 (which may include console 116 or be an independent system) includes a 3D volume 150 of a bronchial tree acquired from a pre-procedural scan or other source, preferably with a segmentation (or map) of the bronchial tree for a bronchial procedure. While the example describes a bronchial tree, it is understood that other volumes, maps or images consistent with the application may be employed/provided.
  • Console 116 may include an optical transreceiver 117 to transmit and receive optical signals or light and/or to retrieve live images from the distal end of the device 100 .
  • Camera 110 may be employed on the end of the scope to send video data back to the console 116 .
  • the video data from the camera 110 and/or from the optical fibers 112 may be correlated with a 3D volume or map 150 as will be described below.
  • the sheath 104 encloses the optical fibers 112 with the FBGs 106 within the instrument channel 102 of the bronchoscope.
  • a fixing mechanism 140 is included and can be operated in at least two states. In an unexpanded state, a diameter of the channel 102 is sufficient to permit a physician/technician to insert the sheath 104 into the instrument channel 102 of the endoscope or device 100 . In an expanded state, at least a part of the sheath 104 is in contact with the walls of the instrument channel 102 , and therefore there is pressure exerted on the walls of the sheath 104 and the instrument channel 102 .
  • This expanded state resists slippage of the sheath 104 relative to the walls, preferably at the distal end of the bronchoscope or device 100 . This provides that the bending of the fibers 112 closely approximates the bending of the bronchoscope 100 .
  • the expanded state may be realized by employing a balloon 142 and an inflation tube 144 to expand the balloon 142 .
  • FIG. 3 shows the balloon 142 in an unexpanded state
  • FIG. 3A shows the balloon 142 in an expanded state.
  • the computer system 130 produces a display 138 that shows the location of the bronchoscope tip determined by the shape determination program 122 (using measured strains from the sensors 106 (e.g., FBGs)), within the bronchial tree identified by the 3D volume 150 .
  • Computer system 130 may include a user interface 152 for interacting with the console 116 , the device 100 and/or the volume/map 150 .
  • the interface 152 may include a keyboard, a mouse, a touch screen system, etc.
  • FIG. 4 a cross-section taken at section lines 4 - 4 in FIG. 3 is depicted.
  • Three FBGs 106 are arranged symmetrically within the flexible sheath 104 with a diameter that permits the sheath 104 to be inserted without resistance into the instrument channel of the endoscope or device 100 .
  • Flexible potting material 105 holds the fibers including the FBGs 106 in place relative to each other and relative to the sheath 104 . By fixing the fibers in the potting material 105 , predictable strain responses can be obtained.
  • a torus-shaped balloon 142 is firmly attached to the flexible insert or sheath 104 .
  • the balloon 142 can be inflated and deflated by means of pressure delivered via a thin flexible tube 144 that extends towards the proximal end of the bronchoscope 100 outside the flexible sheath 104 .
  • the balloon wall does not exert significant pressure on the inside wall of the instrument channel 102 .
  • the balloon 142 exerts pressure on the inside wall of the instrument channel 102 so that there is significant friction that prevents the balloon/sheath combination from easily being withdrawn from the instrument channel 102 .
  • the sheath ( 104 )/balloon ( 142 ) combination may be employed as follows.
  • a pre-procedural scan e.g., CT
  • the patient is prepared for a bronchoscopy or other procedure.
  • a sheath ( 104 ) is connected to the optical console ( 116 ) and inserted into instrument channel ( 140 ) of the bronchoscope with the balloon ( 142 ) in a deflated state.
  • the sheath is inserted into an instrument channel.
  • the sheath includes an optical fiber and a plurality of distributed sensors integrated with the optical fiber (or fibers).
  • the sheath is anchored within the instrument channel.
  • This may include employing a balloon ( 142 ).
  • the balloon is inflated to secure the sheath ( 104 ) within the bronchoscope or device ( 100 ).
  • Pressure applied to the optical fiber by the balloon at a tip of the instrument channel produces a strain in the optical fiber to locate the tip of the instrument channel inside a body. The strain due to the balloon on the fiber will provide an indication of where the tip is located.
  • the scope/device e.g., bronchoscope
  • a reference position is determined within a patient using the pre-procedural volume of the patient.
  • the physician indicates to the computer system ( 130 ) that a particular location corresponds to the reference location and annotates the corresponding location on the pre-procedural image volume.
  • a shape of the optical fiber is determined using the sensors, and the shape is correlated with the pre-procedural volume to provide a location of the portion of the medical device.
  • the shape of the bronchoscope as determined by the shape determination program ( 122 ) is correlated with the pre-procedural volume, preferably with the segmented bronchial tree, by the computer system ( 130 ).
  • the shape determination program receives as input optical measurements from the Fiber Bragg Gratings and provides as output an estimate of the three-dimensional shape of the flexible structure in which the FBGs are embedded.
  • the program may involve a two step process, where optical measurements are first converted to strain measurements; the strain measurements are then processed in combination to yield the estimate of the three dimensional shape of the flexible structure. This correlation would reveal the location of the tip of the bronchoscope within the bronchial tree; the location would be displayed in real-time, guiding the physician to the tissue target.
  • video data may be acquired for reconstructing an image of the body (from inside).
  • bronchoscope video data are acquired, rapid algorithms for 3D reconstruction from image shading cues can be used to obtain surface maps within the bronchoscope field of view.
  • the image is mapped back into real space using shape information derived from the sensors, thereby providing a map between image pixels in camera space and the optical shape sensing reference coordinate system.
  • Each of the 3D surfaces in the video images can be mapped back into real 3D space by using the bronchoscope camera position (e.g., at the end of the scope 100 ) and orientation information derived from the FBG data in combination with a calibration matrix which maps image pixels in camera space back into the optical shape sensing reference coordinate system.
  • Video processing and image comparisons may be performed using programs which search for and compare images to identify a best match. In this way, sufficient and redundant clues are provided to identify a position and orientation of at least the distal end of the scope in real-time during a procedure.
  • reconstructed images can be dynamically registered using pre-procedural volumetric imaging to further improve registration quality and navigation accuracy.
  • the reconstructed 3D airway surfaces from the FBG-enabled bronchoscopy system can be registered with pre-procedural volumetric imaging from CT or magnetic resonance (MR) to further improve registration and navigation accuracy.
  • the pre-procedural volumetric images could be segmented to derive the 3D contours of the bronchi, which in turn could be utilized as prior information to improve the accuracy of the map between image pixels in camera space and the optical shape sensing reference coordinate system.
  • the 3D contours of the bronchi estimated from pre-procedural volumetric images could be utilized to determine constraints on the spatial position of the bronchoscope.
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EP2523593B1 (de) 2015-03-25
WO2011086432A2 (en) 2011-07-21
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