US20210052245A1 - Steam pop detection - Google Patents
Steam pop detection Download PDFInfo
- Publication number
- US20210052245A1 US20210052245A1 US17/093,236 US202017093236A US2021052245A1 US 20210052245 A1 US20210052245 A1 US 20210052245A1 US 202017093236 A US202017093236 A US 202017093236A US 2021052245 A1 US2021052245 A1 US 2021052245A1
- Authority
- US
- United States
- Prior art keywords
- phase
- probe
- acoustic
- patient
- electrical signals
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- 238000001514 detection method Methods 0.000 title description 8
- 238000002679 ablation Methods 0.000 claims abstract description 46
- 238000000034 method Methods 0.000 claims abstract description 32
- 239000000523 sample Substances 0.000 claims abstract description 32
- 230000004044 response Effects 0.000 claims abstract description 10
- 238000012549 training Methods 0.000 claims abstract description 10
- 238000003780 insertion Methods 0.000 claims abstract description 7
- 230000037431 insertion Effects 0.000 claims abstract description 7
- 230000008569 process Effects 0.000 claims abstract description 7
- 238000012544 monitoring process Methods 0.000 claims description 10
- 210000000038 chest Anatomy 0.000 claims description 7
- 238000012545 processing Methods 0.000 claims description 7
- 239000013078 crystal Substances 0.000 claims description 5
- 230000002107 myocardial effect Effects 0.000 claims description 5
- 238000001914 filtration Methods 0.000 claims description 3
- 230000003595 spectral effect Effects 0.000 claims description 2
- 230000001934 delay Effects 0.000 claims 2
- 230000000694 effects Effects 0.000 abstract description 9
- 230000035945 sensitivity Effects 0.000 description 3
- 230000000451 tissue damage Effects 0.000 description 3
- 231100000827 tissue damage Toxicity 0.000 description 3
- 230000003902 lesion Effects 0.000 description 2
- 230000004913 activation Effects 0.000 description 1
- 206010003119 arrhythmia Diseases 0.000 description 1
- 238000004891 communication Methods 0.000 description 1
- 239000004020 conductor Substances 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000030808 detection of mechanical stimulus involved in sensory perception of sound Effects 0.000 description 1
- 229910003460 diamond Inorganic materials 0.000 description 1
- 239000010432 diamond Substances 0.000 description 1
- 238000004880 explosion Methods 0.000 description 1
- 239000002360 explosive Substances 0.000 description 1
- 239000004744 fabric Substances 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 230000007246 mechanism Effects 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000007674 radiofrequency ablation Methods 0.000 description 1
- 238000004148 unit process Methods 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B7/00—Instruments for auscultation
- A61B7/02—Stethoscopes
- A61B7/023—Stethoscopes for introduction into the body, e.g. into the oesophagus
-
- 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
-
- 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
- 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
-
- 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
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
- A61B5/6802—Sensor mounted on worn items
- A61B5/6804—Garments; Clothes
- A61B5/6805—Vests
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7235—Details of waveform analysis
- A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
- A61B5/7267—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems involving training the classification device
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B7/00—Instruments for auscultation
- A61B7/02—Stethoscopes
- A61B7/026—Stethoscopes comprising more than one sound collector
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B7/00—Instruments for auscultation
- A61B7/02—Stethoscopes
- A61B7/04—Electric stethoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
- A61B2017/0011—Sensing or detecting at the treatment site ultrasonic piezoelectric
-
- 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
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
-
- 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
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00351—Heart
- A61B2018/00357—Endocardium
-
- 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
- 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
-
- 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
- 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
- A61B2018/00595—Cauterization
-
- 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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
-
- 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
- A61B2034/2063—Acoustic tracking systems, e.g. using ultrasound
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/02—Details of sensors specially adapted for in-vivo measurements
- A61B2562/0204—Acoustic sensors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6887—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient mounted on external non-worn devices, e.g. non-medical devices
Definitions
- the present invention relates generally to medical devices and systems, and specifically to monitoring of invasive medical procedures.
- RF radio-frequency
- U.S. Patent Application Publication 2001/0039419 describes an ablation apparatus that includes a maneuvering mechanism, a conductive element attached to the apparatus, a sensor attached to the apparatus and an output device in communication with the sensor.
- the sensor senses vibration during the ablation procedure and sends a signal to the output device to reduce power to the conductive element.
- U.S. Pat. No. 5,733,281 describes an electrosurgical feedback system for detecting the effects of electrosurgical energy on tissue.
- the feedback system can include an acoustical detection element that acoustically detects the effects of energy on tissue and then generates an acoustic output signal indicative of these energy effects.
- a power regulation element in response to the acoustic output signal, regulates the electrosurgical energy supplied to the tissue.
- Embodiments of the present invention that are described hereinbelow provide improved methods and systems for monitoring ablation procedures in the body of a patient.
- medical apparatus including an elongate probe configured for insertion into a body of a patient.
- the probe includes an ablation element and an acoustic transducer disposed at a distal end of the probe.
- An array of acoustic sensors is configured to be placed over the body of the patient.
- a control unit is configured, while the distal end of the probe is positioned in a target location in the body, to drive the acoustic transducer in a training phase to emit an acoustic signal, to receive electrical signals from the acoustic sensors in response to the acoustical signal, and to process the electrical signals so as to derive a phase profile focused at the target location.
- the control unit is further configured, in an operational phase, to drive the ablation element to ablate tissue in the body at the target location, and to receive and filter the electrical signals from the acoustic sensors using the phase profile so as to detect acoustical activity at the target location.
- the acoustic sensors are mounted on a vest, which is configured to be placed over a thorax of the patient.
- the acoustic sensors include microphones. Additionally or alternatively, the acoustic transducer includes a piezoelectric crystal, and the control unit is configured to drive the piezoelectric crystal with electrical pulses.
- the ablation element includes an electrode
- the control unit is configured to drive the electrode with radio frequency (RF) electrical energy
- the probe includes a catheter, which is configured for insertion into a chamber of a heart of the patient, so as to ablate myocardial tissue at the target location.
- the control unit is configured to process the filtered electrical signals so as to detect steam pops occurring at the target location.
- a method for monitoring treatment which includes inserting an elongate probe into a body of a patient, with an ablation element and an acoustic transducer disposed at a distal end of the probe.
- An array of acoustic sensors is placed over the body of the patient.
- the acoustic transducer is driven to emit an acoustic signal, and electrical signals are received from the acoustic sensors in response to the acoustical signal and are processed so as to derive a phase profile focused at the target location.
- the ablation element is driven to ablate tissue in the body at the target location, and the electrical signals from the acoustic sensors are received and filtered using the phase profile so as to detect acoustical activity at the target location.
- FIG. 1 is a schematic pictorial illustration of a system for intracardiac ablation and monitoring, in accordance with an embodiment of the invention.
- FIG. 2 is a flow chart that schematically illustrates a method for monitoring an ablation procedure, in accordance with an embodiment of the invention.
- Embodiments of the present invention that are described herein address this difficulty by enabling more sensitive, focused detection of sounds emitted from the ablation site.
- These embodiments use an array of acoustic sensors placed over the body of the patient as a phased array.
- the phases in the array are tuned so as to focus on sounds originating from the location of the ablation, while effectively canceling out sounds originating from surrounding regions.
- the array thus acts as a highly directional microphone, which allows steam pops at the ablation location - even very faint steam pops - to be detected, by automatic signal processing and/or human staff on hand, with high sensitivity.
- an elongate probe such as a catheter
- the probe comprises an ablation element, such as an electrode, and an acoustic transducer, such as a piezoelectric crystal, both of which are disposed at the distal end of the probe.
- An array of acoustic sensors such as an array of miniature microphones mounted on a suitable vest, is placed over the body of the patient, surrounding a target location in the body at which the probe is to perform an ablation procedure.
- a control unit operates the probe and sensor array in two successive phases: In a training phase, the control unit drives the piezoelectric transducer to emit an acoustic signal and receives electrical signals from the acoustic sensors in response to this acoustical signal. The control unit processes these electrical signals so as to derive a phase profile that is effectively focused at the target location. Next, in an operational phase, the control unit drives the ablation element to ablate tissue in the body at the target location, while continuing to receive the electrical signals from the acoustic sensors. The control unit filters these signals using the phase profile derived in the training phase, and is thus able to detect acoustical activity at the target location with enhanced sensitivity while rejecting background sounds.
- RF radio frequency
- FIG. 1 is a schematic pictorial illustration of a system 20 for intracardiac ablation and monitoring, in accordance with an embodiment of the invention.
- An operator 22 typically a physician, inserts a catheter 24 through the vascular system of a patient into a chamber of the patient's heart 26 .
- one or more electrodes 28 are disposed over the distal end of catheter 24 .
- a control unit 30 drives electrodes 28 with RF electrical energy to ablate tissue at the location.
- control unit 30 typically comprises an RF frequency generator and high-power amplifiers, which drive the RF electrical energy through conductors (not shown) in catheter 24 , along with suitable frequency and power control circuits, as are known in the art.
- Navigation of catheter 24 may be facilitated by techniques that are known in the art, such as magnetic or electrical position sensing, and/or image-based tracking.
- suitable magnetic and electrical position sensing capabilities are offered by the CARTO system, produced by Biosense Webster Inc. (Diamond Bar, Calif.). These aspects of the operation of system 20 , however, are beyond the scope of the present disclosure.
- a vest 32 comprising an array of small microphones 34 is placed over the patient's thorax.
- the term “vest” in this context refers to a flexible covering, made from a fabric or other suitable material, that fits securely around the thorax so that microphones 34 are held stably in place against the thorax.
- Microphones 34 may comprise any suitable sort of acoustical sensors, such as omnidirectional piezoelectric elements, which output electrical signals in response to acoustical vibrations.
- a phase-sensitive acoustic processor 36 in control unit 30 receives and processes the electrical signals that are output by microphones 34 . In processing these signals, processor 36 applies a phase profile that is selected so as to focus acoustic reception on the location of the distal end of catheter 24 . This profile is computed and updated dynamically as catheter 24 moves from location to location in heart 26 .
- catheter 24 comprises an acoustic transducer 38 , such as a miniature piezoelectric element (also referred to as an audio transducer), in its distal end.
- transducer 38 and microphones 34 in computing the phase profile is described hereinbelow with reference to FIG. 2 .
- processor 36 applies the appropriate phase profile in filtering the electrical signals output by microphones 34 so as to generate an output in which sounds originating from the current location of the distal end of catheter 24 are amplified, while background sounds are suppressed.
- Processor 36 may play this output in analog audio form, via a speaker 40 , for example, so that operator 22 can hear and respond to the sounds (particularly faint, early-stage steam pops).
- processor 36 may apply digital audio recognition to the output in order to recognize steam pops, for example by frequency-domain matching to a steam pop template. In this latter case, processor 36 may, upon detecting suspected steam pops, automatically reduce or shut off the RF ablation energy. Additionally or alternatively, processor 36 may drive a display 42 or other user output device to warn operator 22 of the possible occurrence of steam pops.
- Processor 36 typically comprises a suitable general-purpose computer processor, along with front-end circuits for amplifying and filtering the signals from microphones and converting the signals to digital form for processing.
- the processor is programmed in software to carry out the functions described herein and may also be used in performing other functions of control unit 30 .
- processor 36 may comprise one or programmable digital signal processors, which are programmed to carry out these processing functions.
- at least some of the functions of processor 36 may be carried out by hard-wired digital logic or analog processing circuits. All such alternative implementations are considered to be within the scope of the present invention.
- FIG. 2 is a flow chart that schematically illustrates a method for monitoring an ablation procedure, in accordance with an embodiment of the invention. The method is described, for the sake of concreteness and clarity, with reference to the elements of system 20 that are shown in FIG. 1 , but the principles of this method may alternatively be implemented in other system configurations, for monitoring this and other sorts of ablation procedures.
- vest 32 containing the array of microphones 34 is positioned securely over the patient's thorax, at an array positioning step 50 .
- Operator 22 then inserts catheter 24 into heart 26 and positions the distal end of the catheter at a target location, where ablation is to be carried out, at a catheter insertion step 52 .
- Processor 36 now initiates a training phase, by driving acoustic transducer 38 to emit an acoustic signal, at an audio actuation step 54 .
- Processor 36 receives the electrical signals that are output by microphones 34 in response to this acoustical signal, and processes these signals so as to derive a phase profile focused at the target location, at a detection tuning step 56 .
- the phase profile typically comprises a respective phase delay in the signal output by each microphone 34 .
- the respective phase delay of each microphone can be represented simply by the time it takes for the corresponding pulse to appear in the electrical signal output by the microphone, relative to a predefined reference.
- frequency-domain analysis may be applied in order to derive a more complex, spectral phase profile.
- phase profile determined at steps 54 and 56 is local, i.e., it applies to the specific location in heart 26 wherein the distal end of catheter 24 is currently positioned.
- the same phase profile may be used at a number of locations in mutual proximity (for example, when a line of ablation lesions is to be formed), it may be desirable to repeat the training phase when the catheter is shifted to a new location.
- control unit 30 initiates the operational phase, driving electrode (or electrodes) 28 to ablate tissue in heart 26 at the target location, at an ablation step 58 .
- Processor 36 receives and filters the electrical signals from microphones 34 using the phase profile so as to detect acoustical activity specifically at the ablation location, at an acoustical detection step 60 .
- Processor 36 thus operates the array of microphones 34 as a phased array, by applying the appropriate, respective phase adjustment (advance or delay) to the signal from each microphone, and then summing the phase-adjusted signals.
- processor 36 can achieve the desired phased-array performance by applying the inverse of the measured delay to the signal from each microphone. (In other words, if the pulse from a given microphone was received X milliseconds before the reference time, processor 36 will apply a delay of X milliseconds to the signal from this microphone, and vice versa.)
- either operator 22 or processor 36 decides whether any steam pops are audible. If not, ablation continues until done, at an ablation completion step 62 . If incipient steam pops are detected, however, ablation is stopped, at an ablation interruption step 64 . This step may be carried out automatically by control unit 30 and/or manually by operator 22 . Alternatively, if only very faint steam pops are heard, it may be possible to continue the ablation at reduced RF energy.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Molecular Biology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Physics & Mathematics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Acoustics & Sound (AREA)
- Plasma & Fusion (AREA)
- Otolaryngology (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Cardiology (AREA)
- Artificial Intelligence (AREA)
- Robotics (AREA)
- Human Computer Interaction (AREA)
- Evolutionary Computation (AREA)
- Fuzzy Systems (AREA)
- Mathematical Physics (AREA)
- Computer Vision & Pattern Recognition (AREA)
- Physiology (AREA)
- Psychiatry (AREA)
- Signal Processing (AREA)
- Surgical Instruments (AREA)
Abstract
Medical apparatus includes an elongate probe for insertion into a body of a patient. The probe includes an ablation element and an acoustic transducer disposed at a distal end of the probe. An array of acoustic sensors is placed over the body. While the distal end of the probe is positioned in a target location in the body, a control unit drives the acoustic transducer in a training phase to emit an acoustic signal, receives electrical signals from the acoustic sensors in response to the acoustical signal, and processes the electrical signals so as to derive a phase profile focused at the target location. In an operational phase, the control unit drives the ablation element to ablate tissue in the body at the target location, and receives and filters the electrical signals from the acoustic sensors using the phase profile so as to detect acoustical activity at the target location.
Description
- The present application is a Continuation Application under 35 U.S.C. § 120 of U.S. patent application Ser. No. 15/457,708, filed Mar. 13, 2017. The entire contents of this application is incorporated by reference herein in its entirety.
- The present invention relates generally to medical devices and systems, and specifically to monitoring of invasive medical procedures.
- Catheter-based ablation of myocardial tissue is commonly used in treating cardiac arrhythmias. Such treatment typically involves applying radio-frequency (RF) electrical energy to ablate the tissue and thus block undesired activation currents. It is critical that the physician apply RF energy of sufficient intensity to create ablation lesions of the required depth to entirely block the undesired currents. Too much RF energy, however, is liable to cause excessive tissue damage and even puncture the heart wall, with life-threatening consequences.
- Excessive ablation energy frequently gives rise to cavitation, as fluids in the tissue vaporize with explosive force. This phenomenon is commonly referred to as a “steam pop.” Typically, as the energy is applied at a given location, steam pops will begin on a small scale and will then escalate (often very quickly) to explosions strong enough to be audible outside the body. By the time the steam pops reach this level, however, it may be too late to turn down the ablation energy and prevent serious tissue damage.
- Various techniques have been proposed for sensing of acoustical activity associated with ablation. For example, U.S. Patent Application Publication 2001/0039419 describes an ablation apparatus that includes a maneuvering mechanism, a conductive element attached to the apparatus, a sensor attached to the apparatus and an output device in communication with the sensor. The sensor senses vibration during the ablation procedure and sends a signal to the output device to reduce power to the conductive element.
- As another example, U.S. Pat. No. 5,733,281 describes an electrosurgical feedback system for detecting the effects of electrosurgical energy on tissue. The feedback system can include an acoustical detection element that acoustically detects the effects of energy on tissue and then generates an acoustic output signal indicative of these energy effects. A power regulation element, in response to the acoustic output signal, regulates the electrosurgical energy supplied to the tissue.
- Embodiments of the present invention that are described hereinbelow provide improved methods and systems for monitoring ablation procedures in the body of a patient.
- There is therefore provided, in accordance with an embodiment of the invention, medical apparatus, including an elongate probe configured for insertion into a body of a patient. The probe includes an ablation element and an acoustic transducer disposed at a distal end of the probe. An array of acoustic sensors is configured to be placed over the body of the patient. A control unit is configured, while the distal end of the probe is positioned in a target location in the body, to drive the acoustic transducer in a training phase to emit an acoustic signal, to receive electrical signals from the acoustic sensors in response to the acoustical signal, and to process the electrical signals so as to derive a phase profile focused at the target location. The control unit is further configured, in an operational phase, to drive the ablation element to ablate tissue in the body at the target location, and to receive and filter the electrical signals from the acoustic sensors using the phase profile so as to detect acoustical activity at the target location.
- In a disclosed embodiment, the acoustic sensors are mounted on a vest, which is configured to be placed over a thorax of the patient.
- In some embodiments, the acoustic sensors include microphones. Additionally or alternatively, the acoustic transducer includes a piezoelectric crystal, and the control unit is configured to drive the piezoelectric crystal with electrical pulses.
- In some embodiments, the ablation element includes an electrode, and the control unit is configured to drive the electrode with radio frequency (RF) electrical energy, and the probe includes a catheter, which is configured for insertion into a chamber of a heart of the patient, so as to ablate myocardial tissue at the target location. In a disclosed embodiment, the control unit is configured to process the filtered electrical signals so as to detect steam pops occurring at the target location.
- There is also provided, in accordance with an embodiment of the invention, a method for monitoring treatment, which includes inserting an elongate probe into a body of a patient, with an ablation element and an acoustic transducer disposed at a distal end of the probe. An array of acoustic sensors is placed over the body of the patient. In a training phase, while the distal end of the probe is positioned in a target location in the body, the acoustic transducer is driven to emit an acoustic signal, and electrical signals are received from the acoustic sensors in response to the acoustical signal and are processed so as to derive a phase profile focused at the target location. In an operational phase, while the distal end of the probe is positioned in the target location, the ablation element is driven to ablate tissue in the body at the target location, and the electrical signals from the acoustic sensors are received and filtered using the phase profile so as to detect acoustical activity at the target location.
- The present invention will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings in which:
-
FIG. 1 is a schematic pictorial illustration of a system for intracardiac ablation and monitoring, in accordance with an embodiment of the invention; and -
FIG. 2 is a flow chart that schematically illustrates a method for monitoring an ablation procedure, in accordance with an embodiment of the invention. - Early detection of steam pops, when they are just beginning to occur during an ablation procedure, can be a valuable tool in avoiding serious tissue damage. Existing detection techniques, however, lack the sensitivity to detect steam pops at this early stage, when the faint sound of small steam pops may be masked by background sounds. By the time the steam pops become clearly audible, the damage to tissue may already have been done.
- Embodiments of the present invention that are described herein address this difficulty by enabling more sensitive, focused detection of sounds emitted from the ablation site. These embodiments use an array of acoustic sensors placed over the body of the patient as a phased array. The phases in the array are tuned so as to focus on sounds originating from the location of the ablation, while effectively canceling out sounds originating from surrounding regions. The array thus acts as a highly directional microphone, which allows steam pops at the ablation location - even very faint steam pops - to be detected, by automatic signal processing and/or human staff on hand, with high sensitivity.
- In the disclosed embodiments, an elongate probe, such as a catheter, is inserted into a body of a patient. The probe comprises an ablation element, such as an electrode, and an acoustic transducer, such as a piezoelectric crystal, both of which are disposed at the distal end of the probe. An array of acoustic sensors, such as an array of miniature microphones mounted on a suitable vest, is placed over the body of the patient, surrounding a target location in the body at which the probe is to perform an ablation procedure.
- Once the distal end of the probe has been positioned at the target location, a control unit operates the probe and sensor array in two successive phases: In a training phase, the control unit drives the piezoelectric transducer to emit an acoustic signal and receives electrical signals from the acoustic sensors in response to this acoustical signal. The control unit processes these electrical signals so as to derive a phase profile that is effectively focused at the target location. Next, in an operational phase, the control unit drives the ablation element to ablate tissue in the body at the target location, while continuing to receive the electrical signals from the acoustic sensors. The control unit filters these signals using the phase profile derived in the training phase, and is thus able to detect acoustical activity at the target location with enhanced sensitivity while rejecting background sounds.
- Although the disclosed embodiments refer specifically to radio frequency (RF) electrical ablation of myocardial tissue, the techniques that are described herein for trained, phased-array acoustic detection at locations in the body may alternatively be applied using other sorts of probes, ablation elements, acoustic transducers and sensors, in monitoring various sorts of medical procedures. All such alternative implementations are considered to be within the scope of the present invention.
-
FIG. 1 is a schematic pictorial illustration of asystem 20 for intracardiac ablation and monitoring, in accordance with an embodiment of the invention. Anoperator 22, typically a physician, inserts acatheter 24 through the vascular system of a patient into a chamber of the patient'sheart 26. As shown in the inset inFIG. 1 , one ormore electrodes 28 are disposed over the distal end ofcatheter 24. Onceoperator 22 has navigated the distal tip ofcatheter 24 to a target location inheart 26, acontrol unit 30 driveselectrodes 28 with RF electrical energy to ablate tissue at the location. For this purpose,control unit 30 typically comprises an RF frequency generator and high-power amplifiers, which drive the RF electrical energy through conductors (not shown) incatheter 24, along with suitable frequency and power control circuits, as are known in the art. - Navigation of
catheter 24 may be facilitated by techniques that are known in the art, such as magnetic or electrical position sensing, and/or image-based tracking. For example, suitable magnetic and electrical position sensing capabilities are offered by the CARTO system, produced by Biosense Webster Inc. (Diamond Bar, Calif.). These aspects of the operation ofsystem 20, however, are beyond the scope of the present disclosure. - To enable detection of faint steam pops that may be caused by the ablation of tissue in
system 20, avest 32 comprising an array ofsmall microphones 34 is placed over the patient's thorax. The term “vest” in this context refers to a flexible covering, made from a fabric or other suitable material, that fits securely around the thorax so thatmicrophones 34 are held stably in place against the thorax.Microphones 34 may comprise any suitable sort of acoustical sensors, such as omnidirectional piezoelectric elements, which output electrical signals in response to acoustical vibrations. - A phase-sensitive
acoustic processor 36 incontrol unit 30 receives and processes the electrical signals that are output bymicrophones 34. In processing these signals,processor 36 applies a phase profile that is selected so as to focus acoustic reception on the location of the distal end ofcatheter 24. This profile is computed and updated dynamically ascatheter 24 moves from location to location inheart 26. To enableprocessor 36 to compute the phase profile accurately,catheter 24 comprises anacoustic transducer 38, such as a miniature piezoelectric element (also referred to as an audio transducer), in its distal end. The use oftransducer 38 andmicrophones 34 in computing the phase profile is described hereinbelow with reference toFIG. 2 . - During the ablation procedure,
processor 36 applies the appropriate phase profile in filtering the electrical signals output bymicrophones 34 so as to generate an output in which sounds originating from the current location of the distal end ofcatheter 24 are amplified, while background sounds are suppressed.Processor 36 may play this output in analog audio form, via aspeaker 40, for example, so thatoperator 22 can hear and respond to the sounds (particularly faint, early-stage steam pops). Additionally or alternatively,processor 36 may apply digital audio recognition to the output in order to recognize steam pops, for example by frequency-domain matching to a steam pop template. In this latter case,processor 36 may, upon detecting suspected steam pops, automatically reduce or shut off the RF ablation energy. Additionally or alternatively,processor 36 may drive adisplay 42 or other user output device to warnoperator 22 of the possible occurrence of steam pops. -
Processor 36 typically comprises a suitable general-purpose computer processor, along with front-end circuits for amplifying and filtering the signals from microphones and converting the signals to digital form for processing. The processor is programmed in software to carry out the functions described herein and may also be used in performing other functions ofcontrol unit 30. Alternatively or additionally,processor 36 may comprise one or programmable digital signal processors, which are programmed to carry out these processing functions. Further alternatively or additionally, at least some of the functions ofprocessor 36 may be carried out by hard-wired digital logic or analog processing circuits. All such alternative implementations are considered to be within the scope of the present invention. -
FIG. 2 is a flow chart that schematically illustrates a method for monitoring an ablation procedure, in accordance with an embodiment of the invention. The method is described, for the sake of concreteness and clarity, with reference to the elements ofsystem 20 that are shown inFIG. 1 , but the principles of this method may alternatively be implemented in other system configurations, for monitoring this and other sorts of ablation procedures. - As an initial step in operation of
system 20,vest 32 containing the array ofmicrophones 34 is positioned securely over the patient's thorax, at anarray positioning step 50.Operator 22 then insertscatheter 24 intoheart 26 and positions the distal end of the catheter at a target location, where ablation is to be carried out, at acatheter insertion step 52. -
Processor 36 now initiates a training phase, by drivingacoustic transducer 38 to emit an acoustic signal, at anaudio actuation step 54.Processor 36 receives the electrical signals that are output bymicrophones 34 in response to this acoustical signal, and processes these signals so as to derive a phase profile focused at the target location, at adetection tuning step 56. The phase profile typically comprises a respective phase delay in the signal output by eachmicrophone 34. In other words, iftransducer 38 is driven atstep 54 to emit short audio pulses, the respective phase delay of each microphone can be represented simply by the time it takes for the corresponding pulse to appear in the electrical signal output by the microphone, relative to a predefined reference. Alternatively, frequency-domain analysis may be applied in order to derive a more complex, spectral phase profile. - The phase profile determined at
steps heart 26 wherein the distal end ofcatheter 24 is currently positioned. Although the same phase profile may be used at a number of locations in mutual proximity (for example, when a line of ablation lesions is to be formed), it may be desirable to repeat the training phase when the catheter is shifted to a new location. - Once the phase profile has been determined in the training phase,
control unit 30 initiates the operational phase, driving electrode (or electrodes) 28 to ablate tissue inheart 26 at the target location, at anablation step 58.Processor 36 receives and filters the electrical signals frommicrophones 34 using the phase profile so as to detect acoustical activity specifically at the ablation location, at anacoustical detection step 60.Processor 36 thus operates the array ofmicrophones 34 as a phased array, by applying the appropriate, respective phase adjustment (advance or delay) to the signal from each microphone, and then summing the phase-adjusted signals. In the simple example given above, in which the phase delay is measured for each microphone in response to an audio pulse emitted bytransducer 38,processor 36 can achieve the desired phased-array performance by applying the inverse of the measured delay to the signal from each microphone. (In other words, if the pulse from a given microphone was received X milliseconds before the reference time,processor 36 will apply a delay of X milliseconds to the signal from this microphone, and vice versa.) - Based on the filtered, summed signal found at
step 60, eitheroperator 22 or processor 36 (or both) decides whether any steam pops are audible. If not, ablation continues until done, at anablation completion step 62. If incipient steam pops are detected, however, ablation is stopped, at anablation interruption step 64. This step may be carried out automatically bycontrol unit 30 and/or manually byoperator 22. Alternatively, if only very faint steam pops are heard, it may be possible to continue the ablation at reduced RF energy. - It will be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.
Claims (16)
1. A medical apparatus, comprising:
an elongate probe configured for insertion into a body of a patient, the probe comprising an ablation element and an acoustic transducer disposed at a distal end of the probe;
an array of acoustic sensors configured to be placed over the body of the patient; and
a control unit, which is configured, while the distal end of the probe is positioned in a target location in the body, to drive the acoustic transducer in a training phase to emit an acoustic signal, to receive electrical signals from the acoustic sensors in response to the acoustical signal, and to process the electrical signals so as to derive a phase profile focused at the target location, and which is further configured, in an operational phase, to drive the ablation element to ablate tissue in the body at the target location, to receive and filter the electrical signals from the acoustic sensors using the phase profile to compute phase-adjusted signals, and to sum the phase-adjusted signals.
2. The medical apparatus of claim 1 , in which the acoustic sensors are mounted on a vest, which is configured to be placed over a thorax of the patient.
3. The medical apparatus of claim 1 , in which the acoustic sensors comprise microphones.
4. The medical apparatus of claim 1 , in which the acoustic transducer comprises a piezoelectric crystal, and in which the control unit is configured to drive the piezoelectric crystal with electrical pulses.
5. The medical apparatus of claim 1 , in which the ablation element comprises an electrode, and in which the control unit is configured to drive the electrode with radio frequency (RF) electrical energy.
6. The medical apparatus of claim 1 , in which the control unit is configured to process the filtered electrical signals so as to detect steam pops occurring at the target location.
7. The medical apparatus of claim 1 , in which the probe comprises a catheter, which is configured for insertion into a chamber of a heart of the patient, so as to ablate myocardial tissue at the target location.
8. The medical apparatus of claim 1 , in which the phase profile comprises a set of phase delays.
9. The medical apparatus of claim 8 , in which the set of phase delays comprises a respective phase delay for each respective acoustic sensor.
10. The medical apparatus of claim 1 , in which the phase profile comprises a spectral phase profile.
11. A method for monitoring treatment, comprising:
inserting an elongate probe into a body of a patient, the probe comprising an ablation element and an acoustic transducer disposed at a distal end of the probe;
placing an array of acoustic sensors over the body of the patient;
in a training phase, positioning the distal end of the probe at various target locations in the body, and while the probe is disposed at each of the various target locations:
driving the acoustic transducer to emit an acoustic signal;
receiving electrical signals from the acoustic sensors in response to the acoustical signal; and
processing the electrical signals so as to derive a phase profile focused at each of the various target locations; and
in an operational phase, while the distal end of the probe is positioned at one of the various target locations:
driving the ablation element to ablate tissue in the body at the one of the various target locations; and
receiving and filtering the electrical signals from the acoustic sensors using the phase profile to compute phase-adjusted signals, and to sum the phase-adjusted signals.
12. The method of claim 11 , in which the acoustic sensors are mounted on a vest.
13. The method of claim 12 , further comprising placing the vest over a thorax of the patient.
14. The method of claim 12 , in which the acoustic sensors comprise microphones.
15. The method of claim 11 , further comprising:
processing the filtered electrical signals;
detecting steam pops occurring at the one of the various target locations; and
interrupting the step of driving the ablation element.
16. The method of claim 15 , in which the probe comprises a catheter, which is configured for insertion into a chamber of a heart of the patient, so as to ablate myocardial tissue.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US17/093,236 US20210052245A1 (en) | 2017-03-13 | 2020-11-09 | Steam pop detection |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US15/457,708 US10828008B2 (en) | 2017-03-13 | 2017-03-13 | Steam pop detection |
US17/093,236 US20210052245A1 (en) | 2017-03-13 | 2020-11-09 | Steam pop detection |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/457,708 Continuation US10828008B2 (en) | 2017-03-13 | 2017-03-13 | Steam pop detection |
Publications (1)
Publication Number | Publication Date |
---|---|
US20210052245A1 true US20210052245A1 (en) | 2021-02-25 |
Family
ID=61622443
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/457,708 Active 2038-08-05 US10828008B2 (en) | 2017-03-13 | 2017-03-13 | Steam pop detection |
US17/093,236 Abandoned US20210052245A1 (en) | 2017-03-13 | 2020-11-09 | Steam pop detection |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/457,708 Active 2038-08-05 US10828008B2 (en) | 2017-03-13 | 2017-03-13 | Steam pop detection |
Country Status (8)
Country | Link |
---|---|
US (2) | US10828008B2 (en) |
EP (2) | EP3375395B1 (en) |
JP (1) | JP2018149294A (en) |
CN (1) | CN108567480A (en) |
AU (1) | AU2018201449A1 (en) |
CA (1) | CA2997464A1 (en) |
ES (1) | ES2745926T3 (en) |
IL (1) | IL257865B (en) |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11134975B2 (en) * | 2017-08-31 | 2021-10-05 | Cilag Gmbh International | Apparatus and method to control operation of surgical instrument based on audible feedback |
Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20120123243A1 (en) * | 2010-11-17 | 2012-05-17 | Roger Hastings | Catheter guidance of external energy for renal denervation |
US20160324569A1 (en) * | 2015-05-04 | 2016-11-10 | Biosense Webster (Israel) Ltd. | Rf ablation with acoustic feedback |
Family Cites Families (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5733281A (en) * | 1996-03-19 | 1998-03-31 | American Ablation Co., Inc. | Ultrasound and impedance feedback system for use with electrosurgical instruments |
US7037268B1 (en) | 1999-03-01 | 2006-05-02 | Medacoustics, Inc. | Low profile acoustic sensor arry and sensors with pleated transmission lines and related methods |
AU2004201785B2 (en) | 1999-03-01 | 2007-10-25 | Harris Corporation | Low Profile Acoustic sensor array and sensors with pleated transmission lines and related methods |
EP1278471B1 (en) | 2000-04-27 | 2005-06-15 | Medtronic, Inc. | Vibration sensitive ablation apparatus |
US6709432B2 (en) | 2002-04-26 | 2004-03-23 | Medtronic, Inc. | Ablation methods and medical apparatus using same |
US20050090725A1 (en) | 2003-10-28 | 2005-04-28 | Joseph Page | Disposable couplings for biometric instruments |
CN100479759C (en) * | 2004-11-30 | 2009-04-22 | 全音速医学技术有限公司 | Ultrasonic medical equipment with variable frequency drive |
BR112012029240A2 (en) * | 2010-05-18 | 2017-05-30 | Zoll Medical Corp | ambulatory medical detection device with multiple detection electrodes |
US8545409B2 (en) | 2011-04-14 | 2013-10-01 | St. Jude Medical, Inc. | Arrangement and interface for RF ablation system with acoustic feedback |
EP2797500A4 (en) | 2011-12-30 | 2015-12-02 | St Jude Medical Atrial Fibrill | Automatic monitoring for and detection of tissue pop |
WO2013162765A1 (en) * | 2012-04-23 | 2013-10-31 | St. Jude Medical, Inc. | Ultrasonic lesion feedback, antipop monitoring, and force detection |
-
2017
- 2017-03-13 US US15/457,708 patent/US10828008B2/en active Active
-
2018
- 2018-02-28 AU AU2018201449A patent/AU2018201449A1/en not_active Abandoned
- 2018-03-05 IL IL257865A patent/IL257865B/en active IP Right Grant
- 2018-03-06 CA CA2997464A patent/CA2997464A1/en not_active Abandoned
- 2018-03-12 ES ES18161146T patent/ES2745926T3/en active Active
- 2018-03-12 EP EP18161146.8A patent/EP3375395B1/en active Active
- 2018-03-12 JP JP2018043873A patent/JP2018149294A/en not_active Abandoned
- 2018-03-12 EP EP19183425.8A patent/EP3566668A1/en not_active Withdrawn
- 2018-03-13 CN CN201810206893.3A patent/CN108567480A/en active Pending
-
2020
- 2020-11-09 US US17/093,236 patent/US20210052245A1/en not_active Abandoned
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20120123243A1 (en) * | 2010-11-17 | 2012-05-17 | Roger Hastings | Catheter guidance of external energy for renal denervation |
US20160324569A1 (en) * | 2015-05-04 | 2016-11-10 | Biosense Webster (Israel) Ltd. | Rf ablation with acoustic feedback |
Also Published As
Publication number | Publication date |
---|---|
EP3375395B1 (en) | 2019-07-17 |
ES2745926T3 (en) | 2020-03-04 |
IL257865A (en) | 2018-04-30 |
IL257865B (en) | 2021-03-25 |
CA2997464A1 (en) | 2018-09-13 |
US10828008B2 (en) | 2020-11-10 |
EP3566668A1 (en) | 2019-11-13 |
CN108567480A (en) | 2018-09-25 |
US20180256129A1 (en) | 2018-09-13 |
EP3375395A1 (en) | 2018-09-19 |
JP2018149294A (en) | 2018-09-27 |
AU2018201449A1 (en) | 2018-09-27 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
AU2008200222B2 (en) | Catheter with microphone | |
US6709432B2 (en) | Ablation methods and medical apparatus using same | |
JP4975243B2 (en) | Device for pulmonary vein mapping and resection | |
US6233477B1 (en) | Catheter system having controllable ultrasound locating means | |
EP3482679A1 (en) | System and method for providing auditory guidance in medical systems | |
JP6797553B2 (en) | RF ablation with acoustic feedback | |
EP3420883B1 (en) | Ultrasound transducers on predetermined radii of balloon catheter | |
JP2007244857A (en) | Lesion assessment by pacing | |
US20210052245A1 (en) | Steam pop detection | |
EP3930582B1 (en) | Acoustic sensing apparatus and method |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: BIOSENSE WEBSTER (ISRAEL) LTD., ISRAEL Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:GOVARI, ASSAF;REEL/FRAME:054381/0484 Effective date: 20170320 |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: APPLICATION DISPATCHED FROM PREEXAM, NOT YET DOCKETED |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: DOCKETED NEW CASE - READY FOR EXAMINATION |
|
STPP | Information on status: patent application and granting procedure in general |
Free format text: NOTICE OF ALLOWANCE MAILED -- APPLICATION RECEIVED IN OFFICE OF PUBLICATIONS |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO PAY ISSUE FEE |