WO1998037827A2 - Systeme de chirurgie guide par l'image - Google Patents

Systeme de chirurgie guide par l'image Download PDF

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Publication number
WO1998037827A2
WO1998037827A2 PCT/IB1998/000190 IB9800190W WO9837827A2 WO 1998037827 A2 WO1998037827 A2 WO 1998037827A2 IB 9800190 W IB9800190 W IB 9800190W WO 9837827 A2 WO9837827 A2 WO 9837827A2
Authority
WO
WIPO (PCT)
Prior art keywords
image
surgical instrument
alignment
starting
starting point
Prior art date
Application number
PCT/IB1998/000190
Other languages
English (en)
Other versions
WO1998037827A3 (fr
Inventor
Willem Peter Van Der Brug
Hubrecht Lambertus Tjalling De Bliek
Frans Andreas Gerritsen
Original Assignee
Koninklijke Philips Electronics N.V.
Philips Ab
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Koninklijke Philips Electronics N.V., Philips Ab filed Critical Koninklijke Philips Electronics N.V.
Priority to EP98901454A priority Critical patent/EP0975272B1/fr
Priority to DE69830719T priority patent/DE69830719T2/de
Priority to JP52925098A priority patent/JP4198192B2/ja
Priority to PCT/IB1998/000190 priority patent/WO1998037827A2/fr
Publication of WO1998037827A2 publication Critical patent/WO1998037827A2/fr
Publication of WO1998037827A3 publication Critical patent/WO1998037827A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/363—Use of fiducial points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3937—Visible markers
    • A61B2090/3945—Active visible markers, e.g. light emitting diodes
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/08—Auxiliary means for directing the radiation beam to a particular spot, e.g. using light beams

Definitions

  • the invention relates to an image-guided surgery system.
  • An image-guided surgery system of this kind is known from United States patent specification US 5,389, 101.
  • An image-guided surgery system is used to visualize a position of a surgical instrument in an operating area within the body of a patient for a surgeon during surgery. Images, such as CT or MRI images, are made of the patient prior to surgery.
  • the image-guided surgery system includes a position-measuring system for measuring the position of the surgical instrument.
  • the image-guided surgery system also includes a computer for deriving corresponding positions in a relevant image from the positions of the surgical instrument measured. During surgery the position measuring system measures the position of the surgical instrument relative to the patient and the computer calculates the position in such a prior image which corresponds to the measured position of the surgical instrument. The prior image is then displayed on a monitor, together with the actual position of the surgical instrument.
  • the surgeon can see the position of the surgical instrument in the operating area in the image on the monitor, without him or her seeing the surgical instrument directly.
  • the surgeon can thus observe the image displayed on the monitor so as to see how to move the surgical instrument in the operating area without substantial risk of unnecessary damaging of tissue, and notably without risk of damaging of vital parts.
  • An image-guided surgery system of this kind is used, for example in neurosurgery in order to show the surgeon accurately where the surgical instrument is situated in the brain during a cerebral operation.
  • an image-guided surgery system which includes an alignment system for deriving an alignment line through a target position, for selecting a starting plane through an end of a surgical instrument, for deriving a starting point on the alignment line and in the starting plane, and for reproducing a position of said end and of said starting point relative to one another in the starting plane.
  • the target position is a position which is usually situated in or on the body of the patient and whereto the end of the surgical instrument is to be guided during a given phase of the operation.
  • the surgical instrument is introduced into the body of the patient via an entrance position on the surface.
  • the target position may in some cases be the final position to be ultimately reached by the end of the surgical instrument.
  • the alignment line passes through the target position and has a direction via which the target position can be readily approached. For example, the alignment line extends through the entrance position and the target position.
  • the user preferably chooses the entrance position so that the target position can be readily reached from the entrance position.
  • the surgical instrument is positioned at the starting point. This can be very readily achieved by moving the end of a surgical instrument in the starting plane until this end reaches the starting point.
  • the alignment system shows the user how to move the end to the starting point. To this end, the alignment system shows, for example the positions of the end and the starting point in the starting plane.
  • the positions of the starting point and the end of the surgical instrument can be revealed to the user in various ways. For example, it is very simple to state the co-ordinates of the starting point and the end of the surgical instrument in the starting plane. It is particularly attractive to display a guide image on an image display unit such as a monitor.
  • the guide image is an image of the starting plane with images of the starting point and the end of the surgical instrument.
  • the user can observe the guide image so as to see how the end of the surgical instrument moves in the starting plane so that the user knows how to move the end of the surgical instrument to the starting point.
  • the alignment system shows the direction in which the end of the surgical instrument must be moved in order to reach the starting point, for example by indicating the desired direction by means of arrows.
  • the user need not take into account displacement of the end of the surgical instrument parallel to the alignment line.
  • the starting plane always contains the end of the surgical instrument.
  • the starting plane can be selected by selecting an auxiliary plane which is situated a predetermined, fixed distance from the end of the surgical instrument.
  • the starting plane is then the plane extending parallel to the auxiliary plane at the predetermined, fixed distance from the auxiliary plane.
  • the auxiliary plane can be chosen so as to extend through a predetermined point on the surgical instrument which is situated at the predetermined, fixed distance from the end of the surgical instrument.
  • the starting plane moves in space in dependence on the movement of the surgical instrument.
  • the position of the starting point relative to the patient also changes, but for practically all surgical interventions it is not important where on the alignment line the starting point is situated.
  • the alignment system reproduces the instantaneous position of the end of the surgical instrument and the position of the starting point. This enables the user to move the surgical instrument to the starting position quickly and accurately in a controlled manner.
  • the surgical instrument is, for example an instrument used to perform the relevant surgical intervention.
  • the surgical instrument may also be a pointer which is positioned in the starting position and is subsequently replaced by the instrument whereby the surgical intervention is performed.
  • the image-guided surgery system according to the invention is suitable for use for a variety of surgical interventions, notably for neurosurgery such as cerebral operations and spinal operations.
  • the alignment system in a preferred embodiment of an image-guided surgery system according to the invention is arranged to reproduce the starting point substantially at the center of the guide image.
  • the starting point is reproduced substantially at the center of the guide image, the user can see very well how the surgical instrument must be moved so as to move the end to the starting point. Furthermore, the surgical instrument is hardly ever moved so that the reproduction of the end of the surgical instrument is moved (almost) out of the guide image, because the end of the surgical instrument is reproduced approximately at the center of the guide image during its displacement to the starting point. Moreover, there is not much risk of confusion between the starting point and the position of the end of the surgical instrument, because it is decided in advance that the starting point will be shown at the center of the guide image.
  • the alignment system in a preferred embodiment of an image-guided surgery system according to the invention is arranged to select the starting plane so as to extend substantially perpendicularly to the alignment line.
  • the starting point will not be situated too far from the position of the end of the surgical instrument when the user starts to move the surgical instrument to the starting point, so that the surgical instrument need be displaced over a short distance only. Consequently, only a small amount of time is required to move the end of the surgical instrument accurately to the starting point. Moreover, it can be readily ensured that the starting point is not situated too far from the patient, so that the surgical instrument can be readily moved accurately to the target position along the alignment line.
  • the image display system in a preferred embodiment of an image-guided surgery system according to the invention is arranged to adjust the ratio of the distance between said end and the starting point to the distance between the reproduction of the end and the reproduction of the starting point in the guide image on the basis of the distance between said end and the starting point.
  • the guide image is reproduced with a magnification or reduction which is dependent on the distance between the end of the surgical instrument and the starting point.
  • a small magnification or even a reduction is used for as long as the end of the surgical instrument is still remote from the starting point, a (larger) magnification being used when the end of the surgical instrument reaches the vicinity of the starting point.
  • the user can thus always see very well how the end of the surgical instrument must be displaced to the starting point because, for as long as the end of the surgical instrument is still remote from the starting point, the reproduction of the end will be situated within the guide image and the reproductions of the end of the surgical instrument and of the starting point can both be observed in the guide image.
  • the reproduction of the guide image is step-wise enlarged as the end of the surgical instrument approaches the starting point.
  • the alignment system in a preferred embodiment of an image-guided surgery system includes a rotatable alignment member for supporting the surgical instrument, the end of the surgical instrument being retained in a fixed position in the alignment member which is arranged to lock the end of the surgical ⁇ element in the starting point, the alignment system being arranged to select the starting plane so as to extend through said fixed position in the alignment member.
  • the starting plane through the fixed position in the alignment member contains the end of the surgical instrument, because this end is retained in said fixed position relative to the alignment member.
  • the alignment member locks the end of the surgical instrument in the starting point, rotation of the surgical instrument about the end is still possible.
  • the surgical instrument is oriented in the direction of the alignment line by rotating the alignment member supporting the surgical element.
  • the alignment system in a preferred embodiment of an image-guided surgery system according to the invention is arranged to reproduce a distance between the end of the surgical instrument and the target position.
  • the surgical instrument can thus be easily moved in the direction of the alignment line until the target position is reached. This is attractive notably when a biopsy is performed.
  • the surgical instrument then consists of a biopsy needle which is positioned in the target position where it takes a sample of the tissue.
  • the alignment system in a preferred embodiment of an image-guided surgery system according to the invention includes an instrument holder which is arranged to adjust the distance between the end of the surgical instrument and the target position while maintaining the orientation of the surgical instrument in the direction of the alignment line.
  • Such an instrument holder supports the surgical instrument. It enables accurate and easy displacement of the surgical instrument in the direction of the alignment line so as to reach the target position without excessive risk to the patient.
  • the invention also relates to a method of aligning a surgical instrument as defined in Claim 10.
  • the method according to the invention achieves easier, faster and more accurate alignment of the surgical instrument, as compared to the alignment performed with the known image-guided surgery system.
  • the image-guided surgery system includes a position measuring system with a camera unit 10 and two CCD image sensors 11.
  • the camera unit 10 is mounted on a patient table 30.
  • the camera unit 10 forms images of the surgical instrument 20 from different directions.
  • the surgical instrument is provided with a plurality of, for example ⁇ three infrared emitting diodes (IREDs) 19.
  • the CCD image sensors produce image signals, notably electronic video signals, which represent the individual images of the surgical instrument 20, notably of the IREDs 19.
  • the position measuring system also includes a computer 12 for deriving the position of the surgical instrument from the image signals.
  • Image information of the patient 21 to be examined or treated is stored in an image memory 13.
  • the image information concerns, for example MRI and/or CT images formed before or during the surgical treatment.
  • Marks 23 notably formed by fiducial markers, on or in the patient 21 are also reproduced in the images of the patient.
  • the positions of the marks 22 are measured by means of the position measuring system, for example by pointing out the marks by means of the surgical instrument.
  • the computer 12 derives the relation between positions in or on the patient 21 and the corresponding positions in the images from the positions of the marks and the positions of the images of the marks in the images formed.
  • the image processor 14 forms an image signal which represents an image which shows image information of the patient 21 and also the instantaneous position of the surgical instrument 20 in the patient.
  • the computer 12, the image memory 13 and the image processor are included in a data processor 9 whereto a monitor 8 is connected.
  • the image signal is applied to the monitor 8.
  • Image information of the patient 21, showing where the surgical instrument 20 is situated, is displayed on the monitor 8. The user can thus move the surgical instrument 20 within the patient 21 without having a direct view of the instrument and without risk of unnecessary damaging of tissue.
  • the image-guided surgery system includes an alignment system by means of which the user can readily position the surgical instrument 20 in a suitable starting position B.
  • the alignment system includes the camera unit 10, the computer 12, the image processor 14 and the monitor 8.
  • the alignment system also includes a system of arms 6 which supports the alignment member 7.
  • the user selects the target position T and also the alignment line 1 from the pre-recorded image information.
  • the alignment line 1 passes through the target position T and through the entrance position E.
  • the entrance position E is selected to be such that the target position T can be readily reached along the alignment line, without unnecessary damaging of tissues or without excessive risk to the patient.
  • the position measuring system 10, 12 measures the position of the end U of the surgical instrument.
  • the computer 12 calculates the position of the target position T and the entrance position E from the positions of the reproductions of the target and entrance position se cted in the image information by the user.
  • the computer 12 subsequently calculates the starting plane a which extends through the instantaneous position U of the end 25 of the surgical instrument and preferably perpendicularly to the alignment line 1.
  • the computer 12 also calculates the point of intersection between the alignment line 1 and the starting plane ; this point of intersection is the starting point B.
  • the computer 12 then calculates the positions of the end U and the starting point B in the starting plane .
  • the image processor forms an image signal which represents the guide image.
  • Such a guide image is displayed on the monitor 18 and shows the position U of the end 25 and the position of the starting point B in the starting plane ⁇ .
  • the position of the starting point is shown at the center of the image, denoted by a circle, and the position of the end 25 is denoted by a cross.
  • the image processor 14 Adjacent to or instead of the position of the starting position B and the position U of the end 25 , the image processor 14 can provide arrows 26 in the guide image on the monitor 8 so as to indicate the directions in which the end 25 must be moved in the starting plane a so as to reach the starting point B.
  • the computer automatically adapts the position of the starting plane ⁇ by ensuring that the starting plane always extends through the position U of the end 25.
  • the starting point is automatically adapted to the movement of the starting plane a. because the starting point is the point of intersection between the alignment line 1 and the starting plane . It has been found that it is not very important where exactly on the alignment line 1 the starting point B is situated.
  • the computer 12 also calculates the distance between the end 25 of the surgical instrument and the target position T; this calculation preferably takes place when the end 25 has been placed in the starting position B. On the basis of this distance the image processor 14 controls the monitor 8 so as to provide a depth indication.
  • the depth indication is, for example a scale graduation 27 on which the distance between the end 25 and the target position T is indicated by means of a pointer 28. The user can thus see on the monitor how far the end 25 must be moved in the direction of the alignment line so as to reach the target position T.
  • the alignment system also includes a system of arms 6 with a plurality of arms 31 which are rotatably coupled to one another, for example by means of hinges 32.
  • the alignment member 7 is secured to an end 29 of the system of arms.
  • the hinges can be _ locked so as to retain the alignment member 7 in a desired position.
  • the surgical instrument 20 fits in an opening 33 in the alignment member 7.
  • the alignment member 7 is, for example a sphere in which a cylindrical channel 33 is recessed so as to extend through the center of the sphere. Using the alignment member 7, the surgical instrument 20 can be readily aligned in the direction of the alignment line 1, the end being retained in the starting position B. By sliding the surgical instrument 20 through the channel 33, the end 25 is moved accurately in the direction of the alignment line 1 to the target position T.
  • the depth indication can be simply used to arrange the alignment member at a fixed distance from the target position T.
  • a fixed distance is, for example a standard length of the biopsy needle.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Pathology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)

Abstract

Un système de chirurgie guidé par l'image est utilisé pour montrer à un utilisateur, par exemple un chirurgien, une position d'un instrument chirurgical dans une zone d'intervention dans le corps d'un patient pendant une intervention chirurgicale. Ce système de chirurgie guidé par l'image comporte un système de cadrage permettant de déduire une ligne de cadrage passant par une position cible, et permettant de sélectionner un plan de départ passant par une extrémité de l'instrument chirurgical, permettant de déduire un point de départ sur la ligne de cadrage et dans le plan de départ, et permettant de reproduire une position de l'extrémité considérée et du point de départ considéré les uns par rapport à l'autre dans le plan de départ. Par exemple, les positions de l'extrémité et le point de départ dans le plan de départ sont reproduits dans une image guide.
PCT/IB1998/000190 1997-02-28 1998-02-16 Systeme de chirurgie guide par l'image WO1998037827A2 (fr)

Priority Applications (4)

Application Number Priority Date Filing Date Title
EP98901454A EP0975272B1 (fr) 1997-02-28 1998-02-16 Systeme de chirurgie guide par l'image
DE69830719T DE69830719T2 (de) 1997-02-28 1998-02-16 Chirurgisches system mit bildführung
JP52925098A JP4198192B2 (ja) 1997-02-28 1998-02-16 画像案内手術システム
PCT/IB1998/000190 WO1998037827A2 (fr) 1997-02-28 1998-02-16 Systeme de chirurgie guide par l'image

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
EP97200600.1 1997-02-28
PCT/IB1998/000190 WO1998037827A2 (fr) 1997-02-28 1998-02-16 Systeme de chirurgie guide par l'image

Publications (2)

Publication Number Publication Date
WO1998037827A2 true WO1998037827A2 (fr) 1998-09-03
WO1998037827A3 WO1998037827A3 (fr) 1998-12-03

Family

ID=11004681

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB1998/000190 WO1998037827A2 (fr) 1997-02-28 1998-02-16 Systeme de chirurgie guide par l'image

Country Status (1)

Country Link
WO (1) WO1998037827A2 (fr)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2001190529A (ja) * 1999-12-02 2001-07-17 Koninkl Philips Electronics Nv スライス画像を再生する装置
JP2002017751A (ja) * 2000-07-06 2002-01-22 Olympus Optical Co Ltd 手術ナビゲーション装置
WO2001062173A3 (fr) * 2000-02-25 2002-04-11 Univ Leland Stanford Junior Procedes et appareils de maintien d'une trajectoire en stereotaxie destines a la recherche d'une cible a l'interieur d'un corps

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0676178A1 (fr) * 1994-04-08 1995-10-11 The Cleveland Clinic Foundation Dispositif d'orientation pour des outils
EP0755660A2 (fr) * 1995-07-28 1997-01-29 Armstrong Healthcare Limited Dispositif d'alignement

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0676178A1 (fr) * 1994-04-08 1995-10-11 The Cleveland Clinic Foundation Dispositif d'orientation pour des outils
EP0755660A2 (fr) * 1995-07-28 1997-01-29 Armstrong Healthcare Limited Dispositif d'alignement

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2001190529A (ja) * 1999-12-02 2001-07-17 Koninkl Philips Electronics Nv スライス画像を再生する装置
WO2001062173A3 (fr) * 2000-02-25 2002-04-11 Univ Leland Stanford Junior Procedes et appareils de maintien d'une trajectoire en stereotaxie destines a la recherche d'une cible a l'interieur d'un corps
JP2002017751A (ja) * 2000-07-06 2002-01-22 Olympus Optical Co Ltd 手術ナビゲーション装置

Also Published As

Publication number Publication date
WO1998037827A3 (fr) 1998-12-03

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