Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
  • A61B17/225—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
  • A61B17/2256—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves with means for locating or checking the concrement, e.g. X-ray apparatus, imaging means
• • 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
  • A61B2034/101—Computer-aided simulation of surgical operations
  • A61B2034/102—Modelling of surgical devices, implants or prosthesis
• • 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
  • A61B2034/107—Visualisation of planned trajectories or target regions
• • 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
  • 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
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/08—Clinical applications
  • A61B8/0833—Clinical applications involving detecting or locating foreign bodies or organic structures

Definitions

• the invention relates to a method for visualizing the alignment of therapeutic sound waves to an area to be treated or processed, and to an apparatus for performing this method.
• intra- or extracorporeally generated pulsed pressure or shock waves are used for lithotripsy, while continuous sound waves e.g. be used for heating the tissue.
• sound wave focus - with the treatment region to be treated or treated. This can be done by moving the sound source and / or the patient as well as by influencing the spatial pressure distribution in the sound field and thus by moving the focus relative to the sound source.
• this alignment process should generally not be carried out automatically, but rather by the user, for example a doctor. So that the user can carry out the positioning a numerical or graphic display is required which allows the user to align the sound wave focus to the treatment region.
• the display is e.g. by fading in a crosshair in a two-dimensional X-ray or ultrasound image:
• a technically simple, but possibly ergonomic solution for the device concept and disadvantageous in terms of construction costs is to mechanically connect the components for image generation - i.e. the X-ray tube / image intensifier or the ultrasonic transducer - to the sound source, so that a fixed spatial relationship between the imaging components and the ultrasound source.
• this device no longer has a fixed spatial association between the imaging system and the sound source, there is no possibility of using fixed marks or the like. fade in. Rather, the now variable spatial position of the sound wave focus relative to the treatment region must be displayed or displayed.
• FIG. 4 of DE-A-195 12 956 Another positioning display is described in Fig. 4 of DE-A-195 12 956.
• the position of the sound wave focus is shown in one plane and an axis perpendicular to it.
• the disadvantage here is that the user must always keep an eye on two movable marks in order to assess the spatial position. Misinterpretations are avoided with this - not pseudo-three-dimensional - display, but the implementation of the image information does not allow sufficiently quick and fatigue-free positioning.
• the invention is based on the object of specifying a method for visualizing the alignment of therapeutic sound waves to an area to be treated or processed as well as an apparatus for carrying out this method, in which the position information is provided by a graphical display that is easy to interpret.
• the invention is based on the following knowledge:
• the approach according to the invention is based on knowledge of the design of three-dimensional bodies on computers ("Computer aided design", "CAD") and the application of artificial reality based thereon (“Virtual reality”, “VR”) .
• CAD Computer aided design
• VR Virtual reality
• the basic principle of VR presentation techniques is that the perspective of those presented. Body changes with the location of the viewer. In contrast to the stereoscopic representation, the still picture alone does not create a spatial impression, since left and right eyes receive the same information.
• the human brain can draw conclusions about the size and the relative position of the displayed objects from such a sequence of images. It is the same if you allow the viewer to place objects in the Seemingly seize the scene (virtual hand) and move it relative to each other. The similarity of the real scene to the one created on the screen gives the viewer the illusion that he is actually in the scene ("immersion", immersion).
• the basic idea of the invention is to use such display techniques for positioning the sound wave focus on a treatment region.
• the sound wave source and the area through which the sound waves propagate, as well as the area to be treated or processed are shown on the screen in perspective by assigning physical figures.
• the perspective view changes when the location or the orientation of the sound wave source and / or the treatment area and / or the location or the orientation of the screen changes.
• the representation correctly reflects the real position of the sound source and the treatment region in order to give the user an accurate impression of the size and spacing of the figures.
• the figure corresponding to the sound wave focus moves in the depicted scene in exactly the same way as in reality.
• the user thus gets the impression that he is in the virtual scene and leads the sound source there to the treatment region (immersion, virtual hand).
• the perspective view changes when the location of an operator changes in accordance with the change in view of the scene for the operator or can be changed manually.
• the signals obtained from a measuring system that detects the relative position between the sound source and the treatment area or location device are converted into an equivalent virtual movement in almost real time via the spatial position of the sound source.
• these are preferably represented as a cone, the jacket of which roughly corresponds to the transition between the focused wave and the edge diffraction wave.
• the surface of the cone shown is shown with a perforated surface such that the treatment area is not covered.
• the jacket of the cone shown can be shown semi-transparent.
• the treatment area is shown approximately in the size in which the sound waves develop a therapeutic or processing effect.
• the treatment area can be represented as a sphere or ellipsoid.
• a particularly preferred embodiment of the method according to the invention has an approximation display which shows the approximation or correspondence of the area in which the sound waves have a therapeutic or Develop a processing effect, indicating the treatment area.
• An additional numerical display or other suitable means provides the user with quantitative information on how exactly he has carried out the positioning.
• the proximity display can be done acoustically - for example by changing the pitch (tone frequency) and / or the tone repetition frequency. Furthermore, the proximity display can take place by a change in the color in which at least one of the physical figures is shown. It is also possible for the proximity display to be numerical.
• the objects shown have surfaces ("rendering"). It is advantageous if light incidence and light reflection are simulated on the surfaces shown, as would result, for example, from an endoscopic or surgical intervention.
• a virtual lighting source can be arranged on the ceiling of the treatment or processing room.
• a virtual lighting source can be arranged in the center of the treatment area.
• a light source is located above the user. This is the usual incidence of light, so that brighter areas on the surface of the cone and sphere are assessed in the correct position as above.
• a second light source is located in the middle of the treatment region, so that there is a brightening in the The area of the tip of the cone results when you approach the target. This avoids undesirable strong shadowing when approaching the target from above.
• the stationary parts can be a treatment couch and / or a positioning device for a locating device - for example an X-ray C-arm or an ultrasound locating device.
• the position of the treatment area can be displayed as a function of the output signal of a locating device.
• 1 shows the distribution of the sound pressure through a broken cone
• 2 shows a treatment scene in which an X-ray C-arm is faded in to explain the input option for the user location
• Fig. 4 shows an apparatus for performing the method according to the invention.
• Fig. 1 shows how the distribution of the sound pressure is represented by a broken cone 1.
• 2 denotes the area to which the sound wave field is to be aligned and which is intended to be "covered” with the sound wave focus (not shown in this figure).
• This representation uses the idea of the entry cone that is usually already available to the user.
• the cone jacket corresponds to the transition between the focused wave and the edge diffraction wave and thus represents in a first approximation the spatial area within which a therapeutically effective sound energy is transmitted.
• the interruption of the cone jacket serves to prevent the treatment region 2 from being covered.
• Another possibility for this is the semi-transparent representation of the cone ("rendering" in "transparent mode”).
• the sound wave focus can not only be represented as the tip of the cone 1, but also clearly in the form of a sphere or an ellipsoid of revolution, the size of which corresponds to the size of the sound wave focus. The user is thus able to estimate the positioning accuracy achieved.
• cone 1, sphere or ellipsoid (sound wave focus) and treatment region 2 penetrate each other.
• 2 explains one possibility for the representation of the user location.
• 2 shows a treatment scene in which an X-ray C-arm 3 is superimposed.
• the C-arm 3 gives the user an orientation about his location in the scene.
• a touch-sensitive screen (“touch screen”) or the like.
• the scene can be rotated.
• the user selects the perspective that corresponds to his actual location, so that he can work in a real scene without having to "rethink” between the screen display and the actual treatment scenario.
• Further options for improving the spatial orientation are the (additional or alternative) display of a treatment couch or other stationary parts of the treatment area.
• magnification is changed so that the user has the impression that he is approaching the treatment region himself.
• this increases the effect of immersion, on the other hand, fine-tuning is improved over the last millimeters of the approximation.
• FIG. 4 shows a typical configuration for a treatment station with sound waves, as is further developed within the scope of the invention.
• the treatment station has a patient couch 10, which is horizontally displaceable, height-adjustable and / or rotatable for positioning a patient (not shown) in a manner known per se.
• An adjustable holding arm 12 for a therapeutic sound source 13 is attached to a stand 11.
• the sound source 13 can be designed in a manner known per se and can be used, for example, to destroy body concrements, to treat pain, to treat the heart, to warm regions of the body or the like. It should be explicitly stated that the above list of possibilities for the formation of the sound source formation of the sound source or its application is not conclusive!
• the sound source 13 can thus be positioned in the desired manner relative to a patient lying on the patient couch 10 by hand or optionally with a servo adjustment.
• a sensor 17 is attached to the sound source 13, which allows the position of the sound source 13 to be detected relative to the patient bed 10 or the recognized area of the patient to be treated by means of a position detection system 18, the output signal of which is sent to an evaluation and control unit, for example a computer system 19, which has a screen 20, on which, by means of the method according to the invention, suitable displays for an operator, in the case of medical applications one Doctor are represented.
• Suitable input options such as a keyboard, a mouse control, a touch screen or a voice control of the system 19, are not shown.
• the position detection system 18 continuously supplies data about the position of the sound source 13 relative to the bed 10 to the control and evaluation unit or the computer system 19.
• the computer program of the computer system 19 contains fast algorithms for calculating the perspective (“VR programs”), for generating a surface (“rendering”) and for calculating the light reflection (“ray tracing”).
• VR programs for calculating the perspective
• ray tracing for calculating the light reflection
• Such programs are known from other - non-medical - applications - for example CAD applications - so that the formation of such programs does not have to be discussed in more detail here.
• the scene displayed on the screen 20 is updated several times per second on the basis of the position data, so that the real-time simulation required for an immersion is obtained.
• image intensifier 16 of the x-ray device or an ultrasound transducer can also be detected at the same time and can be represented in the scene to improve orientation.
• the same computer system can be used to read in images of, for example, the X-ray system ("frame grabber") and from the position of the image intensifier in two projections Determine the spatial position of the treatment region, as described in DE-A-195 12 956.
• Quantitative information about the distance of the cone tip to the center of the sound wave focus can be transmitted in different ways. For example, a numerical display of the distance can be shown.
• Another option is an acoustic signal that sounds at a lower repetition frequency at greater distances. As the distance decreases, the repetition frequency increases continuously. If the distance falls below a predetermined distance, the pitch is raised.
• a third possibility is to change the color of the cone and / or ball, which takes place continuously or when the distance falls below a predetermined distance. Furthermore, it can be provided that a signal is generated when a predetermined target distance is undershot, which acts on the braking device 14 for the movements of the sound source 13.
• a further possible solution is to let the position signal act on a motorized adjustment of the sound source 13 or to influence the spatial pressure distribution of the sound source and thus to automate the positioning.
• Another embodiment provides for a three-dimensional representation of the interior of the body to be used, such as can be obtained by means of CT, NMR or ultrasound.
• the cone figure can overlay this representation be displayed to show the position of the sound wave field in relation to anatomical structures. This can improve therapy and reduce side effects, for example, by avoiding gas-filled cavities or bone structures in the sound field.
• the method described above can also be used in other areas, such as material processing, in which a focused wave field (any waves) is used, the focus of which is to be brought into line with a processing area, in addition to in the field of medicine.
• a focused wave field any waves

Landscapes

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

Priority Applications (4)

Applications Claiming Priority (2)

Related Child Applications (1)

Publications (1)

Family

ID=7880861

Family Applications (1)

Country Status (5)

Cited By (1)

Families Citing this family (13)

Citations (7)

Family Cites Families (3)

• 1998
  • 1998-09-14 DE DE19841951A patent/DE19841951C2/de not_active Expired - Fee Related
• 1999
  • 1999-09-14 DE DE59911202T patent/DE59911202D1/de not_active Expired - Lifetime
  • 1999-09-14 EP EP99955693A patent/EP1112030B1/de not_active Expired - Lifetime
  • 1999-09-14 WO PCT/DE1999/002913 patent/WO2000015121A1/de not_active Ceased
  • 1999-09-14 JP JP2000569707A patent/JP4691254B2/ja not_active Expired - Fee Related
• 2001
  • 2001-03-13 US US09/805,406 patent/US6616618B2/en not_active Expired - Fee Related

Patent Citations (7)

Also Published As

Similar Documents

Legal Events