WO2006087263A1 - Systeme d'enregistrement peroperatoire - Google Patents

Systeme d'enregistrement peroperatoire Download PDF

Info

Publication number
WO2006087263A1
WO2006087263A1 PCT/EP2006/050564 EP2006050564W WO2006087263A1 WO 2006087263 A1 WO2006087263 A1 WO 2006087263A1 EP 2006050564 W EP2006050564 W EP 2006050564W WO 2006087263 A1 WO2006087263 A1 WO 2006087263A1
Authority
WO
WIPO (PCT)
Prior art keywords
arrangement according
patient
reference elements
elements
bearing surface
Prior art date
Application number
PCT/EP2006/050564
Other languages
German (de)
English (en)
Inventor
Hayo Knoop
Ulrich Wyslucha
Original Assignee
Maquet Gmbh & Co. Kg
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 Maquet Gmbh & Co. Kg filed Critical Maquet Gmbh & Co. Kg
Publication of WO2006087263A1 publication Critical patent/WO2006087263A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • 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
    • A61B2034/2055—Optical tracking systems
    • 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
    • A61B2090/3933—Liquid markers
    • 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
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery
    • 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
    • A61B2090/3995—Multi-modality markers
    • 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
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/055—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves  involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • A61B6/0407—Supports, e.g. tables or beds, for the body or parts of the body
    • A61B6/0421—Supports, e.g. tables or beds, for the body or parts of the body with immobilising means
    • A61B6/0428—Patient cradles
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam

Definitions

  • the invention relates to an arrangement for automatic intraoperative registration based on image data sets that have been created by means of an intraoperative tomography method of an anatomical region of a patient.
  • Registration is understood to mean in the following calculations, with the help of which several 3-D objects in the same coordinate system can be related.
  • intraoperative registration generally takes place on the basis of preoperatively acquired 3-D patient image data.
  • image data sets that have been created from an anatomical region of the patient by means of computer tomography (CT) or magnetic resonance tomography (MRI, MRI).
  • CT computer tomography
  • MRI magnetic resonance tomography
  • Positions from the respective image dataset should be retrieved during the operation on the patient. It should also be possible to assess the position and orientation tion of surgical instruments in the image data and to control what is commonly referred to as navigation in the following.
  • Procedures with invasively placed markings are today considered the standard with the highest achievable accuracy. Bone-supported, stereotactic frames or small screws are used as markings, which can be identified both in the image data set and intraoperatively. If the markings are known (image data record position to intraoperative position), the registration can be calculated from this. For this a CT or MRI examination with the attached markings is needed.
  • a disadvantage of this solution is that the invasively set markings burden the patient by the additional intervention for the attachment of the markers and extend the overall duration of the operation.
  • non-invasive procedures it is possible to manually or semi-automatically identify anatomical regions (landmarks) or pasted markings intraoperatively and in the dataset and thus establish an association.
  • non-invasive surface-based methods which reconstruct the surface of the human tissue (skin, bone) both from the image data record and record intraoperatively, for example by means of a laser scanner and calculate the registration with a known allocation.
  • a disadvantage of these methods is their relatively low accuracy and also high expenditure of time. The causes lie in the manual assignment of landmarks, the variability of the corresponding surface (eg skin shifts), the different interpretation by the surgeon or the intraoperative lighting situation in a surface scan.
  • the invention has for its object to provide an arrangement of the type mentioned above, which allows automatic intraoperative registration with high accuracy and the least possible burden on the patient.
  • a patient support surface which is CT or MRI-capable, has means for fixing a patient on the storage area and is provided with stereotactic reference elements.
  • an operation can be continued immediately after the intraoperative imaging without delay.
  • the patient support surface may be a flyable operating table bearing surface or a displaceable radiographic support (transfer board) located thereon.
  • the registration takes place in the following manner:
  • the patient is first temporarily fixed on the bearing surface, for example with the aid of straps, fixed anatomical impressions and / or vacuum pads.
  • the image data records are then created in the tomograph, the reference elements being automatically recognized in the image data. From the position of the reference elements, the position and thus the registration to the image data set can then be calculated by means of an automatic algorithm.
  • the patient remains fixed on the bearing surface so that the registration is maintained during the subsequent procedure.
  • the reference elements can be arranged or formed directly in the bearing surface.
  • the patient support surface may be at least have a part of their length a profile with the support surface for the patient laterally limiting spars, which facilitate a fixation of the patient on the bearing surface, wherein at least a part of the reference elements is arranged in the lateral bars.
  • the reference elements in a patient at least partially enclosing, for example, U-shaped frame which is detachably connected to the patient support surface.
  • the reference elements of cavities are formed in the material of the bearing surface or of the frame which can be connected to it. These cavities may be filled with air or a contrasting material.
  • Such a material is for example aluminum or titanium rods.
  • this material is useful only in conjunction with the removable profile frame because the aluminum or titanium rods may form artifacts.
  • the cavities are fillable via closable openings with a contrast agent and evacuated. This offers the possibility to use a suitable for the imaging method used contrast agent.
  • the bearing surface or the detachably connected to it frame has an interface for the spatially defined coupling of a reference body, which can then be used by the devices to the position and orientation of represent or control surgical instruments.
  • Such a reference body preferably comprises a plurality of radiation-reflecting or emitting elements which have a fixed spatial association with one another.
  • Such elements may be, for example, reflective balls, infrared diodes or RF coils.
  • the intervention Other specific coupling elements of the interface and the reference body expediently designed so that they ensure a unique spatial position of the reference body relative to the bearing surface fixed reference elements when meshing.
  • the reference elements can be rod-shaped in a manner known per se, wherein at least a part of the reference elements is arranged so that the longitudinal axes of at least two reference elements each have an actual or virtual common point of intersection.
  • the solution according to the invention offers a possibility for largely automatic intraoperative registration.
  • the manual interventions of the surgeon or the surgical staff are limited to arranging the frame on the bearing surface, if such is provided, or on the attachment of the reference body.
  • the bearing surface according to the invention can be used independently of the type of imaging device and is in principle suitable for X-ray and MRI applications by appropriate choice of the filling material for the reference elements.
  • the interface does not bind the user to the use of a particular navigation system, but can use the reference body suitable for this purpose.
  • the storage area according to the invention can also be used for various surgical disciplines. This applies in particular to the embodiment with the removable frame, since it can always be used on the anatomical region of the patient to be examined or treated.
  • the method described above is non-invasive because no bone-worn markers are used. By saving a preoperative procedure, the patient is less stressed and gains time. Time savings are also made possible by automatic registration (saving manual registration of eg landmarks) and the possibility to continue the operation immediately.
  • FIG. 1 is a schematic perspective view of a patient support surface according to a first embodiment
  • FIG. 1 shows a representation corresponding to FIG. 1 of a single section of a patient support surface
  • FIG. 3 shows a schematic cross section through a bearing surface according to a second embodiment
  • FIG. 4 shows a schematic section through a serving as a reference element with a contrast agent fillable cavity
  • FIG. 6 is a schematic plan view of a portion of the patient support surface with arranged on this reference bodies and
  • the patient support surface generally designated 10 in FIG. 1 comprises a base frame 12 and support pads 14 disposed therein for a patient 16.
  • the base frame 12 consists of longitudinal beams 18 and a bottom 20. Holes 22 are formed in the base 20 and the longitudinal beams 18 , which serve as reference elements.
  • the patient support surface can be integrally formed, as shown in Figure 1, or consist of several segments of the type shown in Figure 2, which are hinged together, so that they are mutually adjustable, as is known in operating table surfaces. Under certain circumstances, only one segment of a multi-part operating table surface in the manner shown in Figure 2 is formed.
  • the patient bearing surface consists of a base plate 24 and a releasably connected thereto U-shaped profile frame 26, as well as the base frame 12 of the embodiment of Figure 1 has two longitudinal members 18 and a bottom or cross member 20 in which the holes or cavities 22 serving as reference elements are formed.
  • the cavities 22 may be filled with air, evacuated or filled with a contrast material, which may for example also consist of metal.
  • the cavities 22 can each be filled with a contrast medium via a supply line 28 and a valve 30 from the outside, or can be emptied again. In this way, the holes or cavities 22 can be filled with the appropriate contrast agent for the respective imaging method.
  • FIG. 5 shows two bores 22 serving as reference elements, which form an angle with one another, so that their longitudinal axes are arranged in one another. intersect at point 32. This intersection 32 can serve as a reference point for the registration.
  • reference bodies 22 for locating and controlling as well as tracking patient movements are arranged on the bearing surface 10 itself.
  • These reference bodies can consist of radiation-reflecting spheres or radiation-emitting infrared or light-emitting diodes or else be formed by HF coils.
  • an interface in the form of a universal coupling 36 is formed on the patient support surface, for example a spar 18, which can be coupled with a reference body 38 which carries a counter-coupling 40 in a clearly defined relative position.
  • the reference body 38 again comprises balls 34 corresponding to the balls 34 in FIG. 6 or light-emitting diodes or HF coils.
  • the balls 42 are in a unique spatial relationship to a predetermined position of the image data sets, so that a device to be controlled can be precisely controlled by reference to these balls 42.

Abstract

L'invention concerne un système d'enregistrement peropératoire automatique reposant sur des ensembles de données d'images qui ont été produits par un procédé de tomographie peropératoire relativement à une région anatomique d'un patient. Ce système comprend une surface support (10) pour le patient, cette surface étant adaptée à la tomodensitométrie ou à l'imagerie par résonance magnétique, il possède des moyens pour maintenir un patient sur la surface support et il est pourvu d'éléments de référence stéréotaxiques (22).
PCT/EP2006/050564 2005-02-15 2006-01-31 Systeme d'enregistrement peroperatoire WO2006087263A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102005006775A DE102005006775A1 (de) 2005-02-15 2005-02-15 Anordnung zur intraoperativen Registrierung
DE102005006775.1 2005-02-15

Publications (1)

Publication Number Publication Date
WO2006087263A1 true WO2006087263A1 (fr) 2006-08-24

Family

ID=36228669

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2006/050564 WO2006087263A1 (fr) 2005-02-15 2006-01-31 Systeme d'enregistrement peroperatoire

Country Status (2)

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DE (1) DE102005006775A1 (fr)
WO (1) WO2006087263A1 (fr)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103054607A (zh) * 2013-02-01 2013-04-24 徐州医学院 一种放射治疗用ct/mri双体位融合装置
CN103083038A (zh) * 2013-02-01 2013-05-08 徐州医学院 一种ct双体位自动配准与融合装置
US9241682B2 (en) 2013-03-12 2016-01-26 Depuy Synthes Products, Inc Apparatus and method for calibrating an x-ray image of a knee of a patient

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2593185A1 (fr) * 2007-07-10 2009-01-10 T. Derek V. Cooke Methode et appareillage de radiographie
DE102008011014A1 (de) * 2008-02-25 2009-09-10 Siemens Aktiengesellschaft Medizinisches Kissen
EP2510896A1 (fr) * 2011-04-15 2012-10-17 Universität Bern Récipient pour un organe
DE202011005573U1 (de) * 2011-04-21 2012-04-23 Isys Medizintechnik Gmbh Vorrichtung zur Fixierung

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4905267A (en) * 1988-04-29 1990-02-27 Loma Linda University Medical Center Method of assembly and whole body, patient positioning and repositioning support for use in radiation beam therapy systems
US5299253A (en) * 1992-04-10 1994-03-29 Akzo N.V. Alignment system to overlay abdominal computer aided tomography and magnetic resonance anatomy with single photon emission tomography
US5681326A (en) * 1993-06-15 1997-10-28 Elekta Instrument Ab Stereotactical instrument
US6390982B1 (en) * 1999-07-23 2002-05-21 Univ Florida Ultrasonic guidance of target structures for medical procedures
US20040127788A1 (en) * 2002-09-09 2004-07-01 Arata Louis K. Image guided interventional method and apparatus
US6826423B1 (en) * 1999-01-04 2004-11-30 Midco-Medical Instrumentation And Diagnostics Corporation Whole body stereotactic localization and immobilization system

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4905267A (en) * 1988-04-29 1990-02-27 Loma Linda University Medical Center Method of assembly and whole body, patient positioning and repositioning support for use in radiation beam therapy systems
US5299253A (en) * 1992-04-10 1994-03-29 Akzo N.V. Alignment system to overlay abdominal computer aided tomography and magnetic resonance anatomy with single photon emission tomography
US5681326A (en) * 1993-06-15 1997-10-28 Elekta Instrument Ab Stereotactical instrument
US6826423B1 (en) * 1999-01-04 2004-11-30 Midco-Medical Instrumentation And Diagnostics Corporation Whole body stereotactic localization and immobilization system
US6390982B1 (en) * 1999-07-23 2002-05-21 Univ Florida Ultrasonic guidance of target structures for medical procedures
US20040127788A1 (en) * 2002-09-09 2004-07-01 Arata Louis K. Image guided interventional method and apparatus

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103054607A (zh) * 2013-02-01 2013-04-24 徐州医学院 一种放射治疗用ct/mri双体位融合装置
CN103083038A (zh) * 2013-02-01 2013-05-08 徐州医学院 一种ct双体位自动配准与融合装置
US9241682B2 (en) 2013-03-12 2016-01-26 Depuy Synthes Products, Inc Apparatus and method for calibrating an x-ray image of a knee of a patient
US10016177B2 (en) 2013-03-12 2018-07-10 DePuy Synthes Products, Inc. Apparatus and method for calibrating an x-ray image of a knee of a patient

Also Published As

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