WO2006093546A1 - Systeme de visualisation et de mesure anatomiques - Google Patents

Systeme de visualisation et de mesure anatomiques Download PDF

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Publication number
WO2006093546A1
WO2006093546A1 PCT/US2005/044185 US2005044185W WO2006093546A1 WO 2006093546 A1 WO2006093546 A1 WO 2006093546A1 US 2005044185 W US2005044185 W US 2005044185W WO 2006093546 A1 WO2006093546 A1 WO 2006093546A1
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WO
WIPO (PCT)
Prior art keywords
iliac
twist
implant
patient
degree
Prior art date
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PCT/US2005/044185
Other languages
English (en)
Inventor
Jeff Dwyer
David T. Chen
M. Weston Chapman
Original Assignee
Medical Metrx Solutions, Inc.
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.)
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Publication date
Application filed by Medical Metrx Solutions, Inc. filed Critical Medical Metrx Solutions, Inc.
Publication of WO2006093546A1 publication Critical patent/WO2006093546A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1075—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions by non-invasive methods, e.g. for determining thickness of tissue layer
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient ; user input means
    • A61B5/742—Details of notification to user or communication with user or patient ; user input means using visual displays
    • A61B5/7435—Displaying user selection data, e.g. icons in a graphical user interface
    • 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
    • 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
    • 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
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/07—Stent-grafts

Definitions

  • This invention relates to medical apparatus in general, and more particularly to anatomical visualization and measurement systems .
  • scanning devices typically include CT scanners, MRI devices, X-ray machines, ultrasound devices and the like, and essentially serve to provide the physician with some sort of visualization of the patient's interior anatomical structure prior to commencing the actual medical procedure.
  • the physician can then use this information to plan the medical procedure in advance, taking into account patient-specific anatomical structure.
  • the physician can also use the information obtained from such preliminary scanning to more precisely identify the location of selected structures (e.g., tumors and the like) which may themselves be located within the interior of internal organs or other internal body structures. As a result, the physician can then more easily “zero in” on such selected structures during the subsequent medical procedure.
  • selected structures e.g., tumors and the like
  • the anatomical structures of interest to the physician may be quite small and/or difficult to identify with the naked eye.
  • preliminary scanning of the patient's interior anatomical structure using high resolution scanning devices can help the physician locate various structures of interest during the subsequent medical procedure .
  • scanning devices of the sort described above are frequently also used in purely diagnostic procedures.
  • scanning devices of the sort described above might be used to look for stenosis in a blood vessel, or the buildup of plaque in a blood vessel, or a thinning of the aorta wall, etc.
  • scanning devices of the sort described above tend to generate two-dimensional (i.e., "2-D") images of the patient's anatomical structure.
  • the scanning devices are adapted to provide a set of 2-D images, with each 2-D image in the set being related to every other 2-D image in the set according to some pre-determined relationship.
  • CT scanners typically generate a series of 2-D images, with each 2-D image corresponding to a specific plane or "slice" taken through the patient's anatomical structure.
  • each image plane or slice may be set parallel to every other image plane or slice, and adjacent image planes or slices may be spaced a predetermined distance apart.
  • the parallel image planes might be set 1 mm apart.
  • the physician can view each 2-D image individually and, by viewing a series of 2-D images in proper sequence, can mentally generate a three- dimensional (i.e., "3-D") impression of the patient's interior anatomical structure.
  • Some scanning devices include, as part of their basic system, associated computer hardware and software for building a 3-D database of the patient's scanned anatomical structure using a plurality of the aforementioned 2-D images.
  • some CT and MRI scanners include such associated computer hardware and software as part of their basic system.
  • such associated computer hardware and software may be provided independently of the scanning devices, as a sort of "add-on" to the system; in this case, the data from the scanned 2-D images is fed from the scanning device to the associated computer hardware and software in a separate step.
  • a trained operator using such apparatus can create a set of scanned 2-D images, assemble the data from these scanned 2-D images into a 3- D database of the scanned anatomical structure, and then generate various additional images of the scanned anatomical structure using the 3-D database.
  • This feature has been found to be a very powerful tool, since it essentially permits a physician to view the patient ' s scanned anatomical structure from a wide variety of different viewing positions. As a result, the physician's understanding of the patient's scanned anatomical structure is generally greatly enhanced.
  • scanning systems of the sort described above often include hardware and/or software tools to allow measurements to be made of the patient's scanned anatomical structure.
  • many of these systems let a physician overlay lines on an image of the patient' s anatomical structure, and then calculate the length of these lines so as to indicate the size of the structure being viewed.
  • each scanned 2-D slice image is displayed as a separate and distinct image
  • each image generated from the 3-D database is displayed as a separate and distinct image.
  • physicians can sometimes have difficulty correlating what they see on one image with what they see on another image.
  • physicians can sometimes have difficulty correlating what they see on a particular scanned 2-D slice image with what they see on a particular image generated from the 3-D database.
  • a physician may be viewing images of a patient's scanned anatomical structure in preparation for conducting a subsequent medical procedure in which a prosthetic device must be fitted in the patient.
  • a patient may develop an abdominal aortic aneurysm ("AAA") in the vicinity of the aorta's iliac branching, and repair or replacement of the affected vascular structure with a prosthetic device may be indicated.
  • AAA abdominal aortic aneurysm
  • a physician may be desirable to provide a physician with a particular obligue view of a specified portion of a patient's anatomical structure. For example, it may be desirable to provide a physician with a view taken perpendicular to the length of a blood vessel, with that view being taken at a very specific location along that blood vessel. Such a view might be desired for comprehensional and/or measurement purposes. Unfortunately, it can be difficult and/or impossible to accurately generate such a view using existing visualization systems .
  • a physician may be interested in accurately calculating a volume associated with a specific part of a patient's anatomy.
  • a physician might wish to track the volume of a thrombus in an aorta over time, or the size of a tumor during chemotherapy, etc.
  • it can be difficult and/or impossible to accurately make such a calculation using existing visualization systems.
  • one object of the present invention is to provide an improved anatomical visualization and measurement system for visualizing and measuring anatomical structures.
  • Another object of the present invention is to provide an improved anatomical visualization and measurement system wherein a scanned 2-D slice image can be appropriately combined with an image generated from a 3-D database so as to create a single composite image.
  • Another object of the present invention is to provide an improved anatomical visualization and measurement system wherein a marker can be placed onto a 2-D slice image displayed on a screen, and this marker will be automatically incorporated, as appropriate, into a 3-D computer model maintained by the system, as well as into any other 2-D slice image data maintained by the system.
  • Still another object of the present invention is to provide an improved anatomical visualization and measurement system n
  • a margin of pre-determined size can be associated with a marker of the sort described above, and further wherein the margin will be automatically incorporated into the 3-D computer model, and into any other 2-D slice image data, in association with that marker.
  • Yet another object of the present invention is to provide an improved anatomical visualization and measurement system wherein the periphery of objects contained in a 3-D computer model maintained by the system can be automatically identified in any 2-D slice image data maintained by the system, and further wherein the periphery of such objects can be highlighted as appropriate in 2-D slice images displayed by the system.
  • Another object of the present invention is to provide an improved anatomical visualization and measurement system wherein patient-specific anatomical dimensions such as length and/or cross-sectional dimensions can be quickly, easily and accurately determined.
  • Still another object of the present invention is to provide an improved anatomical visualization and measurement system which is particularly well adapted to determine patient-specific anatomical dimensions for structures which have a tortuous and/or branching configuration, e.g., blood vessels.
  • Another object of the present invention is to provide an improved anatomical visualization and measurement system wherein an appropriate set of scanned 2-D images can be assembled into a 3-D database, information regarding patient-specific anatomical structures can be segmented from the information contained in this 3-D database, and this segmented information can then be used to determine anatomical features such as a centerline for the anatomical structure which has been segmented.
  • Still another object of the present invention is to provide an improved anatomical visualization and measurement system which is able to easily and accurately present a physician with a particular oblique view of a specified portion of a patient's anatomical structure, e.g., a view taken perpendicular to the length of a blood vessel, with that view being taken at a very specific location along that blood vessel.
  • Another object of the present invention is to provide an improved anatomical visualization and measurement system wherein patient-specific anatomical volumes can be quickly, easily and accurately determined.
  • Another object of the present invention is to provide an improved anatomical visualization and measurement system wherein an appropriate set of scanned 2-D images can be assembled into a 3-D database, information regarding patient-specific anatomical structures can be segmented from the information contained in this 3-D database, and this segmented information can then be used to calculate desired patient-specific anatomical volumes.
  • Another object of the present invention is to provide an improved method for visualizing and measuring anatomical structures .
  • Another object of the present invention is to provide an improved method wherein patient-specific anatomical dimensions such as length and/or cross-sectional dimensions can be quickly, easily and accurately determined.
  • Still another object of the present invention is to provide an improved method wherein an appropriate set of scanned 2-D images can be assembled into a 3-D database, information regarding patient-specific anatomical structures can be segmented from the information contained in this 3-D database, and this segmented information can then be used to determine anatomical features such as a centerline for the anatomical structure which has been segmented.
  • Yet another object of the present invention is to provide a method for easily and accurately presenting a physician with a particular oblique view of a specified portion of a patient's anatomical structure, e.g., a view taken perpendicular to the length of a blood vessel, with that view being taken at a very specific location along that blood vessel.
  • Yet another object of the present invention is to provide an improved method for quickly, easily and accurately determining patient-specific anatomical volumes.
  • Another object of the present invention is to provide an improved system for modeling how a particular endoluminal prosthesis will deploy in the patient's anatomy.
  • an anatomical visualization and measurement system comprising a first database which comprises a plurality of 2-D slice images generated by scanning an anatomical structure. These 2-D slice images are stored in a first data format.
  • a second database is also provided which comprises a 3-D computer model of the scanned anatomical structure.
  • This 3-D computer model comprises a first software object which is representative of the scanned anatomical structure and which is defined by a 3-D geometry database.
  • means are provided for selecting a particular 2-D slice image from the first database.
  • Means are also provided for inserting a second software object into the 3-D computer model so as to augment the 3-D computer model.
  • the second software object is also defined by a 3-D geometry database, and includes a planar surface.
  • the second software object is inserted into the 3-D computer model at the position which corresponds to the position of the selected 2-D slice image relative to the scanned anatomical structure.
  • Means for texture mapping the specific 2-D slice image onto the planar surface of the second software object are also provided.
  • Means are also provided for displaying an image of the augmented 3-D computer model so as to simultaneously provide a view of both the first software object and the specific 2-D slice image which has been texture mapped onto the planar surface of the second software object .
  • the system comprises a first database which comprises a plurality of 2-D slice images generated by scanning an anatomical structure. These 2-D slice images are stored in a first data format.
  • a second database is also provided which comprises a 3-D computer model of the scanned anatomical structure.
  • This 3-D computer model comprises a first software object which is representative of the scanned anatomical structure and which is defined by a 3-D geometry database.
  • means are also provided for inserting a second software object into the 3-D computer model so as to augment the 3-D computer model.
  • the second software object is also defined by a 3-D geometry database, and includes a planar surface.
  • means are also provided for determining the specific 2-D slice image which corresponds to the position of the planar surface of the second software object which has been inserted into the augmented 3-D computer model.
  • means are also provided for texture mapping the specific 2-D slice image corresponding to the position of that planar surface onto the planar surface of the second software object.
  • display means are also provided for displaying an image of the augmented 3-D computer model to a physician so as to simultaneously provide a view of the first software object and the specific 2-D slice image which has been texture mapped onto the planar surface of the second software object.
  • the 3-D geometry database may comprise a surface model .
  • system may further comprise means for inserting a marker into the first database, whereby the marker will be automatically incorporated into the second database, and further wherein the marker will be automatically displayed where appropriate in any image displayed by the system.
  • system may further comprise a margin of predetermined size associated with the aforementioned marker.
  • system may further comprise means for automatically identifying the periphery of any objects contained in the second database and for identifying the corresponding data points in the first database, whereby the periphery of such objects can be highlighted as appropriate in any image displayed by the system.
  • the scanned structure will comprise an interior anatomical structure.
  • the visualization and measurement system may incorporate means for determining patient-specific anatomical dimensions, such as length and/or cross-sectional dimensions, using appropriate scanned 2-D image data. More particularly, the visualization and measurement system may include means for assembling an appropriate set of scanned 2-D images into a 3-D database, means for segmenting information regarding patient-specific anatomical structures from the information contained in the 3-D database, means for determining from this segmented information anatomical features such as a centerline for the anatomical structure which has been segmented, means for specifying a measurement to be made based on the determined anatomical feature, and means for calculating the measurements so specified.
  • the visualization and measurement system may include means for assembling an appropriate set of scanned 2-D images into a 3-D database, means for segmenting information regarding patient-specific anatomical structures from the information contained in the 3-D database, means for determining from this segmented information anatomical features such as a centerline for the anatomical structure which has been segmented, means for specifying a measurement to be made based on
  • the visualization and measurement system is particularly well adapted to determine patient-specific anatomical dimensions for structures which have a tortuous and/or branching configuration, e.g., blood vessels.
  • the visualization and measurement system is adapted to facilitate (1) assembling an appropriate set of scanned 2-D images into a 3-D database; (2) segmenting the volumetric data contained in the 3-D database into a set of 3-D locations corresponding to the specific anatomical structure to be measured; (3) specifying, for each branching structure contained within the specific anatomical structure of interest, a branch line in the volumetric data set that uniquely indicates that branch structure, with the branch line being specified by selecting appropriate start and end locations on two of the set of scanned 2-D images; (4) calculating, for each branching structure contained within the specific anatomical structure of interest, a centroid path in the volumetric data set for that branching structure, with the centroid path being determined by calculating, for each scanned 2-D image corresponding to the branch line, the centroid for the branch
  • the visualization and measurement system may incorporate means for easily and accurately presenting a physician with a particular oblique view of a specified portion of a patient's anatomical structure, e.g., a view taken perpendicular to a blood vessel, at a very specific location along that blood vessel.
  • the visualization and measurement system may incorporate means for more accurately measuring the dimensions of an anatomical structure by utilizing one or more oblique views taken along the length of that anatomical structure.
  • the visualization and measurement system may incorporate means for determining patient-specific anatomical volumes using appropriate scanned 2-D image data. More particularly, the visualization and measurement system may include means for assembling an appropriate set of scanned 2-D images into a 3-D database, means for segmenting information regarding patient-specific anatomical structures from the information contained in the 3-D database, means for determining from this segmented information anatomical volumes from the anatomical structure which has been segmented, means for specifying a structure of interest, and means for calculating the volume of the specified structure.
  • the present invention also comprises an improved method for visualizing and measuring anatomical structures.
  • the present invention also comprises a method for calculating patient-specific anatomical dimensions using appropriate scanned 2-D image data.
  • the method comprises the steps of (1) assembling an appropriate set of scanned 2-D images into a 3-D database; (2) segmenting information regarding patient-specific anatomical structures from the information contained in the 3-D database, (3) determining for this segmented information anatomical features such as a centerline for the anatomical structure which has been segmented; (4) specifying a measurement to be made based on the determined anatomical feature; and (5) calculating the measurement so specified.
  • the present invention also comprises a method for easily and accurately presenting a physician with a particular oblique view of a specified portion of a patient's anatomical structure, e.g., a view taken perpendicular to a blood vessel, at a very specific location along that blood vessel.
  • the present invention also comprises a method for calculating patient-specific anatomical volumes using appropriate scanned 2-D image data.
  • the method comprises the steps of (1) assembling an appropriate set of scanned 2-D images into a 3-D database; (2) segmenting information regarding patient-specific anatomical structures from the information contained in the 3-D database, (3) determining from this segmented information volumes for the anatomical structure which has been segmented, (4) specifying a structure of interest, and (5) calculating the volume of the specified structure.
  • a computer-based visualization system for visualizing anatomical structure and a graft implant which is to be deployed adjacent the anatomical structure, comprising: a 3-D computer model of the anatomical structure which is to be visualized, said 3-D computer model comprising at least one first software object, wherein said at least one first software object corresponds to the anatomical structure which is to be visualized; a database of second software objects, wherein at least one of said second software objects corresponds to a graft implant which is to be deployed adjacent the anatomical structure; selection apparatus for permitting a user to select said at least one of said second software objects; registration apparatus for positioning said selected at least one of said second software objects into said 3-D computer model so as to create an augmented 3-D computer model, with said selected at least one of said second software objects being positioned in said augmented 3-D computer model in proper registration with said at least one first software object contained in said augmented 3-D model; and processing apparatus for generating an image of said augmented 3-D computer model so as to simultaneously
  • a method for visualizing anatomical structure and a graft implant which is to be deployed adjacent the anatomical structure comprising: providing a 3-D computer model of the anatomical structure which is to be visualized, said 3-D computer model comprising at least one first software object, wherein said at least one first software object corresponds to the anatomical structure which is to be visualized; providing a database of second software objects, wherein at least one of said second software objects corresponds to a graft implant which is to be deployed adjacent the anatomical structure; selecting said at least one of said second software objects; positioning said selected at least one of said second software objects into said 3-D computer model so as to create an augmented 3-D computer model, with said selected at least one of said second software objects being positioned in said augmented 3-D computer model in proper registration with said at least one first software object contained in said augmented 3-D model; and generating an image of said augmented 3-D computer model so as to simultaneously provide a view of said at least one first software object and said selected at
  • a visualization system comprising: a first database comprising a plurality of 2—D slice images generated by scanning an anatomical structure, said 2—D slice images being stored in a first data format; a second database comprising a 3-D computer model of said scanned anatomical structure, said 3-D computer model comprising at least one first software object, said at least one first software object being defined by a 3-D geometry database; insertion apparatus for selectively inserting a second software object into said 3-D computer model so as to augment said 3-D computer model, said second software object being defined by a 3-D geometry database and including a planar surface; determining apparatus for determining the specific 2-D slice image associated with the position of said planar surface of said second software object when said second software object is inserted within said augmented 3-D computer model; texture mapping apparatus for texture mapping said specific 2—D slice image onto said planar surface of said second software object when said second software object is inserted within said augmented 3-D computer model; a third database of third software objects, wherein at least
  • a method for visualizing structure comprising: providing a first database comprising a plurality of 2—D slice images generated by scanning an anatomical structure, said 2—D slice images being stored in a first data format; providing a second database comprising a 3-D computer model of said scanned anatomical structure, said 3-D computer model comprising at least one first software object, said at least one first software object being defined by a 3-D geometry database; providing insertion apparatus for selectively inserting a second software object into said 3-D computer model so as to augment said 3-D computer model, said second software object being defined by a 3-D geometry database and including a planar surface; providing determining apparatus for determining the specific 2-D slice image associated with the position of said planar surface of said second software object when said second software object is inserted within said augmented 3-D computer model; providing texture mapping apparatus for texture mapping said specific 2—D slice image onto said planar surface of said second software object when said second software object is inserted within said augmented 3-D computer model; providing a third
  • a method for determining the degree of twist to be manually introduced into an implant which is to be positioned in the aorta and adjacent iliac branches so as to achieve an effective degree of twist when the implant is positioned in the anatomy, the method comprising: identifying the effective degree of twist desired for the implant; determining the Native Iliac Rotation of a patient; and subtracting the Native Iliac Rotation of a patient from the effective degree of twist desired for the implant so as to determine the degree of twist to be manually introduced into the implant.
  • a method for determining the degree and location of twist to be manually introduced into an implant which is to be positioned in the aorta and adjacent iliac branches so as to achieve an effective degree of twist when the implant is positioned in the anatomy, the method comprising: identifying the effective degree of twist desired for the implant; determining the Native Iliac Rotation of a patient; subtracting the Native Iliac Rotation of a patient from the effective degree of twist desired for the implant so as to determine the degree of twist to be manually introduced into the implant; identifying at least one control point intermediate the two ends of the implant, and dividing the total length of the implant equally across the number of control points so as to yield a plurality of equal length graft segments; and distributing the degree of twist to be manually introduced into the implant equally across each of the graft segments.
  • a method for determining the Native Iliac Rotation of a patient comprising: determining a left iliac centerline; determining a right iliac centerline; choosing a left iliac point on the left iliac centerline; choosing a right iliac point on the right iliac centerline; and determining the line extending between the left iliac point and the right iliac point and expressing the Native Iliac Rotation as a function of the line position relative to the coronal plane of the patient.
  • an apparatus for determining the degree of twist to be manually introduced into an implant which is to be positioned in the aorta and adjacent iliac branches so as to achieve an effective degree of twist when the implant is positioned in the anatomy, the apparatus comprising: apparatus for specifying the effective degree of twist desired for the implant; apparatus for determining the Native Iliac Rotation of a patient; and apparatus for subtracting the Native Iliac Rotation of a patient from the effective degree of twist desired for the implant so as to determine the degree of twist to be manually introduced into the implant.
  • an apparatus for determining the degree and location of twist to be manually introduced into an implant which is to be positioned in the aorta and adjacent iliac branches so as to achieve an effective degree of twist when the implant is positioned in the anatomy
  • the apparatus comprising: apparatus for specifying the effective degree of twist desired for the implant; apparatus for determining the Native Iliac Rotation of a patient; apparatus for subtracting the Native Iliac Rotation of a patient from the effective degree of twist desired for the implant so as to determine the degree of twist to be manually introduced into the implant; apparatus for specifying at least one control point intermediate the two ends of the implant, and dividing the total length of the implant equally across the number of control points so as to yield a plurality of equal length graft segments; and apparatus for specifying the degree of twist to be manually introduced into the implant equally across each of the graft segments .
  • an apparatus for determining the Native Iliac Rotation of a patient comprising: apparatus for determining a left iliac centerline; apparatus for determining a right iliac centerline; apparatus for choosing a left iliac point on the left iliac centerline; apparatus for choosing a right iliac point on the right iliac centerline; and apparatus for determining the line extending between the left iliac point and the right iliac point and expressing the Native Iliac Rotation as a function of the line position relative to the coronal plane of the patient.
  • Fig. 1 is a schematic view showing a scanning device for generating a set of 2-D images of the anatomy of a patient
  • Fig. 2 is a 2-D slice image corresponding to an axial slice taken through the abdomen of an individual
  • Fig. 3 shows a series of data frames corresponding to 2-D slice images arranged in a parallel array
  • Fig. 4 is a schematic view showing the scanning data contained within an exemplary data frame
  • Fig. 5 shows scanning data stored in a first storage device or medium being retrieved, processed and then stored again in a second data storage device or medium;
  • Fig. 6 is a schematic view of a system for retrieving and viewing scanning data
  • Fig. 7 is a schematic view of a unit cube for use in defining polygonal surface models
  • Fig. 8 illustrates the data file format of the polygonal surface model for the simple unit cube shown in Fig. 7;
  • Figs. 9A-9F illustrate a variety of menu choices which may be utilized in connection with the present invention.
  • Fig. 10 illustrates an image drawn to a window using the data contained in the 3-D computer model associated with the present invention
  • Fig. 11 illustrates a 2-D slice image drawn to a window in accordance with the present invention
  • Fig. 12 illustrates a composite image formed from information contained in both the 3-D computer model and the 2-D slice image data structure
  • Fig. 13 is a schematic illustration showing the relationship between axial slices, sagittal slices and coronal slices
  • Fig. 14 illustrates three different images being displayed on a computer screen at the same time, with a marker being incorporated into each of the images;
  • Fig. 15 illustrates a marker shown in an image generated from the 3-D computer model, with the marker being surrounded by a margin of pre-determined size;
  • Fig. 16 illustrates a 2-D slice image, wherein the periphery of an object has been automatically highlighted by the system
  • Fig. 17 is a schematic illustration showing various anatomical structures on a 2-D slice image, where that 2-D slice image has been taken axially through the abdomen of a patient, at a location above the aortic/iliac branching;
  • Fig. 18 is a schematic illustration showing various anatomical structures on another 2-D slice image, where that 2-D slice image has been taken through the abdomen of the same patient, at a location below the aortic/iliac branching;
  • Figs. 17A and 18A are schematic illustrations like those of Figs. 17 and 18, respectively, except that segmentation has been performed in the 3-D database so as to highlight the patient's vascular structure;
  • Fig. 19 is a schematic illustration showing that same patient's vascular structure in the region about the aortic/iliac branching, with branch lines having been specified for the patient's aorta and two iliac branches;
  • Fig. 20 is a schematic illustration showing how the centroid is calculated for the branch structure contained in a particular scanned 2-D image
  • Fig. 21 is a schematic illustration showing the tortuous centroid path calculated for each of the respective branch lines shown in Fig. 19;
  • Fig. 22 is a schematic illustration showing the space curve determined by applying a curve-fitting algorithm to two of the centroid paths shown in Fig. 21, whereby the structure between the branch lines is filled out and the centroid data "smoothed" through a "best fit” interpolation technique;
  • Fig. 23 is a flow chart illustrating how patient-specific anatomical dimensions can be determined from scanned 2-D image data in accordance with the present invention.
  • Fig. 24 is a schematic view showing an oblique slice polygon disposed perpendicular to the centerline of a blood vessel
  • Fig. 25 is a cumulative sum table for calculating lengths along an anatomical structure
  • Fig. 26 illustrates a centerline length calculation dialogue box drawn to a window in a display
  • Fig. 27 illustrates a 3-D graphical icon which has been inserted into the 3-D model and which is visible on the display so as to show the portion of the centerline which has been specified by the physician for a length calculation;
  • Fig. 28 is a cumulative sum table for calculating volumes with respect to an anatomical structure
  • Fig. 29 illustrates a volume calculation dialogue box drawn to a window in a display
  • Fig. 30 illustrates a 3-D graphical icon which has been inserted into the 3-D model and which is visible on the display so as to show the volume which has been specified by the physician using the volume calculation dialogue box;
  • Fig. 31 is a schematic representation of a software object representing the aorta of a patient
  • Fig. 32 is a schematic representation of the software object of Fig. 31 in which the aorta has been rendered transparent;
  • Fig. 33 is a schematic representation of a virtual graft deployed in the aorta of Fig. 31;
  • Fig. 34 is a schematic representation of a virtual graft deployed in the aorta;
  • Fig. 35 is a schematic representation of a Manufacturer Specific Virtual Graft (MSVG) before docking of contralateral 1imb;
  • MSVG Manufacturer Specific Virtual Graft
  • Fig. 36 is a schematic representation of a Manufacturer Specific Virtual Graft (MSVG) after docking of contralateral limb;
  • MSVG Manufacturer Specific Virtual Graft
  • Fig. 37 is a schematic representation of a Manufacturer Specific Virtual Graft (MSVG) , with the yellow zone representing "oversizing";
  • MSVG Manufacturer Specific Virtual Graft
  • Fig. 38 is a schematic representation of a Manufacturer Specific Virtual Graft (MSVG) Designer
  • Fig. 39 is a schematic representation of a Manufacturer Specific Virtual Graft (MSVG) Product Listing
  • Fig. 40 is a schematic representation of an Order Form PDF
  • Fig. 41 is a schematic representation of "Twist Lines"
  • Fig. 42 is a schematic representation of a resultant MSVG
  • Fig. 43 is a schematic representation of MSVG spline creation
  • Fig. 44 is a schematic representation of an MSVG contact model
  • Fig. 45 illustrates a screen display from one preferred construction of the present invention, wherein the display simultaneously provides a 2-D slice window and a 3-D model window, and further wherein the images illustrate Native Iliac Rotation departing from the coronal plane;
  • Fig. 46 is a schematic representation of the centerlines for the left iliac (LIL) branch, the right iliac (RIL) branch and the aorta (AO) ;
  • Fig. 47 is a schematic representation showing the calculation of Native Iliac Rotation off the coronal plane;
  • Fig. 48 is a schematic representation comparing the TwisterooTM and the TwisterooNIRTM products for a patient having a 53 degree Native Iliac Rotation;
  • Fig. 49 is another schematic representation comparing the TwisterooTM and the TwisterooNIRTM products for a patient having a 53 degree Native Iliac Rotation.
  • a scanning device 5 is shown as it scans the interior anatomical structure of a patient 10, as that patient 10 lies on a scanning platform 15.
  • Scanning device 5 is of the sort adapted to generate scanning data corresponding to a series of 2-D images, where each 2-D image corresponds to a specific viewing plane or "slice" taken through the patient's body. Furthermore, scanning device 5 is adapted so that the angle and spacing between adjacent image planes or slices can be very well defined, e.g., each image plane or slice may be set parallel to every other image plane or slice, and adjacent image planes or slices may be spaced a predetermined distance apart. By way of example, the parallel image planes might be set 1 mm apart.
  • the scanning data obtained by scanning device 5 can be displayed as a 2-D slice image on a display 20, and/or it can be stored in its 2-D slice image data form in a first section 23 of a data storage device or medium 25. Furthermore, additional information associated with the scanning data (e.g., patient name, age, etc.) can be stored in a second section 27 of data storage device or medium 25.
  • scanning device 5 might comprise a CT scanner of the sort manufactured by GE Medical Systems of Milwaukee, Wisconsin.
  • a 2-D slice image of the sort generated by scanning device 5 and displayed on display 20 might comprise the 2-D slice image shown in Fig. 2.
  • the 2-D slice image shown corresponds to an axial slice taken through an individual ' s abdomen and showing, among other things, that individual's liver.
  • Scanning device 5 may format its scanning data in any one of a number of different data structures.
  • scanning device 5 might format its scanning data in the particular data format used by a CT scanner of the sort manufactured by GE Medical Systems of Milwaukee, Wisconsin. More specifically, with such a scanning device, the scanning data is generally held as a series of data "frames", where each data frame corresponds to a particular 2-D slice image taken through the patient's body. Furthermore, within each data frame, the scanning data is generally organized so as to represent the scanned anatomical structure at a particular location within that 2-D slice image.
  • Such a data structure is fairly common for scanning devices of the sort associated with the present invention. However, it should be appreciated that the present invention is not dependent on the particular data format utilized by scanning device 5.
  • the scanning data provided by scanning device 5 can be formatted in almost any desired data structure, so long as that data structure is well defined, whereby the scanning data can be retrieved and utilized as will hereinafter be disclosed in further detail.
  • a series of data frames 3OA, 3OB, 3OC, etc. are shown arranged in a parallel array.
  • Each of these data frames 3OA, 3OB, 3OC, etc. corresponds to a particular 2-D slice image taken through the patient's body by scanning device 5, where the 2-D slice images are taken parallel to one another.
  • adjacent image planes or slices are spaced apart by a constant, pre-determined distance, e.g., 1 mm.
  • data frames 3OA, 3OB, 3OC, etc. collectively form a volumetric data set which is representative of the patient's scanned anatomical structure.
  • the scanning data contained within an exemplary data frame 3OA is shown represented in an X-Y coordinate scheme so as to quickly and easily identify the scanned anatomical structure disposed at a particular location within that 2-D slice image.
  • the scanning data relating to a particular X-Y coordinate represents an image intensity value. This image intensity value generally reflects some attribute of the specific anatomical structure being scanned, e.g., the tissue density.
  • the scanning data generated by scanning device 5 is stored in its 2-D slice image data form in first section 23 of data storage device or medium 25, with the scanning data being stored in a particular data format as determined by the manufacturer of scanning device 5.
  • the scanning data stored in first section 23 of data storage device or medium 25 is retrieved, processed and then stored again in a data storage device or medium 30.
  • the scanning data stored in first section 23 of data storage device or medium 25 is retrieved and processed so as to convert the scanning data generated by scanning device 5 from its 2-D slice image data form into a 3-D computer model of the patient's anatomical structure.
  • This 3-D computer model is then stored in a first section 35 of data storage device or medium 30.
  • the scanning data stored in first section 23 of data storage device or medium 25 is retrieved and processed as necessary so as to convert the scanning data into a preferred data format for the 2-D slice image data.
  • the 2-D slice image data is then stored in this preferred data format in second section 40 of data storage device or medium 30.
  • the additional information associated with the scanning data (e.g., patient name, age, etc.) which was previously stored in second section 27 of data storage device or medium 25 can be stored in a third section 42 of data storage device or medium 30.
  • the 3-D computer model has been stored in first section 35 of data storage device or medium 30, and the 2-D slice image data has been stored in a preferred data format in second section 40 of data storage device or medium 30, a physician can then use an appropriately programmed computer to access the 3-D computer model stored in first section 35 of data storage device or medium 30, and/or the 2-D slice image data stored in second section 40 of data storage device or medium 30, to generate desired patient- specific images.
  • a physician can use an appropriately programmed computer 50, operated by input devices 55, to access the 3-D computer model stored in first section 35 of data storage device or medium 30, and/or the 2-D slice image data stored in second section 40 of data storage device or medium 30, so as to generate the desired patient-specific images and display those images on a display 60.
  • the 3-D computer model contained in first section 35 of data storage device or medium 30 is preferably structured as a collection of software objects, with each software object being defined by a polygonal surface model of the sort well known in the art.
  • a scanned anatomical structure such as a human liver might be modeled as three distinct software objects, with the outer surface of the general mass of the liver being one software object, the outer surface of the vascular structure of the liver being a second software object, and the outer surface of a tumor located in the liver being a third software object.
  • Figs. 7 and 8 illustrate a typical manner of defining a software object by a polygonal surface model.
  • Fig. 7 and 8 illustrate a typical manner of defining a software object by a polygonal surface model.
  • FIG. 7 illustrates the vertices of a unit cube set in an X-Y-Z coordinate system
  • Fig. 8 illustrates the data file format of the polygonal surface model for this simple unit cube.
  • more complex shapes such as human anatomical structure can be expressed in corresponding terms.
  • first section 35 of data storage device or medium 30 is created by analyzing the 2-D slice image data stored in first section 23 of data storage device or medium 25 using techniques well known in the art.
  • the 2-D slice image data stored in first section 23 of data storage device or medium 25 might be processed using the well known "Marching Cubes” algorithm, which is a so- called “brute force” surface construction algorithm that extracts isodensity surfaces from a volumetric data set, producing from one to five triangles within voxels that contain the surface.
  • the 2-D slice image data stored in first section 23 of data storage device or medium 25 might be processed into the 3-D computer model stored in first section 35 of data storage device or medium 30 by some other appropriate modeling algorithm so as to yield the desired 3-D computer model which is stored in first section 35 of data storage device or medium 30.
  • the specific data structure used to store the 2-D slice image data in second section 40 of data storage device or medium 30 will also depend on the specific nature of computer 50 and on the particular operating system and application software being run on computer 50.
  • the 2-D slice image data contained in second section 40 of data storage device or medium 30 is preferably structured as a series of data "frames", where each data frame corresponds to a particular 2-D slice image taken through the patient's body, and where the scanning data within each data frame is organized so as to represent the scanned anatomical structure at a particular location within that 2-D slice image.
  • computer 50 comprise a Power PC-based, Macintosh operating system ("Mac OS") type of computer, e.g. a Power PC Macintosh 8100/80 of the sort manufactured by Apple Computer, Inc. of Cupertino, California.
  • Mac OS Power PC-based, Macintosh operating system
  • computer 50 be running Macintosh operating system software, e.g. Mac OS Ver. 7.5.1, such that computer 50 can readily access a 3-D computer model formatted in Apple's well-known QuickDraw 3D data format and display images generated from that 3D computer model, and such that computer 50 can readily access and display 2-D images formatted in Apple's well-known QuickTime image data format.
  • Input devices 55 preferably comprise the usual computer input devices associated with a Power PC-based, Macintosh operating system computer, e.g., input devices 55 preferably comprise a keyboard, a mouse, etc.
  • the 3-D computer model contained in first section 35 of data storage device or medium 30 be formatted in Apple's QuickDraw 3D data format, whereby the Mac OS computer 50 can quickly and easily access the 3-D computer model contained in first section 35 of data storage device or medium 30 and display images generated from that 3-D computer model on display 60.
  • the 2-D slice image data contained in second section 40 of data storage device or medium 30 be formatted in Apple's QuickTime image data format. In this way computer 50 can quickly and easily display the scanned 2-D slice images obtained by scanning device 5.
  • scanning device 5 happens to format its scanning data in the preferred QuickTime image data format, no reformatting of the 2- D slice image data will be necessary prior to storing the 2-D slice image data in second section 40 of data storage device or medium 30.
  • scanning device 5 happens to format its scanning data in a. different data structure, reformatting of the 2-D slice image data will be necessary so as to put it into the preferred QuickTime image data format.
  • image data reformatting is of the sort well known in the art.
  • a physician operating computer 50 through input devices 55 can generate a desired image from the 3-D computer model contained within first section 35 of data storage device or medium 30.
  • the physician can use input devices 55 to (1) open a window on display 60, (2) instruct the computer as to the desired angle of view, (3) generate the corresponding image of the scanned anatomical structure from the desired angle of view, using the 3-D computer model contained within first section 35 of data storage device or medium 30, and (4) display that image in the open window on display 60.
  • a physician operating computer 50 through input devices 55 can display a desired 2-D slice image from the 2-D slice image data contained within second section 40 of data storage device or medium 30.
  • the physician can use input devices 55 to (1) open a window on display 60, (2) select a particular 2-D slice image contained within second section 40 of data storage device or medium 30, and (3) display that slice image in the open window on display 60.
  • computer 50 is preferably programmed so as to provide a variety of predetermined menu choices which may be selected by the physician operating computer 50 via input devices 55.
  • Fig. 10 illustrates an image drawn to a window using the data contained in the 3-D computer model stored in first section 35 of data storage device or medium 30.
  • the physician can use input devices 55 to instruct the image rendering software as to the specific angle of view desired.
  • computer 50 is preferably programmed so that the physician can depress a mouse key and then drag on the object so as to rotate the object into the desired angle of view.
  • computer 50 is preferably programmed so that the physician can also use the keyboard and mouse to move the view closer in or further out, or to translate the object side to side or up and down relative to the image plane. Programming to effect such computer operation is of the sort well known in the art.
  • the physician can use menu choices such as those shown in Figs. 9A-9F to open a window on the display 60 and then to display in that window a desired 2-D slice image from second section 40 of data storage device or medium 30.
  • Computer 50 is programmed so that the physician can select between different slice images by means of input devices 55.
  • Fig. 11 illustrates a 2-D slice image drawn to a window by the operating system using the data contained in second section 40 of data storage device or medium 30.
  • computer 50 is programmed so that, by dragging icon 70 back and forth along slider 75, the physician can "leaf" back and forth through the collection of axial slices, i.e., in the example of Fig. 11, in which axial slice #21 is displayed, dragging icon 70 to the left might cause axial slice #20 to be displayed, and dragging icon 70 to the right might cause axial slice #22 to be displayed.
  • computer 50 is preferably programmed so that the physician can also step the image from the current slice number to a previous or following slice number by using menu commands or by clicking the mouse cursor on the single step icons 76 set at the right side of slider 75.
  • Computer 50 is preferably also programmed so that menu commands are provided to change the slice window display directly to the first or last slice image in the 2-D slice image set, or to change the slice window display to a user-specified slice number. Programming to effect such computer operation is of the sort well known in the art.
  • both 3-D model structure and 2-D slice image structure can be simultaneously displayed in proper registration with one another, thereby providing a single composite image of the two separate images. See, for example, Fig. 12, which shows such a composite image.
  • computer 50 is programmed so that the physician can use input devices 55 to instruct the operating system's image rendering software as to where the aforementioned "additional" software object is to be inserted into the model and as to the particular angle of view desired. Programming to effect such computer operation is of the sort well known in the art.
  • computer 50 is also programmed so that (1) the physician can use input devices 55 to select a particular 2-D slice image from the second section 40 of data storage device or medium 30, and (2) the computer will then automatically insert the aforementioned additional software object into the 3-D computer model so that the object's "blank" planar surface is located at the position which corresponds to the position of the selected 2-D slice image relative to the scanned anatomical structure.
  • programming to effect such computer operation is of the sort well known in the art.
  • the 2-D slice image data generated by scanning device 5 has generally been discussed in the context of the standard "axial" slice images normally generated by scanning devices of the type associated with this invention.
  • the present invention is also adapted to utilize sagittal and/or coronal 2-D slice images.
  • the present invention is adapted to utilize oblique slice images of the type hereinafter described.
  • Fig. 13 the relative orientation of axial, sagittal and coronal slice images are shown in the context of a schematic view of a human body 80.
  • Scanning device 5 will normally generate axial slice image data when scanning a patent.
  • scanning device 5 will also assemble the axial slice data into a 3-D database (i.e., a volumetric data set) of the scanned anatomical structure, and then use this 3-D database to generate a corresponding set of sagittal and/or coronal 2-D slice images.
  • a 3-D database i.e., a volumetric data set
  • scanning device 5 does not have the capability of generating the aforementioned sagittal and/or coronal 2-D slice images
  • sagittal and/or coronal 2-D slice images may be generated from a set of the axial 2-D images in a subsequent operation, using computer hardware and software of the sort well known in the art.
  • computer 50 may be programmed to render such sagittal and/or coronal 2-D slices "on the fly" from the 2-D slice image data contained in second section 40 of data storage device or medium 30.
  • the sagittal and coronal 2-D slice image data may be stored with the axial slice image data in second section 40 of data storage device or medium 30.
  • these sagittal and coronal slice images are stored in exactly the same data format as the 2-D axial slice images, whereby they may be easily accessed by computer 50 and displayed on display 60 in the same manner as has been previously discussed in connection with axial 2-D slice images.
  • axial, sagittal and coronal 2-D slice images can be displayed on display 60, either individually or simultaneously in separate windows, in the manner shown in Fig. 14.
  • the composite image can be created using axial, sagittal or coronal 2-D slice images, as preferred.
  • system of the present invention is also configured so as to generate and utilize oblique 2-D slice image data in place of the axial, sagittal and coronal slice image data described above.
  • computer 50 is programmed so that a physician can use input devices 55 to specify the location of the oblique 2-D slice image desired, and then computer 50 generates that 2-D slice image from the volumetric data set present in second section 40 of data storage device or medium 30 (i.e., from the collection of 2-D slice images contained in second section 40 of data storage device or medium 30) .
  • data storage device or medium 30 can comprise conventional storage media (e.g., a hard disk, a CD ROM, a tape cartridge, etc.), which can be located either on- site or at a remote location linked via appropriate data transfer means .
  • computer 50 is programmed so that a physician can display a specific 2-D slice image in a window opened on display 60, place a marker into that specific 2-D slice image using a mouse or other input device 55, and then have that marker automatically incorporated into both (i) the 3-D computer model contained in first section 35 of data storage device or medium 30, and (ii) any appropriate 2-D slice image data contained in second section 40 of data storage device or medium 30.
  • a physician can display a specific 2-D slice image in a window opened on display 60, place a marker into that specific 2-D slice image using a mouse or other input device 55, and then have that marker automatically incorporated into both (i) the 3-D computer model contained in first section 35 of data storage device or medium 30, and (ii) any appropriate 2-D slice image data contained in second section 40 of data storage device or medium 30.
  • images are thereafter generated from the 3-D computer model contained in first section 35 of data storage device or medium 30, and/or from the 2-D slice image data contained in second section 40 of data storage device or medium 30, these subsequent images will automatically
  • marker 85 displayed in its appropriate location in each of the three displayed 2-D slice images, i.e., in axial slice image 90, sagittal slice image 95, and coronal slice image 100. It is to be appreciated that it is also possible for marker 85 to be displayed where appropriate in an image generated from the 3-D computer model contained in first section 35 of data storage device or medium 30; see, for example, Fig. 15, which shows such a marker 85 being displayed in the image.
  • computer 50 is programmed so that a physician can generate a "margin" of some predetermined size around such a marker. Thus, for example, in Fig. 15, a margin 105 has been placed around marker 85.
  • margin 105 will appear as a 3-dimensional spherical shape around marker 85, just as marker 85 appears as a 3-dimensional shape, since the view of Fig. 15 is generated from the 3-D computer model contained in first section 35 of data storage device or medium 30.
  • marker 85 and margin 105 are displayed in the context of 2-D slice images, the marker and margin will appear as simple circles.
  • Margin 105 can be used by a physician to determine certain spatial relationships in the context of the anatomical structure being displayed on the computer.
  • first section 35 of data storage device or medium 30 constitutes a plurality of software objects defined by polygonal surface models
  • computer 50 is programmed so that a physician can select one or more anatomical structures using an input device 55, and the computer will then highlight the periphery of that structure in any corresponding 2-D slice images displayed on display 60. See, for example, Fig. 16, where a boundary 110 is shown outlining the periphery of an object 115 displayed in a 2-D slice image.
  • the present invention has been described in the context of an anatomical visualization system being used by a physician, it is also to be appreciated that the system could be used in conjunction with inanimate objects being viewed by a non-physician, e.g., the system could be used to visualize substantially any object for which a 3-D computer model and a collection of 2-D slice image data can be assembled.
  • surface model is intended to include polygonal surface models, parametric surface models such as B-spline surface models, quadralateral meshes, etc.
  • the visualization and measurement system may incorporate means for determining patient-specific anatomical dimensions using appropriate scanned 2-D image data.
  • this aspect of the present invention will be discussed in the context of measuring a patient ' s vascular structure in the region of the aortic/iliac branching.
  • such measurement might be conducted in the course of repairing an aortic aneurysm through installation of a vascular prosthesis.
  • a set of 2-D slice images is first generated, where each 2-D slice image corresponds to a specific viewing plane or "slice" taken through the patient's body.
  • different types of tissue are typically represented by different image intensities.
  • FIG. 17 illustrates a 2-D slice image 200 taken through the abdomen of a patient, at a location above the aortic/iliac branching
  • Fig. 18 illustrates a 2-D slice image 202 taken through the abdomen of the same patient, at a location below the aortic/iliac branching.
  • vascular tissue might be shown at 205, bone at 207, other tissue at 210, etc.
  • An appropriate set of these 2-D slice images is assembled into a 3-D database so as to provide a volumetric data set corresponding to the anatomical structure of the patient. Referring back to the system illustrated in Fig. 6, the set of 2-D slice images making up this 3-D database might be •stored in second section 40 of data storage device or medium 30.
  • the 3-D database being referred to now is not the same as the 3-D computer model contained in first section 35 of data storage device or medium 30; rather, the 3-D database being referred to now is simply a volumetric data set made up of the series of 2-D slice images contained in second section 40 of data storage device or medium 30.
  • the patient-specific volumetric data set (formed out of the collection of 2-D slice images contained in the 3-D database) is segmented so as to highlight the anatomical structure of interest .
  • This is preferably effected as follows.
  • the user is presented with 2-D slice images from the 3-D database, which images are preferably stored in second section 40 of data storage device or medium 30.
  • each of these 2-D images corresponds to a specific viewing plane or "slice" taken through the patient's body; or, stated slightly differently, each of these 2-D images essentially represents a plane cutting through the patient-specific volumetric data set contained in the 3-D database.
  • the different types of tissue will generally be represented by different image intensities.
  • the user (who might or might not be a physician) selects a particular 2-D slice image for viewing on display 60, e.g., "slice image #155".
  • the user uses one or more of the input devices 55 to select one or more points located within the anatomical structure of interest. For convenience, such user-selected points can be referred to as "seeds". See, for example, Fig. 17, where a seed point 215 has been selected within the interior of vascular tissue 205 so as to identify blood.
  • the user also uses one or more of the input devices 55 to specify a range of image intensities that appear to correspond to the anatomical structure of interest in the volumetric data set, e.g., blood within the interior of a blood vessel.
  • the appropriately programmed computer 50 then applies a segmentation algorithm of the sort well known in the art to segment out related structure within the patient-specific 3-D database.
  • computer 50 is programmed to apply a 3-D connected component search through the volumetric data set contained in second section 40 of data storage device or medium 30 so as to determine the set of volumetric samples that are (i) within the range specified for blood, and which (ii) can be connected along a connected path back to one of the seeds, where each of the locations along the path is also within the range specified for blood.
  • the result of this 3-D connected component search is a set of 3-D locations in the volumetric data set which correspond to blood flowing through the blood vessel.
  • this set of 3-D locations can be characterized as the "blood region".
  • the segmented anatomical structure i.e., the blood in the blood region
  • the branches in the segmented anatomical structure are identified. For example, and looking now at Fig. 19, in the present illustration dealing with vascular structure in the region of the aortic/iliac branching, the aorta and the two iliac branches would be separately identified.
  • the user specifies a branch line in the volumetric data set that uniquely indicates that vessel segment. This is accomplished by using one or more of the input devices 55 to select, for each branch line, an appropriate "start” location on one of the 2-D slice images contained within second section 40 of data storage device or medium 30, and an appropriate "end” location on another one of the 2-D slice images contained within second section 40 of data storage device or medium 30.
  • branch lines do not need to cover the entire length of interest of the vessel and, in practice, will tend to stop somewhat short of the junction where various branches converge with one another. At the same time, however, for improved accuracy of modeling the branching structure, the branch lines should extend close to the bifurcation point.
  • the start and end locations are used to subdivide the blood region as follows: the region for that vessel branch is the set of locations within the blood region that are between the start plane and the end plane, where the start plane for each vessel branch is the 2-D image plane passing through the start location for the corresponding branch line, and the end plane for each vessel branch is the 2-D image plane passing through the end location for each vessel branch.
  • a vessel branch structure consisting of just three vessel segments coming together at a branch point, e.g., a vessel branch structure such as the aortic/iliac branching shown in Fig. 19.
  • the user would designate one vessel region as the root region (e.g., the aortic region 220 defined by a branch line 225 having a start location 230 contained in a start plane 235, and an end location 240 contained in an end plane 245) and the other vessel regions as branch region A (e.g., the iliac region 250 defined by a branch line 255 having a start location 260 contained in a start plane 265, and an end location 270 contained in an end plane 275), and branch region B (e.g., the iliac region 280 defined by a branch line 285 having a start location 290 contained in a start plane 295, and an end location 300 contained in an end plane 305), respectively.
  • branch region A e.g., the iliac region 250 defined by a branch line 255 having a start location 260 contained in a start plane 265, and an end location 270 contained in an end plane 275
  • branch region B e.g., the iliac region 280 defined by a branch line
  • a centroid path is then calculated. This is accomplished in the following manner. First, at intervals along the vessel line corresponding to the volumetric location of each of the original 2-D slice images contained in second section 40 of data storage device or medium 30, the centroid of the vessel region in that particular 2-D slice image is calculated. This is done by averaging the image coordinates of all locations in that 2-D slice image that are within the vessel region so as to yield a centroid point. See, for example, Fig. 20, which schematically illustrates the manner of calculating the centroid 310 for a representative vessel region 312 in a representative 2-D slice image 315.
  • centroid path for each vessel region is then established by the collective set of centroid points located along that vessel segment in three-dimensional space.
  • the tortuous path corresponding to the root region is called the root centroid path and the tortuous paths corresponding to branch regions A and B are called branch centroid path A and branch centroid path B, respectively.
  • Fig. 21 shows a plurality of centroids 320, a root centroid path generally indicated at 325, a branch centroid path A generally indicated at 330, and a branch centroid path B generally indicated at 335, all shown in the context of a vessel branch structure such as the aortic/iliac branching example discussed above. It is to be appreciated that no centroids will be defined in the "unknown" region 336 bounded by the end plane 245 and the start plane 265, and the "unknown" region 337 bounded by the end plane 245 and the start plane 295.
  • the system is programmed so that it will then apply a curve- fitting algorithm to the tortuous centroid paths determined above so as to supply estimated data for any portions of the anatomical structure which may lie between the aforementioned branch lines, and for "smoothing out” any noise that may occur in the system.
  • a spline fitting algorithm effected in the following manner.
  • two new paths are created, by concatenating the points in the root centroid path 325 with the points in each of the two branch centroid paths 330 and 335, so as to create a path root-A and a path root-B.
  • These two new paths are then used as the input to a spline fitting routine which selects the coefficients for a piecewise polynomial space curve that best approximates the points along the path in a least-squares sense.
  • the number of pieces of the approximation and the order of polynomial may be varied by the user.
  • the resulting curves may be called spline-root-A and spline-root-B. See, for example, Fig. 22, which illustrates the spline-root-B, generally indicated at 340.
  • the distance along the two splines i.e., spline-root-A and spline-root-B
  • the result can be presented to the user.
  • These calculations can be used for a variety of purposes, e.g., to help determine the appropriate size of a vascular prosthesis to be used in repairing an aneurysm at the aortic/iliac junction.
  • a tangent vector and a perpendicular plane can be readily determined either by direct calculation or by definition in those cases where direct calculation would be undefined.
  • the shape of the vessel at that point can be determined, and the radius of a circle that best fits the cross-sectional area of the vessel at that point can also be readily calculated. Again, this result can be used to help determine that desired graft shape.
  • Fig. 23 is a flow chart illustrating how patient-specific anatomical dimensions can be determined from. scanned 2-D data in accordance with the present invention.
  • Oblique Slices Derived From The Centerline it is possible to use the centerline derived above to construct a series of oblique slices through the volumetric data set (which volumetric data set is formed out of the assembled scanned 2-D slice images contained in second section 40 of data storage device or medium 30) such that the reconstructed oblique slices are disposed perpendicular to the centerline.
  • oblique slices per se are generally well known in the art, to the extent that such oblique slices are arbitrary planar resamplings of the volumetric data set.
  • the utility of these arbitrary oblique slices is limited for many applications, since there is no explicit, well-defined relationship between their position and anatomical structures of interest.
  • oblique slices taken perpendicular to the length of the blood vessel are of particular importance to the physician.
  • This problem is avoided with the present invention, which utilizes the centerline as derived above to generate the set of oblique slices lying perpendicular to the blood vessel.
  • This set of oblique slices derived from the centerline is preferably stored in a fourth section 400 of data storage device or medium 30 (Figs. 5 and 6) .
  • any oblique slice In general, one way to think about generating any oblique slice is to consider a four-sided polygon that is placed in the space defined by the volumetric data set. This polygon is then scan converted to resample the axial images so as to generate the oblique slice desired.
  • scan converted is intended to refer to the well-known techniques of subdividing a polygon into regularly spaced intervals on a rectangular grid.
  • a programmable computer is used to generate the specific set of oblique slices that is defined by the centerline derived above. This is accomplished as follows. First, the centerline is divided into n increments. This can be done with points Po, Pi, ..., P n , as shown in Fig. 24. A line Ti is then derived for each of the points Pi, where Ti is the tangent line at that point Pi. Finally a series of oblique slices are produced by constructing a series of four-sided polygons, each of which is centered at Pi arid normal to Ti. The locations of the corners of the polygon are selected such that the resulting image orientation is as close as possible to a preselected image orientation (e.g., axial).
  • a preselected image orientation e.g., axial
  • each four-sided polygon is then scan converted as described above so as to provide the set of oblique slice images lying perpendicular to the centerline.
  • this set of oblique slice images is stored in fourth section 400 of data storage device or medium 30.
  • the corner locations of each four-sided polygon associated with each oblique slice image is also stored in fourth section 400 of data storage device or medium 30, whereby the precise location of each oblique slice image within the volumetric data set is established.
  • the oblique slice images stored in fourth section 400 of data storage device or medium 30 is available to be accessed by computer 50 in exactly the same manner as the 2-D axial slice images stored in second section 40 of data storage device or medium 30.
  • these oblique slices can then be used for a variety of additional purposes.
  • the oblique slice images derived from the centerline can be accessed by computer 50 from fourth section 400 of data storage device or medium 30.
  • the physician can then use input devices 55 to instruct computer 50 to access the oblique slice at a particular location along the blood vessel and measure the diameter of the same.
  • the physician can use input devices 55 to access the particular oblique slice desired and then lay down two diametrically-opposed marks so as to define the diameter of the blood vessel; the computer is adapted in ways well known in the art to then calculate the distance between the two marks.
  • the cumulative sum table can be of the sort shown in Fig. 25.
  • This cumulative sum table is preferably stored in a fifth section 405 of data storage device or medium 30.
  • Computer 50 is also programmed so that the user interface presents a centerline length calculation dialogue box
  • Computer 50 is programmed so that it will then determine the length between the two chosen oblique slices by calculating the difference in their positions from the cumulative sum table.
  • Computer 50 is also programmed so that a 3-D graphical icon
  • This icon represents the portion of the vessel centerline which has been specified by the physician via the two oblique slice images which represent the length end points.
  • a cumulative sum table can also be used to calculate volumes with respect to an anatomical structure, in much the same way that a cumulative sum table can be used to calculate lengths along an anatomical structure.
  • incremental slice volumes are more appropriately calculated in the axial direction rather than in the oblique slice direction. This is because the axial slices all lie parallel to one another, whereas the oblique slices (since they are generated from the centerline) do not.
  • a computer is used to calculate the volume of each axial slice, Vi, by (1) determining the number of pixels in the segmented region of that axial slice, (2) scaling by the appropriate pixel-to-length factor, and then (3) multiplying by the slice thickness.
  • this cumulative sum table can be of the sort shown in Fig. 28.
  • This cumulative sum table is stored in sixth section 410 of data storage device or medium 30.
  • Computer 50 is also programmed so that the user interface presents a volume calculation dialogue box 412 (Fig.
  • Computer 50 calculates the volume for the region specified, using the cumulative sum table.
  • Computer 50 is also programmed so as to place a 3-D graphical icon 415 (Fig. 30) in the 3-D model contained in the first section 35 of data storage device or medium 30. This icon represents the volume specified by the physician using the volume calculation dialogue box.
  • anatomical 3-D computer models were created from software objects representing anatomical objects (e.g., a first software object to represent a liver, a second software object to represent an aorta, etc.); and additional software objects were created to represent non-anatomical objects (e.g., markers 85, margins 105, boundaries 110 and graphical icon 408); and the various software objects (representing both anatomical and non-anatomical objects) were placed into proper registration with one another using techniques well known in the art so as to form a cohesive database for the application program's image rendering software. Accordingly, the program' s image rendering software can render images showing both anatomical objects and non-anatomical objects from various points of view, with the anatomical objects and the non-anatomical objects being in proper registration with one another.
  • anatomical objects e.g., a first software object to represent a liver, a second software object to represent an aorta, etc.
  • additional software objects were created to represent non-anatomical objects (e.g
  • a software object 500 representing the aorta of a patient. Also shown is a series of markers 505 placed into the system (e.g., by a human operator using a mouse) and a series of line segments 510 extending between selected ones of the markers 505. These markers 505 and line segments 510 may be used to plan a surgical procedure, to determine anatomical lengths or angles, etc.
  • a straight tube 515 which may also be used for planning and measurement purposes, etc.
  • a curved tube 520 which may be used for planning and measurement purposes
  • a box 525 which may be used for planning and measurement purposes, e.g., for volume calculations .
  • Fig. 32 is similar to Fig. 31, except that aorta 500 has been rendered transparent.
  • a virtual graft 530 which represents an arterial stent which may be deployed in the aorta, e.g., to treat an aortic aneurysm.
  • Virtual Grafts (VG' s) Virtual Grafts (VG' s), Manufacturer Specific Virtual Grafts (MSVG' s),
  • NIR Native Iliac Rotation
  • TwisterooNIRTM TwisterooNIR
  • VG Virtual Grafts
  • Fig. 34 in simpler versions of the aforementioned Virtual Graft (VG) for aortic stent applications, users are able to place idealized tubes into the aorta model.
  • the Virtual Graft (VG) helps users visualize what the surgery will look like and stems from the more basic Centerline Calculations discussed above.
  • a VG consists of three tubes arranged like a pair of pants.
  • One of these tubes represents the "trunk" of a bifurcated stent graft and the other two tubes represent the legs.
  • Users are able to define the length and diameter of the three tubes but, in this simpler version of the system, must perform calculations on their own to calculate the overlap that is used in placing the parts during surgery.
  • AAA Abdominal Aortic Aneurysm
  • MSVG Manufacturer Specific Virtual Graft
  • MSVG' s Manufacturer Specific Virtual Graft's
  • MSVG' s allows users to select and visualize actual stent graft devices within patient-specific 3D anatomy. This MSVG feature simplifies and enhances the vascular surgeon' s experience in fitting an endoluminal implant in three principal ways .
  • the software system is, in one preferred embodiment, able to model up to 9 different graft devices in the same patient, specifically: 1 bifurcated piece, 1 contralateral leg, 6 extenders and 1 aortic extender.
  • the MSVG feature colors the pieces differently based on the amount they overlap each other and their respective sizes. See Fig. 37.
  • the “yellow zone” in the figures represents “over-sizing” which is similar to the physical overlap but is, in some ways, a more accurate way to understand the interaction. More particularly, it can be a more useful indicator because it represents the amount of surface-to-surface contact that the pieces will have when deployed and this over-sizing is often what actually holds the pieces together.
  • the grafts can have variable diameters along their lengths. These increasing or decreasing tapers come directly from the manufacturer specifications and are quite detailed.
  • a bifurcated piece such as the one in Fig. 35 can have a diameter change along the length of its leg, allowing for a "bell-bottomed" or tapered leg. While not all manufacturers' pieces will include such a diameter change, those that do are now modeled more precisely.
  • graft hooks which are typically metal prongs used to secure a graft to the blood vessel
  • MSVG simulator can be displayed using the MSVG simulator as a red circle around the end of the graft. This allows doctors to judge the hook's location relative to the anatomy.
  • transparent grafts can be used with a visible anatomy to judge the "over-sizing" of a graft relative to both the blood flow anatomy and the thrombus.
  • the Designer displays all of a user's relevant measurements from their session in the left hand pane.
  • the right hand pane there is a list of bifurcated pieces sorted horizontally by length, vertically by iliac diameter and sectioned vertically by aortic diameter.
  • the MSVG Designer also checks to make sure that all of the indicated overlaps are within the manufacturer' s guidelines for required overlap.
  • the Designer software adds up the length of both the contralateral and ipsilateral sides, subtracting overlaps and displays this number in the two length boxes at the bottom left hand side of the measurement panel.
  • the MSVG also includes a cascading list for selecting the amount of "TwisterooTM" for the graft. This feature is discussed in detail below.
  • the program runs final checks to make sure that the selected grafts will display properly in the anatomy. If these pass, it is then on to the visualization module, where the product codes are turned into images and used as texture maps for the 3D creation of the graft. In this way, the vascular surgeon can tell immediately by looking at the Model Window which manufacturer components are being displayed.
  • the desired graft component quantities are transferred via the Internet to a remote server where they are inserted into an Adobe PDF form (see Fig. 40) which is then kept with the model information on a remote server.
  • This form is accessible over the Internet so that users can print it out and send it in, or use it for later reference.
  • This order form is the completion of the validated and reliable transfer of information from the graft manufacturers' internal specifications, to the MSVG Designer, to the visualization module and finally to component order fulfillment.
  • This entire process has been designed to prevent the errors caused by either working with incorrect data, not understanding specifications properly and/or mistyping or otherwise confusing catalog items, from start to finish.
  • TwisterooTM During endovascular AAA repair, a common surgical technique is to rotate the proximal end of the bifurcated endoprosthesis before it is deployed and then to pass the contralateral leg, either anterior or posterior, to the bifurcated leg before docking it. This technique is popular for many reasons. In some anatomies, it allows for a straighter shot out of the iliacs, making for an easier surgery. Some doctors also feel that it can either improve the device seal or can reduce the pressure from the blood flow on the graft. It can also simply be a useful method of deploying a graft to take up some of the "slack" in the limbs. By forcing a graft into a twisted configuration, it will presumably take a longer path, effectively shortening its run down the iliacs. This can be especially pertinent when occlusion of the internal iliac artery is a concern.
  • the TwisterooTM calculation From a high level view, the basic idea of the twist calculation is to create two new "twist lines", one for each iliac, which begin at the end of the graft trunk and continue until the original centerline splits. At this point, the graft will switch tracks and jump back onto the preexisting right iliac leg (RIL) and left iliac leg (LIL) centerlines.
  • RIL right iliac leg
  • LIL left iliac leg
  • the existing centerlines are preferably used because they are a reviewed and validated system to predict the general path a graft will take though the anatomy.
  • the twist lines start at the end of the graft trunk because the trunk will simply follow regular centerlines.
  • TwisterooTM is meant to model twisting primarily in the aneurismal sac.
  • Fig. 41 is an example of two twist lines created for a 180-degree twist and Fig. 42 is an example of the Virtual Graft once it has followed the twist.
  • the iliac branches are assumed to lie in the coronal plane.
  • the first calculation made in the creation of a twist is to calculate the "spread" variable. This is how far the two legs will be pushed off the centerline as spiraling down.
  • This spread H (Left leg diameter/Right leg diameter) which comes from either the MSVG device sizes or a user's generic device parameters. This calculation accounts for potentially different leg diameters for each leg.
  • the second calculation made is to determine where the twist lines should end. This is calculated for each side, and is termed the "attachment" site. In Fig. 41 above, this is the point on the green line, where the gray line ends. This point is calculated by running down the centerline until the RIL and LIL cubes are separated by a distance greater than the "spread". This is where the graft is stopped from following the twist lines and jumps back onto the regular centerline. It is related to the spread because once the centerlines are that distance apart, the graft limbs are no longer capable of intersecting each other.
  • splines are a way of connecting points or interpolating between points in a smooth and continuous manner. To do this, a spline takes into account a curve's energy and tries to connect the points in a smooth way. Catmull-Rom spline formulation is preferably used because it interpolates through all of the given control points and is resistant to kinking.
  • control points are used per side to create the spline.
  • the "septum" defined as the end of the graft trunk
  • the two points located 25 mm away from the ends of the graft are there to influence the path of the graft above. Their location along the centerline influences the endpoint tangents of the resulting splines so that the curve continues smoothly out of the iliac artery.
  • the next step is to add the "spread" into the equation in a way that naturally twists the graft down the length of the sac.
  • the most proximal 4 controls points are translated away from the basic centerline.
  • the degree of twist is plotted on the unit circle and the x and y components of the resulting vector obtained. It is known that at the bottom it is desirable to be directly on the centerline, so the amount of rotation is reduced smoothly as the centerline proceeds distally.
  • the first two control points will be translated directly away from their eventual location, while the middle control points will be translated at 120 and then 60 degrees away. All translations are performed in the plane of the centerline cube that they are based on. With these 6 control points, a Catmull-Rom spline is created and the results stored.
  • a preferred contact model is basically a function that increments down each of the twists, finding the nearest neighbor in the other twist line. Once it finds this neighbor, it then calculates the distance between them and then pushes the two points away from each other until they are at least the "spread" value apart. Any contact that is not removed from the legs via this algorithm is modeled later during the visualization process by calculating the distance from leg to leg, and then adjusting the geometry of the graft limbs to "ovalize" them with a minor axis in the direction of the opposite leg.
  • the MSVG can now be drawn along the twist lines.
  • the most important benefit of this feature is that it can actually model the shortening that a twisted graft's legs will undergo relative to their final location in the iliacs . Previously there was no good way to account for this, and was often simply assumed that it would shorten the graft by several millimeters.
  • NIR Native Iliac Rotation
  • TwisterooNIRTM TwisterooNIRTM
  • the system is capable of recognizing Native Iliac Rotation (NIR) and provides a TwisterooNIRTM product which takes Native Iliac Rotation (NIR) into account when conducting twist calculations.
  • Native Iliac Rotation (NIR) Native Iliac Rotation (NIR) .
  • the bifurcation of the iliac arteries occurs at an angle from the coronal plane, i.e., the iliac arteries branch off in a twisted fashion, with one iliac more anterior than the other.
  • NIR Native Iliac Rotation
  • Fig. 45 there is shown an axial CT scan slice (left side of figure) just below the bifurcation point, and a virtual 3D model (right side of figure) showing the iliac branches extending out of this slice plane. These images show how the two iliac arteries may branch off from one another. More particularly, Fig. 45 shows an example of an anatomy wherein one branch of the iliac artery is significantly more posterior (i.e., closer to the backbone or bottom of the image) than the other branch.
  • the aforementioned TwisterooTM technique for calculating the virtual graft twist does not always result in an accurate assessment of the optimal twist for some patient-specific anatomies.
  • TwisterooNIRTM product there is provided a new technique for measuring the NIR (i.e., the degree of rotation off the coronal plane) of the iliac arteries, which is then used to increase the accuracy of the aforementioned twist calculation and other tools and measurements.
  • NIR i.e., the degree of rotation off the coronal plane
  • NIR Native Iliac Rotation
  • NIR Native Iliac Rotation
  • -3 different centerlines are first produced: (i) a left iliac (LIL) centerline; (ii) a right iliac (RIL) centerline; and (iii) an aorta (AO) centerline (which is coincident with the other two centerlines down through the aneurismal sac until the LIL and RIL centerlines begin to diverge down the left and right sides of the bifurcation, at which point, the AO centerline continues to proceed down the center of the anatomy, directly through the bifurcation and out a short way below the bifurcation.
  • LIL left iliac
  • RIL right iliac
  • AO aorta
  • the XY positions (in the axial plane) of one point from the LIL centerline and one point from the RIL centerline are compared to determine how much the points rotate away from the horizontal.
  • the two points are compared to see how much each point is rotated away from the coronal plane.
  • the compared points from the LIL centerline and the RIL centerline preferably are at the same position in the Z-axis (i.e., along the coronal plane).
  • the left and right iliac centerlines are compared at points approximately one half centimeter below the bifurcation.
  • the length of the centerline is used as a guide to tell a user what part of the LIL and RIL centerlines to compare, since the AO centerline is always of a length defined to just make it past the bifurcation. More particularly, and looking now at Fig. 46, the total number of cubes in the AO centerline is first determined, and then the same number of cubes is used to index into the left and right centerlines. Thus, if there are N cubes in the AO centerline, the n th cube of the LIL centerline (LIL[N]), and the n th cube of the RIL centerline (RIL[N]), are compared.
  • the X and Y positions are determined. This method is further illustrated in Fig. 47, where a diagonal line has been drawn to extend through a centerline cube from both the left (LIL) and the right (RIL) centerline, and the horizontal line represents the coronal plane.
  • the differences (in X, Y terms) of the two points is calculated, and then the inverse tangent of their quotient is calculated.
  • the angle thus derived from these calculations is the Native Iliac Rotation (NIR) of the two iliacs away from the coronal plane.
  • NIR Native Iliac Rotation
  • TwisterooNIRTM Finding the Native Iliac Rotation (NIR) of a patient-specific anatomy allows the calculation of a more natural twist of the virtual graft for each specific patient.
  • NIR Native Iliac Rotation
  • TwisterooTM assumed that the natural state of the rotation was at precisely 0 degrees (i.e., TwisterooTM assumed that every patient had a "neutral" Native Iliac Rotation) . This meant that if the physician wanted to simulate a 180 degree twist, TwisterooTM would simulate the graft legs twisting from 180 degrees all the way back to 0 degrees.
  • TwisterooNIRTM uses the previously-calculated Native Iliac Rotation (NIR) when calculating for twist. TwisterooNIRTM simulates the virtual graft legs twisting from the given degree of twist desired back to the patient-specific Natural Iliac Rotation. TwisterooNIRTM provides a more accurate simulation of the natural position at which the virtual graft legs would be as they enter the iliac arteries.
  • NIR Native Iliac Rotation
  • this is an advantageous method of simulating the twist of a graft because, in an anatomy with a high degree of native twist (e.g., a large Natural Iliac Rotation) , the graft' s twist would end up turning too quickly and in effect overshooting the target, or doing the reverse and not twisting fast enough.
  • a high degree of native twist e.g., a large Natural Iliac Rotation
  • an algorithm would attempt to rotate the virtual graft from an inputted degree of twist to 0 degrees, by building a spline along two control points spaced between the start and end points.
  • the control points would be set so that 1/3 of the twist would be achieved by the first point, 2/3 of the twist would be achieved by the second point and the rest of the twist would be achieved between the second point and the end point, where the graft centerline rejoins the regular graft centerline.
  • the TwisterooTM product would space control points at 66 degrees and 33 degrees of twist. As mentioned above, this creates an undesired path in some instances.
  • the final point will be at 50 degrees, and the control points will proceed thus: 90 degrees, 66 degrees, 33 degrees, and 50 degrees, leaving an S-curve.
  • the TwisterooNIRTM performs its twist calculations by placing two control points in between the beginning and end points just as the TwisterooTM algorithm did. However, the TwisterooNIRTM calculates the amount to twist desired as:
  • the TwisterooNIRTM then divides the Amount To Twist The Virtual Graft (i.e., 40 degrees) by 3 and performs an interpolation to give control points at: 90 degrees, 76 degrees, 63 degrees, and 50 degrees, leaving a much smoother curve than the S-curve described above.
  • FIG. 48 another example of the aforementioned problem is illustrated.
  • This example illustrates a problem which may occur even when the graft is set to 0 degrees of twist.
  • the TwisterooTM product is on the left and the TwisterooNIRTM product is on the right.
  • the degree of twist for both of these grafts is 0 degrees and the Native Iliac Rotation is 53 degrees.
  • the control points are at: 0 degrees, 0 degrees, 0 degrees, and 53 degrees. Since the algorithm cannot predict where the final point will be, it cannot approach this point gradually. This produces an unnatural "jerk" at the end of the graft.
  • the control points are at: 0 degrees, 17 degrees, 35 degrees, and 53 degrees. These control point calculations produce a smooth and more realistic curve for the graft path. Because the grafts will be inserted in a manner that conforms to the twist of the anatomy, the TwisterooNIRTM product reports the Native Iliac Rotation to the user so that they may consider simulating the graft deployment in what has been calculated to be the natural state of the anatomy. Looking now at Fig. 49, this example shows how rotating the graft to the Native Iliac Rotation can produce a subtly different simulation of the way that a surgery may actually proceed. Fig.
  • Fig. 49 illustrates how the graft legs are not required to do as much twisting when their rotation is adjusted to the Native Iliac Rotation (see the image on the right) and Fig. 49 further illustrates how these two simulations actually predict that the graft will terminate at a slightly different place in the iliacs due to the difference in the graft path.
  • This new feature is a method for creating distance calculations.
  • a distance calculation is defined at the distance across the anatomy from one user-defined "Mark” to another.
  • a distance calculation can be defined by selecting ⁇ New Distance Calculation' from a menu. This opens a Dialog through which beginning and ending points can be selected for the calculation from a list of all available Marks. This process has become much easier with the new method.
  • To perform a "Click-Drag” distance calculation the user simply has to click on the Slice Window, hold down the mouse button, and then drag the mouse to the desired endpoint. The system software will then check to make sure that both Marks of the calculation are within the slice volume and, if so, create two marks with a distance calculation between them.
  • the system software will also automatically change the size of the marks created for the start and end points to be of a small size in order to reduce clutter on the screen.
  • One final feature of the "click-drag" distance calculation is that, if the user drags the mouse back within a minimum distance of the start point, the program will no longer perform a distance calculation if the mouse is released and it will automatically return the size of the mark to normal.
  • This simple naming scheme has been extended by adding a new standard "type” field to all Calculations and Marks.
  • This new "name-type” dichotomy allows users to classify their measurements according to a standardized system while still adding their own names if they would like. This can be particularly useful in the context of the software system where the same measurement can be made in different ways.
  • the "Maximum AAA Diameter” type could be measured using either a mark diameter or a distance calculation. For this case the user would give all the measurements the same type, but different names.
  • the first step after creating a mark should be to select its type from menu.
  • This menu is a drop-down list with cascading submenus for aortic types, as well as right and left iliac types.

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Abstract

La présente invention porte sur une méthode de détermination du degré de torsion qui doit être manuellement donné à un implant devant être positionné dans l'aorte et les branches iliaques de manière à obtenir un degré de torsion efficace lorsque l'implant est positionné dans le corps. La méthode consiste à identifier le degré efficace de torsion désirée pour l'implant, à déterminer la rotation iliaque naturelle d'un patient, et à soustraire la rotation iliaque naturelle d'un patient du degré efficace de torsion désiré pour l'implant de manière à déterminer le degré de torsion devant être donné manuellement à l'implant.
PCT/US2005/044185 2004-12-07 2005-12-07 Systeme de visualisation et de mesure anatomiques WO2006093546A1 (fr)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10736696B2 (en) 2011-06-07 2020-08-11 Koninklijke Philips N.V. Rotational position determination apparatus

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5316023A (en) * 1992-01-08 1994-05-31 Expandable Grafts Partnership Method for bilateral intra-aortic bypass
US5575817A (en) * 1994-08-19 1996-11-19 Martin; Eric C. Aorto femoral bifurcation graft and method of implantation
US6162246A (en) * 1999-02-16 2000-12-19 Barone; Hector Daniel Aortic graft and method of treating abdominal aortic aneurysms

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5316023A (en) * 1992-01-08 1994-05-31 Expandable Grafts Partnership Method for bilateral intra-aortic bypass
US5575817A (en) * 1994-08-19 1996-11-19 Martin; Eric C. Aorto femoral bifurcation graft and method of implantation
US6162246A (en) * 1999-02-16 2000-12-19 Barone; Hector Daniel Aortic graft and method of treating abdominal aortic aneurysms

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10736696B2 (en) 2011-06-07 2020-08-11 Koninklijke Philips N.V. Rotational position determination apparatus
US11399893B2 (en) 2011-06-07 2022-08-02 Koninklijke Philips N.V. Rotational position determination apparatus

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