WO2008142629A2 - Marqueur polyvalent - Google Patents

Marqueur polyvalent Download PDF

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Publication number
WO2008142629A2
WO2008142629A2 PCT/IB2008/051951 IB2008051951W WO2008142629A2 WO 2008142629 A2 WO2008142629 A2 WO 2008142629A2 IB 2008051951 W IB2008051951 W IB 2008051951W WO 2008142629 A2 WO2008142629 A2 WO 2008142629A2
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WIPO (PCT)
Prior art keywords
marker
component
ray
marker according
mri
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PCT/IB2008/051951
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English (en)
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WO2008142629A3 (fr
Inventor
Daniel R. Elgort
Guy Shechter
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Koninklijke Philips Electronics N.V.
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Publication of WO2008142629A2 publication Critical patent/WO2008142629A2/fr
Publication of WO2008142629A3 publication Critical patent/WO2008142629A3/fr

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    • 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
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/374—NMR or MRI
    • 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
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • 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
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3995—Multi-modality markers

Definitions

  • the invention relates to a marker for spatially localizing a point of interest. Moreover, it relates to a medical device and a medical system comprising such a marker.
  • Markers that can be localized with the help of some measurement principle are used in many interventional procedures, for example for navigating instruments like a catheter or needle in the body of a patient to a specific target region. While most markers can only be localized with one specific imaging modality or tracking system, the US 2006/0079805 Al describes a multifunctional marker material that can be injected into the body, particularly during diagnosis and treatment of breast cancer, for marking a particular point in the tissue.
  • the injected material comprises small particles that optionally have appropriate densities for radiographic imaging, appropriate surface characteristics for ultrasonic imaging, and appropriate magnetic characteristics for magnetic-resonance imaging (MRI).
  • MRI magnetic-resonance imaging
  • the marker according to the invention serves for spatially localizing a point of interest, for example an anatomical structure within the body of a patient or a point on an interventional instrument.
  • the term "localizing” shall comprise in a broad sense any process that reduces the uncertainty about the spatial position and/or orientation of the point of interest. Preferably, the localization removes all uncertainty (besides unavoidable measurement errors) and provides all desired information about the whereabouts and/or orientation of the point of interest.
  • the proposed marker is sometimes called “multifunctional marker” in the following and comprises in a connected structure (i.e. physically linked) at least three of the following marking components: a) An "MRI-component” that can be localized via magnetic resonance (MR) effects, particularly with a Magnetic Resonance Imaging (MRI) scanner.
  • MR magnetic resonance
  • MRI Magnetic Resonance Imaging
  • the MRI- component can for example (actively or passively) generate a signal which can be localized within an MRI image; in this case a complete image is reconstructed (using the scanner's own data collection infrastructure) and the MRI-component generates a distinct signal that can be localized within the imaged slice or volume.
  • the MRI-component may generate a distinct non- imaging signal that can be interpreted by an MRI scanner. In this scenario, no complete image has to be collected or reconstructed, but it suffices to collect a small number of projections. In a simple case, just three orthogonal projections are for example collected, revealing the marker's X, Y, and Z coordinates, respectively.
  • projections provide far less data than is required for making a complete 2D or 3D image. They can be collected with the scanner's own data collection infrastructure, or MR-tuned coils can be used as "MRI-component” to collect the localization signal, b) An "X-ray-component” that can be localized in X-ray images generated for example with fluoroscopic devices (i.e. imaging devices using a fluorescent screen to display real-time X-ray images) or Computed Tomography (CT) scanners. c) An "EM-component” that can be localized with an electromagnetic tracking system.
  • fluoroscopic devices i.e. imaging devices using a fluorescent screen to display real-time X-ray images
  • CT Computed Tomography
  • EM-component that can be localized with an electromagnetic tracking system.
  • an “electromagnetic tracking system” comprises by definition at least one generator of an electromagnetic field (either as a dynamic electromagnetic field or as a static electric or magnetic field) and at least one receiver for that electromagnetic field, wherein the field measured at the receiver(s) allows to determine the relative position between generator(s) and receiver(s).
  • An "optical-component" that can be localized with an optical tracking system.
  • an "optical tracking system” is a device that localizes a point in space via triangulation of lines-of-sight that comprise this point and further points at spatially known positions.
  • Each of the marking components that constitute the proposed multifunctional marker enables a separate and independent localization of the point of interest. Having three or more marking components available therefore allows to determine the location of the point of interest with different methods, thus increasing the accuracy of the measurement.
  • the parallel use of a number of three or more localization methods can particularly reveal an extraordinary error in one of the applied methods (e.g. due to a malfunction) as an outlier with respect to the other measurements.
  • the presence of a conductive or magnetic material may for instance severely interfere with an electromagnetic tracking system but will leave other marking components unaffected.
  • Another advantage of the proposed multifunctional marker with its at least three independent marking components is that a user has the choice to localize a point with the presently most convenient method, wherein the chosen method may be changed as desired during an interventional procedure.
  • the multifunctional marker can for example be used for interventional device tracking, i.e. for monitoring the current spatial position of an interventional device like a catheter with respect to a given coordinate system. Interventional device tracking is particularly important in minimally invasive surgery, during which the surgeon has no direct visual feedback from the used instruments.
  • physiologic motion tracking and/or compensation Another application of the maker is physiologic motion tracking and/or compensation.
  • physiologic motion is caused by the body itself, for example due to blood flow, muscle contraction, or gastrointestinal activity. Tracking of such a motion is for instance required when the respiratory cycle of a patient shall be monitored.
  • physiologic motion is a source of disturbances for surgical procedures, for example during the positioning of a stent in a vessel of the heart.
  • the rhythmic contraction of the heart and the chest movement due to respiration continuously shift the point of interest, making it difficult if not impossible to overlay a real-time X-ray image with a static vessel map generated previously, e.g. after the injection of a contrast agent.
  • the multifunctional marker further allows the registration and/or fusion of multi-modality imaging information.
  • registration means in this context a mapping between two different coordinate systems, particularly between image coordinates of two different images of a real object, wherein the image coordinates of each object point in the first image are mapped onto its image coordinates in the second image (and vice versa).
  • image coordinates of an anatomical structure have been identified in the first image, the corresponding location of this anatomical structure in the second image can then readily be determined with the help of the registration.
  • a registration is of particular importance if images from different modalities, e.g. from an X-ray apparatus and an MRI scanner or an ultrasonic scanner are processed, because they will typically represent the same anatomical structure quite differently.
  • the multifunctional marker is extremely useful in this case as it shows up in the images generated with different modalities at the same location in object space, thus allowing to readily identify corresponding points in the images. Registration is further needed if images from different modalities shall be accurately fused, that is if their information shall be combined (e.g. pixel-by-pixel) in a single picture. In this case it is of particular importance to correctly know which pixels from the different images correspond to the same point in object space.
  • a further application of the multifunctional marker is the augmentation of medical image data with additional information.
  • An X-ray image of a catheter can for example be augmented with an arrow pointing to the tip of the catheter if said tip has been localized with the help of a multifunctional marker.
  • the multifunctional marker comprises an "US-component" that by definition can be localized by an ultrasonic (US) scanner.
  • US ultrasonic
  • the possibility to localize the multifunctional marker with ultrasound is usually given as a necessary side effect of the other marking components as they provide for example structures and interfaces between different materials which show up in an ultrasonic image.
  • the particular US-component may be provided if this localization of the other marking components is not available or not sufficiently clear.
  • the US-component may specifically be designed for making a good contrast in US images.
  • the US-component may comprise a receiver for ultrasound that can detect externally generated US signals, from which the location of the receiver can be derived.
  • the multifunctional marker may further optionally comprise a fixing mechanism for attaching it to a surface, for example the surface of an instrument or the skin of a patient.
  • the fixing mechanism may for instance be realized by an adhesive mechanism that allows an easy and reversible attachment.
  • the fixing mechanism guarantees that the marker assumes and keeps a definite position relative to the object it is fixed to, which is important as it is usually the position of this object (and not the marker itself) one is actually interested in.
  • the marking components of the multifunctional marker are assembled in a connected structure.
  • the marking components have a static relative arrangement with respect to each other, i.e. the aforementioned connected structure is a solid one (and not e.g. a flexible structure). Due to their static relative arrangement, the position information provided by the several marking components must have a definite mathematical relation allowing for example to infer the positions of some of the marking components from the known positions of others and/or to make correction calculations based on the sum of the available information.
  • the marking components will usually be packed into a little volume as possible, particularly into a volume in the order of 1 cm 3 or smaller, such that they all are as close as possible to a common reference point (if a fixing mechanism like an adhesive packaging that enables attachment to a patient's skin or to a surgical tool is present, this may extend beyond the aforementioned size).
  • the geometries of each individual active marking component should be known as precisely as possible, which will enable the accuracy of the localization information to be much better than 1 cm (instead the information from each component should typically enable localization to a volume of 1 mm or better).
  • the MRI-component of the multifunctional marker may be realized in different ways, some of which are described in literature (e.g. US 6 333 971 B2, US 2004/0167391 Al, US 2005/0149002 Al).
  • the MRI- component comprises a resonance circuit that is tuned or that can at least be tuned to the Larmor frequency of an MRI scanner.
  • the MRI-component comprises a material that is a magnetic resonance (MR) signal source, wherein the term "signal source" is used here for any object that is actively or passively the origin of a signal. Examples of such materials comprise water or saline doped with common MRI contrast agents which provide a locally enhanced MR signal, e.g.
  • the mentioned resonance circuit that is tuned to the MRI scanner's Larmor frequency can also play an important role here. It can inductively couple with the MR scanners RF transmit and receive antennas, which will further enhance the multifunctional marker's MR signal within the images or within the non- imaging MR-based localization data.
  • the resonance circuit can also be directly coupled (i.e. capacitively coupled) to the MR scanner's receiver hardware so that it can directly collect and input a signal to the scanner.
  • the X-ray-component will typically comprise some material that has a high contrast with respect to its surroundings on an X-ray image.
  • the X-ray-component comprises an X-ray opaque material that is shaped in a geometry with six distinguishable degrees of freedom. This means that both the position and the orientation of said shape can be determined in X-ray images, which is the case for shapes with a (preferably pronounced) non-spherical geometry.
  • the EM-component may comprise a field sensor, for example a Hall sensor for detecting magnetic fields.
  • it comprises at least one resonance circuit, for example a coil with associated additional electronic parts, wherein said resonance circuit can detect the presence of an alternating electromagnetic field that is generated by external field generators at known positions in space.
  • the EM-component most preferably comprises three resonance circuits with orthogonal sensitivities, i.e. each resonance circuit being (only) sensitive to another one of three orthogonal spatial directions of the surrounding electromagnetic field.
  • an external electromagnetic field can be detected irrespective of its angle of inclination, and this angle may optionally be determined to provide additional information about the relative orientation between the EM-component and the field generators.
  • the EM-component comprises a transmitter for emitting electromagnetic signals.
  • the emitted electromagnetic signals can be picked up by receivers disposed at known positions in space, and information obtained in this way can be used to estimate the position of the transmitter.
  • the optical-component of the multifunctional marker preferably comprises a reflective surface that can reflect light back to sensors (e.g. cameras) which are disposed at known positions in space and which can identify the reflecting surface in their images.
  • sensors e.g. cameras
  • the reflective surface preferably spreads incident light over a large range of angles such that it can be seen from many different positions.
  • the optical-component may alternatively comprise an active light source, for example an LED. In this case no external illumination is necessary and the optical- component can be localized in sensor images with high certainty.
  • the invention further relates to a medical device comprising: an interventional instrument, particularly a catheter, an endoscope, a needle, or an ultrasonic probe; a multifunctional marker of the kind described above that is attached to the aforementioned instrument.
  • the invention relates to a medical system comprising:
  • At least one imaging apparatus for generating an image of a region of interest may particularly comprise an X-ray device (e.g. a fluoroscopic device or a CT scanner), an ultrasonic device, or an MRI device.
  • an X-ray device e.g. a fluoroscopic device or a CT scanner
  • an ultrasonic device e.g. a magnetoscopy device
  • an MRI device e.g. a magnetoscopy, or an ultrasonic device.
  • At least one tracking system particularly an optical or electromagnetic tracking system.
  • the medical device and the medical system comprise as a crucial component a multifunctional marker of the kind described above. Therefore, reference is made to the preceding description for more information on the details, advantages and improvements of that device and system.
  • the medical system may comprise a registration module for registering the spatial coordinates of the marker as determined by the imaging apparatus with the spatial coordinates of the marker as determined by the tracking system(s).
  • a registration module for registering the spatial coordinates of the marker as determined by the imaging apparatus with the spatial coordinates of the marker as determined by the tracking system(s).
  • Figure 1 shows a top view of a multifunctional marker according to the present invention
  • Figure 2 shows a side view of the marker of Figure 1
  • Figure 3 illustrates schematically the examination of a patient to whom a multifunctional marker according to the present invention has been attached;
  • Figure 4 illustrates said patient at a later stage in which multifunctional markers are used during an interventional procedure.
  • Known designs of fiducial markers are intended to be used with a single imaging modality and/or tracking system.
  • the US 5 923 417 and US 2003/0153827 Al describe for example markers that can be localized exclusively by optical and electromagnetic (EM) tracking systems, respectively; the US 6 847 837 Bl and
  • US 2003/0220559 Al describe markers that can be localized exclusively by magnetic resonance (MR) tracking systems.
  • the US 6 333 971 B2 and the US 2004/0167391 Al describe generic fiducial markers that can be filled with an agent that allows them to be used with either magnetic resonance imaging (MRI) or X-ray computed tomography (CT).
  • MRI magnetic resonance imaging
  • CT X-ray computed tomography
  • the US 6 298 259 Bl describes markers that are compatible with MRI and EM tracking systems.
  • a design of a fiducial marker is proposed here that is capable of being localized by multiple imaging modalities and multiple tracking systems.
  • the goal of this technology is to enable diagnostic or interventional medical systems to present all useful clinical information to the physician in a clear and intuitive manner.
  • the proposed device shall enable multiple medical imaging systems and interventional device tracking systems to monitor the position and orientation of a patient's anatomy and interventional devices (e.g. ultrasound probe or biopsy needle) within a single common coordinate system.
  • the proposed marker contains elements that generate actively or passively a signal that is accessible to each relevant imaging modality and interventional device tracking system. Furthermore, the marker should be able to be securely affixed to a patient and/or interventional device.
  • Figure 1 shows in a schematic top view one possible embodiment of a multifunctional marker 1 with the proposed design
  • Figure 2 shows this marker 1 in a side view.
  • the marking components of the marker 1 are: (a) An "MRI-component" 10, realized as a resonant MR circuit with an inductivity (coil 11) and a capacitance (capacitor 12) that is tuned to an MRI scanner's Larmor frequency and positioned around a (passive) MR signal source 32.
  • signal source is used in the context of the present invention for any object that is the origin of a signal, i.e. either by actively emitting something (e.g. radiation) or passively by interacting with something (e.g. an external magnetic field or X-rays).
  • the capsules 31, 32 simultaneously contain a material serving as MR signal source (i.e. as an alternative realization of an "MRI-component").
  • suitable filling materials for the capsules are water or saline doped with Gd-DTPA, which could serve as both an MR-signal source and an X-ray opaque signal source.
  • the capsules could also include some iodine, which is a commonly used X-ray contrast agent.
  • An "EM-component" 20 realized as tuned resonant circuits with inductivities (coils 21) and capacitances (capacitors 22) that are compatible with a corresponding EM tracking system (not shown).
  • the three coils 21 of the EM-component 20 are directed with their axes in three mutually orthogonal directions of space (i.e. x, y, and z-direction), they will show mutually orthogonal sensitivities for a surrounding electromagnetic field.
  • the coils 21 cannot only be used as sensors for an external field, but also as transmitters, i.e. as generators of an electromagnetic field which is then sensed by the corresponding EM tracking system.
  • An "optical-component" 40 realized by a reflective optical material 41 positioned on the exterior surface of the marker 1.
  • an active light source like an optical LED might be used for this purpose.
  • the marker 1 as a whole further constitutes an "US-component" that shows up with sufficient contrast in ultrasonic images. More particularly, those parts of the marker that have an acoustic impedance which is sufficiently different from that of the surrounding medium where the marker is used (e.g. from blood when the maker is fixed to a catheter) will be visible on US images. Especially the metallic coils 11, 21 can be considered as being “US-components” that are visible in most clinical applications of the marker 1.
  • the marker 1 further comprises a fixing mechanism 50, realized e.g. by an adhesive tape 51, to securely affix it to a patient or interventional device.
  • the Figure shows a cable 60 comprising the necessary wiring for electronic parts of the above marking components, e.g.
  • the described components (a)-(d) of the multifunctional marker 1 have a static relative arrangement; knowing the position and/or orientation of one component, e.g. the X-ray-component 30, will therefore readily allow to infer the positions and/or orientations of the other components, too. In a first, most simple approximation, all components of the marker 1 may even be considered as being located at the same point in space.
  • the marker 1 generates a set of common features/signals that are "visible" to multiple imaging modalities and device tracking systems, including: X-ray fluoroscopy, X-ray CT, MRI, ultrasound, EM tracking systems, optical tracking systems, and MR-based tracking systems.
  • This set of common features allows the data from all of these sources to be accurately aligned, fused, and/or overlaid such that a multi-modality display is created.
  • Figures 3 and 4 illustrate an exemplary clinical scenario in which a medical system 1000 comprising at least one imaging apparatus 100, 300, 600, at least one tracking system 200, 400, and multifunctional markers 1, 1' according to the present invention is used with particular advantage.
  • FIG 3 shows a patient P lying on a table with a multifunctional marker 1 of the kind described in Figures 1 and 2 being taped to the chest.
  • the patient P has been moved into the bore of an MRI scanner 100.
  • Electromagnetic coils 101 of said scanner which are shown in a section in the Figure, surround the patient for generating appropriate magnetic fields inside the body that are needed to generate and to detect magnetic resonance signals.
  • An MRI data processing unit 110 that is coupled to the MRI scanner 100 controls the imaging procedure, collects the generated data, and reconstructs projection images and/or slice images of the body. Due to its MRI component, the multifunctional marker 1 will appear with detectable contrast in these MRI images.
  • the "absolute" spatial coordinates of the marker 1 with respect to a given stationary reference frame X, Y, Z can be calculated from the MRI image coordinates of the marker 1.
  • the Figure further shows an optical tracking system 400, comprising (at least) two cameras 401 and 402.
  • An associated light source 403 illuminates (for example with a characteristic wavelength and/or with modulated intensity) the optical component of the marker 1.
  • the marker 1 can therefore be localized (in image coordinates) in the optical images generated by the cameras 401, 402 with the help of an optical-data processing unit 410 to which the cameras are coupled.
  • the lines of sight Ii , I 2 under which the marker 1 is seen by the cameras can be determined.
  • the point of intersection of the lines of sight - and thus the position of the marker 1 in absolute coordinates X, Y, Z - can then be calculated, too.
  • the accuracy of this procedure can of course be increased if more than two cameras are used.
  • the marker 1 might comprise an active light source, e.g. a blinking LED, which could be monitored by the cameras.
  • the data processing units 110, 410 of the MRI scanner and the optical tracking system, respectively are both coupled to a higher-level registration module 800, e.g. realized by a workstation with a monitor.
  • a higher-level registration module 800 e.g. realized by a workstation with a monitor.
  • information from both devices can be combined.
  • Figure 4 illustrates the patient P during a subsequent interventional procedure during which a catheter 2 is guided through the blood vessels of the body.
  • a second multifunctional marker 1' is fixed.
  • the second multifunctional marker 1' may optionally have the same or a similar design as the first multifunctional marker 1 which is still attached to the body surface at the same position as in Figure 3.
  • the catheter 2 together with the marker 1' attached to it constitute one example of a medical device according to the present invention.
  • any other interventional instrument with a multifunctional marker that is inserted into the body could be considered as an example of such a medical device, e.g. an endoscope, a needle, or an ultrasonic probe.
  • the Figure further shows an EM (electromagnetic) tracking system 200 comprising three electromagnetic coils 201, 202, and 203 that are disposed such that they generate (electro-)magnetic fields along three mutually orthogonal axes.
  • the local orientation and magnitude of these fields can be sensed with the EM components of the multifunctional markers 1, 1'.
  • These EM components and the coils 201-203 are connected (e.g. by wire) to an EM data processing unit 210 that determines and tracks the absolute spatial coordinates X, Y, Z of the markers 1, 1' from the fields they measured at their current positions.
  • the role of the electromagnetic coils 201, 202, and 203 and the EM-components of the markers 1, 1' could be exchanged, i.e. that the EM-components could operate as transmitters of electromagnetic fields that are sensed by the coils 201-203.
  • an X-ray apparatus 300 comprising an X-ray source 301 and an X-ray detector 302 is available for generating X-ray projection images of the patient P.
  • the X-ray apparatus 300 may for example be a CT scanner or a C-arm device in which the source 301 and the detector 302 can commonly rotate around the patient. Due to their X-ray components, the multifunctional markers 1, 1' will appear with a higher, well-detectable contrast in the generated X-ray images.
  • An X-ray data processing unit 310 collects the generated X-ray data. Usually this unit 310 will also be able to reconstruct three-dimensional slice images of the patient P if appropriate X-ray projections from different directions are provided.
  • the Figure shows an ultrasonic (US) scanner 600 coupled to an US data processing unit 610. Due to their construction with US reflective materials (e.g. metals), the markers 1, 1' will show up with high contrast in the ultrasonic images generated by the scanner 600.
  • US reflective materials e.g. metals
  • the various data processing units 210, 310, and 610 are again coupled to the higher-level registration module 800.
  • all the gathered information can be combined and the determined coordinates of the markers 1, 1' can be registered, i.e. mapped onto each other.
  • This allows for example to identify and localize the same anatomical structure in the MRI images generated previously according to Figure 3, and in the X-ray images or the US images generated in real-time during the intervention.
  • An anatomical structure that is only visible in MRI can thus for example be localized in the current X-ray images, allowing a correct guidance of the interventional instruments.
  • the proposed marker design may be used as an accessory for MRI, X-ray, CT, and ultrasound scanners so that the medical images that are collected by the various modalities can be registered/fused together for diagnostic and interventional applications.
  • a version of the marker could be incorporated directly into an ultrasound probe and/or other interventional devices so that its position can actively be monitored while it is being used.
  • the image data collected by an ultrasound probe that has been augmented with the marker could be fused, in real-time, with previously acquired images which may have been collected with a different imaging modality.
  • animated graphical overlays could be incorporated into the multi-modality display which would indicate the current position of interventional devices within the patient's anatomy.
  • Improved clinical outcomes can be achieved with the proposed marker for many diagnostic and minimally invasive interventional procedures by employing multiple medical imaging modalities (e.g. X-ray, computed tomography, magnetic resonance imaging, ultrasound) in combination with tracking systems (e.g. electromagnetic or optical) which localize the patient and/or medical devices, and continually monitor their respective positions and/orientations.
  • medical imaging modalities e.g. X-ray, computed tomography, magnetic resonance imaging, ultrasound
  • tracking systems e.g. electromagnetic or optical
  • the novel marker design will enable a number of clinical challenges to be overcome, including: accurate registration of inter- and intra-modality image data, compensation for respiratory motion of abdominal organs, and tracking/localization of interventional devices (e.g. ultrasound probe, biopsy needle, ablation probe, etc).

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  • Magnetic Resonance Imaging Apparatus (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
  • Medicines Containing Antibodies Or Antigens For Use As Internal Diagnostic Agents (AREA)

Abstract

La présente invention concerne un marqueur polyvalent comportant une pluralité de constituants de marquage qui peuvent être localisés par différents procédés. En particulier, le marqueur peut comporter au moins trois des constituants de marquage suivants : un constituant d'imagerie par résonance magnétique, un constituant de rayons X, un constituant électromagnétique, un constituant optique.
PCT/IB2008/051951 2007-05-24 2008-05-19 Marqueur polyvalent WO2008142629A2 (fr)

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WO2010102119A1 (fr) 2009-03-04 2010-09-10 Imricor Medical Systems, Inc. Localisation de champ combiné et suivi irm
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US10042013B2 (en) 2012-02-14 2018-08-07 Koninklijke Philips N.V. Active position marker system for use in an MRI apparatus
EP3618715A1 (fr) * 2017-06-19 2020-03-11 Mohamed R. Mahfouz Navigation chirurgicale de la hanche à l'aide d'une fluoroscopie et de capteurs de suivi
CN114286651A (zh) * 2019-06-27 2022-04-05 核通运营有限公司 用于医疗成像的标记物
US11598677B2 (en) 2018-06-20 2023-03-07 Koninklijke Philips N.V. Tracking system and marker device to be tracked by the tracking system

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US8611985B2 (en) 2009-01-29 2013-12-17 Imactis Method and device for navigation of a surgical tool
WO2010086374A1 (fr) * 2009-01-29 2010-08-05 Imactis Méthode et dispositif de navigation d'un outil chirurgical
EP2403403A4 (fr) * 2009-03-04 2017-06-28 Imricor Medical Systems, Inc. Localisation de champ combiné et suivi irm
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CN103547214A (zh) * 2011-05-23 2014-01-29 皇家飞利浦有限公司 无线预期运动标记物
WO2012160486A3 (fr) * 2011-05-23 2013-01-17 Koninklijke Philips Electronics N.V. Marqueur de mouvement prospectif sans fil
US9658305B2 (en) 2011-05-23 2017-05-23 Koninklujke Philips N.V. Wireless prospective motion marker
RU2604702C2 (ru) * 2011-05-23 2016-12-10 Конинклейке Филипс Н.В. Беспроводной маркер перспективного движения
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CN106361339A (zh) * 2015-07-23 2017-02-01 西门子保健有限责任公司 带定位单元的医学成像装置和确定定位面上的位置的方法
DE102015213935A1 (de) * 2015-07-23 2017-01-26 Siemens Healthcare Gmbh Medizinische Bildgebungsvorrichtung mit einer Positionierungseinheit sowie ein Verfahren zu einem Bestimmen einer Position auf einer Positionierungsfläche
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EP3618715A1 (fr) * 2017-06-19 2020-03-11 Mohamed R. Mahfouz Navigation chirurgicale de la hanche à l'aide d'une fluoroscopie et de capteurs de suivi
EP3618715A4 (fr) * 2017-06-19 2021-02-17 Mohamed R. Mahfouz Navigation chirurgicale de la hanche à l'aide d'une fluoroscopie et de capteurs de suivi
US11331151B2 (en) 2017-06-19 2022-05-17 Techmah Medical Llc Surgical navigation of the hip using fluoroscopy and tracking sensors
US11826111B2 (en) 2017-06-19 2023-11-28 Techmah Medical Llc Surgical navigation of the hip using fluoroscopy and tracking sensors
US11598677B2 (en) 2018-06-20 2023-03-07 Koninklijke Philips N.V. Tracking system and marker device to be tracked by the tracking system
US11976985B2 (en) 2018-06-20 2024-05-07 Koninklijke Philips N.V. Tracking system and marker device to be tracked by the tracking system
CN114286651A (zh) * 2019-06-27 2022-04-05 核通运营有限公司 用于医疗成像的标记物

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