Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
  • A61B8/0866—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving foetal diagnosis; pre-natal or peri-natal diagnosis of the baby
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/42—Details of probe positioning or probe attachment to the patient
  • A61B8/4209—Details of probe positioning or probe attachment to the patient by using holders, e.g. positioning frames
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
  • A61B8/461—Displaying means of special interest
  • A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
  • A61B8/467—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient characterised by special input means
  • A61B8/469—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient characterised by special input means for selection of a region of interest
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
  • A61B8/5223—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for extracting a diagnostic or physiological parameter from medical diagnostic data
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
  • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
• • 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
  • A61B5/1076—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions inside body cavities, e.g. using catheters

Definitions

• the present invention relates to an ultrasound-based apparatus for monitoring one or more morphological and physiological parameters that are related to the progress of a childbirth.
• a need is particularly felt of a method and an equipment that allow to monitor the conditions of a pregnant woman and her foetus before entering the childbirth room, and during the childbirth itself, in particular in childbirth stage 2 but even in stage 1 and 3.
• it is important to monitor such morphological and physiological parameters as uterine contractions intensity, frequency and duration, foetal cardiac frequency, endocervical canal dilation, endocervical canal length, foetal head station, in particular the distance of the foetal head from an anatomical reference, such as a parturient's bone, pubis, and the like, as well as the foetal head rotation, umbilical cord unwinding, and the evolution of all these parameters.
• Barnev's cervicometer described in Sharf et al., "Continuous monitoring cervical dilation and foetal head station during labor” (Med. Eng. Phys. 2007; 29:61-71).
• Barnev's cervicometer comprises three ultrasound transmitters to be located on the abdomen of the pregnant woman, and a plurality of receivers to be located, typically, on the foetal head and at the edges of the cervical os.
• a labor such as, in particular, the endocervical canal dilation of a parturient, the position of the foetus before and during the descent through the endocervical canal, as well as physiological parameters of the parturient and of the foetus
• an object of the invention to provide an apparatus for real-time monitoring such parameters, by qualitatively and/or quantitatively displaying them on a user interface.
• an apparatus for measuring a labor progress parameter during childbirth by ultrasound images obtained by ultrasonic pulses comprising: an ultrasound probe; - a fastening means for fastening the ultrasound probe onto a parturient's body so that the probe has a visual field that includes a portion of the parturient's body and of a foetus, in particular the parturient's endocervical canal and/or the pubis;
• control unit for receiving and analysing signals from the ultrasound probe, said control unit creating or receiving as input by said probe a reference ultrasound image and a plurality of subsequent ultrasound images, which are taken in succession after the reference ultrasound image;
• control unit comprises: an automatic tracking means for tracking the region of interest, said automatic tracking means adapted to identify respective derived regions of interest in selected images of the plurality of subsequent ultrasound images, the derived regions of interest deriving from the region of interest that is selected in the reference ultrasound image, the tracking means comprising: a means for calculating a predetermined local pixel function for each pixel or group of pixels of the region of interest in the reference ultrasound image and in each selected image of the plurality of subsequent ultrasound images,
• - a means for comparing each position of the derived regions of interest with the position of the region of interest in the reference ultrasound image or of In another image and for calculating a labor progress parameter, in particular of a previous image.
• the automatic tracking means allow to track, substantially in real time and with a predetermined level of accuracy, before and during the childbirth, one or more morphological and physiological labor parameters that are related with the progress of the childbirth, and that allow evaluating the correct evolution of the childbirth itself, without inserting in the parturient's body foreign objects, such as intrusive instruments and sensors.
• the device is adapted to integrate existing ultrasound instruments.
• control unit is adapted to select a further region of interest that is substantially centred about the portion of the parturient's body, the labor progress parameter during childbirth defined by a combination of the region of interest and of the further region of interest.
• the parameter is totally defined without any reference to reference points external to the parturient's body or the foetus, and the tracking of the regions of interest is more reliable, in particular it is independent from movements of the parturient.
• the user interface is adapted to provide to the operator an option of selecting a further reference image among one of the subsequent ultrasound images, such that a first and a second tracking on two pluralities of pixels are carried out contemporaneously, the means for iteratively calculating adapted to perform the steps of:
• the user interface is adapted to provide to said operator an option of selecting the criterion for carrying out the comparison between the first and the second tracking.
• such criterion is selected from the group comprised of:
• the portions of the mother's body and of the child that are included in the visual field of the probe are those portions that markedly change their configuration and their position during the childbirth, in particular the edges of the external os and the head of the foetus; furthermore, portions of the foetus may be included in the visual field, for example the shoulders, which provide an absolute reference for evaluating the rotation of the head.
• the regions of interest may be used for automatically tracking one of the moving portions in the images that follows the reference image, in terms of position with respect to portions of the woman's body that remains substantially fixed during the childbirth, for example the head of the foetus with respect to the pelvis.
• the apparatus comprises a means for measuring a position parameter of the ultrasound probe with respect to a coordinate system external to the parturient
• the control unit has a means for receiving the position parameter and a means for summing said position parameter and the position of said derived region of interest with respect to said probe, such that said means for comparing performs a comparison between the actual position of said regions of interest taking into account said coordinate system external to said parturient .
• the user interface is adapted to define as input a plurality of regions of interest selected by an operator on the reference image.
• each region of interest defines a same labor progress parameter.
• the labor progress parameter defined by the selected region of interest may be the dilation of the parturient's endocervical canal, which may be associated to a distance between two regions of interest selected on the edge of the endocervical canal.
• the labor progress parameter defined by the selected region of interest may be the position of the head of the foetus during the descent along the outlet path through the endocervical canal, i.e. the "foetal head station"; the position may be associated with a region of interest that is selected on a fixed portion of the parturient's body and with a region of interest that is selected on the head of the foetus.
• the fixed portion of the parturient's body may be the pubis.
• the labor progress parameter defined by the region of interest may be the rotation of the head of the foetus, i.e. the "foetal head position"; the rotation is then associated with an angle that is formed by a line that is defined by two regions of interest that are centred on a fixed portion of the parturient's body and by a line that is defined by two regions of interest integral to the foetus.
• the system allows reading all the physiological parameters of the foetus and of the parturient during the childbirth, in particular vital parameters by which the safety conditions for the foetus and the parturient can be monitored.
• Reliable measures of this angle may be obtained by having as a reference the only the line that is defined by two regions of interest of the foetus.
• the length of the endocervical canal is evaluated by measuring the dilation of an upper part and the dilation of a lower part of the endocervical canal, a computing means calculating the length by comparing the dilation of the upper part and of the dilation of the lower part.
• ultrasound reference image and/or the subsequent ultrasound images are images of any cross sectional plane of the visual field selected by the operator.
• the region of interest is a region of a three-dimensional space.
• the region of interest is a three-dimensional region that is directly obtained through a 3D real time or native matricial acquisition.
• the region of interest may be obtained as an union of regions of interest of a plurality of ultrasound images of plane sections of the visual field, wherein the plurality of reference images are obtained by rotating the visual field about an axis that is common to the plane sections.
• the technique of reconstructing three-dimensional images starting from two-dimensional images reduces the calculations that are needed to obtain the reference three-dimensional image, with respect to the case of a direct acquisition of a volumetric image, i.e. a 3D-image.
• the means for iteratively calculating positions of the region of interest comprises:
• - a means for calculating the local pixel function in a plurality of domains of the subsequent ultrasound images; a means for calculating a predetermined object function in each of the domains, the object function associating to each domain a deviation value between the local pixel function as calculated in the domain and the local pixel function as calculated in the region of interest; a means for determining a domain of a subsequent ultrasound image in which the object function has a minimum value.
• the object function is the sum of the square of the differences between a value of the local pixel function as calculated at each pixel of the region of interest of an ultrasound image, and the value of the local pixel function as calculated at each corresponding pixel in a domain of a subsequent ultrasound image, which may not immediately follow the reference image.
• the images of the plurality of subsequent images in which the derived region is identified are selected by sampling at a predetermined frequency.
• the position of the head of the foetus is associated with a further region of interest that is selected on a fixed portion of the parturient's body and/or with a further region of interest that is selected at the head of the foetus.
• the local pixel function is a function that associates to a number each pixel of the region of interest and of the domains.
• the number that is associated by the local pixel function to a pixel may be related to a grey tonality of a grey scale.
• such number may be a value that is deduced by a radiofrequency spectral analysis of an ultrasound image.
• such number may deduced by an analytic technique that is different from radiofrequency spectral analysis.
• the user interface provides a means for signalling an anomalous value of a labor progress parameter or of a phoetus physiological parameter with respect to a predetermined range, or an anomalous combination of a plurality of labor progress parameters and/or of physiological parameters.
• Such anomalous values may represent a condition that is dangerous for the foetus and/or for the mother, with consequent risks for the onset of critical and potentially harmful configurations.
• the apparatus comprises a means for storing values of the labor progress parameters, in particular the anomalous value and the anomalous combination of values.
• a means for storing values of the labor progress parameters in particular the anomalous value and the anomalous combination of values.
• An anomalous parameter value may also be generated that is far away from a physically acceptable range of parameter values, which requires checking equipment reliability, and/or resetting the means for calculating and/or starting again the calculations.
• the apparatus comprises a means for displaying the parameter on the ultrasound images.
• a simplified image of the portions of the parturient 's genital and reproductive system, as well as of the foetus, may be useful for evaluating the progression stage and the correct evolution of the childbirth.
• the numeric values of monitored parameters and/or of physiological data and/or of other useful parameters or images of various types measured with compatible devices may usefully accompany the ultrasound images on a same user interface or on a separate interface.
• an ultrasound- based method for measuring a labor progress parameter the method providing the steps of: fastening an ultrasound probe onto the body of a parturient so that the probe has a visual field that includes a portion of the parturient's body and of a foetus, in particular the parturient 's endocervical canal and/or the pubis; providing a control unit for receiving and analysing signals from the ultrasound probe, creating or receiving as input by said probe a reference ultrasound image and a plurality of subsequent ultrasound images, which are taken in succession after the reference ultrasound image; selecting through a user interface at least one region of interest in the reference ultrasound image, the region of interest substantially centred about the portion of the parturient's body, the region of interest comprising a plurality of pixels; - automatic tracking the region of interest and identifying respective derived regions of interest in selected images of the plurality of subsequent ultrasound images, the derived regions of interests corresponding to the region of interest that is selected in the reference ultrasound image, the tracking step comprising in
• a step is provided of selecting at least a further region of interest that is substantially centred about said portion of the parturient's body, the labor progress parameter during childbirth defined by a combination of the region of interest and of the further region of interest.
• a step is provided of selecting by the operator a further reference image among one of the subsequent ultrasound images, such that a first and a second tracking on two pluralities of pixels are carried out contemporaneously; in this case, further steps are provided of:
• a step is provided of selecting the above-mentioned criterion, which is selected, in particular, from the group comprised of:
• the step of receiving and analysing signals provides:
• the step of iteratively calculating positions of the region of interest provides: - calculating the local pixel function in a plurality of domains of the subsequent ultrasound images; calculating a predetermined object function in each of the domains, the object function associating to each domain a deviation value between the local pixel function as calculated in the domain and the local pixel function as calculated in the region of interest;
• the object function is the sum of the squares of the differences between a value of the local pixel function as calculated at each pixel of the region of interest of an ultrasound image, and the value of the local pixel function as calculated in a domain of a subsequent ultrasound image, which may not immediately follow the reference image.
• a step is provided of selecting the images in which the derived region is identified from the plurality of subsequent ultrasound images by sampling at a predetermined frequency.
• the use of the procedure may be continuous or intermittent, responsive to the childbirth stage and to monitoring needs.
• the position of the head of the foetus is associated with a further region of interest that is selected on a fixed portion of the parturient's body and/or with a further region of interest that is selected on the head of the foetus.
• the method provides a step of signalling an anomalous value of a labor progress parameter with respect to a predetermined range, or an anomalous combination of a plurality of the labor progress parameters.
• the method provides a step of storing values of the labor progress parameters, in particular the anomalous value and the anomalous combination of values.
• FIG. 1 is a schematic views of the apparatus according to the invention, for monitoring one or more morphological and physiological childbirth-related parameters, considered at different instants during the tracking of a parameter;
• Fig. 2 shows more in detail the displaying unit 15 of the apparatus, along with a reference ultrasound image
• FIG. 3 diagrammatically shows a region of interest that is produced for identifying and tracking points on subsequent ultrasound images
• Fig. 4 shows a subsequent ultrasound image
• Fig. 5 diagrammatically shows the steps of scanning the ultrasound image of Fig. 4, by which previously defined anatomic points are retrieved;
• Fig. 6 shows the displaying unit of Fig.2, where an ultrasound image is displayed subsequent to reference image.
• - Fig. 7 represents more in detail a genital and reproductive apparatus of a parturient
• - Fig. 8 is a block diagram that represents the steps to be performed by an operator who interacts with the apparatus according to the invention
• Fig. 9 is a block diagram of the method that is carried out by the algorithm-based program means that is resident in the control unit of the apparatus. Description of preferred exemplary embodiments
• the apparatus comprises an ultrasound probe 1 , which is equipped with a means, not shown, for fixing the probe itself on the skin of a parturient 2 outside the upper ventral region or just below the sternum (fig. 1), depending on the configuration that is actually most suitable for obtaining a satisfactory visualization of the desired portions of the woman's body and of the foetus 3.
• visual field 7 of ultrasound probe 1 includes substantially the whole foetus 3, in particular the head 4 as well as the whole endocervical canal 8 and a portion of the umbilical cord 5.
• another possible suitable position of probe 1 is close to the pubis.
• Ultrasound probe 1 is connected to a control unit 13 that provides an ultrasound image 11 on a displaying unit 15, substantially in real time to.
• displaying unit 15 is integrated in an interactive graphic user interface 14 that comprises furthermore a device 16 for introducing the parameters 25 to be monitored; displaying unit 15, which is shown more in detail in Fig. 2, is used both for displaying ultrasound images 11 and for indicating the parameters 25 to be monitored by selecting anatomic reference points 28',28",29 directly on the reference ultrasound image 11.
• Graphic user interface 14 is also provided with a section 17 for displaying the numerical values of the selected parameters.
• an operator interacts with apparatus 10, in particular with control unit 13, according to the steps of Fig. 8, which are referred to within parentheses.
• the operator firstly fastens ultrasound probe 1 to the parturient's body 2
• parameters 25 may be selected, in particular among: the dilation 26 of endocervical canal 8 (Fig. 7); the length of endocervical canal 8; - the "foetal head station", i.e. the position of head 4 of foetus 3 with respect to a coordinate measured along the outlet path; the "foetal head position” 30 (Fig.2), i.e. the rotation of head 4 of foetus 3 with respect to a predetermined axis 31 ; - uterine contractions intensity, frequency, duration; the position of one or more points of umbilical cord 5.
• the operator selects, directly on reference ultrasound image 11 as displayed by screen 15, anatomic reference points 28', 28" that are needed for real-time calculation of the value of each parameters 25 that have been selected (54).
• the operator selects a couple of points 28" on the edges 9 of the endocervical canal 8 (Fig. 7), or, preferably, a plurality of couples of points that are distributed along edges 9.
• the operator may select for instance a reference axis 31 integral with pelvis 6 of the parturient 2 and a couple of points 28' that identify biparietal diameter 27 of foetus 3 (Figs.
• this evaluation is preferably done in a redundant way, for instance by considering more than one couple of points 28'; in alternative to reference axis 31 integral with pelvis 6, the operator may choose a reference axis that is defined by a couple of points 28" that have been selected for monitoring dilation 26 of endocervical canal 8 (Fig.7).
• the operator can define a parameter of interest, which may be different from the above-listed ones, provided that the new parameter can be expressed as a distance between two points or as a rotation angle of an axis with respect to a reference axis defined on foetus head or on parturient's body, for instance on parturient's pelvis 6.
• a parameter of interest which may be different from the above-listed ones, provided that the new parameter can be expressed as a distance between two points or as a rotation angle of an axis with respect to a reference axis defined on foetus head or on parturient's body, for instance on parturient's pelvis 6.
• foetal head position 30 is the only parameter shown through Figs 2-6, even if the apparatus is adapted to track a virtually unlimited plurality of parameters, provided that a suitable computing power is available.
• control unit 13 works as described hereinafter, performing the steps of the block diagrams of Fig. 9, to which reference is made within parentheses.
• the algorithm carries out a monitoring phase, or automatic "tracking", of specific "pixel patterns" through a sequence of consecutive ultrasound images. More in detail, and with reference to Figs. 2 and 3, control unit 13 creates a region of interest (ROI) 21 about each reference point (61). Each ROI 21 has a prefixed size and comprises a set of pixels 23, which represents the pixel pattern 24 to be retrieved in the subsequent ultrasound images. For each pixel 23, the value of a prefixed local pixel function f is calculated.
• the local pixel function f may associate a numerical value to a grey tonality of a pixel 23 in a grey scale, where the lowest/highest value is used for a white pixel and a highest/lowest value for a black pixel, respectively, or vice-versa.
• control unit 13 defines an ultrasound image 12 (62; Fig. 4) that has been taken by the ultrasound probe, subsequent to reference image 11, in whose pixels the above mentioned reference function f is calculated; as shown in Fig. 5, control unit 13 carries out then a scanning step of subsequent image 12 (63), defining a plurality of domains 36 that have the same shape and size of ROI 21 (64), in order to track a group of pixels which has features that match the features of pixel pattern 24 as initially defined by the algorithm. To this purpose, and still by means of the resident algorithm, control unit 13 compares the set of the values calculated in ROI 21 with the values calculated in each domain 36, and finds out the domain 22 where the distribution of the values is the most similar to the distribution of the values calculated in ROI 21.
• the identified domain 36 is the domain where a predetermined object function F, or distance function, has a minimum value 34.
• the object function F may be the sum of the squares of the differences of values of the local pixel function f calculated for corresponding pixels in ROI 21 and in the domain 22.
• the coordinates Xi,x 2 of this recognized or tracked or derived ROI 22 are displayed substantially in real time on displaying unit 15 (66; Fig. 6), along with a line or a plurality of lines that represent the parameter of interest corresponding to selected groups of anatomic reference points (67), i.e. with simplified images of anatomic details, overlapped to the ultrasound current image.
• the anatomic detail may be, for example, the head of the foetus, together with such orientation parameters as foetal head position 30 or the inclination or the rotation with respect to the shoulders.
• the computing means calculate then the distance and the angles of inclination that are needed for quantitatively expressing parameters 25, and the corresponding values are displayed in section 17 of displaying unit 15. Afterwards, the derived ROIs 22 that are retrieved in the subsequent image 12 are used in an iterative process, for recognizing the ROIs in further subsequent ultrasound images, not shown, up to the end of the session (70). Parameter values 25 may furthermore be displayed as graphs 40 on a section 39 of graphic user interface 14 (68,69), in order to highlight their temporal evolution. Parameter values 25 may also be recorded in a mass memory unit 18, to be displayed in an off-line session.
• Anomalous parameter values and anomalous combinations of parameter values are advantageously saved in a separate memory device, preferably after being highlighted in a separate display unit or mode, not shown.
• the off-line consultation of the data recorded in mass memory unit 18 is useful, for instance, in case of doubts concerning a correct application of safety procedures and/or of good childbirth practice, in particular in case of unexpected complications that may have occurred during the childbirth.
• pixel patterns 24 to be tracked are identified in the initial image 11 ; however, for any anatomic reference point, in subsequent image 12 a pixel pattern 24 may be used which is identified in another ultrasound image, advantageously in an image that is produced immediately before image 12.
• the algorithm will also offer the operator the option 55 (Fig. 8) of considering both types of pixel patterns, in order to maximize the accuracy in ROI recognition, at the expenses of some reduction in temporal resolution of the analysis.
• the operator will be also prompted to define the criterion (56) to be employed by control unit 13 to determine, in each elaborated image, the derived ROI 22 for each initially selected ROI 21.
• the algorithm will first provide two possible derived ROIs 22 as the result of two independent pattern trackings, and then a choice will be automatically made based on the operator-defined criterion.
• each derived ROI 22 can be chosen as the average position between two alternatives that are provided by the algorithm, or it can be chosen as the position of the ROI that has the lowest object function F value 34 between the two values that are provided, or it can be chosen as the position that is closer to or farther from a determined range of possible "expected values", etc.
• An external coordinate system 20 may be employed to correct, due, for instance to a parturient's movement. This way, any possible displacements of probe 1 can be taken into account, due for instance to an incidental movement of the parturient 2, starting from the control of the reference image up to the control of the subsequent images, and the position of ROI 21 of reference image 11 and of the corresponding derived ROIs 22 on subsequent images 12.
• an external or "absolute" coordinate system 20 may be provided, as well as a position sensor that can be associated to probe 1 and connected to control unit 13, in such a way that the absolute position of probe 1 with respect to coordinate system 20 is detected by control unit 13 that is provided with a summing means, which is adapted to sum the position of ROI 21 in the reference ultrasound image 11 and the position of the derived displaced ROI 12 with their corresponding positions in the fixed coordinate system 20.
• a summing means which is adapted to sum the position of ROI 21 in the reference ultrasound image 11 and the position of the derived displaced ROI 12 with their corresponding positions in the fixed coordinate system 20.
• the position sensor and the summing means may be easily implemented by a skilled person, therefore they are not described in detail here.

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