WO2016056838A1

WO2016056838A1 - Medical navigation device

Info

Publication number: WO2016056838A1
Application number: PCT/KR2015/010591
Authority: WO
Inventors: 이상민; 김남국
Original assignee: 울산대학교산학협력단
Priority date: 2014-10-08
Filing date: 2015-10-07
Publication date: 2016-04-14
Also published as: KR101635515B1; KR20160042297A

Abstract

The present disclosure relates to a medical navigation device for guiding entry of a needle-type medical tool, the medical navigation device comprising: a computer for integrating an operation room image with operation plan information, the computer integrating operation plan information with an operation room image, the operation plan information comprising a target point on a surgical target, an entry point, and a path of entry of the needle-type medical tool, which have been planned with reference to a pre-operation image comprising the surgical target; a position grasping means for grasping information regarding the relative position between the patient and the needle-type medical tool and providing the computer with the same; and a UI for interworking with the computer and showing the entry point in the direction of entry of the needle-type medical tool using the operation room image, which is integrated with operation plan information, the UI comprising a navigation screen for displaying the distance between a target point, which has been calculated by the computer, and the end of the needle-type medical tool using the information regarding the relative position such that a plurality of lines, which are arranged at an interval about the entry point, indicate the interval of distance.

Description

Medical navigation equipment

The present disclosure relates to a medical navigation apparatus as a whole, and more particularly, to a medical navigation apparatus that intuitively shows an alignment of a medical tool on a screen and a distance between the medical tool and the target point on one screen.

This section provides background information related to the present disclosure which is not necessarily prior art.

Medical imaging-based biopsy is an interventional procedure that minimizes damage to the surrounding normal tissue and extracts the samples necessary for the pathological diagnosis of neoplastic disease, such as the adrenal glands, pancreas and lymph nodes. It is widely applied to areas such as the peritoneum, lung mediastinum, spine and extremities. Medical imaging-based biopsies use high-resolution images to delicately localize lesions in three dimensions and to view biopsy needles that enter tissues, making it easier to detect small lesions.

The insertion path of the biopsy needle may be guided by a CT or C-arm fluoroscopy image at a procedure for performing a medical image-based biopsy. Due to problems such as radiation exposure, the insertion path is usually planned in advance on the diagnostic image. For example, in the planning of the insertion path, the entry angle of the biopsy needle to the patient's body is important, and the insertion path is planned by defining the entry angle and insertion point. When the patient enters the procedure room and the operation begins, the image acquisition device (eg, Fluoroscopy device, CBCT device) placed in the procedure room is aligned with the planned path, i.e., the orientation in which the biopsy needle will be inserted.

A navigation view is used to accurately guide the biopsy needle during the biopsy procedure. For example, in a navigation view such as surgeon's Eye View shown in FIG. 1, when the insertion point is inserted into the biopsy needle, the center point of the target is shown, and the biopsy needle is based on the insertion point. Looks like this point In this navigation view, the target is displayed as a point and a circle is drawn around the point. Here you can see that a few centimeters at any angle will reach a point, depending on the planning of the insertion path. In addition to the surgeon's Eye View, the user interface screen or navigation screen shows a cross-sectional image perpendicular to the surgeon's Eye View, and has two or three more views of the biopsy needle, and the operator looks at the surgeon's Eye View. Check the orientation and look at the other two views to see the location of the biopsy needle or the distance to the target. Therefore, it is difficult to intuitively recognize directions and distances together because multiple screens must be viewed together. Although the distance information may be displayed numerically, it is intuitively inconvenient to recognize the direction of the biopsy needle and the continuously changing distance.

FIG. 2 is a diagram illustrating an example of a navigation screen for an ablation procedure disclosed in US 2013/0317363, in which the centers of two

circles

453 and 454 coincide with each other to determine whether a medical tool is accurately aimed at a target. You can check with In addition, the distance between the target and the medical instrument is indicated by numbers below. According to this, there is a lack of a means for intuitively recognizing the distance and direction that changes as the medical tool is continuously inserted into the human body.

This will be described later in the section on Embodiments of the Invention.

This section provides a general summary of the disclosure and is not a comprehensive disclosure of its full scope or all, provided that this is a summary of the disclosure. of its features).

According to one aspect of the present disclosure (According to one aspect of the present disclosure), a medical navigation device for guiding insertion of a needle-like medical tool, comprising: a computer integrating surgical planning information into an operating room image; a computer for integrating surgical planning information, including a target point, an insertion point, and an insertion path of a needle-shaped medical tool in a planned lesion in a preoperative image including a surgical target; Positioning means for identifying the relative position information of the patient and the needle-shaped medical tool and providing it to the computer; And a user interface (UI) showing an entry point in the direction of insertion of the needle-shaped medical tool using an operating room image in which the surgery planning information is integrated with the computer. And a user interface displaying a distance between the calculated target point and the end of the needle-type medical instrument, the navigation interface displaying a distance of the distance by a plurality of lines spaced about the insertion point. A medical navigation device is provided.

This will be described later in the section on Embodiments of the Invention.

1 is a view showing an example of a surgeon's Eye View,

2 is a view showing an example of a navigation screen for the ablation procedure disclosed in US Patent Publication No. 2013/0317363;

3 is a view for explaining an example of a medical navigation device according to the present disclosure,

4 is a view illustrating an example of a method of dividing a tumor and generating a surgical plan in a preoperative image;

5 is a view illustrating an example of a preoperative image in which a tumor and an insertion path are visualized;

6 is a view for explaining an example of how the surgical plan is integrated into the operating room image,

7 is a view for explaining an example of the positioning means for grasping the relative position information of the patient and the biopsy needle;

8 is a view for explaining an example of a user interface screen;

9 and 10 are views showing examples of a screen showing both the direction and the depth of the biopsy needle in the user interface screen.

The present disclosure will now be described in detail with reference to the accompanying drawing (s).

3 is a view for explaining an example of a medical navigation device according to the present disclosure, the medical navigation device may be used to navigate the needle insertion interventional robot. Needle-insertion interventional robots are used for biopsy and treatment to reduce radiation exposure and improve procedure accuracy. Intervention robots can be used for biopsy and treatment of 1 cm-grade lesions in the abdomen, chest, and the like. Examples of needle-type medical instruments include biopsy needles.

For example, the medical navigation apparatus includes a computer 600 for processing or generating a medical image, a position detecting means for grasping the relative position information of the patient 50 and the needle-type medical tool 111 and providing it to the computer 600 ( 400, and a user interface 500 interoperating with the computer 600 to show an entry point in the insertion direction of the needle-shaped medical instrument 111 using an operating room image in which surgery planning information is integrated. . The user interface 500 displays the distance between the target point calculated by the computer 600 and the end of the needle medical instrument 111 using the relative position information of the patient 50 and the needle medical instrument 111. Have a screen. The navigation screen displays distances of distances with a plurality of lines spaced around the insertion point.

The needle-type medical tool 111 is provided in the slave robot 100 that operates in conjunction with the computer 600, and master console 200 for controlling the slave robot 100 in cooperation with the user interface 500 in real time. And an image capturing apparatus 300 for capturing the position of the biopsy needle 111 in the human body, and a device 400 for monitoring the position and posture of the slave robot 100, the patient 50, and peripheral devices. can do.

4 is a view illustrating an example of a method of dividing a tumor and generating a surgical plan in a preoperative image. The medical navigation apparatus may be applied to a biopsy of an organ such as lung, kidney, liver, and the like. The application is also not excluded from the site of. In this example, the lungs are described.

As shown in FIG. 4, the preoperative image is thresholded on the lung of the patient to segment the lesion 10 (eg, a tumor) and generate a surgical plan. For example, after obtaining volumetric chest CT images (pulmonary images), the lung images are segmented to prepare a divided lung image. As a result of the segmentation, anatomical structures (eg, blood vessels, ribs, airways, lung boundaries, etc.) included in the lung image can be extracted into a three-dimensional set of voxels, and blood vessels, ribs, segmented from the lung image Anatomical structures, such as airways and the like, may be stored as a lung mask, a vessel mask, a rib mask, an airway mask, or the like. Tumor 10 is divided by a segmentation technique (for example, adaptive threshold) by the HU value appropriate for the tumor 10. 4 shows an example of an axial cross section of a lung image in which the tumor 10 is divided.

The computer 600 is loaded with a preoperative image of the patient, and the operating room image and the preoperative image of the patient acquired at the operating room are registered by the computer 600. As a result of the registration, a surgical plan including the

insertion paths

82 and 84, the insertion point 41, the target point on the tumor, and the like made using the preoperative image is transferred to the operating room image. This is further described below.

The divided tumor 10 may be generated as a 3D image. Thus, the cross section of the tumor can be seen in the direction required by the image processing software, and the tumor can be seen in representative directions such as, for example, axial view, coronal view and sagittal view. (10) can be seen, and a surgical plan can be made based on this.

FIG. 5 is a diagram illustrating an example of a preoperative image in which a tumor and an insertion path are visualized, and an insertion path 82 is visualized in 3D between the actual ribs and the ribs. As described above, the center 11 of the tumor 10, an insertion path 82 and an insertion point for reaching the tumor 10 are added to the preoperative image to generate a surgical plan. The preoperative image is a 3D image, and as shown in FIG. 5 through volume rendering, the surgical plan may be generated in 3D. For example, the tumor 10 is divided from the periphery, the insertion path 82 is visualized in three dimensions, and the tumor 10 is marked with a target point (eg, the center point or edge of the tumor). Tumor 10 has little contrast and is therefore invisible to fluoroscopy cities, and tumor 10 is generally represented in a generally circular shape. Accordingly, unlike the case shown in FIG. 5, the tumor is not visualized to be distinguished from the surroundings, and the location of the tumor may be determined by the internal calculation process of the computer 600.

FIG. 6 is a view illustrating an example of a method of integrating a surgical plan into an operating room image. An operating room image is acquired at an operating room, and the preoperative image and the operating room image are matched to insert an operation path into the operating room image. The plan is transferred. As a method of registration between medical images, rigid registration and deformable registration methods and the like may be used.

The insertion path 82 may be modified through the user interface 500, and an inappropriate insertion path may be removed in consideration of breathing or movement. 6 (a) is an example of a preoperative image, and FIG. 6 (b) is an image in which an operating room image and a preoperative image are matched and an operation plan is transferred.

In order to more reliably confirm the 3D visualized insertion path 82, the insertion path 251, the insertion point, and the target point (eg, axial view, coronal view, sagittal view) on the MPR (multiplanar reconstruction; : The center or edge of the tumor) may be overlaid (FIG. 6 illustrates the axial view).

As such, the biopsy needle 111 may be guided along the insertion path 82 identified on the MPR to perform the procedure. For example, the final confirmed insertion path is transmitted to the slave robot 100 or the user interface 500 (eg, navigation device) or the like using TCP / IP or a dedicated communication protocol. The biopsy needle 111 may of course be a single needle type, but in order to biopsy a multi-spot, a plurality of revolver types may be mounted on the slave robot 100, so that it may be more effective to biopsy each target point sequentially.

FIG. 7 is a view for explaining an example of a positioning means for grasping relative position information of a patient and a biopsy needle, and various methods may be used as the positioning means for grasping the relative positional relationship between the patient and the biopsy needle. For example, as shown in FIG. 7, the patient 960, the slave robot 911 with the biopsy needle 912, the infrared camera 991, the

infrared reflector assemblies

911, 913, 914, the monitor 920 and the computer. 940 is provided. The infrared camera 991 detects the plurality of infrared reflectors 911 and the infrared reflectors or infrared emitters 913 provided at the ends of the biopsy needle 912, indicating the position of the patient 960. The location of the patient 960 can be identified. A computer 940 is provided for overall operation of the master console, and a monitor 920 is also provided. The computer 940 and the monitor 920 may correspond to the computer 600 and the user interface 500 described with reference to FIG. 1.

In the case of using the relative positional relationship between the patient 960 and the needle 912, the computer 940 also functions as a surgical navigation device. In accordance with the adjustment of the master 200 (see FIG. 1) operator, the biopsy needle 912 of the slave robot 911 is operated by the computer 940. The infrared reflector assembly 911 is fixed to the patient 960 to indicate the position of the patient 960, the infrared reflector assembly 913 is fixed to the biopsy needle 912 to indicate the position of the biopsy needle 912, An infrared reflector assembly 914 is positioned on the chest of the patient 960 to indicate patient movement, such as breathing, sneezing of the patient. As the position sensing means for positioning, an infrared camera and an infrared reflector are used, but a magnetic field can be used, and any means can be used as long as the position can be sensed. For example, it is possible to attach a magnetic sensor to the biopsy needle and track with the camera how far it moves.

The infrared reflector assembly 911 may be used to indicate the location information of the patient 960, may function as a reference position of the entire system, may be fixed to the patient 960, but may be fixed to the operating table, or the operating table. An additional infrared reflector assembly (not shown) may serve as a reference position. The location of the biopsy needle 912 relative to the patient 960 can be determined.

Unlike the above examples, an example in which the slave robot itself knows its position is possible. For example, the slave robot is holding the biopsy needle, and the slave robot itself can know its coordinates within the procedure room. It is also possible to detect by itself how many millimeters the biopsy needle moves. Therefore, the computer can calculate the orientation and position of the biopsy needle in the space of the procedure image.

In addition, the computer can calculate the current position of the biopsy needle in the matched operating room image space by imaging with floroscopy city.

It is preferable in terms of accuracy and safety that the positioning means uses a plurality of methods to determine the positional relationship rather than using only one. The distance between the biopsy needle 111 and the target point 11 on the tumor 10 can be calculated by the computer calculating the relative positional relationship of the patient and the biopsy needle identified by one or more of these locating means.

In this example, the user interface screen displays two small circles showing the orientation along with a crosshair to see if the biopsy needle 111 matches the tumor 10, and provides a depth to intuitively determine the distance between the tumor and the tip of the biopsy needle. Indicate the sense. For example, the distance between the tip of the biopsy needle and the target point is displayed, and the distance between the tip of the biopsy needle and the target point of the tumor is displayed in depth with a plurality of curves spaced apart from each other about the insertion point. Since the distance between the tip and the target point of the biopsy needle is constantly changing when inserted into the insertion path, the insertion angle, the insertion point, and the insertion distance determined in the surgical plan, it is preferable to sequentially display the depth on the user interface screen. This is further described below.

8 illustrates an example of a user interface screen, and a plurality of

screens

510, 520, 530, and 540 are displayed on the user interface. For example, the upper screen contains a CT image (e.g., an image transmitted from a floroscopy) and a mask showing various structures or lesions of the lung. In addition, there is a button for performing an operation plan and an information window for displaying procedure information or type.

The main screen 510 displays an operating room image matched with 3D. In addition, MPR images (eg, 520, 530, 540) generated by the computer from the operating room image are displayed on the right side. For example, tumor 10, insertion path 82, insertion point, in the same direction as axial view, coronal view 530 and sagittal view, The direction of the biopsy needle and the like are displayed. In addition, a camera is installed at the end of the biopsy needle to show the insertion point of the skin, and when the centers of the two circles coincide, the angle of the biopsy needle is aimed at the tumor as planned. The operator instructs the computer through the master console and the biopsy needle is inserted into the human body by the operation of the slave robot linked to the computer.

The relative position of the biopsy needle and the patient can be seen in the same way as described in FIG. 7, with the spiral curve 70 (see FIG. 9) centered around the insertion point being the stab depth of the biopsy needle, ie the tip and affected part of the biopsy needle. Shows the distance between targets. This allows the doctor to intuitively recognize the angle and depth of the biopsy needle by looking at this screen.

In the case of using an infrared reflector or a magnetic marker, as a means of determining the relative position, the distance is calculated and displayed on the screen in real time, and as shown in FIG. can do.

On the other hand, if the preoperative image is matched to the operating room image transmitted from the florography, the location of the affected part is grasped in the space of the operating room image and the distance can be obtained by identifying the biopsy needle displayed on the operating room image. By comparing the distance thus obtained with the distance using the marker, errors can be reduced and the distance can be displayed more accurately and safely.

In addition, the movement of the slave robot can be detected by the slave robot itself. That is, the sensor can detect how far the needle has advanced in the slave robot. Therefore, the distance information thereby may be supplemented to the above-mentioned distance information.

On the other hand, the computer can calculate the puncture rate by identifying the biopsy needles appearing on the plurality of operating room images, the time delay and processing the operating image to display on the user interface and the speed is evaluated, the position of the end of the current biopsy needle and The distance can be calculated. This calculated distance can also be used for supplementation.

9 and 10 are diagrams showing examples of the screen showing the direction and depth of the biopsy needle in the user interface screen, and whether the biopsy needle is accurately aimed at the affected part is the center of the center of the two small circles inside It can be seen whether or not. On the other hand, a spiral curve 70 (refer to FIG. 9) is displayed around the center, and the outer spiral indicates a distance from the affected part than the inner spiral. The spirals are numbered in depth. As the biopsy needle pierces the human body, the distance continues to change, which in turn activates certain portions of the spiral corresponding to the distance (e.g. color changes, line thickness changes, flickers, etc.), thereby allowing the operator to determine the direction and depth of the biopsy needle. Intuitively together.

Alternatively, a plurality of circles 75 (see FIG. 10) concentric with the center 11 are shown, with the outer circle farther from the affected part than the inner circle. As the biopsy needle pierces the human body, the distance continues to change, and thus the circle corresponding to the distance is sequentially activated (e.g. color change, line thickness change, blinking, etc.) so that the operator can intuitively adjust the direction and depth of the biopsy needle together. You can check it.

Therefore, it is a great help to perform the procedure accurately and safely without referring to various other screens. For example, until the tip of the biopsy needle reaches the affected part, the biopsy needle is pierced while checking the distance of the tip of the biopsy needle and the affected part in the above-described user interface screen according to the present example, and a CT or medical imaging apparatus immediately before the affected part. You can also consider using a biopsy needle to finally take the image and use it to biopsy the affected area.

Hereinafter, various embodiments of the present disclosure will be described.

(1) A medical navigation device for guiding the insertion of a needle-shaped medical tool, comprising: a computer integrating surgical planning information into an operating room image, comprising: a target point on an image of a planned lesion in a preoperative image including a surgical target, A computer incorporating surgical planning information, including an insertion point and an insertion path of a needle-shaped medical instrument, in the operating room image; Positioning means for identifying the relative position information of the patient and the needle-shaped medical tool and providing it to the computer; And a user interface (UI) showing an entry point in the direction of insertion of the needle-shaped medical tool using an operating room image in which the surgery planning information is integrated with the computer. And a user interface displaying a distance between the calculated target point and the end of the needle-type medical instrument, the navigation interface displaying a distance of the distance by a plurality of lines spaced about the insertion point. Medical navigation device.

(2) The navigation screen for medical navigation, characterized in that the part of the plurality of lines corresponding to the reached distance of the end of the needle-shaped medical tool visually displayed and distinguished from the rest.

(3) A medical navigation apparatus, characterized in that a plurality of lines are spirals centering on an insertion point.

(4) A medical navigation apparatus, characterized in that a plurality of lines have a plurality of causes of concentric insertion points.

(5) The navigation screen displays two circles enclosing the insertion point inside the plurality of lines, and the alignment of the needle-like medical tool and the insertion path is confirmed by coinciding the centers of the two circles. Medical navigation device.

(6) the locating means comprises: a marker for marking the needle-shaped medical tool and the patient; And a sensing device for sensing a marker.

(7) The positioning means includes: a medical imaging apparatus for photographing the operating room image; the computer calculates the location of the affected area in the space of the operating room image by matching the plurality of operating room images and preoperative images , Medical navigation device, characterized in that for calculating the distance between the needle-shaped medical tool and the lesion included in the plurality of operating room images.

(8) The positioning means includes: a sensor provided in the slave robot equipped with the needle-type medical tool, wherein the sensor detects the position of the needle-type medical tool with respect to a reference position of the operating room. .

(9) The medical instrument of claim 9, wherein the needle-type medical instrument is a biopsy needle, and the user interface displays the distance between the target point and the tip of the biopsy needle by sequentially activating some sections corresponding to the corresponding distances in the spiral curve.

(10) The medical instrument of the needle type is a biopsy needle, wherein the user interface sequentially activates a circle corresponding to the corresponding distance to display the distance between the target point and the tip of the biopsy needle.

According to one medical navigation apparatus according to the present disclosure, since the direction and distance of the affected part of the needle-shaped medical tool are displayed together on one navigation screen, there is no need to alternate between the other screens, and the safety of the procedure and The accuracy can be further improved.

According to another medical navigation apparatus according to the present disclosure, since the distance between the affected part and the tip of the needle-type medical tool is activated in a spiral or a plurality of circles sequentially and displayed in a sense of depth, it is convenient to know the depth of stab intuitively, The safety and accuracy of the procedure can be further improved.

Claims

In the medical navigation device for guiding the insertion of the needle-shaped medical tool,

A computer for integrating surgical planning information into an operating room image, comprising: operating plan information including a target point, an insertion point, and an insertion path of a needle-shaped medical instrument in a pre-operative image including a surgical target; Computer integrating to intestinal video;

Positioning means for identifying the relative position information of the patient and the needle-shaped medical tool and providing it to the computer; And

A user interface (UI) that shows an entry point in the direction of insertion of a needle-like medical instrument using an operating room image incorporating surgery planning information in conjunction with a computer, calculated by the computer using relative position information And a user interface for displaying a distance between the target point and the tip of the needle-type medical tool, and having a navigation screen displaying the distance of the distance by a plurality of lines spaced about the insertion point. Navigation device.
The method according to claim 1,

The navigation screen is a medical navigation device, characterized in that for displaying a portion of the plurality of lines corresponding to the distance reached of the end of the needle-shaped medical tool visually distinguished from the rest.
The method according to claim 1,

And a plurality of lines are spirals centering on an insertion point.
The method according to claim 1,

The plurality of lines are a plurality of causes of the concentric with the insertion point.
The method according to claim 1,

The navigation screen displays two circles surrounding the insertion point inside the plurality of lines, and the same direction alignment between the needle-like medical tool and the insertion path is confirmed by coinciding the centers of the two circles. Device.
The method according to claim 1,

Location means are:

Markers to mark needle-like medical instruments and patients; And

Medical navigation device comprising a; sensing device for detecting a marker.
The method according to claim 1,

Location means are:

It includes; medical imaging device for taking an image of the operating room;

The computer calculates the location of the affected part in the space of the operating room image by matching the plurality of operating room images with the preoperative image, and calculates the distance between the needle-type medical tool and the affected part included in the plurality of operating room images. Medical navigation device.
The method according to claim 1,

Location means are:

And a sensor provided in the slave robot having the needle-type medical tool, wherein the sensor detects the position of the needle-type medical tool with respect to a reference position of the operating room.
The method according to claim 3,

The medical needle is a biopsy needle,

The user interface sequentially displays a distance between the target point and the tip of the biopsy needle by sequentially activating some sections corresponding to the corresponding distances in the spiral curve.
The method according to claim 4,

The medical needle is a biopsy needle,

The user interface sequentially displays the distance between the target point and the tip of the biopsy needle by sequentially activating a circle corresponding to the corresponding distance.