WO2016150812A1 - Procédé pour faire fonctionner un ensemble formant microscope chirurgical - Google Patents

Procédé pour faire fonctionner un ensemble formant microscope chirurgical Download PDF

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Publication number
WO2016150812A1
WO2016150812A1 PCT/EP2016/055807 EP2016055807W WO2016150812A1 WO 2016150812 A1 WO2016150812 A1 WO 2016150812A1 EP 2016055807 W EP2016055807 W EP 2016055807W WO 2016150812 A1 WO2016150812 A1 WO 2016150812A1
Authority
WO
WIPO (PCT)
Prior art keywords
surgical microscope
image
relative
virtual image
operating area
Prior art date
Application number
PCT/EP2016/055807
Other languages
German (de)
English (en)
Inventor
Andreas ZOLLORSCH
Tobias Lehner
Original Assignee
Sicat Gmbh & Co. Kg
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Sicat Gmbh & Co. Kg filed Critical Sicat Gmbh & Co. Kg
Priority to EP16711576.5A priority Critical patent/EP3274753A1/fr
Publication of WO2016150812A1 publication Critical patent/WO2016150812A1/fr

Links

Classifications

    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B21/00—Microscopes
    • G02B21/0004—Microscopes specially adapted for specific applications
    • G02B21/0012—Surgical microscopes
    • 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
    • A61B90/20—Surgical microscopes characterised by non-optical aspects
    • 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
    • A61B90/361—Image-producing devices, e.g. surgical cameras
    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B21/00—Microscopes
    • G02B21/18—Arrangements with more than one light path, e.g. for comparing two specimens
    • G02B21/20—Binocular arrangements
    • G02B21/22—Stereoscopic arrangements
    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B21/00—Microscopes
    • G02B21/36—Microscopes arranged for photographic purposes or projection purposes or digital imaging or video purposes including associated control and data processing arrangements
    • G02B21/365—Control or image processing arrangements for digital or video microscopes
    • 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
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • A61B2090/368—Correlation of different images or relation of image positions in respect to the body changing the image on a display according to the operator's position

Definitions

  • the present invention relates to a method of operating a surgical microscope assembly.
  • EP 2 099 377 B1 basically describes a surgical microscope for the use of a tumor operation in the interior of the skull.
  • processed tomographic data of the patient and / or added planning data are displayed as a virtual image in the field of view of the surgeon.
  • DE 10 2010 003 836 discloses a surgical microscope arrangement with a magnetic resonance apparatus, wherein the magnetic resonance apparatus and the surgical microscope are connected to one another via a rigid joint structure.
  • the patient can be examined alternately with the magnetic resonance apparatus or the surgical microscope.
  • the images taken with the magnetic resonance apparatus can be mirrored into the observation beam path of the surgical microscope. This arrangement requires that the patient remains in a defined position.
  • the object underlying the invention is achieved by a method for operating a surgical microscope assembly according to claim 1 and a surgical microscope assembly according to claim 9; preferred embodiments will be apparent from the dependent claims.
  • a real image of a visible operating region of a body to be treated in which a virtual image is superimposed, is displayed in a surgical microscope.
  • the superimposed virtual image is currently generated by a computing unit (eg a PC), in particular based on available volume data.
  • the volume data is pre-generated and / or revised tomographic data that includes the operation area.
  • the virtual image data to be inserted which may also contain planning data, are thereby generated on the operating area taking into account a current viewing direction of the surgical microscope, which makes it possible for the virtual image to be correctly and actually superimposed into the real image in accordance with the viewing direction of the microscope. Relative movements between the surgical microscope and the surgical area are computationally compensated.
  • the method according to the invention is characterized in that the relative viewing direction between the surgical area and the surgical microscope is continuously monitored during an operative procedure and the virtual image is recalculated at least when the relative viewing direction changes. The newly calculated virtual image is then displayed correctly in the real image.
  • the virtual image is based on volume data obtained in particular by a tomography method. Each of these volume data is assigned a local position of the operating area. When considering the relative Alignment between the surgical area and the surgical microscope, the virtual image is generated such that when it is faded in, the virtual image is displayed as if the corresponding volume data is actually visible and in the correspondingly assigned local position.
  • the volume data may also be three-dimensional planning data generated on the basis of the tomographic data of the operation area and located in the same coordinate system as the volume data of the operation area.
  • scheduling data may include a marker that marks the location where the tooth nerve exits the tooth root.
  • a root canal This root canal is determined in its shape and position in the tooth of a patient using a tomography method.
  • This volume data are generated, which describe the root canal geometrically and locally accurate. These volume data are now transferred into the real image as if this root canal was actually visible in this real image; on the other hand, the root canal is not visible in the real image, as it is covered by areas of the tooth. On the other hand, if this occlusion were not present, the root canal would actually be seen there, as the virtual image now suggests.
  • the root tips can be marked with planning markers which highlight the apical end of the tooth root, which is otherwise not visibly visible due to the occlusion, especially at the time of the beginning of the operation.
  • the relative viewing direction is preferably monitored by means of one, preferably two inertial sensors.
  • a first inertial sensor is fixed in place with the surgical microscope.
  • a second inertial sensor is fixed in place to the operating area. The use of one of the two inertial sensors may be sufficient if another, possibly different, sensor is used to monitor the movement of the other part (surgical microscope or surgical area).
  • An inertial sensor basically serves to measure accelerations and yaw rates. By designing suitable inertial sensors, the accelerations of the six degrees of freedom can be measured, ie three longitudinal accelerations and three rotational accelerations.
  • an intertial sensor means an individual sensor or an arrangement of individual sensors, wherein the individual sensor or the arrangement can each determine accelerations in all six degrees of freedom.
  • An inertial sensor may be formed by a suitable combination of acceleration sensors and gyroscopes. By integrating twice over time, one can translational motion can be calculated. By integrating once over the time of rotational motion values, a rotational motion can be calculated.
  • the relative viewing direction of the surgical microscope can be determined and calculated on the basis of rotational angle sensors.
  • Such rotation angle sensors can be installed on the joints of a holding arm for holding the operating microscope and record the movement of the holding arm.
  • the relative orientation can be monitored by a sensor, namely a 3D camera, which is attached fixedly to the surgical microscope or to the surgical area and is directed respectively to the surgical area or the surgical microscope.
  • a sensor namely a 3D camera
  • 3D scan cameras for example sold under the brand name CEREC by Sirona or KINECT by Microsoft. Details on this are described in particular in EP 2 212 646 B1.
  • a 3D scanning camera can pick up a three-dimensional surface of an object to be scanned, in this case the tooth or face of the patient or surgical microscope, and thus generate three-dimensional volume data from its surface.
  • a first three-dimensional surface image (also referred to below as the base registration image) can be recorded and a further, third-dimensional surface image recorded at a later, second time;
  • the base registration image can be a calibration image.
  • a calibration image is preferably first faded into the real image of the surgical area.
  • the calibration image can be a partial image, a volume image or representing a surface image of tomographically obtained volume data of the operating area.
  • the surgeon is then given the opportunity to bring the calibration image into overlap with the real image by means of a user input. If the overlap is reached, this can be confirmed by a user input. With this, the coordinate systems of the real image or the reference system of the volume data can be aligned with the reference system of the operating area.
  • the relative orientation can be automatically monitored based on the degree of overlay of an SD surface scan with a previously created 3D surface scan. Should the area of the real image corresponding to the calibration image be removed from the position of the calibration image in the course of the operation and thus no longer be in overlap with it, the calibration image can be automatically tracked to the corresponding area of the real image corresponds to the calibration image. The degree of tracking then corresponds to the change in the relative orientation, from which in turn the change in the direction of view is calculated.
  • a surgical microscope assembly suitable for use in a method according to any one of the preceding claims.
  • a surgical microscope arrangement comprises a surgical microscope, a computation unit for generating a virtual image, and insertion means (in particular image combiner) for superimposing the virtual image in the real image.
  • the fade-in means may, for example, be a prism or a semitransparent projection surface.
  • the fade-in means can also be a projector which projects both the real image and the virtual image.
  • the arithmetic unit is set up for the continuous generation of the virtual image to be superimposed, in particular on the basis of volume data of the operating area, taking into account a constantly changing relative viewing direction of the surgical microscope on the operating area.
  • the means for monitoring the relative viewing direction comprise, in particular, a first inertial sensor, which is fixedly attached to the surgical microscope, and a second inertial sensor, which is fixedly attached to the surgical area.
  • the means may comprise a 3D digital camera fixedly attached to the surgical microscope and directed to the surgical site or fixedly attached to the surgical site and directed to the surgical microscope.
  • the 3D camera is set up to produce three-dimensional surface scans of the detected body. The method is particularly applicable to dental and jaw operations where the patient is conscious.
  • FIG. 1 shows a surgical microscope arrangement according to the invention
  • FIG. 2 shows two representations of a real image of the operating region according to FIG. 1, which is superimposed into a virtual image, from two different viewing directions;
  • FIG. 3 shows an alternative surgical microscope arrangement according to the invention;
  • FIG. 4 shows a representation of a real image of the operating region according to FIG. 1, in which a calibration image is superimposed, before and after calibration.
  • FIG. 1 schematically shows a surgical microscope arrangement 10 according to the invention.
  • a patient P whose tooth 1 is to be subjected to root canal treatment (endodontics) is shown in simplified form.
  • root canal treatment endodontics
  • the top view of the tooth 1 with the pulp chamber exposed essentially reveals the operating area 15 as seen by the dentist during the operation.
  • This real image 13 is shown in the right image area.
  • the dentist can observe the operation area 15.
  • the real image 13 of the operating region 15 is fed via two lenses 16 into the surgical microscope 1 1 and further guided therein to two eyepieces 17.
  • the dentist looks into the eyepieces 17, in which the visible for him real image 13 is displayed.
  • the real image 13 appears spatially as a stereo image due to the two separate light paths for the dentist.
  • the invention also includes those surgical microscopes that do not generate a stereo image.
  • two projectors 20 are provided which feed a virtual image 14 into the surgical microscope 1 1.
  • the virtual image 14 is superimposed into the real image 13 by means of an image combiner 19.
  • the dentist now sees next to the real image 13 also the superimposed virtual image 14.
  • the virtual image 14 is generated by a PC 12, which relies on tomographically generated or edited 3D volume data of the patient's tooth or jaw region, which will be even more detailed below is explained.
  • There are two inertial sensors ⁇ ⁇ 8 ⁇ and 18 2 are provided, each of which can accommodate the accelerations in the six spatial directions.
  • the first inertial sensor 18i is fixedly attached to the surgical microscope 1 1.
  • the second inertial sensor 18 2 is attached to the patient P, in particular to the head of the patient P. When the head of the patient P moves, essentially the second inertial sensor 18 2 and the tooth 1 make the same movements.
  • FIG. 2 a the real image 13 of the operating region 15 is shown enlarged.
  • the orientation of the direction of view B of the dentist on the operation area 15 is shown.
  • image data 3, 4 which are inserted in the real image 13, can now be recognized by the dentist.
  • This is an artificial representation of root canals 3 and a display of planning data / marker points 4, which are positioned at the root tips.
  • the root canals 3 and the root tips 4 are not visible in the real image 13, since they are hidden by the dentin and the pulp.
  • the data 3, 4 displayed in the real image 13 are parts of a virtual image 14, which was generated by an evaluation of tomographic data of the tooth 1.
  • the dentist can now recognize the position and orientation of the root canals 3 in the image thus supplemented without the real root canals actually being visible. If the dentist moves the surgical microscope 1 1 in order to view the tooth from a different perspective, it thus changes the viewing direction B, which should be clarified with reference to FIGS. 2 b and 2 a. Of course, the same applies if the position of the surgical microscope 1 1 remains unchanged, but the patient's head moves, or if both the surgical microscope 1 1 and the patient's head are moved. Consequently, it depends only on the relative change between the surgical microscope 1 1 and operation area 15.
  • the viewing direction B is now slightly inclined to the left in FIG. 2b.
  • the orientation and arrangement of the root canals 3 and marked root tips 4 changes in the field of vision of the dentist.
  • Such a change in the relative orientation between tooth 1 or operating area 15 and the dentist or the surgical microscope is detected by the aforementioned inertial sensors 18.
  • changed orientation can now be calculated, as the root canals 3 and 4 root tips are aligned relative to the new direction of view B.
  • the virtual image has to be recalculated.
  • graphics libraries such as OpenGL or DirectX. In the example of FIG. 2b, this now leads to the perspective arrangement of the root canals 3 and the markings 4 being shifted further to the left.
  • FIG. 3 shows an alternative embodiment of the surgical microscope 11.
  • the surgical microscope is now essentially divided into two and has an object unit 22 and a head unit 23.
  • the object unit 22 is directed to the operation area 15 and comprises two cameras 21 which record and digitize the real image 13 in stereo.
  • the digitized real image 13 ' is now transmitted to the PC 12.
  • Within the PC 12 is a digital overlay with a digital virtual image 14 '.
  • the digitized real image 13 'and the digital virtual image 14' are transmitted to two projectors 20 which are arranged in the head unit 23.
  • the projectors 20 now project the real image 13 and the virtual image 14 into the respective eyepieces 17.
  • the designation of the images is of only insignificant importance as to whether they are present optically or digitized. Thus, the images are equally referred to as such, regardless of whether they are digitized or optically available. In the figures, only a distinction is made by the fact that digital present images are provided with a dashed reference numeral, while optically perceivable images (light rays) are provided with unmarked reference numerals.
  • the calibration of the surgical microscope arrangement 10 will be described with reference to FIG.
  • the dentist sees through the surgical microscope 1 1 the real image 13 of the operation area 15.
  • a virtual calibration image 25 which was generated from tomographic data of parts of the surface of the operation area 15, appears.
  • the local alignment between the calibration image 25 and the real image is still incorrect at the beginning.
  • the dentist by a user input, for example by pulling mice or by moving the surgical microscope itself, make a rotational movement, zoom, and a translational movement of the calibration 25 and bring the calibration 25 in coincidence with the corresponding areas of the real image 13, such can be seen in Figure 4b.
  • a three-dimensional representation of a region of the tooth surface is suitable as the calibration image.
  • a 3D scanning camera 24 is further provided.
  • this 3D scanning camera 24 can detect surface areas of the operating area or of the patient three-dimensionally.
  • Particularly suitable for this purpose are the already mentioned SD-scan cameras.
  • the 3D scan camera 24 can detect changes to a three-dimensional object, including changes in the relative orientation of a rigid three-dimensional object relative to the 3D scan camera.
  • a 3D surface scan of the surgical area is generated by the 3D scan camera 24, which is used as the basic registration image. Special points are stored and tracked in the base registration image. Any change in the image detail which the 3D scan camera 24 constantly monitors is recognized and compared with the base registration image and the corresponding points in the space. Deviations from this can be detected quickly, and the exact deviation in space can be quickly calculated according to the accuracy of the 3D scanning camera 24 by adjusting the new position of the points with the old positions. In this way, the translation vectors and rotation vectors of these points can be calculated, from which in turn the change of the relative orientation and thus the change of the viewing direction B can be calculated.
  • FIG. 3 shows a holding arm 26 in the form of a multi-jointed arm, on which the surgical microscope (at least the object unit 22) is held.
  • the surgical microscope at least the object unit 22
  • sensors 27 are integrated, through which the angular positions of the joints can be detected. From this, in turn, movements of the surgical microscope 1 1 can be determined.
  • the second inertial sensor 18 2 which is fixedly disposed on the operating region 15, changes in the relative orientation and thus the viewing direction B can be determined.

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  • Health & Medical Sciences (AREA)
  • Physics & Mathematics (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Analytical Chemistry (AREA)
  • General Physics & Mathematics (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Multimedia (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Abstract

L'invention concerne un procédé pour faire fonctionner un ensemble formant microscope chirurgical (10). Une image réelle (13) d'un champ opératoire visible (15) d'un corps à traiter (P), à laquelle une image virtuelle (14) est superposée, est représentée dans un microscope chirurgical (11). L'image virtuelle (14) superposée est générée par l'unité de calcul (12), notamment par référence à des données de volume tomographique du champ opératoire (15) ou des données de volume sous forme de données de préparation ou de repérage. L'image virtuelle (14) à superposer est générée sur le champ opératoire (15) avec prise en compte d'une direction d'observation (B) du microscope chirurgical (11). Au cours d'une intervention chirurgicale, la direction d'observation relative (B) entre le champ opératoire (15) et le microscope chirurgicale (11) est surveillée en permanence et l'image virtuelle (14) est recalculée au moins lors d'un changement de la direction d'observation relative (B) et l'image virtuelle (14) recalculée est superposée à l'image réelle.
PCT/EP2016/055807 2015-03-26 2016-03-17 Procédé pour faire fonctionner un ensemble formant microscope chirurgical WO2016150812A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP16711576.5A EP3274753A1 (fr) 2015-03-26 2016-03-17 Procédé pour faire fonctionner un ensemble formant microscope chirurgical

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102015104560.5A DE102015104560A1 (de) 2015-03-26 2015-03-26 Verfahren zum Betreiben einer Operationsmikroskopanordnung
DE102015104560.5 2015-03-26

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Publication Number Publication Date
WO2016150812A1 true WO2016150812A1 (fr) 2016-09-29

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PCT/EP2016/055807 WO2016150812A1 (fr) 2015-03-26 2016-03-17 Procédé pour faire fonctionner un ensemble formant microscope chirurgical

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EP (1) EP3274753A1 (fr)
DE (1) DE102015104560A1 (fr)
WO (1) WO2016150812A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP4282379A4 (fr) * 2021-02-10 2024-08-07 Zumax Medical Co Ltd Système de diagnostic et de traitement de microscope chirurgical

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Publication number Priority date Publication date Assignee Title
DE102022120203A1 (de) 2022-08-10 2024-02-15 Carl Zeiss Meditec Ag System zum Erfassen und Visualisieren von OCT-Signalen

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DE102007009543A1 (de) * 2007-02-27 2008-08-28 Leica Microsystems (Schweiz) Ag Mikroskopgerät mit Positionserfassung
EP2441410A1 (fr) * 2010-10-13 2012-04-18 KUKA Laboratories GmbH Procédé de création d'une image médicale et poste de travail médical

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EP2099377B1 (fr) 2007-06-18 2013-10-30 BrainLAB AG Procédé et système d'intégration d'information d'un image provenant d'une source extérieure
DE102007054907A1 (de) 2007-11-15 2009-05-28 Sirona Dental Systems Gmbh Verfahren zur optischen Vermessung von Objekten unter Verwendung eines Triangulationsverfahrens
DE102010003836B4 (de) * 2010-04-09 2013-11-21 Leica Microsystems (Schweiz) Ag Mikroskopgerät und Mikroskopieverfahren

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DE102007009543A1 (de) * 2007-02-27 2008-08-28 Leica Microsystems (Schweiz) Ag Mikroskopgerät mit Positionserfassung
EP2441410A1 (fr) * 2010-10-13 2012-04-18 KUKA Laboratories GmbH Procédé de création d'une image médicale et poste de travail médical

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP4282379A4 (fr) * 2021-02-10 2024-08-07 Zumax Medical Co Ltd Système de diagnostic et de traitement de microscope chirurgical

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DE102015104560A1 (de) 2016-09-29
EP3274753A1 (fr) 2018-01-31

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