WO2016191878A1 - Transducteurs ultrasonores utilisés comme dispositifs d'assistance à l'implantation - Google Patents

Transducteurs ultrasonores utilisés comme dispositifs d'assistance à l'implantation Download PDF

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Publication number
WO2016191878A1
WO2016191878A1 PCT/CA2016/050629 CA2016050629W WO2016191878A1 WO 2016191878 A1 WO2016191878 A1 WO 2016191878A1 CA 2016050629 W CA2016050629 W CA 2016050629W WO 2016191878 A1 WO2016191878 A1 WO 2016191878A1
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WO
WIPO (PCT)
Prior art keywords
implantation
implantable medical
tissue
medical device
interest
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PCT/CA2016/050629
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English (en)
Inventor
Thomas Gregory LANDRY
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Nova Scotia Health Authority
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
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Publication of WO2016191878A1 publication Critical patent/WO2016191878A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/18—Internal ear or nose parts, e.g. ear-drums
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • 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
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A61B2090/3929—Active markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0093—Ultrasound system, e.g. for inducing coagulation during eye surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0526—Head electrodes
    • A61N1/0529—Electrodes for brain stimulation
    • A61N1/0534—Electrodes for deep brain stimulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0526—Head electrodes
    • A61N1/0541—Cochlear electrodes

Definitions

  • Implantable medical devices have become increasingly important in the care and treatment of various diseases and conditions, be they simple orthopedic devices for internal fixation of bones or complex devices such as replacement heart valves, deep brain stimulators, and cochlear implants. Proper implantation of such medical devices is important for proper function. While many devices may be placed (however suboptimally) with reference to X-ray or other images of the site of implantation, some are particularly difficult to implant due to fragility / criticality of the surrounding tissue, difficulty of access to the site of implantation, and/or lack of structural information (e.g., due to anatomical features that mask the site from some images). Additionally, current methods of implantation that are performed under anesthesia lack feedback with respect to positioning within the site, other than inspection of those areas directly visible to the surgeon; fine positioning is limited to the accuracy of the available views or images.
  • CIs cochlear implants
  • These implants are also often required to avoid contact with the basilar membrane, as contact could lead to damage, increase inflammatory response, and potentially severe reduction in residual hearing from that cochlea.
  • Preservation of residual hearing is increasingly important, as CIs become more often a complementary treatment to hearing loss of a specific frequency range rather than complete profound hearing loss.
  • DBSIs deep brain stimulators
  • CT computed tomography
  • an implantable medical device has aids to implantation in an implantation site having a tissue of interest, the aids including an ultrasound transducer positioned so as to face the tissue of interest.
  • Implementations may include one or more of the following features.
  • the site has a second tissue of interest and the aids further include a second ultrasound transducer positioned so as to face the second tissue of interest.
  • the site has a several tissues of interest and the aids include several ultrasound transducers so arranged as to produce spatial information for each respective tissue of interest.
  • the device is a cochlear implant.
  • the device is a deep brain stimulator.
  • a system for implantation of an implantable medical device has an implantable medical device as described above, electrical connections between the transducer(s) on that device and an integrated control unit. Implementations may include one or more of the following features.
  • the integrated control unit is operatively coupled to a computer.
  • the computer has a monitor with visual indicia of distance to the tissue of interest.
  • the computer is capable of producing audible alerts when the transducer is closer than a predetermined distance from the tissue of interest.
  • the integrated control unit has a field programmable gate array.
  • the integrated control unit has a multiplexer.
  • a method of implanting an implantable medical device in a living subject includes inserting the implantable medical device while actively coupled to a system having a monitor as described above and positioning the device according to the indicia.
  • a method of implanting an implantable medical device in a living subject includes inserting the implantable medical device while actively coupled to the system having alerts as described above and positioning the device with lninimum eliciting of the alerts.
  • the implantable medical devices described herein are constructed so as to provide improved accuracy of positioning during implantation.
  • the methods described herein improve the process of implantation in that enhanced feedback as to positioning is provided.
  • FIG. 1 shows a perspective view (A) the front and (B) the back of an array of five ultrasound transducers for use with an implantable medical device.
  • FIG. 2 shows a partial cutaway perspective of the array of FIG. 1 embedded in silicone at the tip of a cochlear implant.
  • FIG. 3 shows the arrangement of important anatomical elements with respect to the array of FIG. 1 during insertion in two use cases, with possible visual feedback for each case.
  • FIG. 4 shows a block diagram for a system for guidance and/or verification of implantation.
  • FIG. 5 shows graphs of voltage vs time, with a dashed vertical line representing distance zero at left and the end of the trace representing distance 1 mm at right. From top to bottom these are: baseline, distance ⁇ 700 ran, distance ⁇ 500 urn, distance ⁇ 300 um, distance ⁇ 100 um. All distance graphs were produced by subtracting the baseline at top from the raw data, per the method described herein for reduction of ring noise.
  • FIGs. 6 through 10 depict various geometries of transducer arrays, with the shaded regions each representing the front of an ultrasound transducer.
  • FIG. 11 illustrates electrical paths for daisy chaining of a transducer array to electrodes of an implant.
  • FPGA field programmable gate array
  • Implantable medical devices methods of implantation, and among other things, systems for guidance and/or verification of proper implantation are described herein.
  • Devices equipped with ultrasound transducers are described that are capable of providing realtime echolocation information as to their position in space.
  • Single element transducers obtain information about the material in a line directly in front of the transducer. This information is transmittable to a system equipped with visual, audio, or other output modalities appropriate to the environment.
  • a surgeon, or any other person qualified to implant a given medical device can receive this feedback from the system.
  • the feedback can include an alert, for example, if the implant may be about to contact some tissue or structure that he/she is aiming to avoid contact with.
  • the feedback can also include distance information to help direct the implant towards some tissue/structure he/she is aiming to contact or have a specific proximity to.
  • an implantable medical device has an ultrasound transducer attached to its exterior, in a position that in the process of implantation would face an anatomical feature, the distance from which is important to detennine optimal implantation.
  • the transducer is embedded in silicone or some other carrier material to seal it from the biological environment.
  • the transducer is embedded in a silicone tip that would ordinarily be present in certain implantable medical devices.
  • an implantable medical device has an ultrasound transducer embedded near its exterior in a position that in the process of implantation would face an anatomical feature, the distance from which is important to determine optimal implantation.
  • the transducer is embedded in silicone or some other carrier material to seal it from the biological environment.
  • ultrasound signal to noise ratio for each transducer can be acoustically optimized by applying a coating as a matching layer, of such thickness as to match to a quarter wavelength of the predetennined ultrasound pulse frequency. This feature helps bridge the acoustic impedance mismatch between the piezoelectric substrate of the transducer and its local environment, which can be expected to be water-based in this application.
  • the presence of the matching layer, if any, and/or the identity and thickness of the material for the matching layer will be selected based in part on the acoustic properties of the silicone.
  • an array 101 of 5 ultrasound transducers 103, 105, 107, 109, 111 are arranged in a "box" on a core of conductive epoxy, which forms the ground connection for all transducers via the ground lead 125.
  • Individual elements are electrically isolated using non-conductive material such as epoxy 123.
  • Electrical leads 113, 115, 117, 119, 121 are respectively attached to transducers 103, 105, 107, 109, 111, with each lead attached on its other end so as to provide independent power and input/output to each transducer.
  • the array 101 is fixed to or within an implantable medical device, which in FIG. 2 is depicted as a cochlear implant 201 having the array 101 embedded in silicone that culminates in a tip 203.
  • the ultrasound transducers used are less than about 250 square micrometers in size. In some embodiments, the ultrasound transducers used are less than about 1 square millimeters in size. In some embodiments, the ultrasound transducers used are less than about 5 square millimeters in size. In some embodiments, the ultrasound transducers used are less than about 10 square millimeters in size.
  • the size of the ultrasound transducers used depends upon a number of factors, including the size of the implantable medical device, the space available at the site of implantation, and the resolution required during implantation. In some embodiments, multiple ultrasound transducers exist in/on the implantable medical device to provide spatial information from multiple positions.
  • the positioning of the transducers can be used to create two- or three-dimensional images in the vicinity of the implantable medical device. See for example U.S. Patent Ser. No. 4,271,706, hereby incorporated by reference.
  • ultrasound transducers are arranged into a polygon to provide several independent one-dimensional views with known spatial relationships. See FIGs. 1, 2, 6- 10 for examples of potential arrays of ultrasound transducers arranged in geometries appropriate to such views, including box, wedge, pyramid, and wheel geometries.
  • Array geometries are not limited to what are depicted here and can have any number of individual elements, including wedge shapes with any number of elements, radial shapes with any number of elements (10 sides given in the example Figure), pyramidal shapes with any number of elements, and tetrahedral shapes with any number of elements.
  • the array geometry includes multiple elements facing in the same direction; in some embodiments, the array geometry uses only one element for each direction or polygon face.
  • the ultrasound transducers are fashioned in shapes other than the rectangular ones depicted herein, including circle, square, hexagon, etc.
  • the array only includes elements on the polygonal sides of interest, such as in the L-shape example Figure, which is two elements situated at a right angle to each other. Arrays can be mounted so as to face out from an implant at any arbitrary predetermined orientation w.r.t. the implant.
  • the array includes multiple geometries, such as a radial array and a forward-looking pyramidal array.
  • the array has only a single element, providing one-dimensional distance information for, e.g., the tip of an implant; such a possibility is demonstrated in Example 2 below.
  • the designer can choose to implement any array geometry, number of elements, shape of each element, or orientation of each element w.r.t. the implant as seems best given the specific application, cost point, resolution required, complexity of implantation site, and other factors relevant to implantation of a medical device.
  • FIG. 3 shows examples of how data from the 5 -element array could be displayed to person implanting the device for two use cases of a cochlear implant.
  • the elements are defined based on the direction within the cochlea that they project pulses (forward, medial, lateral, apical, basal).
  • each use case is depicted on top in midmodiolar and longitudinal cross sections of the scala media (SM), scala tympani (ST), and scala vestibule (SV), with a corresponding output modality on bottom.
  • SM scala media
  • ST scala tympani
  • SV scala vestibule
  • Each transducer produces an echo corresponding to the distance from the tissue.
  • the output shows, with arrows on a distance scale, how far away the echoes are from each transducer.
  • the implantable medical device is a cochlear implant. In some embodiments, the implantable medical device is an implantable deep brain stimulator. In some embodiments, the implantable medical device is an implantable pacemaker. In some embodiments, the implantable medical device is an implantable hearing aid. In some embodiments, the implantable medical device is a tinnitus masker. In some embodiments, the implantable medical device is an implantable defibrillator. In some embodiments, the implantable medical device is an auditory brainstem implant. In some embodiments, the implantable medical device is a brain stimulator for epilepsy. In some embodiments, the implantable medical device is an implantable cerebellar stimulator.
  • the implantable medical device is an implantable intracranial pressure monitor.
  • the implantable medical device is an implantable nerve stimulator. Diseases or conditions treated, diagnosed, and/or monitored by such implantable medical devices vary widely depending on the nature of each device.
  • Applicable implantable medical devices of the invention may include any device classified in the U.S. Food and Drug Administration device class III in which the device classification contains the word "implant", "implanted”, or "implantable”; see htt ://www. accessdata.fda. gov/scripts/ cdrli/cfdocs/cfpcd/classification. cfm for a database containing device classifications, applicable regulations and/or consensus standards for construction and/or testing of such devices, all of which are hereby incorporated by reference.
  • implantation of an implantable medical device of the present invention generally proceeds by the methods currently used, except that feedback during implantation allows for enhanced confidence in positioning. It may be that for some such procedures, the feedback provided is sufficient to complete the procedure while reducing the invasiveness, by not requiring as large of an incision or by reducing the degree of tissue retraction needed for direct visualization.
  • cochlear implants are often positioned such that they are in close proximity to the modiolus, in order to maintain closeness with the spiral ganglion neurons of the auditory system. These implants are also often required to avoid contact with the basilar membrane, as contact could lead to damage, increase inflammatory response, and potentially severe reduction in residual hearing from that cochlea.
  • one or more ultrasound transducers are arranged in/on the implantable medical device such that it faces the modiolus when properly inserted, and/or one or more ultrasound transducers are arranged in/on the implantable medical device such that it faces the basilar membrane when properly inserted.
  • deep brain stimulators are implanted in particularly critical tissue, and it is extremely important that no major blood vessels are damaged during implantation.
  • Current practice in DBSI implantation calls for a pre- or intra-operative computed tomography scan of the brain to be captured in order to map a patient's brain structures and blood vessels. The patient's head is then fixed to a stereotaxic frame and device is implanted using the CT map and frame reference points to insert along a predetermined path.
  • one or more ultrasound transducers are arranged in/on the implantable medical device such that it faces the nearest blood vessel when properly inserted.
  • Systems for guidance and/or verification of proper implantation include an implantable medical device equipped with one or more ultrasound transducers, the transducer(s) being operatively coupled to a control unit that is capable of powering the transducers and transmitting the results to a computer for further analysis and display/alert.
  • An embodiment of such a system is shown in FIG. 4.
  • a transducer array 401 has one or more ultrasound transducers 403. Each transducer 403 is connected by an electrical lead 417 (grounded by wire 419) to a multiplexer 405, which is in turn connected to an ultrasound pulser/receiver 407.
  • An FPGA 409 is capable of sending clock sync to an analysis and output computer 411 as well as triggering commands to the ultrasound pulser/receiver 407.
  • the FPGA 409 is configured to output trigger events at a pre-programmed interval consistent with the desired rate of data acquisition and speed of multiplexer switching.
  • the pulser/receiver 407 Upon receiving a trigger event from the FPGA 409, the pulser/receiver 407 forwards the trigger event to the multiplexer 405 to initiate a delayed switch event, and to the computer 411 to begin acquisition of data.
  • the pulser/receiver 407 sends a pulse through the multiplexer 405 to pulse one of the ultrasound transducers 403, with the multiplexer 405 sending an indicator as to which transducer is pulsed to the computer 411.
  • the delayed multiplexer 405 switch event occurs, cycling to a new transducer awaiting the next trial.
  • Each pulse propagates through tissue and echoes are received by each transducer as an ultrasound signal.
  • the ultrasound pulser/receiver 407 by way of the multiplexer 405's signal path receives each ultrasound signal and outputs it to the computer 411, which is equipped with software and/or dedicated hardware to analyze each signal and display one or more indicia on a monitor 413, such as, for example, shown in FIG. 4.
  • the trigger event is interpreted by the multiplexer 405 to provide automatic cycling to the next transducer in sequence after a pre-programmed delay time, e.g., 0.5 ms.
  • the multiplexer 405, the ultrasound pulser/receiver 407, and the FPGA 409 are integrated into a single control unit 415.
  • the output includes color ranges (green, yellow, red) for each transducer in an effort to optimize positioning within the site of implantation.
  • the monitor has audio functionality to produce an audible alert if one or more of the transducers is judged too close to tissue within the site of implantation. In some embodiments, there is a visual alert if one or more of the transducers is judged too close to tissue within the site of implantation.
  • warning begins when the implant is within 10 mm of the tissue. In some embodiments, warning begins when the implant is within 5 mm of the tissue. In some embodiments, warning begins when the implant is within 4 mm of the tissue. In some embodiments, warning begins when the implant is within 3 mm of the tissue. In some embodiments, warning begins when the implant is within 2 mm of the tissue. In some embodiments, warning begins when the implant is within 1 mm of the tissue.
  • warning begins when the implant is within 0.5 mm of the tissue.
  • warning would begin when the implant tip is within 4 mm of the basilar membrane and increase in intensity once the implant tip is within 0.5 mm of the basilar membrane.
  • the increase in intensity is indicated by increase in volume, pitch, or speed of an aural alarm.
  • an alarm could be emitting brief beeps at a rate of 1/sec at 4.0 mm, increasing pro ortionally to 10/sec once the implant tip reaches 0.1 mm.
  • the increase in intensity is indicated by a change in color, brightness, flashing of text, or other visual indicia. In some embodiments, both aural and visual alarms are used.
  • implantable medical devices of the present invention are constructed so as to make the transducer electrically inactive after implantation is complete.
  • implantable medical devices of the present invention are constructed so as to allow for periodic or episodic re-activation of the transducer.
  • electrical leads are customarily available within the implantable medical device, which presents a signal path that can be utilized for activation of the transducer.
  • the ground wire for use with the transducer and implantation system e.g., during implantation
  • the electrical leads and ground wire for the transducer and implantation system may terminate in a plug at the exterior of the implantable medical device; during implantation, the plug can be mated to a corresponding connector and set of wires leading to the other parts of the implantation system, which can be removed post-implantation.
  • trigger rate is set internally in the pulser on a pre-programmed rate, obviating the need for an FPGA.
  • the pulse rate is controlled by software in the computer generating a trigger event which is sent to the
  • pulser/receiver obviating the need for an FPGA.
  • a multi-channel pulser/receiver is used, obviating the need for a multiplexer.
  • Software for analysis of the ultrasound signal may include analysis of time vs voltage for each transducer; for single element transducer systems, such software is available from, e.g., Daxsonics, and can be adapted to accept signal from multiple elements.
  • the site of implantation is small enough that echoes may return to the receiver before the initially generated pulse has decayed, thus potentially obscuring the signal.
  • Software for analysis of the ultrasound signal may also include reduction of this "ring noise" as follows: a baseline pulse is recorded from a position with little to no reflection, and when performing measurements of interest, this baseline is subtracted in order to produce a cleaner signal for analysis. In some embodiments, the baseline is established at the beginning of each session. In some embodiments, a baseline representing the characteristic ring noise for each transducer is saved on the computer for application to subsequent pulses. In some embodiments, the saved baseline is also optimized for the tissue or surgical site to be analyzed. In some embodiments, the software enables a raw signal display. In some embodiments, the software enables the display of the calculated distance to tissue for each ultrasound signal with appropriate labeling for each transducer.
  • each ultrasound transducer is attached (using conductive epoxy or welds, e.g.) to their own respective flexible electrical wires or leads, the other ends of which are then attached in an electrically operative manner to the rest of the system as described above (such as to a multiplexer).
  • the front sides of each ultrasound transducer are attached to their own respective flexible electrical wires or leads, the other ends of which are then electrically coupled to the rest of the system by way of the existing implant electrodes.
  • each has its own electrical connection and wire leading to a different respective connection at an implant electrode 1311 and 1313, each of which in turn has an electrical lead to attach to the implant power source and/or to the system as described above.
  • the implant electrodes are circular and the wires are attached on the inside; the common back face connection 1317 and electrical leads are depicted in FIG. 13 as dashed lines passing through the hollow space inside, so as to only touch each implant electrode at the relevant connection point.
  • the electrical leads are insulated by, e.g., silicone or Teflon coating.
  • the array was placed on a hot plate at 80°C to cure, for approximately 8 hours.
  • the array and ground lead were manually released from the mold.
  • the front face of the elements and the space between elements were cleaned of residual conductive epoxy.
  • Non-conductive epoxy e.g., 301 epoxy mixed with 3 micron aluminum oxide power in a 1 :2 ratio by weight
  • a thin wire strand was then attached to each element front face individually by conductive epoxy.
  • Each strand was soldered to the inner lead of a coaxial cable, giving 5 individual coaxial cables.
  • the coaxial shielding of all cables were then soldered together, and the array ground lead was soldered to this common shielding.
  • SMA SubMiniature version A coaxial RF
  • a system can be constructed that includes real-time ring noise correction and a monitor that continuously shows ring noise corrected data. Motion of the probe toward or away from the cochlear bone will result in a proportionate change in echo distance on the monitor.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Vascular Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Transplantation (AREA)
  • Cardiology (AREA)
  • Pulmonology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)

Abstract

L'invention concerne, entre autres choses, un dispositif médical implantable qui est équipé d'un ou de plusieurs transducteurs ultrasonores, positionnés de manière à fournir des informations spatiales pour permettre une implantation correcte. L'invention concerne également des procédés d'implantation et des systèmes de guidage et de vérification d'implantation correcte.
PCT/CA2016/050629 2015-06-04 2016-06-03 Transducteurs ultrasonores utilisés comme dispositifs d'assistance à l'implantation WO2016191878A1 (fr)

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US62/170,724 2015-06-04

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018149923A1 (fr) * 2017-02-15 2018-08-23 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Enveloppe d'implant décellularisée

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2300705A1 (fr) * 1999-10-01 2001-04-01 Life Imaging Systems Inc. Curietherapie 3d peroperatoire de la prostate, effectuee sous echoguidage
US20040049121A1 (en) * 2002-09-06 2004-03-11 Uri Yaron Positioning system for neurological procedures in the brain
US20060155358A1 (en) * 2005-01-10 2006-07-13 Laduca Robert Methods for placing a stent in a branched vessel
CA2811778A1 (fr) * 2010-09-21 2012-03-29 The Johns Hopkins University Systeme de detection optique destine a la chirurgie d'implants cochleaires

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2300705A1 (fr) * 1999-10-01 2001-04-01 Life Imaging Systems Inc. Curietherapie 3d peroperatoire de la prostate, effectuee sous echoguidage
US20040049121A1 (en) * 2002-09-06 2004-03-11 Uri Yaron Positioning system for neurological procedures in the brain
US20060155358A1 (en) * 2005-01-10 2006-07-13 Laduca Robert Methods for placing a stent in a branched vessel
CA2811778A1 (fr) * 2010-09-21 2012-03-29 The Johns Hopkins University Systeme de detection optique destine a la chirurgie d'implants cochleaires

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018149923A1 (fr) * 2017-02-15 2018-08-23 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Enveloppe d'implant décellularisée

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