WO2022238427A1 - Dispositif et procédé d'établissement de repères avec assistance optique - Google Patents

Dispositif et procédé d'établissement de repères avec assistance optique Download PDF

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Publication number
WO2022238427A1
WO2022238427A1 PCT/EP2022/062677 EP2022062677W WO2022238427A1 WO 2022238427 A1 WO2022238427 A1 WO 2022238427A1 EP 2022062677 W EP2022062677 W EP 2022062677W WO 2022238427 A1 WO2022238427 A1 WO 2022238427A1
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WO
WIPO (PCT)
Prior art keywords
image data
projection
data
landmark
image
Prior art date
Application number
PCT/EP2022/062677
Other languages
German (de)
English (en)
Inventor
Theodoros THEODORIDIS
Original Assignee
Theodoridis Theodoros
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 Theodoridis Theodoros filed Critical Theodoridis Theodoros
Priority to EP22728792.7A priority Critical patent/EP4337130A1/fr
Publication of WO2022238427A1 publication Critical patent/WO2022238427A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B2090/366—Correlation of different images or relation of image positions in respect to the body using projection of images directly onto the body

Definitions

  • the invention relates to a method and a device for the optical support of landmark-supported interventions.
  • interventions are known in medicine in which liquids or tissue samples are taken from a patient or substances are fed into the body using special instruments such as syringes, cannulas or needles.
  • Such interventions include, for example, punctures, injections or biopsies.
  • the interventions mentioned require a high degree of precision and skill on the part of the person treating the patient, so that the respective instrument is inserted so precisely that the removal or injections take place at the desired locations, i.e. the desired tissue is removed or the desired structures are supplied with an active substance will. It is also crucial not to damage any sensitive tissue, organs, vessels or nerves during the procedure.
  • the correct selection of the puncture site, the puncture angle and the puncture depth are essential for the success of such an intervention.
  • the treating person usually determines these parameters before carrying out the intervention using images that were created using imaging methods, for example using X-ray images, computed tomography images (CT), magnetic resonance images (MRT) or ultrasound images (US). 2
  • the treating person can then orientate himself using so-called landmarks of the patient's body.
  • Landmark-based interventions are therefore interventions in which the person treating the patient orients himself to palpatory anatomical points on the patient's body during the intervention and does not use any additional imaging methods to control the puncture site, the puncture angle and the puncture depth.
  • interventional injection therapy on the spine this means that the cannula is placed and advanced solely on the basis of anatomical landmarks and the experience of the treating person.
  • the practitioner orients himself, for example, on the spinous processes of the vertebrae or the position of the pelvic bones in order to determine the ideal puncture position for the respective treatment.
  • a disadvantage of this known method of landmark-supported intervention is that the treating person must have a great deal of experience in order to actually be able to carry out the best possible intervention based solely on the anatomical landmarks. Accordingly, imaging methods are used in whole or in part in a large number of such interventions. X-ray image converters and computed tomography (CT) are preferred imaging methods. Both methods are associated with a high level of radiation exposure for the patient, at least cumulatively over the required treatment time, which requires repeated treatments.
  • CT computed tomography
  • the additional radiation exposure during therapy can be 10 to 100 times the radiation exposure of the diagnosis, depending on the repetition and frequency of the treatments.
  • Such high radiation exposure applies wherever possible due to the high health risks for the patient 3 without jeopardizing patient safety during the intervention to be carried out.
  • the region of interest is understood to mean the part of the body that includes the structure to be treated and at which the intervention is to be carried out accordingly.
  • the invention is based on the idea that an image of the ROI obtained by means of imaging methods, in particular by X-ray, computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound (US), is projected onto the corresponding part of the patient's body during the intervention.
  • CT computed tomography
  • MRI magnetic resonance imaging
  • US ultrasound
  • the image data mentioned can also be supplemented by additional light image data.
  • the light image data also relates to the ROI and facilitates the positioning of the image projection.
  • the image data obtained by means of imaging methods are superimposed congruently with the light image data in order to enable an improved adaptation of the projection to the anatomy of the ROI.
  • the projected image includes additional information that simplifies the intervention for the practitioner.
  • This includes, for example, information about the puncture site, the puncture angle and the puncture depth.
  • the additional information includes, for example, a marking of the puncture site; also an indication of the angle, a graphic marking or a numerical value for the puncture angle and/or a numerical indication of the length of the puncture depth.
  • a scale is preferably depicted on the image, by means of which the projection of the image can be adapted to the real size. If a scale of 10 cm, for example, is given on the image, this scale must also measure 10 cm in the projection.
  • a projection device for projecting the image onto the patient's body is required to carry out the method according to the invention.
  • a projection device comprises a projection unit for light projection of image files and a data memory for storing image files in particular.
  • the exchange or the transmission of data between an external device, for example a computer, a tablet or another storage unit for providing data, and the projection device can take place wirelessly or with a cable by appropriate means. 5
  • the projection device preferably also comprises a distance sensor which is suitable for measuring the distance or the path between the projection device and the projection surface.
  • the projection surface is understood to be the part of the patient's body onto which the image data is projected.
  • the distance data can be useful in calculating a true-to-scale projection of the image data onto the patient.
  • the projection device preferably includes a microprocessor which is suitable for calculating a realistic projection of the image data onto the projection surface from the information on the size and resolution of the image data and the distance between the projection device and the projection surface determined by the distance sensor.
  • a realistic projection of the image data means that the image data is projected onto the patient in the true-to-scale size, so that the projection and the real anatomy of the patient are congruent at least to the extent that they correspond in size.
  • the projection device then carries out a corresponding size adjustment automatically, for example by means of a digital zoom or a lens zoom.
  • the projection device otherwise corresponds in structure to
  • An oblique projection of the images is advantageous so that the treating person covers the projected image as little as possible during the intervention.
  • the projection unit also includes the option of short-distance projection through the implementation of special lens and/or mirror systems such as aspheric lenses.
  • a short-distance projection is advantageous so that the device can also be used in a space-saving manner in smaller treatment rooms. 6
  • the invention also includes a method for image-supported intervention with landmarks.
  • a method according to the invention for image-supported intervention with landmarks comprises at least the following steps:
  • the image data are preferably X-ray image data, CT image data, MRT image data or also US image data.
  • the image data can be two- or three-dimensional.
  • the image data mentioned can also be supplemented by additional light image data.
  • the light image data also relates to the region of interest and is used to facilitate the alignment of the later projection.
  • the image data are superimposed congruently with the light image data in order to enable an improved adaptation of the projection to the anatomy of the region of interest.
  • the procedure for image support of landmark-based interventions can also include the following steps:
  • step (A1) providing region-of-interest image data and superimposing said region-of-interest image data on said light image data; and (D1) hiding the light image data and optionally further data from the projection, step (A1) preferably taking place after step (A) and step (D1) taking place after step (D).
  • the data essential for the intervention are noted in the image files or in the image data in such a way that they can be read by the treating person in a later projection.
  • the data essential for the intervention include, for example, a scale for the true-to-scale projection of the image data, a marking of the puncture site, and information on the puncture angle, the puncture direction, and the puncture depth.
  • the projection device includes a corresponding automated option for image size correction and carries out this size calibration in an automated manner.
  • the device according to the invention has the advantage over the prior art that it is extremely space-saving and inexpensive. It is easy to operate and can be used in practically every medical practice, even outside of a larger clinic.
  • the method according to the invention has the advantage over the prior art that, in contrast to known image-assisted interventions that use imaging methods with a high radiation exposure, it does not entail any additional radiation exposure. This also applies if a large number of interventions have to be carried out as part of a therapy, because the procedure itself does not involve any additional radiation exposure, since the necessary images have already been taken as part of the diagnosis or a check-up.
  • the method according to the invention has the advantage over the known landmark-supported intervention that the supportive projection of the image and intervention data means that appropriate interventions can also be carried out safely by relatively inexperienced practitioners. As a result, a large number of patients can be treated without additional radiation exposure.
  • FIG. 2 shows the processed image file according to FIG. 1 supplemented by a scale and information on the image resolution
  • FIG. 3 shows an exemplary arrangement of the projection device for projecting the image file onto the patient
  • FIG. 4 shows the image file according to FIG. 2 projected onto a patient.
  • FIG. 1 shows an X-ray image 1 of an ROI in the region of the lumbar spine, prepared according to the invention, with the marked vertebrae L3 to L5.
  • the puncture site, the puncture angle and the puncture depth are marked as additional data for orientation for the treating person when carrying out the intervention.
  • Anatomical data 2 such as the course of the iliac crest, the median line and the lumbar vertebrae L3 to L5 are marked as an additional orientation aid for later alignment of the projection on the patient's body. These lines help with alignment for congruent projection of the X-ray image 1 onto the patient's body.
  • FIG. 2 shows the X-ray image 1 according to FIG.
  • the scale 5 helps with the correct size adjustment of the projection on the patient's body. As soon as the scale 5 is shown true to scale on the patient's body, ie in the present case has an actual length of 10 cm in the projection, the projection corresponds to the actual scale of the x-ray image.
  • the treating person can use the anatomical data 2, FIG. 1) for orientation, such as the course of the iliac crest or the position of the lumbar vertebrae, which he can see or feel on the patient.
  • Figure 3 shows a possible arrangement of the projection device 6 for projecting an image file on the body of a patient P, present on the 10
  • the projection 7 is true to scale. Using specific markings on the image file, the treating person A aligns the projection 7 on the body.
  • the projection device 6 can be provided in a mobile manner, for example as a desktop device or mounted on a stand. Stationary attachment is also conceivable, for example to permanently equip different treatment rooms with such a projection device 6 .
  • FIG. 4 shows the projection 7 of the image file 1 according to FIG. 2 onto the region of interest, in this case the back of the patient P. It is easy to see how helpful the projection 7 of the image prepared according to the invention with the aid of the projection device according to the invention is for the treating person A.
  • the treating person A receives a comprehensive insight into the internal anatomy of the patient (2, Fig. 1). Together with the additional data on the intervention (3, FIG. 1) such as puncture site, puncture angle and puncture depth, this enables the treating person A to carry out a much more precise treatment with better treatment success and fewer risks for the patient.
  • the data not required for the further intervention for example the anatomical data (2, Fig. 1) can optionally be hidden from the projection 7 so that, for example, only the data for the intervention (3, Fig. 1) such as the puncture site, puncture angle and puncture depth are projected.
  • the treating person A himself decides which data are needed for the intervention and should be part of this reduced projection 7 .

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Apparatus For Radiation Diagnosis (AREA)

Abstract

L'invention concerne un procédé d'assistance par images destiné à des interventions assistées par des repères, comprenant la fourniture de données d'image de la région d'intérêt au moyen de procédés d'imagerie ; la détermination des données essentielles pour l'intervention ; la mise en œuvre des données essentielles pour l'intervention dans les données d'image pour la projection et la projection fidèle à l'échelle des données d'image sur la région d'intérêt. L'invention concerne également un dispositif de projection pour la mise en œuvre du procédé. Le procédé et le dispositif selon l'invention permettent une orientation nettement améliorée du personnel soignant pendant une intervention assistée par des repères sans irradiation supplémentaire.
PCT/EP2022/062677 2021-05-11 2022-05-10 Dispositif et procédé d'établissement de repères avec assistance optique WO2022238427A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP22728792.7A EP4337130A1 (fr) 2021-05-11 2022-05-10 Dispositif et procédé d'établissement de repères avec assistance optique

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102021112230.9A DE102021112230A1 (de) 2021-05-11 2021-05-11 Vorrichtung und Verfahren zum optisch unterstützten Landmarking
DE102021112230.9 2021-05-11

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WO2022238427A1 true WO2022238427A1 (fr) 2022-11-17

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EP (1) EP4337130A1 (fr)
DE (1) DE102021112230A1 (fr)
WO (1) WO2022238427A1 (fr)

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102012025374A1 (de) * 2012-12-27 2014-07-17 Mehran Mahvash Mohammadi Augmented-Reality-System (Erweiterte Realität) durch direkte Bildprojektion für computergestützte und bildgeführte Neurochirurgie
US20140303662A1 (en) * 2012-11-09 2014-10-09 Kabushiki Kaisha Toshiba Puncture support device
EP3714860A1 (fr) * 2017-12-15 2020-09-30 Suzhou Keling Medical Technology Co., Ltd. Procédé et dispositif de localisation d'une cible sur un corps humain à l'aide de caractéristiques veineuses superficielles

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP6534096B2 (ja) 2014-06-25 2019-06-26 パナソニックＩｐマネジメント株式会社 投影システム
US10639104B1 (en) 2014-11-07 2020-05-05 Verily Life Sciences Llc Surgery guidance system

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140303662A1 (en) * 2012-11-09 2014-10-09 Kabushiki Kaisha Toshiba Puncture support device
DE102012025374A1 (de) * 2012-12-27 2014-07-17 Mehran Mahvash Mohammadi Augmented-Reality-System (Erweiterte Realität) durch direkte Bildprojektion für computergestützte und bildgeführte Neurochirurgie
EP3714860A1 (fr) * 2017-12-15 2020-09-30 Suzhou Keling Medical Technology Co., Ltd. Procédé et dispositif de localisation d'une cible sur un corps humain à l'aide de caractéristiques veineuses superficielles

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
IAN WATTS ET AL: "ProjectDR", VIRTUAL REALITY SOFTWARE AND TECHNOLOGY, ACM, 2 PENN PLAZA, SUITE 701NEW YORKNY10121-0701USA, 8 November 2017 (2017-11-08), pages 1 - 2, XP058442302, ISBN: 978-1-4503-5548-3, DOI: 10.1145/3139131.3141198 *

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EP4337130A1 (fr) 2024-03-20
DE102021112230A1 (de) 2022-11-17

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