WO2023066520A1

WO2023066520A1 - Medical system

Info

Publication number: WO2023066520A1
Application number: PCT/EP2022/025474
Authority: WO
Inventors: Roland Croner; Maciej Pech; Georg Rose
Original assignee: Otto-Von-Guericke-Universität Magdeburg
Priority date: 2021-10-19
Filing date: 2022-10-18
Publication date: 2023-04-27
Also published as: DE102021127102A1

Abstract

The invention relates to a medical system for carrying autonomous and/or remote-controlled surgical interventions on patients using robotics.

Description

medical system

The invention relates to a medical system for performing autonomous and/or remote-controlled operations on patients using robot technology. Medical operations and interventions using robots are becoming increasingly important in surgery or in general in image-guided interventional procedures. So far, partially automated systems have been most widespread, ie telemanipulators in terms of function, which are remotely controlled by a doctor from a neighboring room. A major weakness of these systems is the restriction of visualization to the surgical field using endoscopes. These systems do not allow risk structures to be made visible below the operational level. Better imaging, e.g. by means of magnetic resonance imaging (MRI), would therefore be desirable. However, due to the design of conventional robots, such imaging systems cannot be integrated into the system.

WO 2021/150902 A1 describes an MRT system that is coupled to a robot, the robot arm of which can be guided into the interior of the examination tunnel via a front access opening. The access opening is made in a front panel that covers the front of the magnet system.

US 2017/0371001 A1 describes an MRI system in which the main magnet has a slot through which a circumferential gap is provided for access for a surgical robotic device.

US 2021/0068701 A1 discloses an MRT system with a surgical robot coupled thereto. To reduce the necessary radiation distance, the MRI system is operated with a weak-field magnet. The coupling between the robot and the MRI system includes a rail arrangement for transversal displacement of the robot at the patient's bed.

The invention is therefore based on the object of specifying an improved medical system for operations on patients using robot technology. This object is achieved by a medical system having at least the following features: a) a magnetic resonance imaging (MRI) system with an examination tube in which a patient can be placed completely or at least with a significant or the majority of his body, b) with the MRT imaging compatible robot, through which the MRT imaging is at least essentially not disturbed, c) an automated control system for controlling the robot, which is set up to carry out autonomous and/or remote-controlled operations on the patient, the control system images of the MRT imaging are supplied intraoperatively in real time, the control system being set up to control the robot when carrying out the autonomous and/or remote-controlled operations as a function of the images of the MRT imaging.

In contrast to the telemanipulators mentioned, the medical system according to the invention thus allows an embodiment to carry out operations on the patient autonomously, ie without permanent remote control by the doctor. For this purpose, an advantageous robot that is compatible with MRT imaging is proposed, through which the MRT imaging is at least essentially not disturbed. In an advantageous embodiment, the robot is also designed in such a way that it is also compatible with regard to possible interference from the magnetic fields of the MRT system, ie the robot itself is not impaired in its function by the MRT either. For example, the robot can be non-magnetic and/or non-metallic, at least in the areas that are arranged on and in the MRI system. In particular, the robot can also be designed without an electric drive in this area, e.g. instead be equipped with a hydraulically and/or pneumatically operated drive system.

The medical system according to the invention also allows remote-controlled operations using robot technology, eg in the sense of telemanipulation. A combination is also possible, for example the autonomous execution of certain surgical steps and the remote-controlled execution of other surgical steps. In this sense, the automated control system for controlling the robot can work in a fully automated or partially automated manner, depending on the application. stay here receive the previously explained advantages of the system, such as the operation with MRT visualization with visibility of risk structures.

Due to MRT technology, the examination tube of the MRT system is designed as an examination tube that is essentially closed on the peripheral side in order to ensure a uniform magnetic field. The examination tube can be designed as a cylindrical tube, in particular with regard to its inside, in which the patient is to be placed.

The automated control system is used to control the robot depending on the images of the MRI imaging. The function of the control system can be controlled, for example, by means of intraoperative real-time imaging based on the MRT images. For example, the images can be evaluated by artificial intelligence functions (KI) and target structures on the patient that are to be the subject of the operation can be identified. Even after such structures have been relocated, for example as a result of operational manipulation, the structures can be automatically identified again.

According to an advantageous embodiment of the invention, it is provided that the examination tube, which is otherwise closed on the peripheral side, has one or preferably several peripheral through openings, in particular through bores running radially from the outside into the interior of the MRI system, through which a robot arm of the robot can be passed, wherein the control system is set up to automatically perform manipulations on the patient through one or more passage openings when performing the autonomous and/or remote-controlled operations on the patient by means of one or preferably multiple robot arms of the robot. Advantageously, a special design of the MRT system is thus proposed, in which the peripheral through-openings mentioned are present in the otherwise closed jacket of the examination tube. The coils and magnets of the MRT system are designed and arranged in such a way that the high degree of homogeneity of the magnetic field required for good imaging is nevertheless present within the examination tube where the patient is to be placed. The through-openings that are not in the form of slits each have a thickness over the circumference of the examination tube limited width. Its opening angle, measured from the center of the examination tube, is preferably less than 10°. By providing a plurality of radial through bores, which are arranged distributed over the circumference and possibly over the length of the examination tube, improved accessibility of the surgical sites can be ensured with reduced impairment of the homogeneity of the magnetic field. It is advantageous if at least two passage openings are provided on both sides opposite one another on the casing of the examination tube. At least the areas of the robot introduced into the through-holes should then not be magnetic and/or not metallic.

According to an advantageous embodiment of the invention, it is provided that at least those parts of the robot's drive system that are located in the examination tube are non-electrical and non-magnetic components, such as hydraulic and/or pneumatic components and/or cable pulls. For example, the robot can have a hydraulically and/or pneumatically operated drive system and/or a cable-operated drive system for actuating one or more robotic arms of the robot. As a result, the robot can be designed to be MRI-compatible.

According to an advantageous embodiment of the invention, it is provided that the control system is set up to evaluate images of the MRT imaging using at least one artificial intelligence function and thereby to recognize specific target structures on the patient. For example, the artificial intelligence function may include one or more of the following algorithms: Random Forest, Support Vector Machine, Multi-Layer Perceptron, Convolutional Neural Network, Recurrent Neural Network, Deep Learning.

According to an advantageous embodiment of the invention, it is provided that the robot is designed as a multi-armed robot or as an arrangement of several robots with at least two robot arms that can be controlled by the control system. In this way, simultaneous access from different angles to one or more surgical sites can be made possible by using a plurality of through-openings in the jacket of the examination tube, preferably radial through-bores. The invention is explained in more detail below on the basis of exemplary embodiments using drawings.

Show it

FIG. 1 shows a medical system with an MRT system in a sectional view from the side,

FIG. 2 shows the medical system according to FIG. 1 in a view in the longitudinal direction of the examination tube.

FIG. 1 shows a medical system 1 which has an MRT system 2 . The MRT system 2 has an examination tube 3 which is designed in the form of a tunnel with an interior 4 . A patient 5 can be placed in the interior 4 with at least a substantial part or the majority of his body, e.g. on a bed 6 . The examination tube 3 is connected to an MRT control unit 8 via lines 7 . The MRT control unit 8 controls the examination tube 3 to generate the necessary magnetic fields and receives detected signals via the lines 7, which are processed in the MRT control unit 8 to form images of the MRT imaging. The images can be displayed on a screen 9, for example.

The MRT control unit 8 is also connected to an automated control system 10 for controlling a robot 11 . The MRT control unit 8 supplies the control system 10 with the images of the MRT imaging in real time. These images are evaluated in the control system 10 and as a result specific target structures on the patient 5 are identified, on which an operation is to be carried out autonomously and/or remotely by means of the robot 11 . For this purpose, the control system 10 controls the robot arm 12 of the robot 11 .

The examination tube 3 is essentially constructed in a similar way to a conventional examination tube of a magnetic resonance tomograph, eg with a gradient coil near the inner circumference of the examination tube, several magnets surrounding the gradient coil and a radio frequency antenna or radio frequency coil arranged eg within the gradient coil. The gradient coil ensures a homogeneous magnetic field. By means of the radio frequency antenna or radio frequency coil, radio waves are emitted, which excite the cause hydrogen atoms in the patient. In addition, an additional coil in the form of a scanner coil can be present, which picks up an induced signal from the patient, which can then be processed by the MRT control unit 8 to form the MRT image data.

In contrast to a conventional MRI system, the MRI system 2 shown in Figure 1 has an examination tube 3 in which there are one or more peripheral through openings 13 which lead from the outside to the inside of the examination tube 3, i.e. completely penetrate the jacket . A robot arm 12 can be guided through such passage openings 13 so that a robot 11 placed with its drive mechanism outside the examination tube can reach through such a passage opening 13 with the robot arm 12 and carry out manipulations on the patient 5 .

FIG. 2 shows an example of how an autonomous and/or remote-controlled operation is carried out on the patient 5 who is inside the examination tube 3 . In this case, two robots 11 are used, each of which reaches through openings 13 in the casing of the examination tube 3 with their robotic arms 12 and, for example, performs an intestinal operation. In order to guarantee firmly defined, unchangeable operating parameters of the robots 11 for the control system 10, the robots 11 can be permanently mounted together with the examination tube 3 on a common platform 14, so that the positions of these elements relative to one another do not change while an operation is being carried out.

Claims

7 patent claims:

1 . Medical system (1) having at least the following features: a) a magnetic resonance imaging (MRT) system (2) with an examination tube (3) in which a patient (5) can be placed completely or at least with a substantial or the majority of his body b) a robot (11) that is compatible with MRT imaging and by which the MRT imaging is at least essentially not disturbed, c) an automated control system (10) for controlling the robot (11) that is used to carry out autonomous and/or remote-controlled operations on the patient (5), the control system (10) being supplied with images of the MRI imaging intraoperatively in real time, the control system (10) being set up to guide the robot (11) when carrying out the autonomous and/or to control remote-controlled operations depending on the images of the MRI imaging.

2. Medical system according to claim 1, characterized in that the examination tube (3), which is otherwise closed on the peripheral side, has one or more peripheral through-openings (13), through which a robot arm (12) of the robot (11) can be passed, wherein the Control system (10) is set up to automatically perform manipulations on the patient ( 5) to perform.

3. Medical system according to claim 2, characterized in that at least two passage openings (13) are provided on both sides opposite one another on the casing of the examination tube (3).

4. Medical system according to claim 2 or 3, characterized in that several through openings (13) in the form of radially from the outside through the casing of the examination tube (3) into the interior of the examination tube 8th

(3) running through bores distributed over the circumference and/or the length of the examination tube (3) on the jacket of the examination tube (3). Medical system according to one of Claims 2 to 5, characterized in that the robot arm (12) which can be guided through the at least one passage opening (13) is non-magnetic and/or non-metallic. Medical system according to one of the preceding claims, characterized in that at least those parts of the drive system of the robot (11) that are located in the examination tube (3) are non-electrical and non-magnetic components, such as hydraulic and/or pneumatic components and/or cables. Medical system according to one of the preceding claims, characterized in that the control system (10) is set up to evaluate images of the MRT imaging using at least one artificial intelligence function and thereby recognize specific target structures on the patient (5). Medical system according to one of the preceding claims, characterized in that the robot (11) is designed as a multi-armed robot or as an arrangement of several robots with at least two of the control system (10) controllable robot arms (12).