U.S. patent application number 11/422270 was filed with the patent office on 2006-10-26 for method of determining the position of an instrument relative to a body of a patient.
This patent application is currently assigned to ST. LOUIS UNIVERSITY. Invention is credited to Richard D. Bucholz.
Application Number | 20060241400 11/422270 |
Document ID | / |
Family ID | 21981780 |
Filed Date | 2006-10-26 |
United States Patent
Application |
20060241400 |
Kind Code |
A1 |
Bucholz; Richard D. |
October 26, 2006 |
Method of determining the position of an instrument relative to a
body of a patient
Abstract
A system for determining a position of a probe relative to an
object such as a head of a body of a patient. The head includes a
surface such as a forehead having a contour. Cross sectional images
of the head are scanned and stored as a function of the forehead
contour. If the forehead contour does not appear in the scan
images, then the position of the forehead contour relative to the
scan images is determined with an optical scanner and a ring.
During surgery, the optical scanner also determines the position of
the forehead relative to the ring. An array for receiving radiation
emitted from the probe and from the ring generates signals
indicating the position of the tip of the probe relative to the
ring. A stereotactic imaging system generates and displays an image
of the head corresponding to the measured position of the tip of
the probe. The system may also display scan images from different
scanning technologies which scan images correspond to the same
position in the head.
Inventors: |
Bucholz; Richard D.; (St.
Louis, MO) |
Correspondence
Address: |
SENNIGER POWERS
ONE METROPOLITAN SQUARE
16TH FLOOR
ST LOUIS
MO
63102
US
|
Assignee: |
ST. LOUIS UNIVERSITY
3635 Vista Avenue at Grand Boulevard
St. Louis
MO
|
Family ID: |
21981780 |
Appl. No.: |
11/422270 |
Filed: |
June 5, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10068064 |
Feb 5, 2002 |
7072704 |
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11422270 |
Jun 5, 2006 |
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09457699 |
Dec 9, 1999 |
6374135 |
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10068064 |
Feb 5, 2002 |
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09243804 |
Feb 3, 1999 |
6076008 |
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09457699 |
Dec 9, 1999 |
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08477561 |
Jun 7, 1995 |
5891034 |
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09243804 |
Feb 3, 1999 |
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08053076 |
Apr 26, 1993 |
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|
08477561 |
Jun 7, 1995 |
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07909097 |
Jul 2, 1992 |
5383454 |
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08053076 |
Apr 26, 1993 |
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07858980 |
May 15, 1992 |
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08053076 |
Apr 26, 1993 |
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07600753 |
Oct 19, 1990 |
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07909097 |
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PCT/US91/07745 |
Oct 16, 1991 |
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07858980 |
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07600753 |
Oct 19, 1990 |
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PCT/US91/07745 |
Oct 16, 1991 |
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Current U.S.
Class: |
600/424 ;
600/414; 600/415 |
Current CPC
Class: |
A61B 8/00 20130101; A61B
2090/363 20160201; A61B 90/36 20160201; A61B 90/39 20160201; A61B
2034/2072 20160201; A61B 5/0073 20130101; A61B 5/055 20130101; A61B
2090/378 20160201; A61B 2090/3983 20160201; A61B 90/14 20160201;
A61B 2090/3925 20160201; A61B 8/5238 20130101; A61B 2090/3979
20160201; A61B 2034/105 20160201; A61B 2034/2065 20160201; A61B
2090/373 20160201; A61B 5/061 20130101; A61B 6/501 20130101; A61B
5/0064 20130101; A61B 8/0808 20130101; A61B 2090/3995 20160201;
A61B 2090/364 20160201; A61B 2090/061 20160201; A61B 2034/2055
20160201; A61B 6/12 20130101; A61B 2034/2063 20160201; A61B 6/5247
20130101; A61B 2090/3929 20160201; A61B 2034/2068 20160201; A61B
2090/3945 20160201; A61B 34/20 20160201; A61B 90/10 20160201; A61B
5/1077 20130101; A61B 2090/3954 20160201 |
Class at
Publication: |
600/424 ;
600/415; 600/414 |
International
Class: |
A61B 5/05 20060101
A61B005/05 |
Claims
1. A method for determining a position relative to a body of a
patient in a coordinate system, the method comprising: radiating
first signals from a base fixed in relation to the body of the
patient, the signals representing the position of the base and the
body in the coordinate system; radiating second signals from an
instrument positioned relative to the body, the signals
representing the position of the instrument in the coordinate
system; receiving the first and second signals; and processing the
first and second signals to determine the position of the
instrument relative to the base and the body in the coordinate
system.
2. The method of claim 1, further including retrieving scanned
images of the body; determining the position of the body in the
images of the body; and translating the position of the instrument
relative to the body in the coordinate system to the position of
the instrument relative to the body in the images of the body.
3. The method of claim 2, further including displaying the position
of the instrument relative to the body in the images of the
body.
4. A method for indicating a location relative to the body of a
patient, the method comprising the steps of: fixing reference
points in relation to the body; providing body signals from the
reference points, the signals representing the position of the
reference points and the body; positioning an instrument relative
to the body, the instrument being located remote from the body;
providing instrument signals from the instrument, the signals
representing the position of the instrument; receiving the body and
instrument signals; and determining the position of the instrument
relative to the reference points and the body based on the body and
instrument signals.
5. The method of claim 4, further including obtaining a scan image
of the body, determining the position of the body in the scan image
of the body; and translating the position of the instrument
relative to the body to the position of the instrument relative to
the body in the scan images of the body.
6. The method of claim 4, further including displaying the position
of the instrument relative to the body.
7. A method for determining a position relative to a body of a
patient in a coordinate system, the method comprising: radiating
first signals from the body of the patient, the signals
representing the position of the body in the coordinate system;
radiating second signals from an instrument positioned relative to
the body, the signals representing the position of the instrument
in the coordinate system; receiving the first and second signals;
and processing the first and second signals to determine the
position of the instrument relative to the body in the coordinate
system.
8. The method of claim 7, further including retrieving scanned
images of the body; determining the position of the body in the
images of the body; and translating the position of the instrument
relative to the body in the coordinate system to the position of
the instrument relative to the body in the images of the body.
9. The method of claim 8, further including displaying the position
of the instrument relative to the body in the images of the body.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of Ser. No. 10/068,064,
filed Feb. 5, 2002, allowed, which is a divisional of Ser. No.
09/457,699, filed Dec. 9, 1999, now U.S. Pat. No. 6,374,135, which
is a continuation of Ser. No. 09/243,804, filed Feb. 3, 1999, now
U.S. Pat. No. 6,076,008, which is a continuation of Ser. No.
08/477,561, filed Jun. 7, 1995, now U.S. Pat. No. 5,891,034, which
is a continuation of Ser. No. 08/053,076, filed Apr. 26, 1993,
abandoned, which is a continuation-in-part of Ser. No. 07/909,097,
filed Jul. 2, 1992, now U.S. Pat. No. 5,383,454 and is a
continuation-in-part of Ser. No. 07/858,980, filed May 15, 1992,
abandoned, and said Ser. No. 07/909,097, filed Jul. 2, 1992 is a
continuation of Ser. No. 07/600,753, filed Oct. 19, 1990, abandoned
and said Ser. No. 07/858,980 is a continuation-in-part of
PCT/US91/07745, filed Oct. 17, 1991, which is a
continuation-in-part of Ser. No. 07/600,753, filed Oct. 19, 1990,
abandoned.
BACKGROUND OF THE INVENTION
[0002] Precise localization of position has always been critical to
neurosurgery. Knowledge of the anatomy of the brain and specific
functions relegated to local areas of the brain are critical in
planning any neurosurgical procedure. Recent diagnostic advances
such as computerized tomographic (CT) scans, magnetic resonance
imaging (MRI) scanning, positron emission tomographic (PET)
scanning, and magnetoencephotographic (MEG) scanning have greatly
facilitated preoperative diagnosis and surgical planning. However,
the precision and accuracy of the scanning technologies have not
become fully available to the neurosurgeon in the operating room.
Relating specific structures and locations within the brain during
surgery to preoperative scanning technologies has previously been
cumbersome, if not impossible.
[0003] Stereotactic surgery, first developed 100 years ago,
consists of the use of a guiding device which channels the surgery
through specific parts of the brain as localized by preoperative
radiographic techniques. Stereotactic surgery was not widely used
prior to the advent of modern scanning technologies as the
injection of air into the brain was required to localize the
ventricles, fluid containing chambers within the brain.
Ventriculography carried a significant complication rate and
accuracy in localization was marginal.
SUMMARY OF THE INVENTION
[0004] It is an object of this invention to provide a system which
can determine the position of a probe within an object and display
an image corresponding to the determined position. It is a further
object of this invention to provide a system which can determine
the position of an ultrasound probe relative to an object and,
still further, which can display scan images from other scanning
technologies corresponding to the scan images produced by the
ultrasound probe. It is a further object of this invention to
provide a system which can relate scan images of an object produced
with one technology to scan images of the same object produced with
another technology.
[0005] The invention comprises a system for indicating a position
within an object. The system includes reference points means in
fixed relation to the object. Means generates images of the object,
said images including reference images corresponding to the
reference points means. The system also includes reference means
located outside the object and a probe including a tip. First means
determines the position of the tip of the probe relative to the
reference means. Second means measures the position of the
reference points means of the object relative to the reference
means, so that the position of the tip relative to the reference
points means of the object is known. Means translates the
determined position of the tip of the probe into a coordinate
system corresponding to the images of the object. Means displays an
image of the object which corresponds to the translated position of
the tip of the probe.
[0006] The invention also comprises a system for indicating a
position within a body of a patient. The system includes reference
points means in fixed relation to the body. Means generates images
of the body, said images including reference images corresponding
to the reference points means. The system further includes
reference means located outside the body and a probe including a
tip. First means determines the position of the tip of the probe
relative to the reference means. Second means determines the
position of the reference points means of the body relative to the
reference means, so that the position of the tip relative to the
reference points means of the body is known. Means translates the
determined position of the tip of the probe into a coordinate
system corresponding to the images of the body. Means displays an
image of the body which corresponds to the translated position of
the tip of the probe.
[0007] The invention also comprises a method for indicating a
position of a tip of a probe which is positioned within an object
such as a body on images of the body wherein the body and the
images of the body include reference images corresponding to a
reference point. The method includes the steps of determining the
position of the tip of the probe relative to a reference means
having a location outside the body; determining the position of the
reference points of the body relative to the reference means so
that the position of the tip relative to the reference points of
the body is known; translating the determined position of the tip
of the probe into a coordinate system corresponding to the images
of the body; and displaying an image of the body which corresponds
to the translated position of the tip of the probe.
[0008] The invention also comprises a system for determining a
position of an ultrasound probe relative to a part of a body of a
patient wherein the probe is positioned adjacent to and scanning
the body part. An array is positioned in communication with the
probe. First means determines the position of the ultrasound probe
relative to the array. Second means determines the position of the
body part relative to the array. Means translates the position of
the ultrasound probe into a coordinate system corresponding to the
position of the body part.
[0009] The invention also comprises a system for relating scan
images of a body of a patient. The scan images are produced from
first and second scanning technologies. The system includes
reference points means in fixed relation to the body. Means relates
the first scanned images to the reference points means. Means
relates the second scanned images to the reference points means.
Means selects a particular first scanned image. Means determines
the position of the particular first scanned image relative to the
reference points means. Means generates a second scanned image
which has the same position relative to the reference points means
as the determined position so that the generated second scanned
image corresponds to the particular first scanned image.
[0010] The invention also comprises apparatus for indicating a
position relative to a body of a patient. The apparatus comprises
radiopaque markers and means for noninvasively supporting the
markers on the surface of the skin of the body. The supporting
means may comprise a sheet of material overlying the body, and
means on the sheet of material for supporting the markers.
[0011] The invention may be used with a scanner for scanning a body
part of a patient in order to generate images representative of the
body part. The improvement comprises means for marking the surface
of the skin on the body part with a radiopaque material, whereby
the generated images include images of the marking means.
[0012] Other objects and features will be in part apparent and in
part pointed out hereinafter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1A is a perspective illustration of a reference ring of
the prior art which is mounted by uprights to a patient's head to
support the cylindrical frame structure of FIG. 1B or the ring 306
of FIG. 3B.
[0014] FIG. 1B is a perspective illustration of a cylindrical frame
structure of the prior art which is mounted around a patient's head
during the scanning process.
[0015] FIG. 1C is a plan view according to the prior art of the
rods of the cylindrical frame structure of FIG. 1B taken along a
plane midway between the upper and lower rings.
[0016] FIG. 1D is a perspective illustration of the coordinate
system of a three dimensional scanned image.
[0017] FIG. 2A is a perspective view of the caliper frame of the
prior art used to target a position in the brain and to determine a
position in the head relative to the phantom base.
[0018] FIG. 2B is a perspective view of the caliper frame of the
prior art of FIG. 2A illustrating its angles of adjustment. FIG. 2C
is a block diagram of the steps involved in the prior art process
of determining the position of a probe relative to the scanned
images so that the image corresponding to the probe position can be
identified and viewed by the surgeon.
[0019] FIG. 2D is a perspective illustration of a three dimensional
coordinate system of a probe.
[0020] FIG. 3A is a block diagram of one system of the invention
for indicating the position of a surgical probe within a head on an
image of the head.
[0021] FIG. 3B is a perspective schematic diagram of a microphone
array, probe and base ring according to one system of the
invention.
[0022] FIG. 3C is a block diagram of the steps involved in the
process according to the invention for determining the position of
a surgical probe relative to the scanned images so that the image
corresponding to the probe position can be identified and viewed by
the surgeon.
[0023] FIG. 3D is an illustration showing three reference points on
a head for use as a frame of reference during preoperative scanning
and surgery.
[0024] FIG. 4A is a perspective schematic diagram of an infrared
detector array, probe, reference bar, clamp and optical scanner
according to one system of the invention.
[0025] FIG. 4B is a block diagram of a system for use with the
apparatus of FIG. 4A for determining the contour of a forehead.
[0026] FIG. 5 is a flow chart of the translational software for
translating coordinates from the probe coordinate system to the
scanned image coordinate system according to the invention.
[0027] FIG. 6A is a perspective schematic diagram of a detector
array, reference bar, clamp and ultrasound probe according to one
system of the invention;
[0028] FIGS. 6B and 6C illustrate ultrasound and scanned images,
respectively.
[0029] FIG. 7 illustrates the orientation of the base ring with a
scanning plane for relating the position of a probe with a scanned
image or for interrelating the scanned images of different scanning
technologies which correspond to a common position in the head
according to one system of the invention.
[0030] FIG. 8 illustrates the use of a remote depth finder for
determining the contour of a forehead.
[0031] FIGS. 9 through 11 illustrate apparatus including a cap and
grommets for holding radiopaque markers during scanning.
[0032] Corresponding reference characters indicate corresponding
parts throughout the several views of the drawings.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0033] With the advent of modern scanning equipment and techniques,
several stereotactic systems have been developed and are presently
available. These stereotactic systems allow a surgeon to localize
specific points detected on CT, MRI, PET, or MEG scans which have
been previously generated prior to the surgical procedure being
performed. In particular, the stereotactic systems allow the
selection of specific points detected on the scans to be localized
within the brain by the surgeon during the surgical procedure using
a mechanical device.
[0034] In use, the prior art stereotactic systems often require a
base such as a ring 120 (also known as a BRW head ring) in FIG. 1A.
Ring 120 is firmly attached to the patient's skull via uprights 122
and sharp pins 124 throughout scanning and surgery.
[0035] During scanning, some form of localizing device, such as a
cylindrical structure 100 in FIG. 1B, is attached to ring 120.
Structure 100 comprises an upper circular ring 102 in parallel with
a lower circular ring 104. Lower ring 104 is mounted to reference
ring 120 so that the three rings 102, 104 and 120 are in parallel
planes. Rings 102 and 104 are interconnected by six vertical rods
106 and three diagonal rods 108. These specific marking rods are
also called fudicels. The three diagonal rods 108 diagonally
interconnect rings 102 and 104. Any plane orthogonal to an axis 110
of structure 100 which passes through structure 100 will create a
unique pattern of six cross sectional views of rods 106 and three
cross sectional views of rods 108. The resultant spacing between
the diagonal and upright rods defines a unique orthogonal plane
within structure 100. FIG. 1C shows, for example, the spacing of
the rods when the position of the scan plane 112 is parallel to and
midway between rings 102 and 104 of structure 100.
[0036] After the scanning process, the images obtained are analyzed
and the position of rods 106 and 108 shown in the images is
measured. By knowing the position of rods 106 and 108, the specific
location of a scan with respect to structure 100 and therefore with
respect to base ring 120 can be determined. As shown in FIG. 1D,
the scans can be arranged within a scanned image coordinate system
125 with the reference plane RP set in fixed relation to the
position of ring 120. A scan plane SP can be defined within the
scanned image coordinate system 125 by at least three reference
points SP1, SP2 and SP3 located on the head of the patient. By
associating a scan image with a scan plane SP in the scanned image
coordinate system, a point on the scan can be identified with a
point in the patient's head.
[0037] During surgery, the surgeon can use the stereotactic system
to calculate a specific position within the brain corresponding to
a scan image and then target that portion of the brain with a
probe. First, the structure 100 used during scanning is removed
from ring 120 and a specially designed caliper frame 200, as
illustrated in FIG. 2A, is attached to ring 120. Frame 200 holds a
surgical probe 202 which is positioned on an arch 206 for insertion
into the patient's head. Frame 200 indicates the alpha, beta, gamma
and delta angles on scales 208, 210, 212 and 214 for directing
probe 202 to a particular target, as shown in FIG. 2B. The distance
216 from the tip of probe 202 to arch 206 is also determined. A
computer is then used to correlate the position of the targeted
scan image in the scanned image coordinate system with the
corresponding angles alpha, beta, gamma and delta and distance 216
on frame 200 to enable the surgeon to apply the probe to the
targeted area of the brain. A target picked out on a scan of a
specific image can be approached with a fair degree of accuracy
using this surgical procedure.
[0038] In the past, the surgeon has also used the stereotactic
system in reverse in order to determine the position of the probe
202 in the brain relative to the scanned images so that the scan
image corresponding to the probe position can be identified and
viewed. To do this, the surgeon again attaches frame 200 to ring
120. Probe 202 is then positioned in frame 200 and inserted into
the brain. Frame 200 is then removed from ring 120 and mounted to a
phantom base 250 in a manner as illustrated in FIG. 2A. Phantom
base 250 has a coordinate system (X.sub.1, Y.sub.1, Z.sub.1).
Generally, caliper frame 200 identifies a point 201 over phantom
base 250. A pointing device 252 is positioned to have its tip 254
at point 201. The X.sub.1-Y.sub.1 plane of phantom base 250 is
parallel to the plane in which the reference points RP1, RP2 and
RP3 are located. The (X.sub.1, Y.sub.1, Z.sub.1) coordinates define
the position of point 201. As a result, the position of point 254
with respect to the X.sub.1-Y.sub.1 plane and, therefore, with
respect to the reference plane RP is now known. A computer is used
to calculate the specific position within the brain and the
particular scan which corresponds to the calculated position can
now be accessed and viewed on a scanning system. This prior art
process is shown in diagram form in FIG. 2C.
[0039] After this cumbersome and time-consuming process, the
surgeon has now determined the position of the tip 201 of probe 202
with respect to the scanned images and can now view the image
corresponding to the probe position to decide the next step in the
surgical procedure. This entire process takes approximately ten to
fifteen minutes and increases the risks of intraoperative
contamination as the base of frame 200 is nonsterile. Because of
these considerations, this surgical procedure is not commonly
performed.
[0040] Although stereotactic surgery as performed with the
apparatus of the prior art allows a surgeon to be guided to a
specific point with accuracy, it has not been particularly useful
in allowing the surgeon to identify the particular location of a
probe within the brain at any point during the surgical process.
Frequently in neurosurgery, brain tumors or other target points
within the brain are indistinguishable from surrounding normal
tissue and may not be detected even with the use of frozen
sections. Moreover, with modern microsurgical techniques, it is
essential that the neurosurgeon identify specific structures within
the brain which are of critical functional importance to the
patient. The boundaries of these structures must be accurately
defined and specifically known to the surgeon during the surgical
process. In this way, these tissues will not be disturbed or
otherwise damaged during the surgical process which would otherwise
result in injury to the patient. The minimal accuracy afforded by
stereotactic surgery is generally insufficient for modern
microsurgical techniques. Consequently, stereotactic surgery is not
generally available to the majority of patients undergoing
surgery.
[0041] The present invention solves these problems by allowing the
surgeon to retrieve and display quickly the scanned image which
corresponds to the current position of a tip 301 of a surgical
probe 302. A cursor appears on the displayed scan to show the
position of probe tip 301 within the displayed scan. FIGS. 3A-3C
and 5 illustrate a system of the invention which includes sound
emitters 360 and 370 and microphone detectors 350 and associated
hardware to determine the position of probe tip 301 relative to a
reference ring 306 on the patient's head. Because the position of
the scanned images relative to reference ring 306 is known from the
scanning procedure, the position of probe tip 301 relative to the
scanned images is known and the relevant image can be displayed.
FIGS. 3A and 4A-8 illustrate a system of the invention which
includes infrared emitters 540 and 545 and detectors 550 in place
of the sound emitters 360, 370 and microphone detector 350 for
determining the position of a reference bar 548 and a probe tip
541. A computer 396 and an infrared scanner 380 relate the scanned
images to the shape of the forehead and relate the shape of the
forehead to the position of reference bar 548. Reference bar 548 is
then associated with the scanned images through the forehead shape
without the use of the cylindrical reference frame 100 during
scanning. The use of the forehead shape as a reference point also
allows the scanned images from different scanning technologies to
be interrelated. As an alternative to reference ring 306 and
reference bar 548 described above, FIG. 3D uses reference pins 307
affixed to the skull for determining the position of the patient's
head during surgery. As a further alternative, FIGS. 9-11 use a
removable cap for holding markers during scanning. The positions of
the markers are marked on the head for later use during surgery in
registering the surgical space with the scan images. FIG. 6
includes an ultrasound probe 500 for use during surgery. Other
advantages are also provided as more fully described below.
[0042] In relating the position of a probe tip, e.g., probe tip
301, to a scanned image, it can be seen in FIGS. 1D and 2D that the
surgeon must know the specific location of tip 301 with respect to
the scanned image coordinate system (X.sub.o, Y.sub.o, Z.sub.o) of
the scans that were preoperatively performed. In other words, probe
tip 301 has a particular coordinate system (X.sub.2, Y.sub.2,
Z.sub.2) which is illustrated in FIG. 2D. Ideally, the surgical
probe coordinate system (X.sub.2, Y.sub.2, Z.sub.2) must be related
to the scanned image coordinate system (X.sub.o, Y.sub.o, Z.sub.o).
The prior art as illustrated in FIG. 2B has suggested relating
these coordinate systems via the phantom base coordinate system
(X.sub.1, Y.sub.1, Z.sub.1). However, as noted above, this
relational process is inaccurate, time-consuming and cumbersome.
The invention uses a 3D digitizer system to locate the position of
probe tip 301 within the probe coordinate system (X.sub.2, Y.sub.2,
Z.sub.2) and to relate it to the scanned image coordinate system
(X.sub.o, Y.sub.o, Z.sub.o)
[0043] FIGS. 3A and 3B show a microphone array 300, a temperature
compensation emitter 304, a surgical probe 302, and a base ring
306. Microphone array 300 includes a plurality of microphones 350
which are preferably spaced one meter apart. Microphones 350 may be
attached to the operating light above the patient's head in direct
line of sight of all of the emitters 360 and 370. Microphones 350
thereby detect the sound emitted from the emitters. Surgical probe
302 preferably is a surgical coagulating forceps such as a bipolar
coagulating forceps. Probe 302 could also be a drill, suction tube,
bayonet cauterizing device, or any other surgical instrument
modified to carry at least two sound emitters 360 thereon for
determining position. Emitters 360 on probe 302 are essentially
coaxial on an axis 362 with tip 301. Emitters 360 are in line and
immediately below the surgeon's line of sight so that the line of
sight is not blocked. Probe 302 has a bundle of wire 364 attached
thereto for connection to an electrical power source. The wires
required to energize emitters 360 are combined with bundle 364. The
surgeon is familiar with handling such a probe connected to a wire
bundle; therefore, this apparatus does not inconvenience the
surgeon. During surgery, ring 306 is affixed to the reference ring
120 attached to the patient's head and is essentially coplanar with
it. Ring 306 includes a plurality of emitters 370 which are
preferably positioned 90 degrees apart with the center emitter
being located at the anterior of the head. This permits ring 306 to
be mounted around the head so that all three emitters are in line
of sight with array 300.
[0044] In use, the position of each of emitters 360 and 370 is
determined individually in order to determine the position of the
devices to which the emitters are attached. This is accomplished by
rapidly energizing the emitters one at a time in a predetermined
sequence and measuring the time required for the individual sounds
to reach each of microphones 350 in array 300. A 3D digitizer 312
controls this operation through a signal generator 308 and a
multiplexer 310. Digitizer 312 may be an off-the-shelf Model
GP-8-3D three dimensional sonic digitizer produced by Scientific
Accessories Corporation. Under the control of digitizer 312,
multiplexer 310 applies an energizing signal from signal generator
308 first to a temperature compensation emitter 304, then
sequentially to emitters 370 on ring 306, then sequentially to
emitters 360 on probe 302. During this time, digitizer 312 receives
and digitizes the output signals produced by microphones 350 in
response to the energizations of the emitters. The digitized output
signals are output to a computer 314.
[0045] Computer 314, following the flow chart shown in FIG. 5 as
more fully described below, is programmed with the predetermined
pattern and timing for energizing emitters 360 and 370. Computer
314 includes a spatial acquisition and recording (SAR) program 316
which acquires and records spatial coordinates based on the
digitized signals. For example, the SAR program 316 may be the
SACDAC program licensed by PIXSYS of Boulder, Colo. SAR program 316
measures the time of transmission from each of the emitters to each
of the microphones 350. By comparing these times, SAR program 316
calculates the position of each of emitters 360 and 370. Since ring
306 contains three emitters 370, SAR program 316 can calculate the
position of ring 306 through standard geometric computations. This
plane essentially defines the reference plane of the scan images
because it is coplanar with the reference points RP1, RP2 and RP3
in the scanning coordinate system of FIG. 1D. Similarly, since
probe 302 contains two emitters 360, SAR program 316 can calculate
the position of probe tip 301 through standard geometric
computations. After SAR program 316 determines the respective
positions of ring 306 and probe tip 301 relative to array 300, it
next determines the position of ring 306 relative to tip 301 within
the probe coordinate system of FIG. 2D.
[0046] One consideration in using sound emitters to determine
position is that the speed of the emitted sound will vary with
changes in the temperature of the air in the operating room. In
other words, since the system is very accurate, the period of time
that it takes from the instant a particular emitter 360 or 370 is
energized to emit sound until the instant that each of microphones
350 of array 300 receives the sound will vary with air temperature.
In order to calibrate the system for these changes, temperature
compensation emitter 304 is located in a fixed position relative to
array 300. Temperature compensation emitter 304 may be, for
example, a sonic digitizer as is used in the Scientific Accessories
Corporation Model GP-8-3D. SAR program 316 knows, through
calibration, the distance between temperature compensation emitter
304 and each of the microphones 350 of array 300. The speed of
sound transmitted from temperature compensation emitter 304 to
microphones 350 is measured by the SAR program and compared against
the known distance to determine the speed at which the sound is
being transmitted through the air. Therefore, SAR program 316 can
immediately calculate the reference standard, i.e., the velocity of
the emitted sound through the air. This instantaneous reference is
applied to the sound emitted from the other emitters 360 and 370 to
determine accurately the position of the other emitters.
[0047] After SAR program 316 has accurately determined the position
of probe tip 301 in the probe coordinate system shown in FIG. 2D,
it outputs the coordinates to translational software 318 in
computer 314. Translational software 318 then translates the
coordinates from the surgical probe coordinate system of FIG. 2D
into the scanned image coordinate system shown in FIG. 1D, as more
fully described below. A memory 320 accessed through a local area
network (LAN) 321 stores each of the images of the preoperative
scan according to the respective positions of the scans within the
scanned image coordinate system of FIG. 1D. The respective
positions of the scans are known from the position of rods 106 and
108 in the scans, which information is stored in memory 320. The
translated coordinates generated by translational software 318 are
provided to stereotactic image display software 322, also resident
within computer 314. Stereotactic image display software 322
actuates a stereotactic imaging system 324 to generate a scan image
from the data stored in memory 320 corresponding to the translated
coordinates. Stereotactic imaging system 324 displays the generated
image on a high resolution display 326. Display 326 preferably
displays the axial, saginal and coronal views corresponding to
probe tip 301. Stereotactic image display software 322 and
stereotactic image system 324 may be any off-the-shelf system such
as manufactured by Stereotactic Image Systems, Inc. of Salt Lake
City, Utah. This cycle of calibrating the system through
temperature compensation emitter 304, sequentially energizing
emitters 370 and 360 to determine the respective positions of ring
306 and probe 302, and generating and displaying a scan image
corresponding to the position of probe tip 301 all occur each time
the surgeon closes a switch to activate the system. The switch (not
shown) may be positioned on probe 302, in a floor pedal (not
shown), or wherever else may be convenient to the surgeon.
[0048] As seen above, ring 306 is one apparatus for determining and
positioning the reference points RP1, RP2 and RP3 with respect to
microphone array 300. An advantage of ring 306 is that, each time
emitters 360 on probe 302 are energized, emitters 370 on ring 306
are also energized to redefine the reference plane. This allows the
surgeon to move the patient's head during surgery.
[0049] Alternatively, as shown in FIG. 3D, the reference points
RP1, RP2 and RP3 can be established with the 3D digitizer 312 and
three reference pins 307. Reference pins 307 are radiolucent
surgical screws with radiopaque tips. Pins 307 are permanently
affixed to the patient's skull before surgery and before the
preoperative scanning. The radiopaque tips thereby provide a
constant reference during scanning and throughout the stereotactic
surgical procedure. During surgery, probe tip 301 is positioned on
each of pins 307 and actuated to emit a signal which is detected by
microphone array 300 and output to 3D digitizer 312. This allows
the position of tip 301 to be determined at each of these points.
This is performed during a reference mode of operation of 3D
digitizer 312. At the end of the reference mode, SAR program 316
calculates the position of the reference points RP1, RP2 and RP3.
The use of pins 307 requires that the reference points have to be
reestablished before the position of probe 302 is determined to
avoid changes in the reference plane due to movement of the head. A
further variation contemplates that emitters 370 may each be
separately mounted to pins 307 or other fixed structures positioned
at each of the reference points.
[0050] In summary, this process according to the invention is
illustrated in FIG. 3C and identifies the location of probe tip 301
for the surgeon. Initially, the reference plane is determined by
energizing ring 306 or by positioning probe tip 301 at the
reference points. Next, the emitters of probe 302 are energized so
that the position of probe tip 301 in the head is determined in the
probe coordinate system (X.sub.2, Y.sub.2, Z.sub.2). Translational
software 318 then converts the probe coordinate system into the
scanned image coordinate system (X.sub.o, Y.sub.o, Z.sub.o) so that
the image corresponding to the position of probe tip 301 can be
generated and displayed.
[0051] In another system of the invention as shown in FIG. 4A,
infrared emitters 540 and 545 and an array 552 of detectors 550 are
used respectively in place of sound emitters 360 and 370 and
microphones 350 of FIG. 3B. Fixed reference bar 548, a surgical
probe 542, and related components are used in place of ring 306,
probe 302, and related components of FIG. 3B. A Mayfield clamp 570
of known construction is used in place of ring 120 for rigid
attachment to the patient's head 394. Clamp 570 includes sharp pins
572 attached to adjustable jaws 574 and 576. Clamp 570 is thereby
adjusted for rigid attachment to head 394. Reference bar 548 is
rigidly attached to clamp 570 so that there is no relative movement
between bar 548 and head 394. No temperature compensating emitter
such as emitter 304 in FIG. 3B is required in FIG. 4A because the
apparatus of FIG. 4A uses the position of emitters 540 and 545 as
viewed by detectors 550 (as more fully explained below) to
determine probe and ring positions instead of the time of
transmission of the emitted signal as with the embodiment of FIG.
3B.
[0052] In use, infrared detectors 550 are attached to a mounting
bar 551 in fixed relation to each other. Detectors 550 are
generally positioned so that their views converge on a phantom
point. For example, the two outer detectors 550L and 550R may view
a field of two intersecting vertical planes and the center detector
550C would view a horizontal plane. This can be accomplished by
employing vertical slits on the field of view of the outer
detectors and a horizontal slit on the field of view of the center
detector. The phantom point is set to be in the general vicinity of
the patient's forehead 390. Mounting bar 551 is suspended from the
operating room light in direct line of sight of the patient's
forehead 390 and of emitters 540 and 545. Detectors 550 thereby
detect the infrared light emitted from emitters 540 and 545.
Detectors 550 include a large number of linear chip cameras such as
CCD (charge coupled device) cameras or pixels. A cylindrical lens
(not shown) may also be used behind the slits in detectors 550 to
collimate the infrared light. By knowing which particular pixel of
the large number of pixels found in each of the three detectors 550
receives the infrared light from emitters 540 and 545, the angle to
a particular emitter from each of detectors 550 can be determined
and, therefore, the positions of each of emitters 540 and 545 can
be determined using conventional mathematical analysis.
Accordingly, the position of probe tip 541 within the scan image
coordinate system is known.
[0053] The apparatus of FIGS. 4A, 4B, 6A, 7 and 8 may be controlled
with the computer and other hardware shown in FIG. 3A using the
software shown in FIG. 5. Apart from the use of infrared light in
place of sound and the measurement of the position of the emitters
through geometry instead of the timed delay of sound, the operation
of this hardware and software parallels the operation disclosed
above.
[0054] An advantage of using infrared light is that it allows for
the use of the contour of a portion of the patient's head 394,
preferably the forehead 390 above and around the patient's eyes, to
relate the position of the probe 542 to the scan images. This is
accomplished with an optical scanner 380 which generates an
infrared laser beam which is reflected off of the patient's
forehead 390 in timed sequence with the firing of emitters 545 to
determine the forehead contour relative to reference bar 548. Such
optical scanning of the forehead allows preoperative scanning to
occur well in advance of anticipated surgery and without
intubation. Other benefits and features of the improvement are more
fully explained below.
[0055] In particular, FIGS. 4A and 4B include infrared detector
array 552, probe 542, reference bar 548 and optical scanner 380.
Surgical probe 542 preferably is a surgical coagulating forceps
such as a bipolar coagulating forceps. Probe 542 could also be a
drill, suction tube, bayonet cauterizing device, or any other
surgical instrument modified to carry at least two infrared
emitters 540 thereon for determining position. Emitters 540 on
probe 542 are essentially coaxial on an axis 544 with tip 541.
Emitters 540 are in line and immediately below the surgeon's line
of sight so that the line of sight is not blocked. Probe 542 has a
bundle of wire 364 attached thereto for connection to an electrical
power source. The wires required to energize emitters 540 are
combined with bundle 364. Bar 548 comprises a bar with a plurality
of at least three infrared emitters 545 positioned thereon. During
surgery, the line of sight between some of the emitters 545 and the
array 552 may be blocked by a surgical hose or other object. This
could temporarily prevent array 552 from detecting the position of
bar 548. Accordingly, it is preferable to place more than three
emitters (e.g., seven or eight emitters) on bar 548 so that the
line of sight for at least three emitters is always maintained.
Such additional emitters can also be used to more precisely locate
the position of bar 548. Bar 548 which holds emitters 545 is also
preferably positioned slightly away from head 394 for increased
clearance around head 394 and to reduce the number of instances
where the line of sight between emitters 545 and array 552 is
blocked. Optical scanner 380 is generally located in front of the
patient's forehead 390. Optical scanner 380 and its associated
software to generate a forehead image are standard, off-the-shelf
components such as those used to scan an object to determine its
three-dimensional shape. For example, a limb scanner such as the
PIXSYS Optical Scanner used to develop three-dimensional models for
artificial limbs may be used.
[0056] During the preoperative scanning process, when the cross
sectional scanned images of the patient's head 394 are created,
head 394 is fastened securely in a cushioned cradle 392 with
surgical straps (not shown). If the contour of forehead 390 appears
in the scan images, then computer 396 employs forehead fitting
software 398 to derive the forehead contour from the scan images
and to database the scan images as a function of the forehead
contour in memory 320. If the scan images do not show the forehead
390, then (as shown in FIG. 7) head 394 is firmly clamped in fixed
relation with a reference source, such as a ring 590, having
emitters 592 thereon. Optical scanner 380 is then used to determine
the position of the forehead contour relative to ring 590 (as more
fully described below). Because the position of the scan images
relative to ring 590 is known from the scanning procedure, the
position of the scan images relative to the forehead contour is
known. This information is then databased in memory 320 and used
during surgery to relate the position of probe 542 to the scan
images.
[0057] Forehead scanning with optical scanner 380 is accomplished
in the following way. During preoperative scanning, head 394 is
rigidly attached to ring 590 in FIG. 7. This attachment may be
accomplished with a base ring (not shown) such as ring 120 in FIG.
3B. Under the control of 3D digitizer 312, scanner 380 emits an
infrared laser beam which bounces off a single point on forehead
390 and is detected by array 552. Computer 396 determines the
position in space of this first point on forehead 390, such as by
triangulation. Next, emitters 592 on ring 590 are energized
sequentially. Array 552 detects these emissions and computer 396
determines the relation between the first detected position on
forehead 390 and the position of ring 590. This process is repeated
many times, with scanner 380 tracing a path across forehead 390.
All of the data comprising the position of each point of reflection
from forehead 390 and the related position of ring 590 is input
into forehead fitting software 398 of computer 396. Computer 396
thereby determines the contour of forehead 390 and, thus, the
position of the forehead contour relative to ring 590. Forehead
fitting software 398 may be any off-the-shelf or custom software
which graphs a set of points so that a curve defining the contour
of the forehead can be calculated. Computer 396 then outputs data
relating the position of the forehead contour with the position of
ring 590 to translational software 318 of computer 314. During
scanning, the position of the scan images relative to ring 590 is
known so that the position of the scan images relative to the
forehead contour is also known. Accordingly, the scan images are
stored in memory 320 as a function of the forehead contour.
[0058] Prior to surgery, head 394 is clamped with a mechanism such
as the Mayfield clamp 570 shown in FIG. 4A for maintaining head 394
in rigid position. Reference bar 548 is rigidly attached to clamp
570 with emitters 545 in line of sight with array 552. Optical
scanner 380 next scans the forehead to determine the position of
the forehead contour relative to bar 548. The forehead contour
derived from this second optical scanning is matched to the
forehead contour stored for the scanned images in memory 320 so
that the current position of bar 548 with respect to the scanned
images is known. The forehead contour matching between the stored
forehead contour and the forehead contour derived from the second
optical scanning is accomplished using the well known Pellazari
Chen algorithm or any other suitable surface matching algorithm.
Bar 548 used during surgery includes emitters 545 which communicate
with array 552 to establish the position of bar 548. Since the
position of probe 542 relative to bar 548 is known (because of
communication via emitters 540 and 545 and array 552) and since the
position of bar 548 relative to the scanned images is known, the
position of probe 542 relative to the scanned images is known.
Accordingly, a scanned image corresponding to the position of tip
541 of probe 542 is generated and displayed.
[0059] One advantage of using either optical scanner 380 or
surgical pins 307 in establishing a reference is that the reference
ring, such as ring 120, is removed after preoperative scanning and
before surgery. This is advantageous because the patient can not be
intubated while ring 120 is attached to the skull. In the prior
art, where ring 120 can not be removed during the time between
preoperative scanning and surgery, the patient must be intubated
(and therefore anesthetized) prior to preoperative scanning. Thus,
by using the contour of forehead 390 to define the reference point,
the preoperative scanning is performed without the need for
intubation and the anesthesia accompanying it. This is particularly
advantageous during PET, MEG and any other type of functional
scanning where the patient must be conscious to elicit behavior
during scanning. It is also advantageous during any form of
scanning where the medical equipment for providing intubation and
anesthetic would otherwise interfere with the scanning technology,
such as MRI scanning.
[0060] In summary, when CT scanning is used, the patient lies with
the head held in place on a CT table during the preoperative
scanning process. The scans are organized in memory 320 according
to the forehead contour appearing in the scans. Prior to surgery,
the patient's head 394 is rigidly held in a Mayfield clamp or
similar clamp on which reference bar 548 is mounted. Optical
scanner 380 is then used to determine the patient's forehead
contour relative to bar 548. Since the position of the scan images
relative to the forehead contour is already known, the position of
bar 548 relative to the scan images is known. During surgery, the
surgeon positions probe 542 in the position desired within head
394. Emitters 540 of probe 542 and emitters 545 of bar 548 are then
energized so that the position of probe tip 541 relative to bar 548
and, therefore, relative to the scan images is known. This is
accomplished through the translational software 318 which converts
the probe coordinate system (X.sub.2, Y.sub.2, Z.sub.2) into the
scanned image coordinate system (X.sub.o, Y.sub.o, Z.sub.o) so that
the image corresponding to the position of probe tip 541 can be
generated and displayed.
[0061] Further summarizing, when MRI, PET or MEG scanning is used,
the patient lies on an MRI, PET or MEG table with head 394 rigidly
attached to ring 590. Optical scanner 380 then scans forehead 390
to determine the position of the forehead contour relative to ring
590. The MRI, PET or MEG scanning is then performed and the scan
images are produced in known relation to the position of ring 590
and, therefore, in known relation to the forehead contour. The
scans are organized in memory 320 according to the forehead
contour. Prior to surgery, head 394 is rigidly held in a Mayfield
clamp or similar clamp on which reference bar 548 is mounted.
Optical scanner 380 is then used to determine the patient's
forehead contour relative to bar 548. Since the position of the
scan images relative to the forehead contour is already known, the
position of bar 548 relative to the scan images is known. During
surgery, the surgeon positions probe 542 in the position desired
within head 394. Emitters 540 of probe 542 and emitters 545 of bar
548 are then energized so that the position of probe tip 541
relative to bar 548 and, therefore, relative to the scan images is
known. This is accomplished through translational software 318
which converts the probe coordinate system (X.sub.2, Y.sub.2,
Z.sub.2) into the scanned image coordinate system (X.sub.o,
Y.sub.o, Z.sub.o) so that the image corresponding to the position
of probe tip 541 can be generated and displayed.
[0062] Referring to FIG. 5, a flow chart of the operation of
translational software 318 is shown as it is used with the
apparatus of FIG. 3B. Initially, the surgeon locates probe 542 in
the position which is to be determined. (If ring 306 is not being
used to identify the location of the reference plane, the initial
step is for the surgeon to use the reference mode of 3D digitizer
312 to identify the reference plane by locating probe tip 541 at
several points in the plane.) The system then initializes at a step
400 so that translational software 318 opens a window menu at a
step 402 of a multitasking program such as DESQ VIEW distributed by
Quarterdeck Office Systems of Santa Monica, Calif. Such software
permits simultaneous execution of multiple software programs. In
general, once a program is selected for actuation, it continues to
run either in the foreground or in the background until
deactuated.
[0063] Translational software 318 continues initializing by
selecting stereotactic imaging system 324 through stereotactic
image display software 322 and actuating stereotactic imaging
system 324 in the foreground by opening the stereotactic window at
a step 404. Thereafter, translational software 318 returns to the
window menu at a step 406 moving stereotactic image display
software 322 to the background and selects the digitizer window at
a step 408 to actuate digitizer 312 in the foreground. Computer 314
is then ready to be actuated by the foot switch.
[0064] The surgeon then actuates a foot pedal or other switch which
indicates that the system should perform a computation. Actuation
of the foot switch is essentially the beginning of a start step
410. Upon actuation, if sound transducers 360 and 370 and
microphones 350 of FIG. 3B are being used, digitizer 312 initiates
calibration through temperature compensation emitter 304 to
determine the velocity of the sound waves in the air, energizes
emitters 370 of ring 306 to locate the reference plane and
energizes emitters 360 of probe 302 to locate the position of probe
tip 301. The signals detected by microphone array 300 are digitized
so that SAR program 316 determines the coordinates of tip 301. At a
step 412, translational software 318 selects the coordinates from
SAR program 316.
[0065] Next, the window menu is again accessed at a step 414 and
the window menu switches stereotactic image system software 322 to
the foreground at a step 416 to specifically control the operation
of stereotactic imaging system 324. At this point, translational
software 318 issues an F1 command to stereotactic image display
software 322 which in turn prepares stereotactic imaging system 324
to accept coordinates. At a step 420, the window menu is again
selected so that at a step 422 computer 314 switches the digitizer
window into the foreground. At a step 424, the digitizer window
menu is accessed and coordinate translation is selected. At a step
426, digitizer 312 begins calculating the coordinates and at a step
428 the coordinate calculation is ended. Translational software 318
then returns to the digitizer window menu at a step 430, switches
windows to place stereotactic image system software 322 in the
foreground at a step 432 to prepare it for receiving the
coordinates and again returns to the main window menu at a step
434. Finally, the coordinate information is translated, including
any necessary manipulation, and transferred to stereotactic image
display software 322 at a step 436 which actuates stereotactic
imaging system 324 to generate the particular image from memory 320
and display it on the high resolution display 326. Stereotactic
image display software 322 instructs stereotactic imaging system
324 to display a cursor on display 326 at the coordinates which
corresponds to the position of probe tip 301. Thereafter, computer
314 is in a standby mode until the foot switch of the surgeon is
again actuated to execute translational software 318 beginning with
the start step 410.
[0066] The translation that occurs in step 436 depends on the
position of the probe coordinate system relative to the scanned
image coordinate system and the units of measure. The systems are
preferably coaxial and the units of measure the same so that
algebraic adjustment is unnecessary. However, it is contemplated
that the coordinates systems may not be coaxial, in which case
translation would require arithmetic and/or trigonometric
calculations. Also, the sequence, e.g., (X.sub.2, Y.sub.2,
Z.sub.2), in which the coordinates are generated by the digitizer
312 may be different than the sequence, e.g., (X.sub.o, Y.sub.o,
Z.sub.o), in which the stereotactic image system software 322
receives coordinates. Therefore, the sequence in which the
coordinates are transferred may have to be reordered.
[0067] Those skilled in the art will recognize that the above
computer programming could be accomplished in a number of other
ways without departing from the scope of the invention. As one
example, and apart from the use of multitasking programs and their
associated windows and menus, a personal computer could be directly
programmed to calculate the coordinates of the position of probe
tip 301 for use in generating the scan image corresponding to the
position of tip 301 from the data stored in memory 320.
[0068] The steps performed by translational software 318 for the
system of FIG. 4A are similar to those described above for the
system of FIG. 3B with the following exceptions. First, the system
of FIG. 4A does not require a calibration emitter such as emitter
304 in FIG. 3B so that the corresponding step is skipped in the
software for FIG. 4A. Further, infrared emitters 540 and 545 are
used in place of sound emitters 360 and 370 for determining the
position of probe tip 541 and bar 548. As above, the various
positions of the emitters are determined based on the angle of the
view of detectors 550 to each of emitters 540 and 545. The angle is
known from knowing which pixel within each of detectors 550 detects
the infrared light. Still further, when the optical scanner 380 is
used, translational software 318 for the system of FIG. 4A includes
additional steps for operating optical scanner 380 through
multiplexer 310 to scan a series of infrared laser beams across
forehead 390 for detection by detectors 550. This data is received
by digitizer 312 and passed to computer 396 so that the forehead
contour can be determined through software 398. Data identifying
the forehead contour is then passed back to translational software
318 for use as a reference.
[0069] Referring to FIG. 6A, a system of the present invention
employing an ultrasound localizer is illustrated. The ultrasound
system includes a mechanism such as a Mayfield head clamp 570 for
maintaining head 394 in rigid position. Reference bar 548 is
rigidly attached to clamp 570 as above with emitters 540 in line of
sight with array 552. The forehead contour is determined by optical
scanning using optical scanner 380 and array 552 of detectors 550
as shown in FIG. 4A and as more fully described above. The
ultrasound system also includes an ultrasound probe 500 which may
be used in the operating room to scan the brain. Ultrasound probe
500 includes a plurality of at least three noncolinear emitters 502
which are energized via a line 504 by multiplexer 310. The signal
emitted by emitters 502 is received by array 552 to determine the
position of the body of ultrasound probe 500 relative to the
position of forehead 390. This is accomplished through
translational software 318 which controls digitizer 312 and
multiplexer 310 to energize emitters 502 in a predetermined
sequence to determine the position of the body of probe 500. This
is the same technique used above in FIGS. 3B and 4A for determining
the position of probes 302 and 542 and of rings 306 and 548.
Ultrasound probe 500 is also connected via a line 506 to a system
508 of known construction which analyzes the ultrasound scanning
and provides the analyzed information to a monitor 510 which
displays the ultrasound image. Since array 552 can determine the
position of the body of ultrasound probe 500 at any point in time,
via digitizer 312, the particular plane of the image displayed on
monitor 510 is known.
[0070] An ultrasound image is illustrated by way of example in FIG.
6B. Because the plane of the ultrasound scan image is known, the
surgeon can signal stereotactic imaging system 324 to generate a
scan image from a different scanning technology on display 326
which corresponds to the ultrasound image. FIG. 6C illustrates such
a corresponding image. Alternatively, system 508 may be linked to
stereotactic imaging system 324 directly via a data link 515 to
communicate the position of the scan plane for the image shown on
monitor 510 so that stereotactic imaging system 324 can
automatically generate and display the corresponding scanned image
for a different scanning technology on display 326. As a result,
the image from the ultrasound system, as illustrated on monitor
510, is shown on one monitor and may be compared to a corresponding
image obtained from CT, MRI, PET, MEG or some other type of
preoperative scanning. The cross section through the three
dimensional data set as developed by the ultrasound system is
determined by a high speed graphics system 508, such as
manufactured by Silicon Graphics. This allows for better
interpretation of the ultrasound scans as the anatomy from the MRI,
CT, PET or MEG scans can be seen directly. Furthermore, the
ultrasound system allows scanning in the operating room. Since the
brain tissue is elastic and the position of various tissue may
change from time to time, use of an ultrasound scan in the
operating room permits a more definite localization of various
brain tissues. For clarity, ultrasound probe 500 is shown in FIG.
6A as spaced away from head 394. Usually, ultrasound probe 500 is
positioned in contact with the skull during use. The probe may also
be affixed to the skull during surgery for continual monitoring of
the position of the brain.
[0071] FIG. 7 shows a system of the present invention for
correlating the scan images from different scanning technologies. A
scanner 600 represents any of the several scanning technologies
currently available (e.g. CT, MRI, PET, MEG) and is intended to
include any other scanning technologies that may be developed.
Scanner 600 scans head 394 in a plane 602. Plane 602 is usually
defined visually by an array of light beams. If the pertinent
scanning technology reveals the position of the forehead contour in
the scan images, then computer 396 employs forehead fitting
software 398 to derive the forehead contour from the scan images.
Computer 396 organizes the scan images as a function of the
forehead contour for storage in memory 320.
[0072] If the pertinent scanning technology does not reveal the
position of the forehead contour in the scan images, then ring 590
is rigidly attached to head 394. The optical scanner 380 is used
prior to scanning to relate the position of the forehead contour
relative to ring 590 (as described in the text accompanying FIG.
4A). Ring 590 lies in a plane 604. During scanning, planes 602 and
604 are preferably maintained in parallel relation by initially
aligning ring 590 coplanar with the visual array of light beams
defining plane 602. However, it is not necessary to initially align
ring 590 coplanar with scan plane 602. As long as the relative
relationship in space between ring 590 and plane 602 is known and
that relationship is maintained during the scanning, the
orientation of the forehead relative to the scan plane can be
calculated. Since ring 590 will appear in at least one scan and
since the position of one scan within a group is known with respect
to the other scans in the group, the respective positions of the
scans relative to ring 590 is known. Since the position of the
forehead contour relative to ring 590 was determined by scanning
the forehead with scanner 380, the position of the forehead contour
relative to the scan images is known. Computer 396 now employs
forehead fitting software 398 to organize the scan images as a
function of the forehead contour. This information is databased in
memory 320. The forehead contour is then used to relate the scan
images of one technology such as PET to the scan images produced
from any other technology such as CT, MRI, or MEG.
[0073] When the scan images from several technologies are
available, it is contemplated within the scope of the invention to
use a like number of displays to display each of the scan images
corresponding to the position of the probe 302 or 542, or to use a
lesser number of displays, each showing multiple scan images.
Likewise, it is contemplated that a scan image from one technology
may be used as a reference in locating corresponding scan images
from other technologies. Finally, while this disclosure broadly
describes the use of the invention for scanning the patient's head,
it is contemplated within the scope of the invention to use the
invention for scanning and analyzing other portions of the body of
the patient.
[0074] FIG. 8 shows a laser depth finder 620 for use in scanning
the forehead contour when the line of sight between optical scanner
380 and array 552 in FIG. 4A is blocked. FIG. 8 includes a Mayfield
clamp 570 for holding head 394 in fixed relation to a reference bar
548 having emitters 545 thereon. Depth finder 620 may be any of the
laser based depth finders commonly available which are accurate to
within the required tolerances. At least three emitters 622 are
affixed to depth finder 620. Emitters 622 are controlled via
multiplexer 310 so that computer 314 can determine the position of
depth finder 620 in addition to the position of bar 548. In
operation, depth finder 620 emits an infrared laser beam which is
reflected off of forehead 390 and detected by a detector within
depth finder 620. The circuitry inside depth finder 620 calculates
the distance between the illuminated point on forehead 390 and a
reference point on depth finder 620 and outputs a signal
corresponding to the calculated distance via a line 624 to computer
314. Computer 314 then sequentially fires emitters 545 and 622 via
multiplexer 310 to determine the positions of bar 548 and depth
finder 620. Accordingly, at the end of this first cycle, one point
of the forehead contour can be calculated. This cycle is repeated a
number of times until computer 314 has obtained sufficient points
to map the forehead contour.
[0075] FIGS. 9-11 show an alternative system for registering scan
images with the surgical space. FIG. 9 includes a cap 700 which
fits snugly over head 394. Cap 700 is secured by an adjustable
strap 702. In use, there should be no relative movement between cap
700 and head 394. A plurality of grommets 704 are sewn into cap 700
at regular intervals. FIG. 10 shows one such grommet in greater
detail and FIG. 11 shows the cross-section through FIG. 10 at the
indicated line. As can be seen in these figures, grommets 704
encircle and thereby reinforce fabric 706 of cap 700. A hole 707
centrally positioned within each grommet 704 is cut into fabric 706
and provides space for supporting a marker 708 and also provides
access to underlying skin 710 on head 394. Fabric 706 is preferably
elastic in nature. The hole 707 in fabric 706 is smaller than the
external dimensions of marker 708 so that fabric 706 is stretched
slightly to hold marker 708. For example, hole 707 may be a slit
within fabric 706.
[0076] Markers 708 include an internal reservoir filled with a
radiopaque substance which is detected by the scanner during
scanning and which appears on the scan images. For example, the
markers for CT scanning are filled with omnipaque, the markers for
MRI scanning are filled with gadolinium, and the markers for PET
scanning are filled with a radioactive tracer. The capacity of the
reservoirs in markers 708 is different for the different scanning
technologies because each scanning technology has a different
resolution. However, markers 708 preferably have a uniform external
dimension so that the same cap 700 can be used with any of the
different types of scanners and related markers. Markers 708 are
easily attached within and removed from fabric 706 to allow quick
access for marking skin 710 underneath. This is also helpful for
patients who are undergoing more than one scanning procedure using
different scanning technologies. When multiple scanning
technologies are used, the markers for the different technologies
may be attached to fabric 706 within the same grommets 704 so that
the images produced by the different scanners all show markers 708
in the same places. Markers 708 preferably consist of clear plastic
material such as polyethylene tubing filled with a contrast medium
710 in the center and sealed at both ends with epoxy 712. Markers
708 can be either prefilled and sealed with suitable contrast
medium or fillable by needle puncture with the contrast medium.
[0077] For cranial surgery, cap 700 is preferably made of fabric
consisting of 85% Dupont Antron Nylon and 15% Lycra Spandex.
Although one size may fit most patients, the cap 700 can be sized
or shaped to specific patients. Three-quarter inch grommets 704 are
sewn at routine intervals over the entirety of the cap. For surgery
on other parts of the body, a flexible material is used which fits
snugly like an ace wrap bandage. Again, grommets 704 are sewn every
one or two inches. As with cap 700, there is a hole in the fabric
706 in the center of each grommet for holding markers 708.
[0078] In use, the patient is instructed to wash his/her hair and
to not apply any hair spray, lotion, or other materials prior to
scanning in order to provide as oil-free of a surface as is
possible. After cap 700 is snugly fit over head 394 and secured
with chin strap 702, the surgeon selects at least three (preferably
more) grommets 704 which will be used to hold markers 708. As
accuracy of three point registration increases with greater
separation of markers, markers 708 are preferably placed over the
largest area available to insure a low margin of error. If surgery
is planned, hair surrounding the operative area can be clipped or
left in place as desired by the surgeon. A small amount of hair is
clipped or displaced around the area where markers 708 will be used
to allow the positioning of markers 708 close to skin 710. Skin 710
is marked with indelible ink 716 through the holes in fabric 706 of
the grommets 704 in which a marker 708 is to be attached. Markers
708 are then attached to said fabric. During this time, the surgeon
carefully checks to insure that each marker 708 is positioned
adjacent to and directly over the ink mark 716 on skin 710. Ink
mark 716 is preferably positioned in the center of the hole in
fabric 706. The patient is then positioned on the scanning table
and head 394 is scanned. After scanning, markers 708 are removed.
During removal of the markers, the surgeon carefully checks to see
that each marker did not move during scanning by checking to see
that each is still positioned adjacent to and directly over the
corresponding ink mark 716. Further, the ink marks should appear in
the center of the holes in fabric 706. If a marker is no longer in
position adjacent the related ink mark and/or if the ink mark is
not in the center of the hole, it indicates that movement of the
marker has occurred some time during scanning. Accordingly, the
particular ink mark 716 and its corresponding marker 708 are not
used during the subsequent registration process where the scan
images are registered with the surgical space. If enough of the
markers have moved from their positions so that the position of
three of the markers can not be confirmed, then the scan is
repeated.
[0079] If scanning occurs immediately prior to surgery, the
indelible ink marks 716 may need no protection from the possibility
of smudging or accidental removal. The patient is issued a paper
cap to wear until the time of surgery and is instructed not to
remove or interfere with the ink marks. If there will be a delay
between scanning and surgery, there are several ways to assure the
integrity of the indelible marks. For example, benzoin can be
applied to the area surrounding the indelible mark and allowed to
dry. A strip of three-quarter inch transparent tape is then applied
to the area. Collodium may also be used in a similar way to protect
the marks.
[0080] After the integrity of at least three ink marks 716 has been
confirmed, a three point solution utilizing directional cosines
from two frames of reference enables the surgeon to register the
surgical space with the scan images. If the integrity of more than
three marks 716 is confirmed, the additional marks can be used for
redundancy to insure that the registration was properly performed.
The registration process can be accomplished using the apparatus
shown in FIGS. 4A and 3A. In particular, following scanning with
cap 700 and markers 708, computer 314 processes and stores the scan
images in memory 320 as a function of the markers 708 which appear
in the scan images using similar techniques as those described
above. Prior to surgery, head 394 is clamped in clamp 394. The tip
541 of probe 542 is then touched on each of the ink marks 716 on
skin 710 of head 394 while the emitters 540 and 545 are energized.
Because computer 314 now knows the position of each of ink marks
716 relative to reference bar 548, it can determine the position of
the scan images relative to reference bar 548. During surgery, as
described above, emitters 540 and 545 enable computer 314 to also
know the position of probe tip 541 relative to reference bar 548.
Accordingly, computer 314 knows the position of probe tip 541
relative to the scan images. Computer 314 then generates a scan
image corresponding to the position of tip 541. The generated image
is displayed on display 326.
[0081] As can be seen, there are many advantages of using cap 700
and markers 708 to register the scan images to the surgical space.
For example, and unlike the placement of reference pins 307 in FIG.
3D, the placement of markers 708 does not cause any pain to the
patient. This is because markers 708 are noninvasive and do not
require the skin to be broken when they are used. Accordingly,
redundant markers are used which provide greater accuracy and which
insure in most cases that at least three of the markers will be
useable for registering the scan images. Another advantage is that
routine scans can be taken with markers 708 in place. If the
initial scan locates a lesion that requires surgery, the position
of the scan images relative to markers 708 is known and the same
scan images can be used during surgery. Because of the pain
involved in implanting reference pins 307, however, they would
rarely be used during routine scanning. If a lesion is found during
such routine scanning, the entire scan has to be retaken again
after pins 307 are implanted. Yet another advantage of using
markers 708 during scanning is that they are removed prior to
surgery and so they do not need to be sterilized. Thus, the
difficulty otherwise encountered in trying to sterilize such
markers is avoided.
[0082] For surgery on parts of the body other than the head, a
material with grommets 704 sewn at regular intervals is wrapped
once around the part being examined and attached with fasteners
that do not distort the image produced. The material is applied
snugly, like an ace wrap, with grommets every one to two inches.
Alternatively, the fabric can be made into a corset like structure,
with the salient feature being reinforcement with grommets that
allow holes to be made in the fabric without weakening it, and that
also allow placement of markers 708. As with cap 700, the skin is
marked with indelible ink 716 under each marker. After scanning,
marker 708 is removed and the skin mark 716 is checked to insure
that the marker has not moved.
[0083] Those skilled in the art will recognize that apparatus other
than cap 700 could be used for positioning markers 708 within the
scope of the invention. For example, markers 708 can be held in
place adjacent an ink mark 716 using tape. Such transparent tape
has been found to be particularly effective in positioning markers
on the forehead and other hairless areas. Further, apparatus other
than grommets 704 and fabric 706 can be used to hold markers 708
within cap 700. Such other apparatus includes any of the commonly
found fasteners and mechanical fixtures capable of holding
relatively small objects.
[0084] When introducing elements of the present invention or the
preferred embodiments(s) thereof, the articles "a", "an", "the" and
"said" are intended to mean that there are one or more of the
elements. The terms "comprising", "including" and "having" are
intended to be inclusive and mean that there may be additional
elements other than the listed elements.
[0085] In view of the above, it will be seen that the several
objects of the invention are achieved and other advantageous
results attained.
[0086] As various changes could be made in the above constructions
without departing from the scope of the invention, it is intended
that all matter contained in the above description and shown in the
accompanying drawings shall be interpreted as illustrative and not
in a limiting sense.
* * * * *