U.S. patent application number 11/447053 was filed with the patent office on 2007-02-22 for specialized tabletops for medical imaging.
This patent application is currently assigned to Sentinelle Medical, Inc.. Invention is credited to Christopher Alexander Luginbuhl, Cameron Anthony Piron, Donald B. Plewes.
Application Number | 20070039101 11/447053 |
Document ID | / |
Family ID | 37766118 |
Filed Date | 2007-02-22 |
United States Patent
Application |
20070039101 |
Kind Code |
A1 |
Luginbuhl; Christopher Alexander ;
et al. |
February 22, 2007 |
Specialized tabletops for medical imaging
Abstract
A system of interchangeable specialized tabletops for medical
imaging, such as tomographic imaging, is constructed with features
that permit improvements in patient imaging and treatment specific
to a particular anatomy of interest. Such features include
cutaways, holes and removable structures, ramps and integrated
devices that allow access to tissues for intervention or imaging
under multiple imaging modalities. Such features are also
integrated, which aids in the positioning and immobilization of
patient tissues and devices relative to those tissues. Structures
and methods optimally use multiple tabletops with minimal space
requirements, and of show medical imaging uses involving the
storage of multiple tabletops.
Inventors: |
Luginbuhl; Christopher
Alexander; (Toronto, CA) ; Piron; Cameron
Anthony; (Toronto, CA) ; Plewes; Donald B.;
(Toronto, CA) |
Correspondence
Address: |
Mark A. Litman & Associates, P.A.
York Business Center, Suite 205
3209 West 76th St.
Edina
MN
55435
US
|
Assignee: |
Sentinelle Medical, Inc.
|
Family ID: |
37766118 |
Appl. No.: |
11/447053 |
Filed: |
June 5, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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60687420 |
Jun 3, 2005 |
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Current U.S.
Class: |
5/600 |
Current CPC
Class: |
A61B 6/4417 20130101;
A61B 6/04 20130101; A61B 5/055 20130101 |
Class at
Publication: |
005/600 |
International
Class: |
A47B 71/00 20060101
A47B071/00 |
Claims
1. A tabletop for use in medical procedures comprising a support
surface for a patient and engaging elements on a) at least two
lateral sides or b) at the bottom of the tabletop under the support
surface for engaging guiding components that comprise i) part of an
imager, ii) part of a preparatory station, or iii) patient
transporter, the tabletop comprising at least one structure
selected from the group consisting of: a supporting structure other
than a single extended flat surface that supports specific portions
of the human anatomy; apertures in the structural support surface
that allows for body parts to extend through the holes to provide
access to those body parts during medical examination or
procedures; apertures in the structural support surface that allows
interventional or imaging devices to extend through the holes to
gain access to body parts during medical examination or procedures;
structural elements on the tabletop that support specific portions
of the human anatomy and are adjustable to fit or accommodate
patients or body parts of patients of different dimensions;
adjustable body support elements that are removable, adjustable and
replaceable manually; structural elements such as bridging elements
connecting sections of a tabletop, that are removable in order to
gain access to patient tissues; structure that supports, guides and
secures interventional medical devices while allowing those devices
to be used for medical procedures; optical or electromagnetic
position trackers having a reference component fixed to the
tabletop which measures the position of a movable tracked component
attached to an interventional or imaging device; cooling means
integral with the tabletop; pneumatic or hydraulic system for
motivating the tabletop or components on the, fluid drainage paths
and connector to a fluid receptor on that fluid path; controlled
pressure bladders for assisting in the comfortable positioning of
patients; pressure controls for the bladders so that they may be
inflated or deflated to alter points of support for patients to
relieve local stress on the patient; actuators for attachments to
limbs or joints of patients to assist in the manipulation of the
limbs or joints during medical procedures or imaging procedures;
remote control system for the actuators; engaging system on the
sides and/or bottom of the tabletop to engage support elements on a
transporter, and latching or locking elements to secure the
tabletop to structures on which the tabletop is placed.
2. The tabletop of claim 1 wherein the tabletop comprises an
elongated patient support surface and an opening in the patient
support surface allowing body parts to pass into the opening when a
patient's front lies on the patient support surface, the tabletop
having engaging guide supports along at least one of a) both
lateral longitudinal edges of the tabletop and b) along the bottom
of the tabletop, the engaging guide supports allowing the tabletop
to be slidably engaged with guides on a system selected from the
group consisting of a patient transporter, an imager and a
preparatory station.
3. The tabletop of claim 2 wherein the opening is positioned on a
location of the support surface such that a patient lying on
his/her front against the support plane will have body parts
exposed and accessible through the opening, the opening comprising
at least one of a fixed-size aperture in the support plane, an
adjustable aperture in the support plane, or an opening in the
support surface that extends to the edge of the support
surface.
4. The tabletop of claim 3 further comprising at least one elevated
arch element on the support surface which can support specific body
portions of a patient.
5. The tabletop of claim 4 wherein the arch support element is
adjustable in at least one dimension of height and width.
6. The tabletop of claim 4 wherein the arch support element can be
removed or securely positioned by snap engagement or manually
controlled clamp engagement.
7. The tabletop of claim 2 wherein inflatable/deflatable bladders
are present on the support plane to assist in positioning or
comforting a patient.
8. The table top of claim 2 wherein adjustable limb support
elements are secured to the tabletop to support at least one limb
of a patient while positioned on the tabletop.
9. The tabletop of claim 5 wherein the tabletop has structural
elements that engage with receptor structural elements in an MR
imager to stabilize the tabletop within the MR imager.
10. The tabletop of claim 2 comprising rails, slides or clamping
arms suitable for the fixturing of magnetic resonance responsive
coils in positions adjustable in at least two degrees of freedom
such that the coils may be held motionless in positions close to
tissues of the patient, the coils extending above or below the
tabletop's surface,
11. A method of performing an imaging or interventional medical
procedure on a patient comprising positioning a patient on the
tabletop of claim 1 and imaging the patient or performing an
interventional medical procedure on the patient.
12. The method of claim 11 wherein a portion of the patient is
allowed to extend downwardly through an aperture in the tabletop
and an interventional procedure is performed on the patient through
the aperture,
13. The method of claim 12 wherein the interventional procedure is
performed after the patient is imaged with an imaging technology
selected from the group consisting of X-ray imaging, PET, magnetic
resonance imaging, ultrasound imaging and computerized x-ray
tomography.
14. The method of claim 13 wherein remote controlled interventional
apparatus is used to perform the interventional procedure, and
materials in the interventional apparatus do not interfere with the
imaging technology to a degree that prevents functional viewing of
the interventional procedure.
15. The method of claim 12 wherein the tabletop with a patient
thereon is positioned within an imager, images are taken of a
region of the patient associated with the portion of the patient,
the tabletop with patient is removed from the imager, and an
interventional technique is performed on the region of the patient
that was imaged.
16. A method of providing at least one tabletop according to claim
1 for association with a device that supports the tabletop, the
method comprising: a) providing a prep station with at least two
tabletops carried on the prep station in slidably removable
position, b) sliding one of the at least two tabletops onto another
support element having fitted support for receiving the one of the
at least two tabletops and c) securing the one of the at least two
tabletops onto the another support element.
17. A system for use in medical procedures comprising an imager, a
transporter, a tabletop, and a preparatory station comprising: a
preparatory station comprising a moveable assembly having multiple
ports, each port for acceptance and removal of a tabletop by
allowing the tabletop to slide along a guiding system into and out
of a port, the transporter and the imager having a tabletop guiding
system that allows a tabletop compatible with the preparatory
station to be accepted and guided by the guiding systems on the
transporter and imager.
18. A method of performing a medical procedure on a tabletop
according to claim 1 wherein there is an aperture in the tabletop
that extends from a relatively central position on the support
surface completely through to an edge of the tabletop, and the
procedure comprises prostate biopsy, where a man lies on his back
on the support surface, the man's legs slightly splayed and the
man's thighs lying directly above the aperture, wherein a physician
uses the aperture to gain access to reach between the man's thighs
and then inserting a needle into the perineum.
19. A tabletop for use in medical procedures comprising a support
surface for a patient and engaging elements on a) at least two
lateral sides or b) at the bottom of the tabletop under the support
surface for engaging guiding components that comprise i) part of an
imager, ii) part of a preparatory station, or iii) patient
transporter, the tabletop comprising: a supporting element elevated
above a support surface for a trunk of a patient, the elevated
element supporting specific portions of the human anatomy selected
from arms, legs and upper torso, and are adjustable to fit or
accommodate patients or body parts of patients of different
dimensions; apertures in the structural support surface that allows
for body parts to extend through the holes to provide access to
those body parts during medical examination or procedures or
apertures in the structural support surface that allows
interventional or imaging devices to extend through the holes to
gain access to body parts during medical examination or procedures;
and latching or locking elements to secure the tabletop to
structures on which the tabletop is placed.
20. The tabletop of claim 19 wherein the supporting element
elevated above a support surface comprises a support for thighs or
hips that may be pivoted to expose areas of a patient to permit
access for invasive procedures.
Description
RELATED APPLICATION DATA
[0001] The present application claims priority from Provisional
U.S. Patent Application No. 60/687,420, filed 3 Jun. 2006, and
titled Specialized Tabletops for Medical Imaging.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to medical imaging and patient
supports or tabletops for medical imaging and especially for
tomographic imaging. Tabletops, transport mechanisms and a remote
preparation station are used to enhance imaging and intervention
capability and facilitate patient handling processes using minimal
floor space.
[0004] 2. Description of Prior Art
[0005] It is preferable that the tabletop used in a tomographic
system such as X-ray computerized tomography (CT) or magnetic
resonance imaging (MRI) be free to detach from the imaging
apparatus in order to i) freely remove the patient from the
presence of the room and its associated magnetic field (if any) ii)
be able to prepare the patient outside of the imaging room or iii)
use more than one tabletop in connection with the imager, so as to
save time by interleaving or multiplexing the patient handling and
scanning aspects of the total imaging time for each patient.
[0006] A number of different shapes and forms of imagers are in
use, most having an annular form, with the patient being imaged in
the central aperture which extends through the length of the
machine. Some MRI imagers have an imaging volume characterized by
an open gap bracketed by large plates either on both sides of the
patient or on top and underneath the patient. Although annular
imagers are shown in figures provided in this description, the
presently described technology and the invention applies to imagers
of all types.
[0007] Some imagers (as in 24 of FIG. 2) have a patient transporter
2 that is used to remove just the tabletop 4 from the imager. The
tabletop 4, 6 is normally mounted either on wheels 72 (see FIG. 13)
or on a horizontal stage 8 so that it can be advanced to position
for imaging (FIG. 4), or removed to the home position (FIG. 3). The
imager system 24 in FIG. 2 forms the basis for U.S. Pat. No.
6,101,644.
[0008] Similarly, U.S. Pat. No. 6,854,140 (Bartels) describes a
transport carriage for a patient bed having a first arm for
placement of the patient bed thereon and a second arm for coupling
the patient bed thereto. A medical treatment or examination system
employing such a transport carriage has a number of medical devices
for treatment of examination of a subject, each of these medical
devices having a patient support mechanism associated therewith,
with a differently configured patient bed. The patient beds are
removable from the respective support mechanisms, and the transport
carriage is configured to receive and transport any of these
differently configured patient beds.
[0009] U.S. Pat. No. 6,205,347 (Howard) describes a multi-modality
diagnostic imaging system includes a first imaging subsystem (A),
such as a computed tomographic (CT) system, for performing a first
imaging procedure on a subject. A second imaging subsystem (B),
such as a nuclear medicine system (NUC), performs a second imaging
procedure on a subject. The second imaging subsystem (B) is remote
from the first imaging system (A). A patient couch (28) supports a
subject. A patient transfer subsystem (C) transfers a patient couch
(28) between the first imaging subsystem (A) and the second imaging
subsystem (B). The first and second imaging subsystems (A, B) can
be operated concurrently to perform different imaging procedures on
different subjects supported by separate patient couches. Data
generated by the first imaging subsystem (A) can be used to correct
emission data generated by the second imaging subsystem (B).
[0010] Transporters are conventionally used to displace tabletops
and any patients thereon. In use, the tabletop is rigidly coupled
to the transporter so that no relative motion of the tabletops to
the transporter is permitted. The coupling can occur with a
frictional connection or a clamping means.
[0011] There is normally a vertical stage 10 (FIG. 2) integrated
with the imager permitting a vertical translation of the tabletop.
If the transporter 2 is not used to prepare and position the
patient away from the imager, then the vertical stage 10 may be
used to lower the tabletop to ease patient positioning. An
alternate embodiment 12 of the vertical stage 10 is shown in FIG.
13.
[0012] FIG. 2 and FIG. 5 show a patient transporter that is
positioned for use at the end of the tabletop when the tabletop is
at the home position. Similarly, FIGS. 13 and 14 show an alternate
patient transporter 14 which is positioned from the side of the
tabletop in conjunction with imagers whose vertical stage 12 is
affixed to the floor.
[0013] It is often advantageous to use the imager's vertical stage
10, 12 to remove the supporting means from under the tabletop
whenever the transporter is being used to install or remove the
tabletop (FIG. 6 and FIG. 7).
[0014] Another attribute of imaging transport systems is to provide
such a system which makes it easy to provide multiple tabletops
without greatly increasing the floor space needed for the use and
storage of multiple tabletops. FIG. 8 demonstrates a means of
interleaving tabletops on transporters of an established type, not
a subject of this invention. The vertically adjustable upper stage
48 of those transporters puts the next tabletop to be used in the
topmost position. This ensures that the patient may be freely
positioned on the topmost tabletop, and can even be returned to
this position after imaging where intervention or subsequent
treatment may be performed. A second tabletop is in storage
underneath, where it does not require significant floor space for
storage.
[0015] To save imager time by preparing a subsequent patient while
a first patient is being scanned, it is normally necessary to have
two or more transporters and two or more tabletops. There is no
evidence in the prior art of any system using fewer transporters
than tabletops for an imaging or patient handing (e.g. a system
using three or more tabletops with only two transporters).
Additionally, if more than two tabletops are to be used in such a
system, the tabletops cannot be interleaved in the manner shown in
FIG. 8, and the space needed for storage of the tabletops and
transporters increases.
[0016] In U.S. Pat. Nos. 5,259,011, 5,842,987, the authors claim
time saving resulting from multiplexing the patient imaging and
preparation portions of a clinical exam. A more elaborate scheme
for multiplexing is presented by Damadian in U.S. Pat. Nos.
5,490,513 and 5,623,927, which use an MRI into which patients are
introduced through two or more openings.
[0017] U.S. Pat. No. 4,727,328 (Carper et al.) claims a patient
transport stretcher, and U.S. Pat. No. 4,956,885 (Alich, et al.)
describes a cantilevered fiberglass stretcher for MRI, of the type
shown in FIG. 2. U.S. Pat. No. 4,914,682 (Blumenthal) describes a
tabletop which is removable from the imager.
[0018] InSightec (www.insightec.com) currently markets the
ExAblate.TM. 2000, a system using a dedicated MRI tabletop which
comprises ultrasound transducers and a transducer positioning
system which are used to thermally ablate tissues in the breast or
uterus. The system is described in U.S. Pat. No. 6,735,461 (Vitek,
et al.). The system is intended to deliver therapy using ultrasound
while in the MRI's bore. The ultrasound is never used for imaging.
There is no additional access to, or imaging of the patient
permitted by the system. This system is retrofitted to a standard
General Electric stretcher.
[0019] U.S. patent application Ser. No. 10/916,738, filed 12 Aug.
2004, titled "HYBRID IMAGING METHOD TO MONITOR MEDICAL DEVICE
DELIVERY AND PATIENT SUPPORT FOR USE IN THE METHOD," describes a
system having a dedicated stretcher combined with a dedicated
tabletop for improved access to the breast. The tabletop 18 shown
in FIG. 1 is substantially similar to one described and illustrated
in that application. The inventors are the same as those of the
present disclosure. This application is incorporated herein by
reference in its entirety.
[0020] A number of adaptations to these standard technologies for
purposes of intervention have been described. U.S. Pat. No.
6,459,923 (Plewes et al.) claims a stretcher having an
interventional area which is used by removing a section from the
tabletop to provide access for intervention. The invention thus
comprises two shorter tabletops which are bridged together, and
which rely on the support of a stretcher which has a corresponding
section of its top missing. There is also a means of bridging the
gap in the stretcher on which the tabletop lies, so that the
tabletop has a support for its wheels to roll on as it is advanced
into the imaging volume. This type of bed is also described by in
U.S. Pat. No. 5,729,849 (Garakani).
[0021] U.S. Pat. No. 6,446,286 claims patient imaging tables having
regions of reduced radiation attenuation which are variously
described as holes, thin areas, or areas of different materials to
be used in nuclear imaging.
[0022] U.S. Pat. No. 6,776,527 details a means of using a stretcher
to repeatably bring a table top and patient into a known position
with a CT scanner relative to a PET scanner.
[0023] US Patent application 2004102690 details a transporter which
attaches to tabletops that can be used with different types of
imagers. This invention is intended to ease patient handling by
removing the need to transfer the patient from one patient support
to another.
[0024] British patent GB2394412 describes a transporter which has
tabletop support elements which can accept and support two or more
different tabletops, i.e. a computer tomography tabletop, and MRI
tabletop, and angiographic tabletop, etc. Tabletops having
different contours are supported in such a way as to prevent
unintentional lateral displacement. This enables imaging the same
patient with multiple imaging technologies without repositioning
the patient on separate tables, but does not add any new
capabilities to those provided by the individual imaging
technologies.
[0025] U.S. Pat. No. 6,640,364 details a tabletop that is used to
co-register MRI and X-ray images, by keeping the patient in the
same configuration while transporting them from one imaging system
to the other. They specify that the motion be in a straight line
away from the MRI. Although the X-ray pedestal has rails intended
to facilitate linear motion of the tabletop and the tabletop is
said to be accepted by either imaging system, there is no apparent
means for physically transferring it to the MRI's stretcher. No
multiple tabletops or special features of the tabletop are
indicated.
[0026] A similar invention is claimed by Olszewski, et al. in
DE29818100U, in which a patient lies on a horizontally slidable
tabletop and can thus be delivered from an X-ray computer
tomography machine to a nearby support surface whose support
columns are moveable, thus providing access for a c-arm x-ray
machine. Again, no mention is made of multiple tabletops or
tabletops for special purposes.
[0027] Similarly, U.S. Pat. No. 5,619,763 describes a means for
transferring a tabletop from a support to a pedestal to improve the
ability to position patients for nuclear imaging. Although this
patent mentions transferring tabletops from one means of support to
another, neither tabletop support nor pedestal permits access to
the underside of the tabletop and the tabletop is not said to
embody any special features. Only transferring by rolling
longitudinally is detailed.
[0028] EP0501071 (Deucher et al.) claims a means of storing a
patient couch for a CT scanner, such that it will fit within a
standard military enclosure. They are able to reduce the floor
space required for the patient stretcher by storing on an oblique
angle. They do not save space when storing multiple stretchers, or
when the stretcher is in use.
SUMMARY OF THE INVENTION
[0029] The original technology described herein provides a class or
tabletops including the plurality of different tabletops (FIG. 1)
for a tomographic imaging system such as X-ray computerized
tomography (CT) or magnetic resonance imaging (MRI). The various
tabletops include specially optimized systems for imaging or
intervention of a particular body part. These tabletops may be
configured to fit various MRI vendors standard systems (Siemens,
Toshiba, Philips, as non-limiting examples). These MRI systems in
particular are commercially available with the ability to
interchange a second, identical tabletop using a dedicated tabletop
transporter as shown in FIGS. 2-7 and FIGS. 13-14.
[0030] In accordance with the presently described technology, two
or more tabletops are interchanged using any one of several types
of transporters (FIG. 8 and 9). If it is desirable to reduce the
number of transporters used while making use of multiple tabletops,
and thus there are more tabletops than transporters, a preparatory
station (FIG. 10) may be used in conjunction with one or more
transporters for the storage of multiple tabletops, patient
preparation, and for performing intervention.
[0031] Specialized tabletops may be installed in place of the
normal tabletop, in addition to (placed on top of or clamped on top
of) the normal tabletop, either in the usual manner or overhanging
one or another end of the ordinary tabletop supports.
[0032] There is a plurality of permutations where multiple
embodiments exist for different aspects of the system. A viable
system comprises one element from each of the following:
[0033] tabletop purpose (breast, prostate, etc)
[0034] on top of original tabletop or replacing original
tabletop
[0035] overhanging either end of support (whether that is a
stretcher, an MRI or an original tabletop) or not overhanging
[0036] Method of placing and removing tabletop (transporter from
side 14, transporter from end 2, novel transporter 32)
[0037] More than one transporter or using a prep station
BRIEF DESCRIPTION OF THE DRAWINGS
[0038] FIG. 1 shows a perspective view of a variety of tabletops.
From top left to right: a normal tomography tabletop (prior art), a
tabletop having an aperture for ultrasound examination and/or
intervention, a breast imaging tabletop integrating ramps,
apertures and provisions for fixturing devices used to immobilize
tissue and fixture interventional devices, a prostate tabletop
having a cutaway for interventional access, an X-ray tabletop
having an integrated flat panel X-Ray detector, a breast imaging
tabletop having a removable element, a breast tabletop having
multiple apertures. From the bottom left: a prostate interventional
tabletop having a foreshortened body support and adjustable
leg-supporting stirrups, a prostate interventional tabletop having
an upper body support connected to a foot support with arched
members.
[0039] FIG. 2 (Prior art) shows an exploded view of an imager,
showing the transporter and other parts used to position the
tabletops
[0040] FIG. 3 (Prior art) shows a perspective view of an imager
showing the normal tabletop at the home position.
[0041] FIG. 4 (Prior art) shows a perspective view of an imager
with the normal tabletop advanced by the horizontal stage to the
scan position.
[0042] FIG. 5 (Prior art) shows a perspective view of an imager
with a transporter engaged with the normal tabletop.
[0043] FIG. 6 (Prior art) shows a perspective view of an imager
showing a transporter engaged with the normal tabletop and the
vertical and horizontal stages lowered in preparation for the
removal of the tabletop.
[0044] FIG. 7 (prior art) shows a perspective view of an imager
with its tabletop withdrawn on a transporter.
[0045] FIG. 8 shows a perspective view of Siemens tabletop (prior
art) on a transporter (prior art) interleaved with a
special-purpose tabletop. Minimal space is used by interleaving
them, while it is still possible to perform patient positioning or
intervention on the uppermost tabletop according to the novel
teachings of the present application.
[0046] FIG. 9 shows a perspective view of a Siemens imaging system
in combination with a specialized tabletop installed in place of
the normal tabletop on the horizontal stage of the imager.
[0047] FIG. 10 shows a perspective view of a patient preparatory
station away from the imager that integrates lights, mirrors,
position tracking devices, vertical adjustability, storage for
multiple tabletops, and room for interventional access to a
suitable tabletop.
[0048] FIG. 11 shows a perspective view of a prep station with a
specialized tabletop mounted, showing a Siemens tabletop (prior
art) on a transporter (prior art) being delivered to a second
storage berth.
[0049] FIG. 12 shows a perspective view showing a specialized
tabletop removed from a prep station, and positioned on an imager.
A Siemens tabletop (prior art) is stored on the prep station.
[0050] FIG. 13 (prior art) shows an exploded perspective view of an
alternate imager, being representative of a Phillips magnetic
resonance imaging system, whose vertically adjusting tabletop
support is affixed to the floor, and whose transporter approaches
from the side of the tabletop.
[0051] FIG. 14 (prior art) shows a perspective view of the Philips
imager in FIG. 13
[0052] FIG. 15 shows a perspective view of the Philips imager,
where the normal Philips tabletop is stored on a prep station, and
a special-purpose tabletop is put in place using a transporter FIG.
16 shows a perspective view of an imager showing how its tabletop
may be advanced through its bore, so as to leave one end
cantilevered out of the end of the imager opposite the vertical
stage.
[0053] FIG. 17 shows a perspective view of an imager with a special
purpose tabletop which sits on top of the normal tabletop,
overhanging it, and which is advanced through its bore in order to
provide access to the patient through the tabletop's gap.
[0054] FIG. 18 shows a perspective view of an imager with a special
purpose tabletop which sits in place of the normal tabletop,
overhanging the horizontal stage, and which is advanced through its
bore in order to provide access to the patient through the
tabletop's gap.
[0055] FIG. 19 shows a perspective view of an imager with a special
purpose tabletop which sits in place of the normal tabletop,
overhanging the horizontal and vertical stages, in order to provide
access to the patient through the tabletop's gap.
[0056] FIG. 20 shows a perspective view of an imager with a special
purpose tabletop which sits on top of the normal tabletop,
overhanging the normal tabletop and the horizontal and vertical
stages, in order to provide access to the patient through the
tabletop's gap.
[0057] FIG. 21 shows a novel embodiment of a transporter which
carries a special purpose tabletop which uses sliding rails that
only permit translation in the direction the tabletop travels when
advancing to the scan position.
[0058] FIG. 22 shows the transporter and tabletop of FIG. 21, where
the imager's vertical stage has been lowered to permit the removal
of the transporter and tabletop.
[0059] FIG. 23 shows an alternate embodiment of the transporter and
tabletop of FIGS. 21-22, wherein the special purpose tabletop is to
be installed over top of the normal tabletop.
[0060] FIG. 24 shows an alternate embodiment of a tabletop for
prostate intervention, comprising a shorter tabletop having ramps
and strut-supported stirrups for leg support.
[0061] FIG. 25 shows the tabletop for prostate intervention of FIG.
24 where the tabletop has been removed from the imager and where
the stirrups have been spread apart for improved interventional
access.
GLOSSARY OF NUMBERS IN FIGURES
[0062] 2 Transporter, end approach (Siemens) [0063] 4 table top
("normal table top") [0064] 6 Table top on wheels (Philips, FIG.
13) [0065] 8 Horizontal stage (Siemens magnet) [0066] 10. Vertical
stage (Siemens magnet) [0067] 12 Alternate embodiment (Philips) of
vertical stage. [0068] 14 Alternate transporter, side approach
(Philips) [0069] 16 Special Purpose (US aperture) tabletop [0070]
18 Special Purpose (breast) tabletop [0071] 20 Special Purpose
(prostate) tabletop [0072] 22 Special Purpose (X-ray) tabletop
[0073] 24 "Imager" (MRI or CT) [0074] 26 Cantilever constraints
[0075] 28 T slot bosses [0076] 30 T-slots [0077] 32 Transporter
with T-slot constraint. [0078] 34 Bore of imager [0079] 36 US
aperture [0080] 38 ramps (in breast tabletop) [0081] 40 Provision
for affixing devices for tissue immobilization (compression plates)
[0082] 42 Cutaway for interventional access (prostate) [0083] 44
X-ray flat panel detector [0084] 46 Provision for affixing
interventional devices. [0085] 48 Vertically adjustable upper stage
of transporter [0086] 50 Multiple berths for tabletops (on prep
station) [0087] 52 Vertically adjustable storage (on prep station)
[0088] 54 Position tracking devices (on prep station) [0089] 56
Lights (on prep station) [0090] 58 Blood catchment (on prep
station) [0091] 60 Mirrors for patient positioning (on prep
station) [0092] 62 Feature to guarantee alignment of transporter
when releasing or attaching tabletop (on prep station) [0093] 64
Wheels (on prep station) [0094] 66 Cutout (breast) [0095] 68 Simple
transporter [0096] 70 Prep station [0097] 72 Wheels (Philips
tabletop) [0098] 74 tabletop (breast, removable arch) [0099] 76
removable arch [0100] 78 arch fixation means [0101] 80 tabletop
(breast, with CC access) [0102] 82 CC access apertures [0103] 84
short prostate tabletop [0104] 86 ramps (short prostate tabletop)
[0105] 88 adjustable struts (short prostate tabletop) [0106] 90
stirrups (short prostate tabletop) [0107] 92 pivot (short prostate
tabletop) [0108] 94 prostate tabletop [0109] 96 arched members
(prostate tabletop) [0110] 98 interventional gap (prostate
tabletop)
DETAILED DESCRIPTION OF THE INVENTION
[0111] In accordance with the technology described herein, a
specialized tabletop is selected from a plurality of tabletop forms
( shown in FIG. 1), which tabletop is best suited to the needs of
the procedure to be undertaken. Described here are tabletops which
integrate features for optimized patient positioning, imaging and
intervention such as: [0112] contoured ramps 38 used to elevate and
immobilize the anatomy of interest, [0113] apertures 36, 82, 98 to
enable physicians to access and to bring devices into contact with
selected tissue. [0114] removable structural elements 46, which can
safely be removed from the table top when the tabletop is supported
by a suitable means, such as a prep station. [0115] integrated
imaging devices 44 such as an X-ray flat panel detector. [0116]
structures suited to the fixturing of compression plates 40. [0117]
structures suited to guidance and fixturing of devices such as
interventional probes 46. [0118] actuators which manipulate one or
more joints during or between imaging sequences. [0119] a shorter
patient support 84 than the normal tabletop 4, enabling improved
access to tissues. [0120] support elements such as stirrups 90 to
hold the legs and feet of a patient in an adjustable degree of
separation and elevation. [0121] supports 90 for body parts having
a means of adjustment 88 such that the patients position can be
modified for intervention after being imaged.
[0122] The systems of the novel technology described herein
comprise both novel tabletops and novel carrier systems
(transports) and staging platforms for the tabletops to be used in
medical imaging and medical operation facilities. The tabletops may
be characterized in a number of different ways. The tabletops are
preferably fitted with glides, engaging elements, especially
longitudinally disposed elements such as rails or other track or
rail engaging components so that the tabletop can be moved with
facility along, off of, or onto the transporter or onto the
tabletops guiding supports on the imager or preparation station.
The tabletop may have specific design components and structure to
enable specific region body support and specific regions body
access for medical procedures. Among these features may be ramps
that support one or more of the upper torso, the thorax, the hips,
the legs, the arms, the legs, etc. Apertures may be provided on the
tabletop to allow access (from underneath the tabletop). Access
panels or openings are uniquely provided herein for access to the
groin, body or spine region of a patient, as for surgery,
diagnosis, treatments, ultrasound imaging, and the like.
[0123] Specific structure that can be provided, in addition to
mirrors positioned to facilitate practitioner viewing through
apertures in the tabletop, lights to facilitate viewing of the
patient through apertures in the tabletop and other elements
already mentioned, would be pivoting stirrups, pivoting stirrups
attached to limb supports, especially for the calves, adjustable
body segment supports such as a head, neck or upper torso support
that can slide and lock longitudinally, fixed opening in the
tabletop support area around preselected body part regions (e.g.,
around the groin or breasts), fixed openings with complete opening
to one side of the tabletop so that patients may be slid into
position without having to raise the body of the patient to have
the body part extend into an opening in the tabletop, and the
like.
[0124] Portions of the tabletop that connect ends of the tabletop
together across an aperture may be arched, have ramps, and
compression plates (for fixing tissue more securely and with
greater control of pressure (especially around the apertures where
sensitive tissue areas may extend through the apertures).
[0125] A preparatory station according to teachings herein
comprises a moveable (e.g., rolling) support for multiple
tabletops. Guide elements (slide or rail engaging elements) on the
individual tabletops may be used to position the individual
tabletops onto different levels on the preparatory station, so that
individual tabletops may be positioned (e.g., slid) into and out of
place on the preparatory station for use as desired. Different
tabletop formats may be present on the preparatory station so that
individual tabletops may be removed as needed for different
procedures or when different steps in a single procedure are
needed.
[0126] FIG. 1 shows a perspective view of a variety of tabletops 4,
16, 18, 20, 22, 74, 80, 84 and 94. From top left to right, in FIG.
1 shows: a normal tomography tabletop 4 (prior art), a tabletop 16
having an aperture 36 for ultrasound examination and/or
intervention, a breast imaging tabletop 18 integrating ramps 38,
apertures 36, 42, 66 (cutout for breast positioning) and 82 and
provisions for fixturing 40, 46 devices used to immobilize tissue
and fixture interventional devices, a prostate tabletop 20 having a
cutaway for interventional access, an X-ray tabletop 22 having an
integrated flat panel X-Ray detector 44, a breast imaging tabletop
80 having a removable element, a breast tabletop having multiple
apertures. There is an element referred to herein as an "arch"
which is defined as an element that is grounded or fixed onto a
support surface and is elevated above that support surface, with or
without the open area in the structure that is normally associated
with the classic shape and geometry of an arch. Element 78 shows a
two part detachable arch that supports or confines the arms and
upper torso of a patient. Element 82 is a combined coil (CC) access
or replacement panel. Although the upper torso element 38 is not
referred to as an arch, in the image support tabletop 80 furthest
to the right, the upper torso element 38 is shown with attached
arches. From the bottom left: a prostate interventional tabletop 84
having a foreshortened body support, ramp 86, adjustable struts 88
and adjustable leg-supporting stirrups 90, a prostate
interventional tabletop 94 having an upper body support 98
connected to a foot support with arched members 96. The various
tabletops have unique individual features that promotes and enables
their use in specific or general surgical procedures in combination
with imaging techniques. The table tops may be carried, slid, or
engaged with supports or into systems. A system compatible edge, or
engaging format along the sides and/or bottom of the tabletops
would enable their exchangeable use within a known imaging and/or
surgical system.
[0127] FIG. 2 (Prior art) shows an exploded view of an imager 24,
showing the transporter 2 and other parts used to position the
tabletops 4 (Note: This is an approximate representation of a
Siemens Avanto MRI. See
http://www.medical.siemens.com/siemens/en_US/gg_mr_FBAs/images/product_im-
ages/GG_Overview/Product_Overview_Avanto_HP5.jpg. A horizontal
stage 8 for the tabletop is provided as is a vertical stage 10. The
tabletop would be carried in concert with the horizontal and
vertical stages (8 10) on the transporter 2, moved to the imager
24, and the patient inserted along with all three components 4, 8
and 10.
[0128] FIG. 3 (Prior art) shows a perspective view of an imager 24
showing the normal tabletop 4 at the home position. This is an
approximate representation of a Siemens Avanto.TM. MRI. See
http://www.medical.siemens.com/siemens/en_US/gg_mr_FBAs/images/product_im-
ages/GG_Overview/Product_Overview_Avanto_HP5.jpg). The elements 8
and 10 are the same as in FIG. 2. All elements of same numbers in
these figures represent the same or similar elements in all other
figures.
[0129] FIG. 4 (Prior art) shows a perspective view of an imager 24
with the normal tabletop 4 advanced by the horizontal stage 8 to
the scan position within the imager.
[0130] FIG. 5 (Prior art) shows a perspective view of an imager 24
with a transporter 2 engaged with the normal tabletop 4.
[0131] FIG. 6 (Prior art) shows a perspective view of an imager 24
showing a transporter 2 engaged with the normal tabletop 4 and the
vertical 10 and horizontal 8 stages lowered in preparation for the
removal of the tabletop 4.
[0132] FIG. 7 (prior art) shows a perspective view of an imager 24
with its tabletop 4 withdrawn on a transporter 2.
[0133] FIG. 8 shows a perspective view of Siemens tabletop 4 (prior
art element, and only substantive element of prior art in FIG. 8)
on a transporter 2 (prior art) interleaved with an inventive
special-purpose tabletop 18 according to the novel disclosure of
technology that constitutes invention. Minimal space is used by
interleaving them, while it is still possible to perform patient
positioning or intervention on the uppermost tabletop 18 according
to the novel teachings of the present technology.
[0134] FIG. 9 shows a perspective view of a Siemens imaging system
in combination with a specialized tabletop 18 installed in place of
the normal tabletop on the horizontal stage 8 of the imager 24.
[0135] FIG. 10 shows a perspective view of a patient preparatory
station 70 away from the imager that integrates lights 56, mirrors
60, position tracking devices 54, vertical adjustability
52,alignment element 62, casters or rollers 64, storage for
multiple tabletops 50, and room for interventional access to a
suitable tabletop.
[0136] FIG. 11 shows a perspective view of a prep station 70 with a
specialized tabletop 18 mounted, showing a Siemens tabletop element
4 (prior art) on a transporter 2 (prior art) being delivered to a
second storage berth.
[0137] FIG. 12 shows a perspective view showing a specialized
tabletop 18 removed from a prep station 70, and positioned on an
imager 24. A Siemens tabletop element 4 (prior art) is stored on
the prep station 70.
[0138] FIG. 13 (prior art) shows an exploded perspective view of an
alternate imager 24, being representative of a Phillips magnetic
resonance imaging system, whose vertically adjusting tabletop
support 12 is affixed to the floor, and whose transporter 14
approaches from the side of the tabletop 6. The tabletop 6 has
rollers 72 thereon so that the tabletop 6 is moved easily, but
there are no engaging elements.
[0139] FIG. 14 (prior art) shows a perspective view of the Philips
imager 24 in FIG. 13 FIG. 15 shows a perspective view of the
Philips imager 24, where the normal Philips tabletop 6 is stored on
an inventive prep station 70, and a special-purpose tabletop 18
according to the present teachings is put in place using a
transporter 12
[0140] FIG. 16 shows a perspective view of an imager 24 showing how
its tabletop 4 on the horizontal stage 8 may be advanced through
its bore, so as to leave one end cantilevered out of the end of the
imager opposite the vertical stage 10.
[0141] FIG. 17 shows a perspective view of an imager 24 with a
special purpose tabletop 18 which sits on top of the normal
tabletop 4 on a horizontal stage 8, overhanging it, and which is
advanced through its bore in order to provide access to the patient
through the tabletop's gap.
[0142] FIG. 18 shows a perspective view of an imager 24 with a
special purpose tabletop 18 which sits in place of the normal
tabletop, overhanging the horizontal stage 8, and which is advanced
through its bore in order to provide access to the patient through
the tabletop's gap. Grooves can be seen on the vertical stage 10
that engage with grooves on the horizontal stage so that movement
of the tabletop 18 is secure, stable and controlled within the bore
of the imager 24.
[0143] FIG. 19 shows a perspective view of an imager 24 with a
special purpose tabletop 18 of the present technology which sits in
place of the normal tabletop (not shown), overhanging the
horizontal 8 and vertical 10 stages, in order to provide access to
the patient through the tabletop's gap. Cantilever restraints 26
are shown to control movement of the tabletop 18 on the horizontal
support 8.
[0144] FIG. 20 shows a perspective view of an imager 24 with a
special purpose tabletop 18 which sits on top of the normal
tabletop 4, overhanging the normal tabletop and the horizontal
support 8 and vertical 10 stages, in order to provide access to the
patient through the tabletop's gap. Cantilever restraints 26 are
shown extending further out of the horizontal support 8 to control
movement of the tabletop 18 on the horizontal support 8.
[0145] FIG. 21 shows a novel embodiment of a transporter 68 which
carries a special purpose tabletop 18 which uses sliding rails 28
that permit translation only in the direction the tabletop 18
travels when advancing into the bore 34 to the scan position in the
imager 24. T-slots 30 assure smooth maneuvering of the tabletop
along sliding rails 28. Innermost (with respect to the bores)
T-slots may having extending or retracting functions thereon to
lock the tabletop or restrict the tabletop within the bore 34 and
may be retracted or extended (respectively) to allow removal of the
tabletop from the bore when desired.
[0146] FIG. 22 shows the transporter 68 and tabletop 18 of FIG. 21,
where the imager's vertical stage 10 has been lowered to permit the
removal of the transporter 68 and tabletop 18 of the present
technology by disengaging from the tabletop 18. The main support of
the tabletop has been labeled 34 in this figure.
[0147] FIG. 23 shows an alternate embodiment of the transporter 68
and tabletop 18 of FIGS. 21-22, wherein the special purpose
tabletop 18 is to be installed over the top of the normal tabletop.
The main support of the tabletop has been labeled 34 in this
figure.
[0148] FIG. 24 shows an alternate embodiment of a tabletop 84 for
prostate intervention as a short prostrate tabletop, comprising a
shorter tabletop 84 having ramps 86 and strut-supported stirrups 90
for leg support. Also shown is a pivot 92 allowing pronation or
orientation of limbs, as in a prostrate table, to permit better
access to the region of interest during invasive procedures.
[0149] FIG. 25 shows the tabletop 84 for prostate intervention of
FIG. 24 where the tabletop 84 has been removed from the imager and
where the stirrups or pivots 90 have been spread apart for improved
interventional access.
[0150] Imaging on traditional tabletops does not always permit
optimal patient positioning for imaging or for intervention. The
patient position required for imaging is often different than that
required for intervention. Additional features are built into a
tabletop for constraining or repositioning a particular body part.
Contours and apertures in a tabletop are used to immobilize or gain
access to that body part. In order to reduce respiratory motion
during imaging, breasts are advantageously imaged prone, and the
prostate is best imaged supine. Positioning the patient in these
ways effectively prevents physicians from accessing the tissues for
intervention. But breast imaging and intervention may be performed
prone where suitable ramps 38 and cutouts 66, 82 are provided in
the tabletop. Similarly, prostate intervention may be performed
supine if a cutaway 42, 98 is provided for the access of the
physician.
[0151] Further improved access to the prostate is afforded by a
tabletop such as that of FIG. 24 where the legs are supported by
stirrups 90 on adjustable struts 88. Such a tabletop permits the
physician to maximize the elevation and separation of the patient's
knees for better access to prostate through the rectum, while
maintaining a configuration that allows the patient to be advanced
into the imager's bore. It may be further advantageous to separate
the patient's legs once he is removed from the bore of the imager,
which is accomplished by adjusting the stirrups 90 positions with
the adjustable struts 88 supporting them (FIG. 25).
[0152] In general, these tabletops may be configured to ensure the
patient's clearance from the bore of the imager, but may then be
adjusted to provide patient positioning as preferred for
intervention or surgery. This is particularly desirable when a
patient will have pre-operative imaging done and will then undergo
surgery. If the tabletop is adjustable in the same directions as a
surgical table, e.g with armboards, stirrups, head and neck
positioning, etc, then the benefits of surgical positioning are had
without the need to transfer the patient from the imaging tabletop.
An adjustable tabletop of this kind could be place directly on top
of a surgical table, or onto a transporter 2.
[0153] Respiratory motion of the liver and kidneys is minimized in
tomographic imaging if the patient is positioned supine. In order
to subsequently locate the same tissues with ultrasound, it is
advantageous to not move the patient from the position held during
tomographic imaging. In order to access tissues through the back of
a supine patient, an ultrasound permeable membrane or aperture 36
is required.
[0154] The accessibility afforded by the present invention to
devices used for other imaging modalities is complimented by the
integration of position markers that can be identified using more
than one imaging modality. If these points can be identified on two
or more imaging modalities, they permit a co-registration of the
coordinate systems used in those imaging modalities. It is also an
established practice to use a position tracking device to track the
positions and orientations of suitable tools, handpieces or markers
(which can, in turn, be brought into a known relationship with
markers visible on the images). Our invention facilitates
registration with the tracker's co-ordinate system by providing a
means of repeatably fixing such a tracker to the tabletop in a
known position and orientation.
[0155] Position tracking devices that are compatible with the
imaging technology may be integrated into the tabletop by being
embedded in the structure of the bed. As with the trackers above
that repeatably affix to the tabletop, integrated trackers
typically have an optimal working range or may require a line of
sight to function, so the exact position of the tracker within the
tabletop is chosen to suit the tracker's characteristics and the
anatomy under investigation.
[0156] Since RF energy deposition resulting in heating is a common
feature of MRI, it is advantageous to provide a tabletop with
integrated temperature control to cool the patient or sample under
investigation. Alternatively, a heating tabletop may be provided
for use with patients under sedation who would otherwise be in
danger of hypothermia. The means commonly used to control patient
temperature may not be as well suited to tomographic imaging, as
size limitations of the bore 34 of the imager may make conventional
approaches unsuitable. We propose a tabletop having an array of
passages connecting to a means of supply and return of a fluid used
to transfer heat to or from the patient, through a thermally
conductive tabletop. The fluid is chosen to avoid contributing any
signal or any contrast effect to the imaging means. A temperature
sensor such as a thermistor or thermocouple is advantageously
integrated to improve the means of temperature control and prevent
extremes of temperature at or near the patient's skin.
Alternatively, in the absence of fluid flow, thermoelectric cooling
or electric heating elements can be integrated into the
tabletop.
[0157] In many cases, it is desired to use X-ray C-arm imaging to
gather more images of the particular tissues under examination.
Traditional tabletops limit this capability by introducing
structural elements of the tabletop into the field of view. In
accordance with the present invention, it is possible to provide a
tabletop having an integrated X-ray detector 44 which is mounted
adjacent to the patient without excess structural elements
intervening.
[0158] For MR imaging, tabletops may integrate specialized MRI
coils (receiver or transceiver antennae) to improve coil
sensitivity, according to the inherent needs of imaging a
particular body part. Alternatively, tabletops may integrate
fixtures for the rigid attachment of modular, re-positionable coils
which permit those coils to be brought closer to the anatomy to
improve coil sensitivity and can be positioned for each patient to
guarantee unencumbered access for interventional devices.
Interchangeability provides an option either to integrate coils
into the table top or to permit removable, re-positionable or
interchangeable coils for use on different magnets with different
field strengths, for use in spectroscopy or for use on different
imagers having different numbers of channels.
[0159] In conjunction with this invention, transporters are used to
displace tabletops and any patients thereon, to maintain the
position of the tabletop when the imager's vertical stage is
lowered, so as to permit access to the patient by making use of a
gap or aperture in the bottom of the tabletop, and to raise the
tabletop higher than its normal position, to ease physician access
to the underside of tabletops. Alternately, the tabletop may be
raised higher than its normal position with a prep station.
[0160] Intervention is performed on the table top with the patient
in the same configuration as during tomographic imaging. The
tabletop and patient may remain in the imaging volume of the imager
(FIG. 4), may be removed to the home position (FIG. 3), may be
removed to a point in between the home position and the imaging
volume, may be removed from the imager entirely using a
transporter, or may be transported to a different room entirely.
Creating clearance underneath the tabletop is useful for access to
gaps, cutaways and apertures in the tabletop. This may be done by
positioning the tabletop at the home position with the imager's
vertical stage 10 lowered (FIG. 15), or with the tabletop and
patient on the transporter (FIG. 8) or prep station (FIG. 11). An
alternative means of fitting specialized table tops in such a way
as to gain access to gaps, cutaways or apertures is to cantilever a
portion of the tabletop over the near (FIG. 19) or far end (FIG.
18) of the imager's horizontal stage 8. Alternatively, such a
cantilevered tabletop may be fitted over top of the normal tabletop
4, and extended over the near (FIG. 20 ) or far end (FIG. 17).
Camping or latching constraints 26 may be used to prevent
separation of a cantilevered tabletop from its support.
[0161] Time savings resulting from remote patient preparation is
not a novel aspect of this system. The patient preparatory station
may also integrate any of:
[0162] position tracking devices which use stereoscopic optical
cameras or electromagnetic transmitters and receivers to make
rapidly repeated measurements of the position and orientation of a
marker, which marker is affixed to a patient tissue, a tabletop, an
interventional device such as a biopsy needle, or an imaging device
such as an ultrasound transducer.
[0163] mirrors disposed in a horizontal or near horizontal plane
near the bottom of the structure, used to aid in positioning
patients by permitting visualization of tissues visible through
apertures in the underside of tabletops.
[0164] height adjustability of tabletops by means of sliding or
telescoping elements, tabletops being raised to ease physician
access to tissues accessible from under a tabletop, and lowered to
facilitate patients getting on and off of tabletops.
[0165] system for fully supporting a tabletop, which tabletop has
one or more structural elements removed from its fixation
components, such as additional support arms disposed at regular
intervals along the length of the area which receives
tabletops.
[0166] components or systems for locking down a tabletop with a
mechanical safety interlock such as a clamp when one or more of its
structural elements has been removed such that transport of the 30
tabletop in an unsafe condition is prevented.
[0167] Equipment used to facilitate vacuum assisted biopsy, such as
a vacuum pump, fluid handling means and control electronics. The
integration of this equipment inside the prep station permits
convenient use and storage of vacuum biopsy equipment without
requiring separate equipment to be brought into proximity with the
patient.
[0168] Wheels to facilitate relocation of the prep station, which
wheels have swivel and rolling locks to prevent the unintentional
displacement of the prep station.
[0169] guidance means and suitable mechanical interlocks to ensure
that transporters may only release tabletops onto the supports of a
prep station when those transporters are correctly positioned
relative to the prep station.
[0170] collection means for collection of bodily fluids, embodied
either as a drain and storage tank which interfaces with and
receives fluid from a fluid collection means integrated in a
tabletop, or a catch basin, drain and storage tank which collect
fluids which are not collected by a tabletop, such as those that
issue from a gap in the tabletop. Pressure control and vacuum
control in the collection means is contemplated, as are one-way
flow systems, one way valves and meters.
[0171] storage such as drawers and shelves in the prep station for
accessories such as imaging or interventional equipment, in
addition to the multiple tiers for receiving multiple
tabletops.
[0172] a shelf or shelves that may be used to support an ultrasound
imaging machine, a biopsy tray or other imaging or interventional
equipment when such equipment is being used in a location close to
the patient which is visible to and accessible to the physician,
such as under the tabletop bearing the patient.
[0173] a means of repositioning all or part of the patient without
entirely removing the patient from the tabletop such as the
provision of adjustable armboards or stirrups near the tabletop or
the ability to provide inclination/declination of a tabletop (or a
portion of the tabletop so that it may bend at a longitudinal joint
and/or a joint perpendicular or angled to the longitudinal aspect
of the tabletop) such as Trendelenberg positioning by means of
individually height adjustable tabletop support arms.
[0174] side rails sized as the standard surgical side rail for the
fixation of accessories.
[0175] In further accordance with the invention, and in order to
use more than two tabletops described above, it is advantageous to
have an efficient means of storing or stacking tabletops. FIG. 10
illustrates a prep station 70 used for that purpose. It may be kept
in proximity to the imager, or in a separate room. It is used for
storage of tabletops, preparation of patients for imaging, and for
procedures carried out on a table top subsequent to imaging.
[0176] It comprises a vertically adjustable array of storage berths
50 which accept and support tabletops. Its vertical adjustability
using slides 52 permits any tabletop from a large selection to be
transferred to and from a transporter, whether or not that
transporter is itself vertically adjustable. The topmost berth may
be used for positioning a patient, or carrying out procedures such
as intervention. The vertical adjustability is of sufficient range
to permit the topmost berth to be brought to a suitable working
height for the physician to perform subsequent intervention or
non-tomographic imaging.
[0177] The prep station may be mounted on wheels 64 for convenience
of use and storage in various locations. The prep station, although
fitted with wheels, is different than a transporter, in that it may
contain materials or apparatus which are not suitable for proximity
to, or for use in proximity to an imager such as an MRI. It is
intended to accept tabletops from transporters. It has integrated
channels 62, rails or other guidance means used to repeatably guide
transporters into position for the addition and removal of
tabletops. Additionally, it may be brought to and used in a
surgical suite.
[0178] Advantageously, and in accordance with the preferred
embodiment of the invention, it comprises lights 56, a fluid
catchment 58, position tracking devices 54 and mirrors 60 for use
performing interventions when suitable tabletops are used. The
tabletops reside in a known position relative to these lights and
position tracking devices.
[0179] Further advantageously (FIG. 21), a simple type of
transporter 68 may be used in connection with imagers having a
vertical stage 10, 12, which relies on the lowering of that
vertical stage to engage the tabletop on the transporter, removing
it from the imager, and does not require any clamping or locking
mechanism in order to support and transport the tabletop. The
simplified transporter 68 employs constraints 28 which correspond
to slides or rails 30 on the tabletops used therewith 34. The
slides or rails permit horizontal translation of the tabletop
between the home position and the imaging volume, but do not allow
the tabletop to be lowered on the vertical stage. If the vertical
stage is lowered, the tabletop remains fixed on the simplified
transporter and can be removed from the imager (FIG. 22).
[0180] An alternate embodiment of the system described above and
shown in FIG. 21, 22 is shown in FIG. 23. This transporter and
tabletop are sized and disposed appropriately to permit placement
of a special purpose tabletop over top of the normal tabletop 2, or
a similar special purpose tabletop such as a tabletop with an
aperture for ultrasound 16. This is accomplished by lowering the
vertical stage 10, which carries the normal tabletop 2. The special
purpose tabletop 34 is then brought into alignment with the normal
tabletop on the vertical stage, and the vertical stage is raised
until the special purpose tabletop 34 is supported by the imager's
vertical stage and the normal tabletop. In this way, the necessity
of picking up and displacing the existing tabletop is removed. The
special purpose tabletop 34 is advantageously constructed to be
thin so as to minimize the space required in the imaging volume for
the extra tabletop. This approach is also very suitable for imaging
systems whose tabletops are not removable.
[0181] The technology may be used in such surgeries such as for
example, in a prostate biopsy, where a man lies on his back, with
legs sightly splayed (still fitting into the bore of the imager)
and his thighs lie directly above the aperture. A physician then
uses the cutaway (e,g, the hole extending completely to and through
an edge of the tabletop (as in FIG. 1, Table 20) to gain access to
reach between the patient's thighs and for the physician to insert
a needle into the perineum.
[0182] The tabletop may also be constructed of lightweight
construction such that the tabletop can be placed by hand over top
of or in place of an imager's general-purpose tabletop in such a
way that a transporter can be used to remove later it with a
patient on it.
[0183] The invention may be described as including various distinct
elements, including at least a tabletop for use in medical
procedures comprising a support surface for a patient and engaging
elements on a) at least two lateral sides or b) at the bottom of
the tabletop under the support surface for engaging guiding means
that comprise i) part of an imager, ii) part of a preparatory
station, or iii) patient transporter. The tabletop may comprise at
least one structure selected from the group consisting of:
[0184] structure other than a single extended flat surface that
supports specific portions of the human anatomy;
[0185] apertures in the structural support surface that allows for
body parts to extend through the holes to provide access to those
body parts during medical examination or procedures;
[0186] apertures in the structural support surface that allows
interventional or imaging devices to extend through the holes to
gain access to body parts during medical examination or
procedures;
[0187] structural elements on the tabletop that support specific
portions of the human anatomy and are adjustable to fit or
accommodate patients or body parts of patients of different
dimensions.
[0188] Adjustable body support elements that are removable,
adjustable and replaceable manually (without wrenches or
screwdrives);
[0189] structural elements such as bridging elements connecting
sections of a tabletop, that are removable in order to gain access
to patient tissues.
[0190] structure that supports, guides and secures interventional
medical devices while allowing those devices to be used for medical
procedures,
[0191] optical or electromagnetic position trackers having a
reference component fixed to the tabletop which measures the
position of a movable tracked component attached to an
interventional or imaging device;
[0192] cooling means integral with the tabletop;
[0193] a pneumatic or hydraulic system for motivating the tabletop
or components on the tabletop (such as longitudinal expansion,
compression plates, aperture walls, etc.),
[0194] fluid drainage paths and connector to a fluid receptor on
that fluid path,
[0195] controlled pressure bladders for assisting in the
comfortable positioning of patients,
[0196] pressure controls for the bladders so that they may be
inflated or deflated to alter points of support for patients to
relieve local stress on the patient,
[0197] actuators for attachments to limbs or joints of patients to
assist in the manipulation of the limbs or joints during medical
procedures or imaging,
[0198] remote control system for the actuators,
[0199] engaging system on the sides and/or bottom of the tabletop
to engage support elements on a transporter, and
[0200] latching or locking elements to secure the tabletop to
structures on which the tabletop is placed.
[0201] The tabletop may specifically comprise an elongated patient
support plane and an opening in the patient support plane allowing
body parts to pass into the opening when a patients front lies on
the patient support plane, the tabletop having engaging guide
supports along at least one of a) both lateral longitudinal edges
of the tabletop and b) along the bottom of the tabletop, the
engaging guide supports allowing the tabletop to be slidably
engaged with guides on at least one of a transporter, imager or
preparatory station. The tabletop may have the opening positioned
on a location of the support plane such that a patient lying on
his/her front against the support plane will have body parts
exposed and accessible through the opening, the opening comprising
at least one of a fixed-size aperture in the support plane, an
adjustable aperture in the support plane, or an opening in the
support plane that extends to the edge of the support plane. This
tabletop may further comprise at least one elevated arch element on
the support plane which can support specific body portions of a
patient. The arch support element may be adjustable in at least one
dimension of height and width, or the arch support element can be
removed or securely positioned by snap engagement or manually
controlled clamp engagement. There may be inflatable/deflatable
bladders present on the support plane to assist in positioning or
comforting a patient. The adjustable limb support elements may be
secured to the tabletop to support at least one limb of a patient
while positioned on the tabletop. The tabletop may comprise rails,
slides or clamping arms suitable for the fixturing of coils in
positions adjustable in at least two degrees of freedom such that
said coils may be held motionless in positions close to the
patient's tissues, above the tabletop's surface,
[0202] The novel technology of this application may also comprise a
method of performing an imaging or interventional medical procedure
on a patient comprising positioning a patient on the tabletop
described above, and imaging the patient or performing an
interventional medical procedure on the patient. The method may
allow a portion of the patient to extend downwardly through an
aperture in the tabletop and an interventional procedure is
performed on the patient through the aperture, The method may have
the interventional procedure performed after the patient is imaged
with an imaging technology selected from the group consisting of
X-ray imaging, PET, magnetic resonance imaging, ultrasound imaging,
and computerized x-ray tomography, or remote controlled
interventional apparatus is used to perform the interventional
procedure, and materials in the interventional apparatus do not
interfere with the imaging technology to a degree that prevents
functional viewing of the interventional procedure. The method may
have the tabletop with a patient thereon positioned within an
imager, images are taken of a region of the patient associated with
the portion of the patient, the tabletop with patient is removed
from the imager, and an interventional technique is performed on
the region of the patient. A method of may be practiced wherein at
least one tabletop according to the above descriptions is provided
for association with a device that supports the tabletop comprising
providing a prep station with at least two tabletops carried on the
prep station in slidably removable position and sliding one of the
at least two tabletops onto another support element having fitted
support for receiving the one of the at least two tabletops.
[0203] A novel system for use in medical procedures comprises an
imager, a transporter, a tabletop, and a preparatory station
comprising:
[0204] a preparatory station comprising a moveable assembly having
multiple ports, each port for acceptance and removal of a tabletop
by allowing the tabletop to slide along a guiding system into and
out of a port,
[0205] the transporter and the imager having a tabletop guiding
system that allows a tabletop compatible with the preparatory
station to be accepted and guided by the guiding systems on the
transporter and imager.
[0206] The use of removable structural elements 76 in special
purpose tabletops 74 (FIG. 1) is advantageous for a number of
reasons. Removal of one or more structural elements permits
simplified 20 patient handling and positioning when the tabletop is
adequately supported underneath and along its length. It may be
advantageous to affix the tabletop to this support with an
interlock until its removable elements have been replaced and it is
ready for transport. After imaging and transporting the patient
back to a stable support such as a prep station 70, the structural
element may be removed for optimal interventional access and
patient comfort.
* * * * *
References