U.S. patent application number 12/534542 was filed with the patent office on 2009-11-26 for integrated physiology and imaging workstation.
This patent application is currently assigned to GENERAL ELECTRIC COMPANY. Invention is credited to Brenda Donaldson.
Application Number | 20090292181 12/534542 |
Document ID | / |
Family ID | 37396062 |
Filed Date | 2009-11-26 |
United States Patent
Application |
20090292181 |
Kind Code |
A1 |
Donaldson; Brenda |
November 26, 2009 |
INTEGRATED PHYSIOLOGY AND IMAGING WORKSTATION
Abstract
A physiology workstation includes a communications interface
conveying physiology signals and ultrasound data representative of
a region of interest. The ultrasound data is obtained by an
ultrasound device in real-time during a procedure. Also included is
a physiology processing unit, an ultrasound processing unit, and a
display unit displaying the physiology signals and the ultrasound
images, the physiology signals and ultrasound signals being
presented jointly to a user in real-time during the procedure being
carried out on the subject. The display unit includes at least one
monitor co-displaying the physiology signals and ultrasound images
in adjacent windows on a single display. The physiology processing
unit, ultrasound processing unit and display unit are located in a
control room divided from a procedure room. The communications
interface extends between the procedure and control rooms and the
physiology processing unit is configured to remotely control the
ultrasound system via the communications interface.
Inventors: |
Donaldson; Brenda; (Harrison
Township, MI) |
Correspondence
Address: |
DEAN D. SMALL;THE SMALL PATENT LAW GROUP LLP
225 S. MERAMEC, STE. 725T
ST. LOUIS
MO
63105
US
|
Assignee: |
GENERAL ELECTRIC COMPANY
Schenectady
NY
|
Family ID: |
37396062 |
Appl. No.: |
12/534542 |
Filed: |
August 3, 2009 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11433951 |
May 15, 2006 |
7572223 |
|
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12534542 |
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11182473 |
Jul 15, 2005 |
7569015 |
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11433951 |
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Current U.S.
Class: |
600/301 ;
382/128; 600/300; 715/771 |
Current CPC
Class: |
G16H 40/63 20180101;
A61B 8/0833 20130101; G16H 10/60 20180101; A61B 8/582 20130101;
G16H 40/67 20180101; A61B 5/318 20210101; A61B 5/021 20130101; A61B
8/04 20130101; A61B 8/0841 20130101; G16H 30/20 20180101 |
Class at
Publication: |
600/301 ;
600/300; 715/771; 382/128 |
International
Class: |
A61B 5/00 20060101
A61B005/00 |
Claims
1. A physiology network, comprising: physiology lead inputs
configured to receive leads to be attached to a subject located in
a procedure room; an imaging device, located in the procedure room
for obtaining real-time images of a region of interest of the
subject during a physiology procedure; a database storing
previously acquired pre-case images of the region of interest, a
physiology processing unit communicating with the physiology leads
and imaging device, the physiology processing unit receiving and
processing physiology signals from the physiology leads; and a
display unit displaying the physiology signals and co-displaying
the pre-case images and the real-time images.
2. The network of claim 1, further comprising a medical network
joined to the physiology processing unit, a remote workstation and
a server joined to the medical network, the remote workstation and
the display unit co-displaying the real-time images.
3. The network of claim 1, further comprising a frame grabber
coupled to the display unit to capture real-time images selected by
a user, the captured real-time images being saved in the database
as part of a patient record associated with the subject undergoing
the physiology procedure.
4. The network of claim 1, wherein the display unit presents the
real-time images and pre-case images integrated and simultaneously
with one another.
5. The network of claim 1, further comprising memory storing
patient records, the physiology processing unit capturing still
images from at least one of the physiology signals and real-time
images and stores the still images with a corresponding one of the
patient records in the memory.
6. The network of claim 1, further comprising a video processor
that combines one or more frames generated from different types of
image information to form a final displayed image, the image
information corresponding at least one of the real-time images and
the pre-case images.
7. The network of claim 1, further comprising a video processor
that super imposes color data and greyscale data to form a single
multi-mode image frame, the color and greyscale data corresponding
to at least one of the real-time images and the pre-case
images.
8. The network of claim 1, further comprising a remote device user
interface, located remote from the procedure room and joined to the
physiology processing unit, for entering at least one of settings,
parameters and modes that are conveyed to the imaging device in
order to remotely control the imaging device, the imaging device
adjusting operation based on the at least one of settings,
parameters and the modes entered at the remote device user
interface.
9. The network of claim 1, further comprising a physiology user
interface located in the control room and controlling physiology
operations, wherein the remote device user interface is presented
on the display unit as a virtual keyboard comprised of keys
assigned to the settings, parameters and modes of the imaging
device.
10. The network of claim 1, wherein the imaging device constitutes
one of an ultrasound device, an IVUS device, an x-ray device, a
fluoroscopy device, an ablation device and a physiology mapping
device.
11. The network of claim 1, further comprising a link between the
physiology processing unit and the imaging device, wherein the link
constitutes one of a data bus, a wireless link, a video cable, a
network connection and a local area network.
12. A method for maintaining a physiology network, comprising:
configuring physiology lead inputs to receive leads to be attached
to a subject located in a procedure room; obtaining real-time
images of a region of interest of the subject during a physiology
procedure from an imaging device located in the procedure room;
obtaining, from a database, previously acquired pre-case images of
the region of interest, receiving and processing physiology signals
from the physiology leads at a physiology processing unit
communicating with the physiology leads and imaging device; and
co-displaying, on a display unit, the physiology signals, the
pre-case images and the real-time images.
13. The method of claim 12, further comprising joining a medical
network to the physiology processing unit, a remote workstation and
a server, and co-displaying the real-time images on the remote
workstation and the display unit.
14. The method of claim 12, further comprising capturing, with a
frame grabber coupled to the display unit, real-time images
selected by a user, and saving the captured real-time images in the
database as part of a patient record associated with the subject
undergoing the physiology procedure.
15. The method of claim 12, wherein the display unit presents the
real-time images and pre-case images integrated and simultaneously
with one another.
16. The method of claim 12, further comprising storing, in memory,
patient records, capturing still images from at least one of the
physiology signals and real-time images, and storing the still
images with a corresponding one of the patient records in the
memory.
17. The method of claim 12, further comprising superimposing
real-time and pre-case images upon one another to form a single
multi-mode image frame.
18. The method of claim 12, further comprising combining one or
more frames generated from different types of image information to
form a final displayed image, the image information corresponding
at least one of the real-time images and the pre-case images.
19. The method of claim 12, further comprising superimposing color
data and greyscale data to form a single multi-mode image frame,
the color and greyscale data corresponding to at least one of the
real-time images and the pre-case images.
20. The method of claim 12, further comprising: providing a remote
device user interface, located remote from the procedure room;
utilizing the remote device user interface to enter at least one of
settings, parameters and modes that are conveyed to the imaging
device in order to remotely control the imaging device; and
adjusting operation of the imaging device based on the at least one
of settings, parameters and the modes entered at the remote device
user interface.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 11/433,951, filed May 15, 2006, now U.S. Pat.
No. 7,572,223, which is a continuation-in-part of U.S. patent
application Ser. No. 11/182,473, filed Jul. 15, 2005, now U.S. Pat.
No. 7,569,015, entitled "INTEGRATED PHYSIOLOGY AND IMAGING
WORKSTATION", both of which are hereby incorporated by reference in
their entirety.
BACKGROUND OF THE INVENTION
[0002] Embodiments of the present invention generally relate to
physiology and imaging workstations, and more particularly to
integrating various physiology and imaging features and
functionality into a single workstation.
[0003] Today, physiology workstations are used in catheter labs,
hemodynamic (HD) labs and electrophysiology (EP) labs to conduct
various tests and procedures. Sometimes, the laboratory is
organized into a procedure room, a control room and a remote
monitoring room. Alternatively, there may not be a separate control
or remote monitoring room. Instead, a sterile area where the
patient lies is in the center of the room, and located in another
area of the same room are the EP system and HD system, stimulator,
etc. When available, the control and remote monitoring rooms are
isolated from the sterile environment of the procedure room and are
shielded from the x-rays generated in the procedure room by certain
types of imaging equipment, such as fluoroscopy, magnetic resonance
(MR) or computed tomographic (CT) imaging equipment. Presently,
physiology workstations located in either the procedure, control or
monitoring rooms are attached through cables to sensors, catheters,
and instruments related only to the study. For example,
conventional workstations are directly attached to surface ECG
leads, intercardiac leads provided on a catheter, pressure sensors
provided on a catheter and the like. The EP workstation is also
directly attached to a stimulator that induces stimulus signals
through a pacing tip on the catheter, such as to induce pacing to
the heart.
[0004] Presently, the physiology workstation operates entirely
separate and independent from imaging systems provided, such as an
ultrasound workstation. The ultrasound workstation is a stand-alone
system positioned in the procedure room proximate the patient and
is controlled and operated by the physician or designated operator.
The ultrasound system is attached to an ultrasound catheter or a
surface probe that obtains ultrasound images. The ultrasound system
may be attached to various probes including transthoracic,
transesophageal, intravascular or intracardiac. The ultrasound
system is directly attached to a second set of surface ECG leads,
separated and distinct from the surface ECG leads connected to the
EP workstation. The ultrasound images are displayed on a dedicated
ultrasound monitor positioned directly on the stand-alone
ultrasound system in the procedure room. The ultrasound monitor in
the procedure room is separate and distinct from the monitors in
the control and remote monitoring rooms. The ultrasound system has
a separate user interface dedicated and specific to ultrasound
features and functionality. The ultrasound system also includes
entirely independent and dedicated processing hardware and
software, memory and the like. Thus, today, EP and HD studies are
performed utilizing a stand-alone ultrasound system that is
separate and distinct from the electrophysiology workstation.
[0005] Conventional EP and HD workstations and ultrasound systems
suffer from various disadvantages, that are addressed by various
embodiments of the present invention.
BRIEF SUMMARY OF THE INVENTION
[0006] Therefore, in one aspect of the present invention, there is
provided a physiology workstation configuration that includes a
communications interface conveying physiology signals derived from
a subject and ultrasound data representative of a region of
interest of the subject, the ultrasound data being obtained by an
ultrasound device in real-time during a procedure carried out on
the subject. The physiology workstation also includes a physiology
processing unit receiving and processing the physiology signals, an
ultrasound processing unit receiving and processing the ultrasound
data to generate ultrasound images, the physiology processing unit
combining the physiology signals with the ultrasound images from
the ultrasound processing unit; and a display unit displaying the
physiology signals and the ultrasound images, the physiology
signals and ultrasound signals being presented jointly to a user in
real-time during the procedure being carried out on the subject.
The display unit includes at least one monitor, the monitor
co-displaying the physiology signals and ultrasound images in
adjacent windows on a single display. Also, the physiology
processing unit, ultrasound processing unit and display unit are
located in a control room that is divided from a procedure room
where the subject is located, the communications interface
extending between the procedure and control rooms and the
physiology processing unit configured to remotely control the
ultrasound system via the communications interface.
[0007] Another aspect of the present invention is a physiology
system that includes EP leads configured to be attached to a
subject located in a procedure room an ultrasound system for
obtaining ultrasound images of a region of interest of the subject,
and a physiology processing unit communicating with the physiology
leads and ultrasound system, the physiology processing unit
receiving and processing physiology signals from the physiology
leads and ultrasound images. The system also includes a display
unit, joined to the physiology processing unit, displaying the
physiology signals, and an ultrasound remote interface, joined to
the physiology processing unit, for entering at least one of
ultrasound control parameters and ultrasound modes. The ultrasound
system is configured to adjust operation based on at least one of
ultrasound control parameters and the ultrasound modes entered at
the physiology processing unit. The ultrasound remote interface
includes a secondary U/S keyboard mouse or soft key functions, or a
combination thereof, wherein the U/S keyboard, mouse, or soft keys
are located proximate the display unit, the ultrasound system
further having a primary U/S keyboard.
[0008] Yet another aspect of the present invention is a physiology
workstation that has a communications interface conveying
physiology signals derived from a subject and ultrasound data
representative of a region of interest of the subject, wherein the
ultrasound data is obtained by an ultrasound device in real-time
during a procedure carried out on the subject, a physiology
processing unit receiving and processing the physiology signals,
and an ultrasound processing unit receiving and processing the
ultrasound data to generate ultrasound images, the physiology
processing unit combining the physiology signals with the
ultrasound images from the ultrasound processing unit. The
workstation also includes a display unit displaying the physiology
signals and the ultrasound images, the physiology signals and
ultrasound signals being presented jointly to a user in real-time
during the procedure being carried out on the subject. The display
unit includes at least one monitor, the monitor co-displaying the
physiology signals and ultrasound images in adjacent windows on a
single display. Also provided is an ultrasound device connecting to
one of various devices: an intravascular ultrasound catheter, an
intracardiac echo catheter, a transthoracic probe, or a
transesophageal probe.
BRIEF DESCRIPTION OF THE DRAWINGS
[0009] FIG. 1 illustrates a block diagram of a physiology
workstation formed in accordance with an embodiment of the present
invention.
[0010] FIG. 2 illustrates a block diagram of ablation and imaging
equipment in accordance with an embodiment of the present
invention.
[0011] FIG. 3 illustrates a block diagram of the ultrasound
processor unit of the workstation of FIG. 1 formed in accordance
with an embodiment of the present invention.
[0012] FIG. 4 illustrates a block diagram of an electrophysiology
system distributed between multiple rooms within a physiology
laboratory in accordance with an embodiment of the present
invention.
[0013] FIG. 5 illustrates a block diagram of an alternative
physiology system distributed between multiple rooms within a
laboratory in accordance with an embodiment of the present
invention.
[0014] FIG. 6 illustrates exemplary window layout for a
configuration of monitors for a physiology workstation formed in
accordance with an embodiment of the present invention.
[0015] FIG. 7 illustrates a block diagram of an alternative
embodiment in which remote control is provided for various systems
and devices formed in accordance with an embodiment of the present
invention.
[0016] FIG. 8 illustrates a screenshot of an exemplary window
presented on one of the monitors of the physiology workstation
formed in accordance with an embodiment of the present
invention.
[0017] FIG. 9 illustrates a block diagram of a physiology network
having a remote physical keyboard and formed in accordance with an
embodiment of the present invention, wherein the remote physical
keyboard provides keys corresponding to all or nearly all the
functionality of an associated ultrasound system.
[0018] FIG. 10 illustrates a block diagram of a physiology network
having a remote keyboard configured to communicate with the
ultrasound system via a wired or wireless connection separate from
a medical network.
[0019] FIG. 11 illustrates a block diagram of a physiology network
having a visual keyboard simulator software module configured to
run, at least in part, on the remote (physiological) workstation,
to display a simulated keyboard on an image monitor, and to
communicate with the local (ultrasound) workstation to thereby
control the ultrasound system. Also, the remote physical keyboard
is a standard PC-style keyboard having either fewer or different
keys than the remote physical keyboard shown in FIG. 10.
[0020] FIG. 12 illustrates a block diagram of a physiology network
having a visual keyboard simulator software module configured to
run, at least in part, on the remote (physiological) workstation,
to display a simulated keyboard on a review monitor, and to
communicate with the local (ultrasound) workstation to thereby
control the ultrasound system.
[0021] FIG. 13 illustrates a block diagram of a physiology network
having a visual keyboard simulator software module configured to
run, at least in part, on the remote (physiological) workstation,
to display a simulated keyboard on an image monitor, and to
communicate with the local (ultrasound) workstation to thereby
control the ultrasound system. A remote keyboard that is configured
to communicate signals other than control signals to the ultrasound
system via a wired or wireless connection separate from a medical
network is also provided.
[0022] FIG. 14 illustrates a block diagram of a physiology network
wherein the remote keyboard is directly connected to the ultrasound
system via a wired or wireless connection other than the medical
network.
[0023] FIG. 15 illustrates a keyboard that provides all or
essentially all of the keys that are present on an ultrasound
system.
DETAILED DESCRIPTION OF THE INVENTION
[0024] FIG. 1 illustrates a physiology workstation 10 formed in
accordance with an embodiment of the present invention. The
workstation 10 is located in a control room or procedural room and
is utilized in connection with HD, EP and ablation procedures,
among other things. FIG. 2 illustrates a procedure room which may
be separate and discrete from the control room (when used) and from
a remote monitoring room within the facility (e.g. a hospital,
clinic and the like). The workstation 10 is operated by an
operator, while the patient and procedure team are located in the
procedure room. The workstation 10 integrates, among other things,
real-time information, real-time intracardiac echography,
fluoroscopic images, mapping data and pre-surgery planning CT &
MR images. The workstation 10 offers integrated monitoring, control
and review of HD, EP, patient, and mapping information as well as
stored and real-time diagnostic images, ECG signals and IC
signals.
[0025] As shown in FIG. 2, the procedure room includes an
ultrasound system 11, a fluoroscopy system 17 and a patient bed 13
to hold the patient while an HD, EP or ablation procedure is
carried out. The fluoroscopy system 17 is provided proximate
patient bed 13 to obtain fluoroscopic images of the region of
interest while the doctor is conducting a procedure. It is also
possible to use a magnetic system to guide catheters, such as by
using a magnetic system provided by Stereotaxis, Inc., St. Louis,
Mo. A stimulator would be present in an EP configuration. Catheters
19 (EP or HD), an ablation catheter 23 and ultrasound catheter 25
are provided to be inserted or otherwise utilized throughout the
procedure. EP catheter 19 performs sensing and stimulating
functions. The ablation catheter 23 may represent an RF ablation
catheter, a laser ablation catheter or a cryogenic ablation
catheter. The ultrasound catheter 25 is configured to obtain
ultrasound images of the region of interest, as well as images that
indicate directly the position and placement of catheters and the
ablation catheter relative to the region of interest or to
elucidate anatomy and/or perform measurements such as atrial or
ventricular dimension, blood flow through a valve or to obtain
other various dimensions and measurements. Surface ECG leads 27 are
provided and attached to the patient to obtain surface ECG
information. The surface ECG leads 27 and the catheters 19 are
joined to a sensor amplifier 29 which amplifies signals sensed by
the surface ECG leads 27 and EP catheters 19 prior to transmitting
the sensed signals over a communications interface 24. When
stimulus pulses are to be delivered to the patient, the stimulus
signals are passed either around or through the sensor amplifier 29
to the corresponding catheters 19. An ablation source and
controller 31 controls operation of the ablation catheter 23 and
provides ablation-related data over the communications interface 24
to the workstation 10 (FIG. 1).
[0026] The beamformer 33 is responsible for transmit and receive
beam forming operations. The link between the beamformer 33 and
ultrasound catheter 25 may comprise individual channels associated
with each transducer element within the transducer head of the
ultrasound catheter 25. The beamformer 33 controls the phase and
amplitude of each transmit signal delivered over the link to induce
a transmit or firing operation by the ultrasound catheter 25.
Reflected echoes are received at the ultrasound catheter 25 and
delivered to the beamformer 33 as analog signals representative of
the detected echo information at each individual transducer
element. By way of example, the signals transmitted may represent
low level analog RF signals transmitted to, or received from, the
transducer elements of the ultrasound catheter 25. Optionally, the
beamformer 33 may also control transmission and reception in
connection with non-catheter type U/S probes, such as a
transesophageal probe 47, a surface cardiac probe 49, an
intravenous, intraarterial probes and the like.
[0027] The beamformer 33 includes a demodulator and filters to
demodulate and filter the received analog RF signals and produce
therefrom digital base-band I and Q data pairs formed from acquired
data samples. The I, Q data pairs are derived from the reflected
ultrasound signals from respective focal zones of the transmitted
beams. The I and Q data pairs are filtered (e.g. such as in FIR
filters that are programmed with filter co-effecients to pass a
band of frequencies centered at a desired fundamental frequency of
the transmit wave form or at harmonic or sub-harmonic frequencies
of the transmit signal's fundamental frequency). The I, Q data
pairs corresponds to each data samples within the region of
interest. The beamformer 33 may pass the I, Q data pairs to a FIFO
buffer 37 which then passes the I, Q data pairs over the
communications interface 24 under the control of the controller 39.
Alternatively, the beamformer 33 may directly stream the I, Q data
pairs over the communications interface 24 as generated without
buffering. Optionally, the beamformer 33 may store the I, Q data
pairs in memory 7 in the ultrasound system 11. an ultrasound
processor module 9 may be provided in the ultrasound system 11 to
process the I, Q data pairs to form ultrasound images that are
passed over communications interface 24 and/or stored in memory
7.
[0028] A real-time monitor 41, a review monitor 43 and
documentation monitor 45 are located proximately the patient bed 13
for viewing by the procedure team and physician during the
procedure monitors 41, 43 and 45 and are remotely controlled to
present the same information as presented on the real-time monitor
48, operation monitor 50 and documentation monitor 52,
respectively, located at the workstation 10.
[0029] The workstation 10 includes a signal management module 12
which is configured to receive and transmit a variety of signals
and data that are conveyed to and from the patient over leads,
cables, catheters and the like. Examples of signals that may be
received by the signal management module 12 include intercardiac
(IC) signals 14 from EP catheters, patient monitoring signals 15
(e.g., from a blood pressure cuff, SPO2 monitor, temperature
monitor, CO2 levels and the like), ECG signals 16 from surface ECG
leads 27, pressure signals 18 from an open lumen catheter, and
intracardiac signals. The signal management module 12 also receives
fluoroscopic imaging data 20 from the fluoroscopic system 17,
ultrasound imaging data 21 from the beamformer 33, and ablation
data 22 (e.g., power, temperature, impedance) from the ablation
source and controller 31. The fluoroscopic system 17 is an x-ray
apparatus located in the procedure room. The ultrasound data 21
also may be collected at a transesophageal ultrasound probe, an
intraoperative ultrasound probe, a transthoracic probe,
intravascular probe and/or intracardiac echo probe.
[0030] Optionally, the ultrasound system 11 may be operated in an
acoustic radiation force imaging (ARFI) mode. ARFI allows
examination of the functionality of tissue subsets, such as in the
heart, organs, tissue, vasculature and the like. ARFI is a
phenomenon associated with the propagation of acoustic waves
through a dissipative medium. It is caused by a transfer of
momentum from the wave to the medium, arising either from
absorption or reflection of the wave. This momentum transfer
results in the application of a force in the direction of wave
propagation. The magnitude of this force is dependent upon both the
tissue properties and the acoustic beam parameters. The duration of
the force application is determined by the temporal profile of the
acoustic wave. ARFI images the response of tissue to acoustic
radiation force for the purpose of characterizing the mechanical
properties of the tissue. When the duration of the radiation force
is short (less than 1 millisecond), the tissue mechanical impulse
response can be observed. ARFI imaging has many potential clinical
applications, including: detecting and characterizing a wide
variety of soft tissue lesions, and identifying and characterizing
atherosclerosis, plaque, and thromboses.
[0031] The communications interface 24 extends from the workstation
10 to the various equipment proximate the patient bed. When
different rooms are provided the interface 24 extends through the
wall or other divider separating the control and procedure rooms,
into the procedure room. The communications interface 24 conveys,
among other things, IC signals 14, patient monitoring signals 15,
surface ECG signals 16, pressure signals 18, fluoroscopic imaging
data 20, ultrasound imaging data 21 and ablation data 22. The
content and nature of the information conveyed over the
communications interface 24 is explained below in more detail. In
one embodiment, the communications interface 24 is comprised of
physical connections (e.g. analog lines, digital lines, coaxial
cables, Ethernet data cables and the like or any combination
thereof).
[0032] Optionally, the communications interface 24 may include, in
whole or in part, a wireless link between the workstation 10 in the
control room and one or more of the ultrasound, fluoroscopic,
ablation, and EP instruments, devices, apparatus and systems in the
procedure room 11. For example, ultrasound data 21 may be
communicated wirelessly from a transmitter that is located within
the procedure room 11 at the beamformer 33 to a receiver that
communicates with the workstation 10 in the control room. The
receiver would then convey the imaging data 21 to the signal
management module 12.
[0033] The signal management module 12 selectively controls access
of signals and data onto the communications interface 24. The
signal management module 12 may comprise a simple configuration of
switches that are manually operated by the user via the user
interface 26. Alternatively, switches in the signal management
module 12 may be automatically controlled by the processor 28 based
upon various criteria including, among other things, the type of
procedure currently being conducted. The signal management module
12 may include processing capabilities (e.g. a CPU, DSP and the
like) to internally and automatically decide certain switching
operations. The signal management module 12 may include memory,
such as to temporarily buffer incoming and/or outgoing signals
and/or data from/to the communications interface 24. The
communications interface 24 conveys analog and digital signals. In
the event that the communications interface 24 conveys analog
signals, the signal management module 12 may include analog to
digital converters to convert the analog signals to digital data
and vise versa.
[0034] In one embodiment, the beamformer 33 may be located in the
procedure room 11 proximate the patient and the ultrasound catheter
25. The beamformer 33 in the procedure room 11 converts the raw
echo signals from the individual transducer element channels into
I, Q data pairs, each data pair of which represents a data sample.
The I, Q data pairs from the beamformer 33 are supplied as the
ultrasound data 21 over the communications interface 24 to the
workstation 10. The ultrasound data 21 is passed to the ultrasound
processor unit 36. In the present example, the U/S processor module
9 is bypassed and not used. The ultrasound data processor module 36
may perform mid-processing operations (e.g., B-mode, Doppler,
Strain, ARFI, etc.) upon the ultrasound I, Q data pairs.
[0035] In another embodiment, the U/S processor module 9 and the
U/S system 11 is used for mid-processing operations and the U/S
processing module 36 performs scan conversion operations. In yet
another embodiment, the U/S processor modules 9 and 36 at the U/S
system 11 and workstation 10, respectively, divide and share the
mid-processing operations.
[0036] The signal management module 12 may communicate directly
with an external stimulator 30. The stimulator 30 may deliver
electrical signals (such as for pacing) directly over interface 24,
or through the signal management module 12 and the IC leads 14, to
one or more catheters 19 positioned within the patient. Examples of
stimulators are the Micropace by Micropace Pry Ltd and the Bloom
offered by Fisher Imaging.
[0037] The workstation 10 is used in an EP study to provide a
detailed evaluation of the hearts electrical system. During an EP
study, typically 3-5 catheters 19 are used. Each EP catheter 19
includes platinum electrodes spaced near the tip of the catheter,
where such electrodes have the ability to record electrical signals
from inside the heart as well as deliver stimulus pulses to the
heart from different locations, such as to pace the heart. The
workstation 10 evaluates normal and abnormal conductions and
rhythms. The protocol used during the EP study may van from site to
site or procedure to procedure (e.g. corrected sinus node recovery
time, AV Wenckebach and the like).
[0038] The stimulator 30 is utilized to induce a pacing train of
pulses in order to stabilize a refractory period. The pacing train
is considered to have "entrained" the heart once it has captured
the heart for a predetermined series of beats. Once the heart is
entrained, extra stimuli are added to mimic certain capabilities of
the heart. The stimulator 30 may drive ventricular protocols
through pacing from a ventricular catheter. One reason for
ventricular pacing may be to assess the conduction retrograde
through the AV node or bypass tract. When assessing conduction
retrograde through the AV node, a VAWBK will also be obtained.
Another ventricular protocol is the ventricular effective
refractory period (VERPs). The stimulator 30 may also be used to
induce arrhythmias. For example, during ventricular protocols,
ventricular tachycardia or ventricular fibrillation may be induced
as an end point. A patient's level of consciousness is assessed
while attempts are made at overdrive pacing (if appropriate). When
a patient loses consciousness, an external defibrillation shock is
delivered.
[0039] The incoming signals from the patient over the
communications interface 24 are passed from the signal management
module 12 to a signal conditioning circuit 38 which performs
various signal processing operations upon the incoming signals. The
signal conditioning circuit 38 passes conditioned signals to the
processor module 28 and optionally may pass the conditioned signals
to a frame grabber 40 or directly to memory 42 or a database 44.
The processor module 28 manages overall control and operation of
the workstation 10. The processor module 28 receives user inputs
through the user interface 26. The processor module 28 stores data,
images and other information in the memory 42 and/or in the
database 44. The frame grabber 40 also accesses memory 42 and
database 44 in order to obtain and store various data, images and
the like. While the memory 42 and database 44 are shown as part of
the workstation 10, it is understood that one or both of the memory
42 and database 44 may be part of the workstation 10, separate from
but located locally to the workstation 10 (e.g. in the control
room) or remote from the workstation 10 and the control room (e.g.
in another part of the facility or at an entirely separate
geographic location (e.g. a different hospital, university, state,
country and the like)).
[0040] The memory 42 and database 44 may store diagnostic images,
such as CT and MR images acquired prior to the procedure, and
ultrasound images acquired prior to, during, or after the
procedure. The stored images facilitate pre- and post-procedure
analysis for image optimization, manipulation and analysis. The
ultrasound images may represent intracardiac ultrasound images
obtained from the ultrasound catheter 25. Optionally, the
ultrasound images may be obtained utilizing a transesophageal probe
47, an interoperative probe, an intravascular catheter, and an
external cardiac probe 49.
[0041] Some configurations of the present invention are useful in
hemodynamic cases. IVUS is used in such cases to assess the tissue
type of occlusions of arteries, for example, whether they are
calcified or soft tissue. IVUS is also used to obtain a more
accurate percentage of luminal narrowing in arterial disease. ICE
may be used in a hemodynamic case to measure the flow across an
abnormal opening between chambers of the heart such as patent
foramen ovale or an intra-ventrical shunt.
[0042] In each of the workstation 10 and U/S system 11, the timing
information may be derived from the time of day, or from a
reference clock. Alternatively, the various processors may have
synchronized clocks which result in all the various systems being
synchronized to the identical spot in the cardiac cycle.
Alternatively, the timing information may be associated with the
cardiac cycle of the patient which is determined by the EP or
surface cardiac ECG signals.
[0043] The processor module 28 communicates uni-directionally or
bi-directionally with the display controller 46 which controls
monitors 48, 50 and 52. The monitors 48, 50 and 52 may simply
present displayed information as explained hereafter. Optionally,
the monitors 48, 50 and 52 may include input buttons for operation
by the user to directly enter certain commands and instructions at
the monitor 48, 50 and 52. Optionally, the monitors 48, 50 and 52
may represent touch sensitive screens that enable the user to enter
information directly by touching active areas of a corresponding
monitor 48, 50 and 52.
[0044] In the example of FIG. 1, a touch sensor control 54 is
illustrated that detects touch actions relative to monitor 48. The
touch sensor control 54 provides the results of the touch action to
the processor 28. The touch action result may simply represent an
X,Y coordinate at which a touch event occurred. Alternatively, the
touch sensor 54 may first determine the X,Y coordinate of the touch
event and subsequently determine the intended action or instruction
based upon the display content of monitor 48 under the control of
the display controller 46. For example, the touch sensor control
may return a "select drop down menu".
[0045] In the example of FIG. 1, monitors 48-52 have been assigned
different categories of functions (e.g. real-time monitoring,
operations monitoring, documentation monitoring and the like).
Monitor 48 presents numerous windows, such as ablation window 56, a
real-time EP monitoring window 58, a real-time image window 60 and
a preprocessing planning window 62.
[0046] The monitor 50 displays windows related to operation
control, such as an ICE user interface window 64, an EP/HD
recording user interface window 66, a mapping user interface window
68 and a catheter steering user interface window 70. The user
interface windows 64-70 allow the operator to enter and change
parameters, modes, patient information, values and the like in
connection with a particular EP or HD study.
[0047] The monitor 52 is configured to present windows associated
with documentation of a particular patient case. Monitor 52
presents a case review window 72, a case reporting window 74 and a
case log window 76. The case-related windows 72-76 allow the user
to review patient history information, as well as current patient
information associated with the EP or HD study.
[0048] The workstation 10 integrates the display of ultrasound
images with other EP or HD study information and/or ablation
procedure information by utilizing one or more of monitors 48, 50
and 52. For example, real-time image window 60 may present
ultrasound images obtained from an ultrasound catheter or probe,
while planning window 62 presents previously acquired CT or MR
images. Integrating the ultrasound images into the workstation
affords, among other things, an improved standard of care,
increased user confidence and shorter procedure time.
[0049] Optionally, the real-time image window 60 may present
ultrasound images as an image loop, in which a sequence of
ultrasound frames is acquired and associated with one or more
cardiac cycles. The loop of ultrasound images may be repeatedly
displayed or frozen. While the real-time image window 60 presents
the ultrasound images, the real-time EP/HD window 58 simultaneously
displays real-time EP or hemodynamic signals corresponding to the
ultrasound image loop. The planning window 62 may present
associated mapping data acquired earlier during the EP or HD
study.
[0050] The signal management module 12 also communicates directly
with an ablation control device 32 which is used to control various
ablation procedures. The ablation control device 32 may constitute
RF catheter ablation, laser catheter ablation, cryogenic ablation
and the like. The ablation device 32 is attached to a generator 34
that produces the energy utilized to achieve ablation. For example,
in an RF ablation or laser ablation system, the generator 34
represents a RF generator or a laser source. During RF catheter
ablation, energy is delivered from a RF generator through an RF
catheter having a tip located proximate anatomy that is desired to
undergo ablation. Ablation is generally performed in order to
locally destroy tissue deemed responsible for inducing an
arrhythmia. The RF energy represents a low-voltage high-frequency
form of electrical energy that produces small, homogeneous, lesions
approximately 5-7 millimeters in diameter and 3-5 millimeters in
depth.
[0051] The ablation device 32 may be used in a variety of
procedures. The most common type of generic supra ventricular
tachycardia (SVT) is atrioventricular nodule reentrant tachycardia
(AVNRT). In the most common form AVNRT, the inferior atrianodule
input to the atrioventricular (AV) node serves as the anterograde
limb (e.g. the slow pathway) of the reentry circuit and the
superior antrionodule input serves as the retrograde limb (e.g. the
fast pathway). Typically, AVNRT is treated by targeting the slow
pathway through ablation near the inferior tricuspid valve annulus
at the level of the coronary sinus OS or somewhat higher. Another
common type of SVT is orthodramic reciprocating tachycardia (ORT),
a reentrant rhythm using the AV node as the anterograde limb and
accessory AV connection (e.g. the accessory pathway) as the
retrograde limb. The SVT rhythm disturbance can be cured by
targeting the accessory pathway as it crosses the mitral or
tricuspid valve annulus. Another type of SVT is unifocal atrial
tachycardia which may arise in either atrium. The unifocal atrial
tachycardia originating in the left atrium is treated through a
transsceptal catherization through a foramen ovale or transceptal
puncture.
[0052] Atrial flutter, another arrhythmia, is most commonly due to
a large reentrant circuit in the right atrium, whereby entry
proceeds counter clockwise up the atrial septum and down the
lateral wall of the right atrium, inscribing inverted flutter waves
in the inferior leads. The reentrant circuits associated with
atrial flutter used an isthmus of tissue between the tricuspid
valve annulus and the inferior vena cava. Linear ablation of the
isthmus cures these common forms of atrial flutter. Atrial
fibrillation is more commonly treated by crossing the intraarterial
septum with a catheter and creating ablation lines in the left
atrium which electrically isolates the pulmonary veins. The atrial
fibrillation is generally curable and the patient does not require
a pacemaker. Ablation may also be performed in connection with
ventricular tachycardia.
[0053] RF catheter ablation is performed utilizing a sinusoidal
high frequency (e.g. 500 kHz) form of electrical current that
causes small lesions within the heart. Tissue destruction is
primarily caused by thermal injury, such as desiccation necrosis.
The RF energy causes resistive heating of a rim of tissue in direct
contact with the electrode at the tip of the catheter. Tissue below
the surface is heated by conduction of the heat from the
para-electrode region. The lesion size is determined by the
conduction of the heat through the tissue and by convective heat
loss due to the blood pool. In general, the temperature at the
interface between the electrode tip and the endocardial tissue
should be approximately 50.degree. Celsius or higher in a
non-irrigated catheter to cause tissue necrosis. Optionally, the
tissue may be heated to higher temperatures. The size and depth of
the lesion is controlled by the amount of energy delivered to the
tissue. An acute lesion includes a central zone of coagulation
necrosis surrounded by a border of hemorrhage and inflammation.
[0054] FIG. 3 illustrates an exemplary block diagram of the
ultrasound processor module 36 of FIG. 1 or the U/S processor
module 9 of FIG. 2 formed in accordance with an embodiment of the
present invention. The ultrasound processor module 9, 36 is
illustrated conceptually as a collection of modules, but may be
implemented utilizing any combination of dedicated hardware boards,
DSPs and processors. Alternatively, the modules of FIG. 3 may be
implemented utilizing an off-the-shelf PC with a single processor
or multiple processors, with the functional operations distributed
between the processors. As a further option, the modules of FIG. 3
may be implemented utilizing a hybrid configuration in which
certain modular functions are performed utilizing dedicated
hardware, while the remaining modular functions are performed
utilizing an off-the shelf PC and the like.
[0055] The operations of the modules illustrated in FIG. 3 may be
controlled by a local ultrasound controller 87 or by the processor
module 28. The modules 51-59 perform mid-processor operations.
[0056] The ultrasound processor module 36 receives ultrasound data
21 in one of several forms depending upon the distribution of
ultrasound operations between the ultrasound system 11 and
workstation 10. In the embodiment of FIG. 3, the received
ultrasound data 21 constitutes I, Q data pairs representing the
real and imaginary components associated with each data sample. The
I, Q data pairs are provided to a color-flow module 51, a power
Doppler module 53, a B-mode module 55, a spectral Doppler module 57
and M-mode module 59. Optionally, other modules may be included
such as a strain module, a strain rate module, 3-D or 4-D
reconstruction ARFI module and the like. (As used herein, "4-D
reconstruction" refers to real-time reconstruction, i.e., images
are displayed and updated rapidly so that the delay is short enough
to use the images as feedback to make decisions on a procedure
being performed at the moment.) Each of modules 51-59 process the
I, Q data pairs in a corresponding manner to generate color-flow
data 61, power Doppler data 63, B-mode data 65, spectral Doppler
data 67, M-mode data 69, and 3-D or 4-D reconstruction ARFI module
91 all of which may be stored in memory 71 temporarily before
subsequent processing and/or stored in memory 42 or database 42.
The color-flow, power Doppler, B-mode, spectral Doppler and M-mode
data 61-69, and 3-D or 4-D reconstruction ARFI data 93 are stored
as sets of vector data values, where each set defines an individual
ultrasound image frame. The vector data values are generally
organized based on the polar coordinate system.
[0057] The scan converter module 73 reads from memory 71 the vector
data values associated with an image frame and converts the set of
vector data values to Cartesian coordinates to generate an
ultrasound image frame 75 formatted for display. The ultrasound
image frames 75 generated by scan converter module 73 may be passed
back to memory 71 for subsequent processing or may be passed to the
database 44 (FIG. 1), memory 42 and/or to the processor 28 or
display controller 46.
[0058] Once the scan converter module 73 generates the ultrasound
image frames 75 associated with B-mode data, color-flow data, power
Doppler data and the like, the image frames may be restored in
memory 71 or passed over bus 35 to the database 44, memory 42
and/or to the processor 28.
[0059] As an example, it may be desired to view a B-mode ultrasound
image in real-time on the real-time image window 60 on monitor 48
associated with the ultrasound signals detected by an ultrasound
catheter 25 (FIG. 2). To do so, the scan converter obtains B-mode
vector data sets for images stored in memory 71. The B-mode vector
data is interpolated where necessary and converted into the X,Y
format for video display to produce ultrasound image frames. The
scan converted ultrasound image frames are passed to the display
controller 46 which may include a video processor that maps the
video to a grey-scale mapping for video display. The grey-scale map
may represent a transfer function of the raw image data to
displayed grey levels. Once the video data is mapped to the
grey-scale values, the display controller 46 controls the real-time
monitor 48 to display the image frame in the real-time image window
60. The B-mode image displayed in the real-time image window 60 is
produced from an image frame of data in which each datum indicates
the intensity or brightness of a respective pixel in the display.
The display image represents the tissue and/or blood flow in a
plane through the region of interest being imaged.
[0060] The color-flow module 51 may be utilized to provide
real-time two-dimensional images of blood velocity in the imaging
plane. The frequency of sound waves reflected from the inside of
the blood vessels, heart cavities, etc., is shifted in proportion
to the velocity of the blood vessels; positively shifted for cells
moving toward the transducer and negatively shifted for cells
moving away from the transducer. The blood velocity is calculated
by measuring the phase shift from firing to firing at a specific
range gate. Mean blood velocity from multiple vector positions and
multiple range gates along each vector are calculated and a
two-dimensional image is made from this information. The color-flow
module 51 receives the complex I, Q data pairs from the beamformer
33 (FIG. 2) and processes the I, Q data pairs to calculate the mean
blood velocity, variance (representing blood turbulence) and total
pre-normalized power for all sample volumes within the operator
defined region.
[0061] The 2D video processor module 77 combines one or more of the
frames generated from the different types of ultrasound
information. For example, the 2D video processor modules 77 may
combine a B-mode image frame and a color-flow image frame by
mapping the B-mode data to a grey map and mapping the color-flow
data to a color map for video display. In the final displayed
image, the color pixel data is superimposed on the grey scale pixel
data to form a single multi-mode image frame 79 that is again
re-stored in memory 71 or passed over bus 35. Successive frames of
color-flow and/or B-mode images may be stored as an image loop in
memory 71, memory 42 or database 44. The image loop represents a
first in, first out circular image buffer to capture image data
that is displayed in real-time to the user. The user may freeze the
image loop by entering a freeze command at the user interface 85.
The user interface represents a keyboard and mouse and all other
commands associated with ultrasound system user interface.
[0062] The spectral Doppler module 57 operates upon the I, Q data
pairs by integrating (summing) the data pairs over a specified time
interval and then sampling the data pairs. The summing interval and
the transmission burst length together define the length of the
sample volume which is specified by the user at the user interface
85. The spectral Doppler module 57 may utilize a wall filter to
reject any clutter in the signal which may correspond to stationery
or very slow moving tissue. The filter output is then fed into a
spectrum analyzer, which may implement a Fast Fourier Transform
over a moving time window of samples. Each FFT power spectrum is
compressed and then output by the spectral Doppler module 57 to
memory 71. The 2D video processor module 77 then maps the
compressed spectral Doppler data to grey scale values for display
on the real-time monitor 48 as a single spectral line at a
particular time point in the Doppler velocity (frequency) versus a
time spectrogram.
[0063] A 3D processor module 81 is also controlled by user
interface 85 and accesses memory 71 to obtain spatially consecutive
groups of ultrasound image frames and to generate three dimensional
image representation thereof, such as through volume rendering or
surface rendering algorithms. The three dimensional images may be
generated utilizing various imaging techniques, such as
ray-casting, maximum intensity pixel projection and the like.
[0064] FIG. 4 illustrates a block diagram of a system configuration
for an alternative embodiment distributed between the areas
associated with a physiology lab. The lab includes a control area
78 located immediately adjacent a procedure area 80 and a
monitoring area 82. The control and procedure areas 78 and 80 may
in separate rooms with a window provided between the rooms in order
that the operator of a workstation 86 may view of the activities
taking place in the procedure room.
[0065] The control area 78 includes the workstation 86 that it is
joined to a real-time monitor 122, review monitor 124, image
monitor 126 and stimulator 128. The workstation 86 includes a CPU
130 that is joined to a mouse 132 and keyboard 134 to facilitate
user inputs. A display controller 136 is joined to the CPU 130
control the information and images presented on the monitors 116,
118, 122, 124 and 126. The display controller 136 is also joined
directly to the stimulator 128 in order to obtain information
associated with stimulus signals.
[0066] The procedure area 80 includes a patient bed 84. A patient
monitor 88 is located proximate the patient to monitor the patient
vital signs. An interface adapter 90 is joined with bedside
peripheral devices. The interface adapter 90 enables information
from the bedside peripheral devices to be received and processed by
the patient monitor 88. The adapter 90 enables the peripheral
device information to be displayed, trended and stored at the
patient monitor 88. In addition, the interface adapter 90 provides
the information, from the peripheral devices, to the workstation 86
over data link 92 which traverses the dividing wall between the
procedure area 80 and control area 78. For example, a peripheral
device may represent an endtidal CO2 module, that provides
information used to guide conscious sedation of the patient.
[0067] A catheter 94 is attached to a catheter control module 96,
which is joined with an ablation source 98 and a catheter imaging
module 100. The catheter imaging module 100 is joined to an
amplifier 102. Only one catheter 94 is shown, but multiple
catheters 94 or probes may be utilized. The catheters 94 may
include one or more EP catheters, ICE catheters, IVUS catheters,
ablation catheter, hemodynamic catheters, and the like. The
catheters 94 are attached to the catheter control module 96
simultaneously. For example, an EP catheter and an ablation
catheter may be joined to the different input ports of the catheter
control module 96.
[0068] The catheter control module 96 routes signals and data based
upon the catheter source. For example, EP signals sensed at the
catheter 94 are routed through the amplifier 102 over link 104 to
the workstation 86. Stimulus signals from stimulator 128 are
delivered, over link 106, through the amplifier 102 or around
amplifier 102, to the catheter 94. When catheter 94 represents an
ablation catheter, the ablation source 98 delivers the necessary
ablation energy (e.g., laser, RF, cryogenic) to the catheter 94.
Signals and outputs are read from the ablation source 98 via an
output from the ablation catheter designed for this purpose and a
serial connection on the ablation device. Optionally, ablation
energy may not be routed through the control module 96. When the
catheter 94 represents an RF catheter, the ablation source 98
represents an RF signal generator. When the catheter 94 represents
a cryogenic ablation catheter, the ablation source 98 supplies a
cryogenic medium to the tip of the catheter 94 sufficient to cause
tissue necrosis. Optionally, the ablation source 98 may be directly
attached to an ablation catheter, thereby circumventing the
catheter control module 96.
[0069] Speakers 108 and a microphone 110 are provided in the
procedure area 80 and joined to the workstation 86 through link
109. The workstation 86 also includes speakers and a microphone 112
and 114 to enable the individuals in the procedure area 80 and in
the control area 78 to communicate with one another.
[0070] The monitor area 82 includes one or more monitors, such as a
real-time monitor 116 and a remote review monitor 118. The
real-time and remote review monitors 116 and 118 are joined to the
workstation 86 over links 120 present, to the people in the monitor
area 82, the same information as illustrated on the real-time
monitor 122 and review monitor 124 in the control area 78. An image
monitor 126 is also provided in the control area 78, and may
similarly be duplicated in the monitor area 82.
[0071] Optionally, the procedure area 80 may include one or more
slave monitors, such as slave real-time monitor 138 and slave
review monitor 140. The slave monitors 138 and 140 enable personnel
in the procedure room to easily visualize the real-time IC signals,
surface ECG signals, hemodynamic waveforms, ultrasound images and
the like.
[0072] FIG. 5 illustrates an alternative embodiment configured to
provide remote operator control. In FIG. 5, a control room 150
separated from a procedure room 152. The control room 150 includes
a workstation 154 having a processor 156 that communicates with a
display controller 158 to display information on real-time monitor
160 and review monitor 162. A switch box 164 interconnects a mouse
and keyboard 166 and 168 with the CPU 156. The mouse and keyboard
166 and 168 are located at the workstation 154 in the control room
150 to facilitate user inputs and control. The switch box 164 is
also joined, over a remote link 174, to a mouse and keyboard 170
and 172 which are provided in the procedure room 152. The mouse and
keyboard 170 and 172 are located remote from the workstation 154
and a separate room namely the procedure room 152. A remote
real-time monitor 176 and a remote review monitor 178 are also
provided in the procedure room 152 remote from the workstation 154.
The remote real-time monitor 176 and review monitor 178 are
controlled over remote links 180 by the display controller 158.
[0073] The remote mouse and keyboard 170 and 172 and the remote
real-time and review monitors 176 and 178 allow a user to enter
data or control functions of the ultrasound system directly into
the workstation 154 via a specialized mouse or mouse and keyboard
combination through switch 164. The switch 164 automatically
switches between the local and remote mouse and keyboard 166, 168
and 170, 172 such that only one combination of mouse and keyboard
is active at any point in time.
[0074] FIG. 6 illustrates more detailed examples of the window
content that may be presented in various combinations on the
monitors 48-52, 116-118, 122-126, 160-162 and 176-178. The monitors
in FIG. 6 represent a navigation monitor 182, an operations monitor
184 and a documentation monitor 186. The navigation monitor
includes an ablation window 188, real-time EP signal window 189,
real-time imaging window 190 with integrated mapping indicia and
pre-case image window 191 (e.g. previously acquired CTR MR images).
The operations monitor 184 includes windows associated with
intracardiac echography, mapping, catheter steering and EP
recording. The documentation monitor 186 includes windows
associated with integrated case review, integrated case reports and
an integrated case log.
[0075] Optionally, the beamformer 33 may be moved from the
procedure room 11 and located at the ultrasound processor unit 36.
In this embodiment, the ultrasound data 21 would represent raw echo
signals conveyed over separate channels from each transducer
element of an ultrasound device (e.g. probe or catheter). The raw
echo signals from the transducer elements would not undergo
beam-forming before arriving at the workstation 10. For example,
the ultrasound catheters 19 may include a transducer having 64
elements and thus 64 separate channels may be organized within the
ultrasound data 21. The raw echo ultrasound data 21 would then be
routed to the ultrasound data unit 36 to perform beamforming
processing to generate I, Q data pairs and from that generate
ultrasound vector data sets, each set of which corresponds to a 2D
image frame. The ultrasound vector data sets may include one or
more of B-mode data, color flow data, power Doppler, 3-D or 4-D
reconstruction, and the like. The ultrasound vector data sets may
be stored directly in the database 44 and/or memory 42. The
ultrasound vector data sets may be passed through signal
conditioner 38 to processor 28.
[0076] FIG. 7 illustrates a block diagram of an alternative
embodiment in which remote control is provided for various systems
and devices. In FIG. 7, a physiology workstation 702 (e.g. EP or H.
D. workstation) and includes a physiology workstation processing
module 704 that communicates with, and is controlled by, a
physiology workstation user interface 706. The physiology
workstation 702 may be located in a new separate room (e.g. a
control room) remote from the systems 720-724. Alternatively, the
physiology workstation 702 may be located in the same room as the
systems 720-724. A remote device user interface 708 also
communicates with the physiology workstation processing module 704.
The monitors 710-713 are joined to the physiology workstation
processing module 704 to illustrate the various information,
images, signals, and the like explained above. A link 716 is
maintained between the physiology workstation processing module 704
and various remote devices, such ultrasound system 720, IVUS
catheter 721, x-ray system 722, ablation system 723 and physiology
mapping system 724. The systems 720-724 may each include the
associated types of acquisition apparatus (e.g. catheters, probes,
C-arm, coils and the like, as well as monitors and user
interfaces).
[0077] The link 716 may include one or more links connected to each
of the systems 720-724. For example, the link 716 may include a
single serial or parallel line directly extending from the remote
device user interface 708 of the systems 720-724, and attached
thereto, at a user interface input. Alternatively or in addition,
link 716 may include a data bus conveying serial or parallel data
between the processors within module 704 and one or more of systems
720-724 (e.g. ECG data, EP data, HD data, image frames and the
like). The link 716 may also include one or more video cables
extending between a video output (e.g. VGA) at one of systems
720-724 and a video input at one or more of monitors 710-713.
[0078] Optionally, the link 716 may constitute a network
connection, such as supporting an Internet protocol (IP) or the
transmission control protocol (TCP), or other protocols. The data
may be transmitted over link 716 as raw ultrasound or x-ray data,
formatted in the Hypertext markup (HTML) language, and the like.
Optionally, the link 716 may be constructed as a local area network
configuration, a client/server configuration, an intranet
configuration, a file sharing configuration and the like.
Communications modules 704a and 720a-724a would be provided at each
of the module 704 and systems 720-724 configured in accordance with
the appropriate configuration. The communications modules 704a and
720a-724a may represent USB ports, while the link 716 represents a
USB cable. Alternatively, the communications modules 704a and
720a-724a may represent serial or parallel connectors, HSSDC
connectors. Fiber Channel connectors and the like, while the link
716 represents the corresponding type of communications medium.
Alternatively, the link 716 may be wireless (e.g., RF, Bluetooth,
etc.).
[0079] The remote device user interface 708 may be used to control
the operation of one or more of the systems 720-724. For example,
the remote device user interface seven OA may be used to enter
system parameters, settings, modes, create measurements and the
like. The remote device user interface 708 permits the operator of
the physiology workstation 702 to remotely control the operation,
and remotely adjust the settings, modes and parameters, of one or
more of the systems 720-724. The remote device user interface 708
improves workflow within the procedure room, increases productivity
of an EP or HD team in the procedure room and end the review room,
and decreases the overall procedure duration.
[0080] By way of example, when the remote device user interface 708
is used in connection with control of the ultrasound system 720 or
IVUS or ICE catheter or probe 721, the remote operator may be
afforded the ability to change a modes, adjust the gain of the
ultrasound probe or catheter, freeze select images on the monitor
at the physiology workstation 702 and the monitor at the ultrasound
system 720, and the like. Optionally, the remote device user
interface 708 may constitute a dedicated keyboard identical to a
keyboard provided with one of systems 720-724. In some
configurations of the present invention, the remote device may
comprise a specialized mouse and multifunction keys combined with
soft key functions on the remote device. As used herein, the term
"soft keys" refers to icons on a computer screen that emulate
buttons on the remote device and which may be activated by the
mouse and/or one or a combination of keyboard keys.
[0081] FIG. 8 illustrates a screenshot of an exemplary window
presented on one of the monitors of the physiology workstation. The
screenshot of FIG. 8 represents a hemodynamic window 600, including
three ECG traces, above a graph plotting the pressure at a
particular point within the heart. In the example of FIG. 8, the
pressure information is being obtained from an open lumen catheter
having an outer end located proximate the mitral valve. The peaks
and valleys within the graph represent the diastolic points (DP)
and systolic points (SP) in the cardiac cycle. The pressure at each
DP and SP is indicated as well. The EDP represents the end
diastolic pressure. Along the bottom of the graph are a series of
time stamps identifying the time (relative to the system clock) at
which each pressure point was measured. The upper and lower
controls (UpperCtrl and LowerCtrl) may be adjusted by the operator
to adjust the dynamic range over which the pressure is
measured.
[0082] In some embodiments the physiology workstation is connected
either via direct connection to an ultrasound system utilizing
fiber optic or standard networking cabling allowing bi-directional
communication between the two systems using standard protocols.
This connection allows remote control of the ultrasound system via
the user interface of the physiology workstation. Ultrasound
functions such as changing modes, changing gain, measurements,
storing of images, etc can be controlled via the physiology
workstation. In addition the clocks of the two systems are
synchronized allowing the user to know that data points that occur
at discreet points in time represent data collected simultaneously.
Images and measurements may be stored to the physiology workstation
and displayed to the user concomitant with other data obtained by
the physiology workstation.
[0083] Also, in some configurations, a physiology workstation is
provided that comprises a communications interface conveying
physiology signals derived from a subject and ultrasound data
representative of a region of interest of the subject. The
ultrasound data is obtained by an ultrasound device in real-time
during a procedure carried out on the subject. A processing unit
receives and processes the physiology signals. An ultrasound
processing unit receives and processes the ultrasound data to
generate ultrasound images. The processing unit combines the
physiology signals with the ultrasound images from the ultrasound
processing unit. A display unit displaying the physiology signals
and the ultrasound images. The physiology signals and ultrasound
signals are presented jointly to a user in real-time during the
procedure being carried out on the subject. The ultrasound system
is controlled via hardware and software keys on the EP or HD
system. The EP or HD system is configured to pass commands to the
ultrasound system, which displays the results of those commands on
both the ultrasound and EP or HD system. The ultrasound system is
configured to be controlled either via the EP or HD system or from
controls directly on the ultrasound system.
[0084] More particularly, and referring to FIG. 9, in some
configurations of the present invention, a physiological network
900 is provided that is configured to operate with a medical
network 902. An ultrasound system 308 is located in a procedure
room 904. Ultrasound system 308 includes an ultrasound probe 236. A
physiological workstation 302 (also referred to herein as a "local
workstation") is configured to operate in a procedure room 906 and
is operatively coupled via medical network 902 to display
ultrasound signals obtained from a subject during an ultrasound
procedure carried out on the subject. Local workstation 302 has a
network interface 305 configured to communicatively couple to
medical network 902. A database 358 storing patient records
associated with the subject undergoing the physiological procedure
is also provided. A server 316 is operatively coupled to medical
network 902 and database 358. Server 316 is configured to provide,
to a local workstation 309 (which can be a display on ultrasound
system 308) and remote workstation 302, a patient record associated
with the subject. Local workstation 309 co-displays the ultrasound
signals and information from the patient record to an operator of
local workstation 309. A remote workstation 302 is configured to
operate in a control room 906 different from procedure room 904, so
that a person in the control room can control ultrasound system 308
while receiving, processing, and displaying the ultrasound signals
obtained from the subject in real-time 41, while an ultrasound
procedure is being performed on the subject. Remote workstation 302
can comprise an EP workstation, an HD workstation, or a combination
EP/HD workstation. Ultrasound probe 236 can be, for example, an
intravascular ultrasound probe, and ultrasound system 308 can be,
for example, a 2-D ultrasound system or a 3-D ultrasound system. In
some configurations, remote workstation 302 and either or both
local workstation 908 or ultrasound system 308 have synchronized
clocks. These clocks (which may comprise embedded software or
firmware modules) can be synchronized, for example, to the time on
server 316.
[0085] In some configurations of the present invention, a keyboard
910 is provided in control room 906. Keyboard 910 is configured to
communicate with ultrasound system 308 via either a wired
connection 912 separate from medical network 902 or a wireless
connection 914 (see FIG. 10) separate from medical network 902.
Wired connection 912 can be, for example, a custom cable or a USB
connection. Wireless connection 914 can be, for example, any of the
802.11 wireless protocol connections or a bluetooth connection.
[0086] Also, in some configurations of the present invention and
referring to FIG. 11, remote workstation 302 includes an image
monitor 224 and a visual keyboard simulator software module
configured to run, at least in part, on remote workstation 302. (To
receive simulated keypresses, a portion of the keyboard simulator
software module may be configured to run on local workstation 908
in some configurations.) An image 916 of a keyboard is displayed on
image monitor 224. Image monitor 224 may include a touchscreen for
operating the keyboard simulator from image 916, or EP or HD PC 918
may be configured to activate simulated keypresses on image 916
using a separate physical keyboard 920 or mouse 922. Virtual
keypresses from keyboard 916 are transferred through medical
network 902. In some configurations, a pair of keyboard/video/mouse
(KVM) switches 924, 926 and a custom cable 928 are provided to
communicate between a remote key board 930 and ultrasound system
308. However, because some KVM switches 924, 926 are unable to
effectively communicate signals that control ultrasound system 308.
Therefore, signals that control ultrasound system 308 are generated
by the visual keyboard simulator software module in response to
simulated keypresses and transmitted via LAN 902 to ultrasound
system 308.
[0087] In some configurations and referring to FIG. 12, the
keyboard simulator software module is configured to display
keyboard image 916 on review monitor 43 instead of, or in addition
to, image monitor 224. Review monitor 43 may comprise a
touchscreen.
[0088] In yet another configuration or configurations and referring
to FIG. 13, a pair of KVM switches 924, 926 is provided and a
point-to-point wired or wireless local area network (LAN) 932
configured to communicatively couple local workstation 908 to
remote workstation 302 is also provided. Data communicated via KVM
switches 924, 926 and LAN 932 exclude control signals resulting
from use of the visual keyboard simulator software module for
controlling ultrasound system 308. Such control signals are instead
communicated, for example, via medical network 902.
[0089] In some configurations and referring to FIG. 14, a keyboard
910 in control room 906 is configured to communicate with
ultrasound system 308 via a connection 914 separate from medical
network 902. Connection 914 is either (or both) a wired connection
(such as a USB connection) separate from medical network 902 or a
wireless connection (e.g., bluetooth, 802.11 wireless) separate
from the medical network 902.
[0090] In all of the above configurations, keyboard 910 can be a
keyboard that provides all or essentially all of the keys that are
present on ultrasound system 308. A keyboard that has such keys is
illustrated in FIG. 15. The use of such a keyboard (in
configurations that do not exclude physical keyboard control of
ultrasound system 308) allow all or essentially all of the
functions of ultrasound system 308 to be performed remotely by the
same keypress or keypresses that would be performed locally.
However, keyboard 910 can replaced with a standard PC keyboard 930
if the necessary ultrasound control functions are mapped to the
available keys on PC keyboard 930. Other types of keyboards may
also be used with appropriate mappings.
[0091] Unless otherwise explicitly excluded, in configurations in
which a keyboard is used, a mouse or other suitable pointing device
and/or a voice recognition module and microphone may also be
provided in conjunction with, or in appropriate cases, instead of
the keyboard.
[0092] The term "co-displays" is not limited to displaying
information on a common CRT or monitor, but instead refers also to
the use of multiple monitors located in immediately adjacent one
another to facilitate substantially simultaneous viewing by a
single individual.
[0093] The figures illustrate diagrams of the functional blocks of
various. The functional blocks are not necessarily indicative of
the division between hardware circuitry. Thus, for example, one or
more of the functional blocks (e.g., processors or memories) may be
implemented in a single piece of hardware (e.g., a general purpose
signal processor or a block or random access memory, hard disk, or
the like). Similarly, the programs may be stand alone programs, may
be incorporated as subroutines in an operating system, may be
functions in an installed imaging software package, and the
like.
[0094] While the invention has been described in terms of various
specific embodiments, those skilled in the art will recognize that
the invention can be practiced with modification within the spirit
and scope of the claims.
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