U.S. patent application number 13/964385 was filed with the patent office on 2015-01-01 for 3-d mapping for guidance of device advancement out of a guide catheter.
This patent application is currently assigned to CORINDUS, INC.. The applicant listed for this patent is Corindus, Inc.. Invention is credited to Per Bergman, Steven Blacker, Jerry Jennings, Nicholas Kottenstette, Jean-Pierre Schott.
Application Number | 20150005745 13/964385 |
Document ID | / |
Family ID | 52116262 |
Filed Date | 2015-01-01 |
United States Patent
Application |
20150005745 |
Kind Code |
A1 |
Bergman; Per ; et
al. |
January 1, 2015 |
3-D MAPPING FOR GUIDANCE OF DEVICE ADVANCEMENT OUT OF A GUIDE
CATHETER
Abstract
The present disclosure involves a process for guiding the distal
end of a guide wire or working catheter as it emerges from the
distal end of a guide catheter into a blood vessel. The distal end
of the guide wire or working catheter is provided with an X-ray
marker, a determination is made that this distal end has emerged
from the distal end of the guide catheter and a fluoroscopic image
of the distal end of a guide wire or working catheter is taken.
This image is correlated with the length of guide wire or working
catheter inserted into the guide catheter. After further
advancement of the guide wire or working catheter, another
fluoroscopic image of the distal end of a guide wire or working
catheter is taken and this image is correlated with the length of
guide wire or working catheter which has been inserted into the
guide catheter.
Inventors: |
Bergman; Per; (West Roxbury,
MA) ; Blacker; Steven; (Framingham, MA) ;
Jennings; Jerry; (Chelsea, MA) ; Kottenstette;
Nicholas; (Worcester, MA) ; Schott; Jean-Pierre;
(Weston, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Corindus, Inc. |
Waltham |
MA |
US |
|
|
Assignee: |
CORINDUS, INC.
Waltham
MA
|
Family ID: |
52116262 |
Appl. No.: |
13/964385 |
Filed: |
August 12, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61839459 |
Jun 26, 2013 |
|
|
|
Current U.S.
Class: |
604/510 |
Current CPC
Class: |
A61B 2090/376 20160201;
A61M 2025/0166 20130101; A61B 2034/2065 20160201; A61B 2034/301
20160201; A61F 2/958 20130101; A61M 25/0108 20130101; A61M 25/09041
20130101; A61B 2090/061 20160201; A61B 6/487 20130101; A61M 25/0113
20130101; A61B 2017/22042 20130101; A61B 6/12 20130101; A61B
2034/107 20160201; A61B 2018/00386 20130101; A61B 6/485 20130101;
A61B 2090/3966 20160201; A61B 6/504 20130101; A61M 2025/09166
20130101; A61B 2018/00375 20130101; A61B 34/20 20160201; A61M
25/104 20130101; A61B 2017/00075 20130101 |
Class at
Publication: |
604/510 |
International
Class: |
A61M 25/01 20060101
A61M025/01 |
Claims
1. A process for guiding the distal end of a guide wire or working
catheter as it emerges from the distal end of a guide catheter
residing in a blood vessel comprising; providing the distal end of
the guide wire or working catheter with an X-ray marker;
determining that this distal end has emerged from the distal end of
the guide catheter; taking a fluoroscopic image of the distal end
of a guide wire or working catheter; correlating this image with
the length of guide wire or working catheter which has been
inserted into the guide catheter; after further advancement of the
guide wire or working catheter, taking another fluoroscopic image
of the distal end of a guide wire or working catheter and
correlating this image with the length of guide wire or working
catheter which has been inserted into the guide catheter; using
this information to guide the further advancement of guide wire or
working catheter.
2. The process of claim 1 wherein fluoroscopic images are taken
repeatedly and correlations are performed repeatedly during the
further advancement of the guide wire or working catheter.
3. The process of claim 2 wherein each correlation is used to guide
the advancement of the guide wire or working catheter from the
point of that correlation.
4. The process of claim 1 wherein the emergence of the distal end
of the guide wire or working catheter is determined using an X-ray
marker on the guide catheter and a fluoroscopic image that includes
this marker and the distal end of the guide catheter.
5. The process of claim 4 wherein this X-ray marker is located
close enough to the distal end of the guide catheter that any
movement of the guide wire or working catheter the out of plane of
this fluoroscopic image can be ignored in making the
determination.
6. The process of claim 1 wherein the emergence of the distal end
of the guide wire or working catheter is determined using an X-ray
marker on the guide catheter.
7. The process of claim 6 wherein the length of guide wire or
working catheter fed to the guide catheter after the distal end of
the guide wire or working catheter is detected at this X-ray marker
is measured and this measurement is used to determine the
emergence.
8. The process of claim 1 wherein the foreshortening in the
fluoroscopic images is used to estimate the path of the blood
vessel extending from the distal end of the guide catheter to the
ultimate destination of the distal end of the guide wire or working
catheter.
9. The process of claim 1 wherein the ultimate destination is a
valve or chamber of a human heart or a lesion in a human blood
vessel.
10. The process of claim 1 wherein the emergence is determined with
image processing software.
11. The process of claim 1 wherein the information is used to align
the plane of a 2-D fluoroscopic image approximately tangent to the
path of further advancement.
12. The process of claim 11 wherein multiple 2-D fluoroscopic
images are used to determine a series of tangents to the blood
vessel along the path of further advancement and the X-ray
equipment is adjusted to provide a 2-D fluoroscopic image whose
plane is approximately tangent to a portion of the path of further
advancement yet to be traversed.
13. The process of claim 12 wherein the X-ray equipment generating
the 2-D fluoroscopic images is mounted on a C-arm and the C-arm is
rotated to align the plane.
14. The process of claim 11 wherein the images are taken as the
guide wire or the working catheter is advanced and the time
interval between successive images is short enough that any change
from moving away from to moving toward the plane of the 2-D
fluoroscopic images may be readily detected.
15. The process of claim 2 wherein the discrepancies between the
actual length fed and the apparent travel in the fluoroscopic
images are fitted to an anatomical model.
16. The process of claim 1 wherein fluoroscopic images in more than
one plane are used.
17. The process of claim 1 wherein successive images are compared
using a common reference point appearing in all the images.
18. The process of claim 1 wherein successive images are compared
using a common subregion of the image appearing in all the
images.
19. The process of claim 2 wherein the timing of the successive
images is such that cardiac motion is normalized.
Description
CROSS-REFERENCE TO RELATED PATENT APPLICATIONS
[0001] This application is a Non-Provisional of U.S. Provisional
Application No. 61/839,459, filed Jun. 26, 2013, entitled "ROBOTIC
IMAGE CONTROL SYSTEM", of which is incorporated herein by reference
in its entirety.
BACKGROUND OF THE INVENTION
[0002] Systems exist for the robotic feeding of percutaneous
interventional devices such as guide wires and working catheters
into guide catheters. The guide catheters are typically placed by
manual manipulation of medical personnel such that their distal
ends are adjacent to the site of action for the intervention,
typically a valve or chamber of the heart or a lesion in a blood
vessel such as an artery. In the case of coronary arteries the
guide catheter may be placed adjacent to the entrance of the artery
into the aorta. The interventional devices such as guide wires and
working catheters may be fed by the operation of robotic controls
by medical personnel such as shown in U.S. Pat. No. 7,887,549. The
working catheters may be equipped with balloons, stents or stents
enclosing balloons. The path of a guide wire or working catheter as
it emerges from the distal end of a guide catheter should follow
the lumen of the blood vessel into which it is being inserted and
this path may not lie in a single 2-D plane. Guiding the
advancement of such a device with a fluoroscopic image that
typically lies in a plane thus presents some challenges.
SUMMARY OF THE INVENTION
[0003] The present invention involves a process for guiding the
distal end of a guide wire or working catheter as it emerges from
the distal end of a guide catheter into a blood vessel. The distal
end of the guide wire or working catheter is provided with an X-ray
marker, a determination is made that this distal end has emerged
from the distal end of the guide catheter and a fluoroscopic image
of the distal end of a guide wire or working catheter is taken.
This image is then correlated with the length of guide wire or
working catheter that has been inserted into the guide catheter.
After further advancement of the guide wire or working catheter,
another fluoroscopic image of the distal end of a guide wire or
working catheter is taken and this image is correlated with the
length of guide wire or working catheter which has been inserted
into the guide catheter. This information is used to guide the
further advancement of guide wire or working catheter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0004] This application will become more fully understood from the
following detailed description, taken in conjunction with the
accompanying figures, wherein like reference numerals refer to like
elements in which:
[0005] FIG. 1 is a schematic of the environment in which
percutaneous interventional procedures are robotically
performed.
[0006] FIG. 2 is a schematic of the placement of a guide catheter
and a guide wire in a human body.
[0007] FIG. 3 is a schematic of a guide catheter in relationship to
the plane of a 2-D fluoroscopic image.
[0008] FIG. 4 is a flow diagram of creating a 3-D map of the path
of a guide wire emerging from a guide catheter.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0009] Referring to FIG. 1, the environment in which the various
embodiments of the present invention find particular utility
involves a catheter laboratory 10 for robotically performing
percutaneous interventional procedures. A patient 11 is supported
on a table 14 and the procedure is observed with fluoroscopic X-ray
equipment 12. A cassette 22 supported by a robotic arm 20 which is
used to automatically feed a guide wire 50 (shown in FIG. 2) into a
guide catheter 40 seated in an artery of the patient 11. The
cassette 22 is controlled from a remote station 24 in order to
isolate the medical personnel conducting the procedure from
exposure to the X-ray radiation used to monitor the procedure by
use of fluoroscopic equipment. The station includes remote controls
26 for controlling the cassette 22 and a screen 28 with which to
monitor the progress of the procedure. It displays the arterial
system 29 being addressed by the procedure. U.S. Pat. No.
7,887,549, incorporated herein by reference, has a detailed
disclosure of this environment.
[0010] Referring to FIG. 2, a guide catheter 40 that has been fed
into the torso 30 of a patient 11 to reach the cardiac region 32.
Within the guide catheter 40 is a guide wire 50 whose tip 52 has
not yet passed out of the distal end 42 of the guide catheter 40.
The X-ray equipment which is used to monitor the progress of the
guide wire 50 as it passes through the guide catheter 40 and
approaches its distal terminus 42 may be controlled such that it
images the entire path until the guide wire tip enters the cardiac
region 32 and then just images the cardiac region 32. It may also
be controlled to take images at a more frequent rate once the tip
52 enters the region 32.
[0011] Referring to FIG. 3, a guide catheter 40 follows the path of
an artery that is not illustrated. It has a portion 47 that has
passed below the plane 90 of the fluoroscopic image into a lower
plane 94 and it has a portion 49 that has passed above the plane 90
into a higher plane 92. Iterative fluoroscopic images in plane 90
can be combined with measurements of the length of guide wire being
fed into the guide catheter to yield an indication of the 3-D path
of the guide catheter and therefore the artery itself.
[0012] Referring to FIG. 4, a step-by-step procedure may be
followed to develop the indication of the 3-D path of a guide wire
or working catheter as it emerges from the distal end of a guide
catheter from iterative fluoroscopic images.
[0013] One embodiment involves using the Pythagorean Theorem to
estimate the location of the tip of a guide wire in three
dimensional space. The apparent length of the guide wire distal
portion in a fluoroscopic image is taken as one leg, the length of
guide wire involved in the image is taken as the hypotenuse and the
height out of the plane is taken as the other leg of a right
triangle. Basic trigonometry allows a calculation of the angle of
the hypotenuse out of the plane of the image.
[0014] One embodiment involves taking fluoroscopic images
repeatedly and performing correlations repeatedly during the
further advancement of the guide wire or working catheter. Each
correlation may be used to guide the advancement of the guide wire
or working catheter from the point of that correlation.
[0015] One embodiment involves determining the emergence of the
distal end of the guide wire or working catheter using an X-ray
marker on the guide catheter and a fluoroscopic image that includes
this marker and the distal end of the guide catheter. This X-ray
marker may be located close enough to the distal end of the guide
catheter that any movement of the guide wire or working catheter
the out of plane of this fluoroscopic image can be ignored in
making the determination without creating a significant error. One
embodiment involves measuring the length of guide wire or working
catheter fed to the guide catheter after the distal end of the
guide wire or working catheter is detected at this X-ray marker and
this measurement is used to determine the emergence.
[0016] One embodiment involves using the foreshortening in the
fluoroscopic images to estimate the path of the blood vessel
extending from the distal end of the guide catheter to the ultimate
destination of the distal end of the guide wire or working
catheter.
[0017] One embodiment involves using image-processing software to
determine when the distal end of the guide wire or working catheter
has emerged from the guide catheter. This software may also be
involved in controlling the taking of fluoroscopic images and the
correlations of these images with the length of guide wire or
working catheter fed to the guide catheter.
[0018] One embodiment involves using the information obtained from
determining the position in three dimensional space of the distal
end of a guide wire or working catheter to align the plane of a 2-D
fluoroscopic image approximately tangent to the path of its further
advancement. Multiple 2-D fluoroscopic images may be used to
determine a series of tangents to the blood vessel along the path
of further advancement and the X-ray equipment is adjusted to
provide a 2-D fluoroscopic image whose plane is approximately
tangent to a portion of the path of further advancement yet to be
traversed. One embodiment involves taking the 2-D fluoroscopic
images with X-ray equipment mounted on a C-arm and rotating the
C-arm is to align the plane.
[0019] One embodiment involves taking fluoroscopic images at
frequent enough intervals after the distal end of a guide wire or
working catheter has emerged from the distal end of the guide
catheter that any change from moving away from to moving toward the
plane of the 2-D fluoroscopic images may be readily detected.
[0020] One embodiment involves fitting the discrepancies between
the actual length fed of a guide wire or working catheter and the
apparent travel after emergence from the distal end of the guide
catheter in the fluoroscopic images to an anatomical model. The
precise three-dimensional path of any given blood vessel may be
unique to that blood vessel and to the person in whom that blood
vessel resides but blood vessels of a certain type generally follow
a certain generalized path. For instance the right coronary artery
(RCA) follows the same generalized path away from the ascending
aorta despite differences from individual to individual.
[0021] One embodiment involves taking multiple fluoroscopic images
at a given point in the progression of the guide wire or working
catheter out of the distal end of the guide catheter. The images at
a given point lie in different planes. This facilitates determining
the position of the distal end of the guide wire or working
catheter in three-dimensional space at that point in its
progression.
[0022] One embodiment involves using standard comparison techniques
on successive fluoroscopic images. Successive images may be aligned
using a feature or "reference point" expected to be invariant
between the images being compared. Alternatively a shift or a shift
and rotation within the fluoroscopic plane may be calculated to
cause the second image to correspond to the first with a high
degree of correlation. One image may be selected as a reference or
"gold standard" image and all other images compared to it or two
successive images may just be compared to each other. If the two
images as a whole cannot be matched with a high degree of
correlation, the effective area of interest can be minimized to
contain just the information needed to follow the distal end of the
guide wire or working catheter. Successive images may be timed so
that they both occur at the same point in the patient's cardiac or
breathing cycle or both. The aim is to minimize any difference
between the images that is not related to the progression or travel
of the guide wire or working catheter.
[0023] While the foregoing written description of the invention
enables one of ordinary skill to make and use what is considered
presently to be the best mode thereof, those of ordinary skill will
understand and appreciate the existence of variations,
combinations, and equivalents of the specific embodiment, method,
and examples herein. The invention should therefore not be limited
by the above described embodiment, method, and examples, but by all
embodiments and methods within the scope and spirit of the
invention as claimed.
* * * * *