U.S. patent application number 15/141322 was filed with the patent office on 2017-03-23 for needle positioning apparatus and method.
This patent application is currently assigned to Perfint Healthcare Private Limited. The applicant listed for this patent is Perfint Healthcare Private Limited. Invention is credited to Kasi Viswanathan Agilandam, Roy Santosham, Kannan Neelakanta Sarma, Gnanasekar VELUSAMY.
Application Number | 20170079720 15/141322 |
Document ID | / |
Family ID | 39303897 |
Filed Date | 2017-03-23 |
United States Patent
Application |
20170079720 |
Kind Code |
A1 |
VELUSAMY; Gnanasekar ; et
al. |
March 23, 2017 |
NEEDLE POSITIONING APPARATUS AND METHOD
Abstract
Apparatus for accurate positioning of a needle guide is
disclosed. The apparatus provides a means for taking as input the
position vector for the point of insertion of the needle into the
body. This point of insertion can be selected from images produced
by a Computer Tomography system. Similarly, the apparatus has a
means for taking as input the point of target. A controller
determines the directional vector between point of insertion and
point of target. A guide manipulator accurately positions the
needle guide in line with the directional vector, such that the
needle can easily be inserted through the guide to the point of
target. The positioning of the guide manipulator in accordance with
the directional vector is done with the help of motors.
Inventors: |
VELUSAMY; Gnanasekar;
(TamilNadu, IN) ; Sarma; Kannan Neelakanta;
(TamilNadu, IN) ; Agilandam; Kasi Viswanathan;
(Karnataka, IN) ; Santosham; Roy; (TamilNadu,
IN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Perfint Healthcare Private Limited |
Chennai |
|
IN |
|
|
Assignee: |
Perfint Healthcare Private
Limited
Chennai
IN
|
Family ID: |
39303897 |
Appl. No.: |
15/141322 |
Filed: |
April 28, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14318935 |
Jun 30, 2014 |
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15141322 |
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13743960 |
Jan 17, 2013 |
8774901 |
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14318935 |
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11682375 |
Mar 6, 2007 |
8401620 |
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13743960 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 6/461 20130101;
A61B 34/70 20160201; A61B 6/03 20130101; A61B 10/0233 20130101;
A61B 34/10 20160201; A61B 2090/376 20160201; A61B 34/32 20160201;
A61B 90/11 20160201; A61B 6/0407 20130101; A61B 2034/107 20160201;
A61B 2034/101 20160201; A61B 6/032 20130101; A61B 34/30 20160201;
A61B 2090/067 20160201 |
International
Class: |
A61B 34/10 20060101
A61B034/10; A61B 10/02 20060101 A61B010/02; A61B 6/00 20060101
A61B006/00; A61B 6/04 20060101 A61B006/04; A61B 34/00 20060101
A61B034/00; A61B 90/11 20060101 A61B090/11; A61B 6/03 20060101
A61B006/03 |
Foreign Application Data
Date |
Code |
Application Number |
Oct 16, 2006 |
IN |
1903/CHE/2006 |
Claims
1. An apparatus, comprising: a needle positioning device configured
to position a needle guide at a fixed target location with respect
to a patient disposed on a movable cradle of an imaging system such
that a needle can be inserted through an opening defined by the
needle guide and moved relative to the needle guide, through an
insertion point on the patient and within a target point within the
patient; and processing circuitry configured to: receive images of
the patient from the imaging system; determine, based at least in
part on the received images, a location of the insertion point
relative to a gantry of the imaging system in which a needle is to
be inserted into the patient when the patient is disposed on the
movable cradle; and determine a directional vector between the
insertion point and the target point within the patient, the fixed
target location of the needle guide to be in line with the
directional vector based at least in part on the determined
location of the insertion point and the directional vector.
2. The apparatus of claim 1, wherein the needle positioning device
includes a support base selectively lockable to a docking system,
the needle guide being coupled to the support base.
3. The apparatus of claim 2, wherein the fixed target location of
the needle guide is determined at least in part based upon a
position of the support base with respect to the imaging
system.
4. The apparatus of claim 1, wherein the processing circuitry is
configured to determine the target point within the patient based
at least in part on the images received from the imaging system,
and the fixed target location of the needle guide is determined at
least in part based on the insertion point and the target
point.
5. The apparatus of claim 1, wherein the needle positioning device
includes a positioning element, the positioning element including
first and second members, the first and second members configured
to rotate about mutually perpendicular axes.
6. The apparatus of claim 1, further comprising a skin level sensor
adapted to be disposed on a skin surface of the patient and to
provide signals to the processing circuitry indicating whether a
correction of a spatial orientation of the needle guide is
needed.
7. The apparatus of claim 1, wherein the needle positioning device
includes a guide manipulator configured to position the needle
guide at the target location, the guide manipulator having five
axes of movement.
8. The apparatus of claim 1, further comprising a display portion
coupled to the processing circuitry and configured to display the
images received from the imaging system.
9. The apparatus of claim 1, wherein the processing circuitry is
configured to determine the fixed target location of the needle
guide based at least in part upon a length of a needle to be
inserted through the needle guide such that a predetermined portion
of the length of the needle can be inserted relative to the needle
guide, through the insertion point, and into the target point.
10. The apparatus of claim 1, wherein the processing circuitry is
configured to determine the insertion point and the target point
based at least in part on the images received from the imaging
system, and the fixed target location of the needle guide is
determined at least in part based on the insertion point and the
target point and a length of a needle to be inserted through the
needle guide such that a predetermined portion of the length of the
needle can be inserted relative to the needle guide, through the
insertion point, and into the target point.
11. The apparatus of claim 1, wherein the processing circuitry is
further configured to cause the needle positioning device to be
moved to position the needle guide at the target location.
12. An apparatus, comprising: a mobile support base configured to
be positioned at a location relative to an imaging system; a guide
manipulator supported on the support base and configured to
position a needle guide at a fixed target location along a
directional vector such that a needle can be inserted through the
needle guide at the fixed target location, through an insertion
point on a patient disposed on the patient cradle of the imaging
system, and into a target point within the patient; and processing
circuitry configured to: receive images of the patient from the
imaging system; determine, based at least in part on the received
images, a location of the insertion point relative to a gantry of
the imaging system; determine the directional vector between the
insertion point and the target point based at least in part on the
images received from the imaging system; determine the target
location of the needle guide to be in line with the directional
vector based at least in part on the determined location of the
insertion point and the directional vector; and cause the guide
manipulator to be moved to position the needle guide at the target
location relative to the patient such that the needle guide is in a
fixed position relative to the movable patient cradle.
13. The apparatus of claim 12, further comprising: a skin level
sensor adapted to be disposed on a skin surface of the patient and
to provide an indication to the processing circuitry whether a
correction to a spatial orientation of the needle guide is
needed.
14. The apparatus of claim 12, wherein the processing circuitry is
configured to determine the insertion point and the target point
based at least in part on the images received from the imaging
system, and the processing circuitry is configured to determine the
location of the needle guide based at least in part on the
insertion point and the target point and a length of a needle to be
inserted through the needle guide such that a predetermined portion
of the length of the needle can be inserted relative to the needle
guide, through the insertion point, and into the target point.
15. The apparatus of claim 12, wherein the processing circuitry is
configured to determine the insertion point and the target point
based at least in part on the images received from the imaging
system, and the processing circuitry is configured to determine the
target location to position the needle guide at least in part based
on the insertion point and the target point and coordinates derived
from the position of the support base with respect to the imaging
system.
16. An apparatus, comprising: a support base configured to be
positioned at a location relative to an imaging system; a guide
manipulator supported on the support base and configured to
position a needle guide at a target location with respect to a
patient disposed on a movable patient cradle of the imaging system;
and processing circuitry configured to: receive images of the
patient from the imaging system; determine, based at least in part
on the received images, a location of an insertion point on the
patient relative to a gantry of the imaging system when the patient
is disposed on the movable cradle of the imaging system; determine
a directional vector between the insertion point on the patient and
a target point within the patient; determine, based at least in
part on the received images, the target location to position the
needle guide, the target location being in line with the
directional vector and based at least in part on the determined
location of the insertion point and the directional vector; cause
the needle guide to be moved to the target location; and maintain
the needle guide in a fixed position at the target location such
that a needle can be inserted through the opening of the needle
guide and into the patient at the insertion point and inserted into
the target point within the patient.
17. The apparatus of claim 16, wherein the support base is
selectively lockable to a docking system.
18. The apparatus of claim 16, wherein the processing circuitry is
configured to determine the target location of the needle guide
based at least in part on the insertion point and the target point
and coordinates derived from the position of the support base
relative to the imaging system.
19. The apparatus of claim 16, wherein the processing circuitry is
configured to determine the target location of the needle guide
based at least in part on a length of a needle to be inserted
through the needle guide and through the insertion point such that
a predetermined portion of the needle can be inserted through the
insertion point and into the target point.
20. The apparatus of claim 16, wherein the includes a plurality of
wheels configured to support the support base and to allow the
support base to be moveable to and from a desired position relative
to the imaging system, the support base configured to be locked at
the desired position.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 14/318,935, filed Jun. 30, 2014, entitled
"Needle Positioning Apparatus and Method," which is a continuation
of U.S. patent application Ser. No. 13/743,960, filed Jan. 17,
2013, entitled "Needle Positioning Apparatus and Method" (now U.S.
Pat. No. 8,774,901), which is a divisional of U.S. patent
application Ser. No. 11/682,375, filed Mar. 6, 2007, entitled
"Needle Position Apparatus and Method" (now U.S. Pat. No.
8,401,620), which claims priority to and the benefit of Indian
patent application number 1903/CHE/2006, filed Oct. 16, 2006, each
of the disclosures of which is hereby incorporated by reference
herein in its entirety.
FIELD OF INVENTION
[0002] The present invention relates to a needle guide positioner.
In particular, the present invention relates to an apparatus and a
method for accurately positioning a needle with respect to a target
within a patient's body to facilitate different clinical procedures
involving needle insertion into the patient's body.
BACKGROUND
[0003] Biopsy is a medical procedure in which cells or tissues are
removed from the body for examination. The procedure involves
removing specimens of a tissue from part of a body lesion. These
specimens are then examined under the microscope to determine the
medical condition.
[0004] In a typical biopsy procedure, the affected part of the
patient's body is scanned to pinpoint the location of the lesion.
In order to extract samples from the lesion, a needle is inserted
to touch the lesion. The needle is inserted such that it does not
puncture any other vital organ or structure in the patient's body.
Currently, the biopsy incisions are usually made by hand. The
practitioner determines the point of insertion of the biopsy needle
through external measurements. For example, the point of insertion
can be determined by placing a cotton pellet mixed with contrast or
iodine. The area can also be determined by drawing lines on the
patient or by marking the area of entry by a marker. The position
and angle of the insertion in such cases may not be accurate
resulting in repeated insertions in the patient's body.
[0005] Image guided interventional procedures are preferred by
practitioners. Such procedure shows the path taken by the needle
during insertion, thereby reducing the risk to the patients and
increasing the accuracy of insertion. Also, image guidance helps to
avoid unwanted injury to vital organs and blood vessels. Commonly
used imaging systems are Ultrasound, X-Rays, C-Arms, Computed
Tomography Scanners, Magnetic Resonance Imaging etc.
[0006] Information relevant to attempts to address the limitations
inherent in existing methods of needle positioning can be found in
US patents U.S. Pat. No. 6,785,572, and U.S. Pat. No. 6,246,898; US
patent applications US2004152970A1, US2005177054A1, and
US2006020279A1; European patent EPI 524626, and WIPO patent
application WO03091839A2. However, each one of these references
suffers from one or more of the following limitations. Firstly,
these devices require real time imaging and tracking of the needle.
Therefore, the radiation exposure time to the patient and
practitioner is high. Secondly, the cost of such devices as well as
the preparation time for setting up these devices is high. Thirdly,
existing procedures require repeated punctures in the patient's
body for accurate positioning of the needle.
[0007] In light of the drawbacks of the existing art, there exists
a need for an apparatus and a method for accurate positioning of a
biopsy needle. Further, there exists a need for an apparatus and a
method for accurate positioning of a needle guide such that the
practitioner does not need to perform repeated insertions to reach
the lesion of interest. Additionally, there is a need for an
apparatus and a method that can allow biopsy insertions to be
performed with minimal exposure to radiation.
BRIEF SUMMARY OF THE INVENTION
[0008] An object of the present invention is to provide a device
for accurate positioning of a needle guide.
[0009] Another object of the invention is to reduce the number of
punctures made on the body during biopsy procedure, thereby
reducing the time of the procedure and the discomfort to the
patient.
[0010] Yet another object of the invention is to provide an
apparatus and a method that allows for positioning of the biopsy
needle in an offline mode by using the images acquired during CT
scan, without constant exposure to scanning radiations.
[0011] In accordance with the above mentioned objectives, an
apparatus for accurate positioning of a needle guide is disclosed.
The apparatus provides a means for taking as input the position
vector of a point of insertion of the needle into the body. This
point of insertion can be selected from images produced by a
Computer Tomography system. Similarly, the apparatus has a means
for taking as input a point of target. A controller determines the
direction vector between the point of insertion and the point of
target. A guide manipulator accurately positions the needle guide
in line with the direction vector, such that the needle can easily
be inserted through the guide to the point of target. This
positioning of the guide manipulator in accordance with the
direction vector is done with the help of motors.
[0012] In an embodiment of the invention, the apparatus is a
multi-axis needle manipulator. The apparatus has a clamp capable of
linear movement along at least one axis. Attached to the clamp is a
positioning element including first and second members. The first
and the second members are capable of rotating along mutually
perpendicular axes. A means for determining position vectors
obtains position information for the point of insertion and the
point of target. A controller determines the spatial orientation of
the positioning element and the clamp based on the position vectors
of the point of insertion and the point of target. The needle guide
is aligned to the spatial orientation through the help of a
plurality of motors.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] Various embodiments of the invention will hereinafter be
described in conjunction with the appended drawings provided to
illustrate and not to limit the invention, wherein like
designations denote like elements.
[0014] FIG. 1 shows the environment in which the apparatus of the
present invention works.
[0015] FIGS. 2A and 2B are schematics representing the insertion of
a needle to a point of target in accordance with an embodiment of
the invention.
[0016] FIG. 3 illustrates an embodiment of the needle positioner in
accordance with an embodiment of the present invention.
[0017] FIG. 4 is an orthogonal view of the guide manipulator in
accordance with an embodiment of the invention.
[0018] FIGS. 5A and 5B each depict an orthogonal view of the
positioning element with the second member of the positioning
element in a different orientation and the needle guide in closed
and release positions, respectively, in accordance with an
embodiment of the invention.
[0019] FIG. 6 is a schematic of the controller in accordance with
an embodiment of the invention.
[0020] FIG. 7 is a schematic of the data input means in accordance
with an embodiment of the invention.
[0021] FIGS. 8A, 8B, 8C, and 8D illustrate the computation of the
direction vector for aligning the needle guide.
[0022] FIGS. 9A and 9B illustrate a flow chart illustrating the
method to position a needle guide in accordance with an embodiment
of the invention.
[0023] FIG. 10 illustrates a skin level sensor for providing
correction to the spatial orientation of the needle guide, in
accordance with an alternative embodiment of the invention.
DETAILED DESCRIPTION
[0024] Accurate placement of a needle within the body can
dramatically change patient management. It can help avoid invasive
surgeries and minimize morbidity and mortality. Some examples of
use of medical procedures that require needle insertion include:
percutaneous biopsies (acquiring of tissue for pathological
analysis which gives accurate diagnosis), drainage procedures
(aspiration of unwanted toxic fluids from within the body), focal
injection of medications (treatment of cancers and pain
management), ablation of tumors (in treatment of tumors by radio
frequency, cryo and laser energy), vertebral facetal injections and
focused irradiation of tissues.
[0025] The invention discloses an apparatus and a method for
accurate positioning of a needle guide in a patient's body. The
apparatus accurately positions a needle guide with respect to a
point of target within the patient's body. Such needle positioning
is useful for various clinical procedures including, but not
limited to, targeted medicine delivery, biopsy, bone marrow
extraction, fluid biopsy, liposuction, orthopedic procedures and
the like.
[0026] The apparatus, in accordance with an embodiment of the
invention, provides a multi-axis manipulator, which takes scanned
images of the affected portion of the body as input. The precise
points of insertion and target are determined from these images.
This can be done manually by an expert or can be device-assisted,
through image analyzing technology. The manipulator aligns the
needle guide for facilitating the easy and accurate insertion of
the needle with respect to the point of target.
[0027] FIG. 1 shows the environment in which the apparatus of the
present invention works. Apparatus 102 works in conjunction with an
imaging system such as a Computer Tomograph (CT) system 104. CT
system 104 has a movable cradle 106 slidable over table 107. A
patient's body 108 is placed on movable cradle 106 and slid into a
gantry 110 for CT imaging. Inside gantry 110, images of the
affected area in the patient's body 108 are taken. These images are
slices of the affected area, i.e., a series of cross-section views
of the affected area in the patient's body 108. For example, the
images could be CT scan images of the patient's brain. CT system
generates a three-dimensional image of the internals of the
affected area of the patient's body 108 from a large series of
two-dimensional X-ray images taken around a single axis of
rotation. These series of images are also referred to as image
slices. While the system of the present invention has been
discussed in conjunction with a CT imaging system it will be
apparent to one skilled in the art that the CT system is used for
exemplary purposes only. Other systems for obtaining an image of
the affected area of the patient's body 108 can also be used
without deviating from the scope of the invention. For example,
other imaging systems including Magnetic Resonance Imaging,
Ultrasound and the like can also be used in conjunction with the
present invention.
[0028] Apparatus 102 can be a standalone device that can be moved
to a desired position along movable cradle 106 and locked with
respect to the CT system. In an embodiment apparatus 102 can be
locked with respect to the CT system using a docking system
attached to a (fixed) base of movable cradle 106. Alternatively,
apparatus 102 can be an integrated with the CT system. In such an
embodiment, apparatus 102 leverages the motion of movable cradle
106, thereby obviating the need of linear motion of apparatus 102
with respect to movable cradle 106.
[0029] Apparatus 102 takes imaging data from the CT system in the
form of DICOM images. Digital Imaging and Communications in
Medicine (DICOM) is a comprehensive set of standards for handling,
storing, printing, and transmitting information in medical imaging.
It includes a file format definition and a network communications
protocol. The communication protocol is an application protocol
that uses TCP/IP to communicate between systems. DICOM files can be
exchanged between two systems that are capable of receiving image
and patient data in DICOM format. The DICOM images from the CT
system are received by apparatus 102. Apparatus 102 facilitates the
marking of the points of insertion and target on the DICOM images,
and computes the coordinates for the position of the apparatus.
Details of obtaining the points of insertion and target, and
computing the coordinates for the position of the apparatus are
discussed in conjunction with FIGS. 5A, 5B and FIG. 6.
[0030] FIGS. 2A and 2B are schematics representing the procedure of
needle insertion useful for clinical procedures such as biopsy in
accordance with an embodiment of the present invention. FIG. 2A is
a Superior Inferior (SI) plane view, while FIG. 2B is a horizontal
section view of the affected portion of the patient's body 108. The
needle is required to enter the patient's body 108 at point of
insertion 202 and is required to touch target 204 at point of
target 206. In one embodiment of the invention, target 204 is a
lesion in the patient's body 108. In an alternate embodiment,
target is a particular organ in the patient's body 108 for targeted
delivery of medicine.
[0031] Point of insertion 202 and point of target 206 can be
manually identified by a medical specialist. Point of insertion 202
and point of target 206 can also be automatically identified
through image recognition techniques. Details regarding the
identification of point of insertion 202 and point of target 206
are discussed in conjunction with FIGS. 5A and 5B. Point of
insertion 202 and point of target 206 are identified such that the
needle can directly reach the point of target 206 without damaging
internal body parts 208 and 210 that lie in between the point of
insertion 202 and point of target 206. As depicted in FIGS. 2A and
2B, the needle needs to be inserted along a direction vector 212
which is at angles .alpha. and .beta. from x and z axis
respectively to ensure that it reaches point of target 206
seamlessly without affecting internal body parts 208 and 210. The
direction vector 212 is difference between the position vector of
point of target 206 and the position vector of point of insertion
202.
[0032] FIG. 3 illustrates the needle positioner in accordance with
an embodiment of the present invention. Apparatus 102 has a guide
manipulator 302, a data input means 304, and a controller 306. Data
input means 304 obtains data related to the coordinates of point of
insertion 202 and point of target 206. Data input means 304 has
been discussed in detail in conjunction with FIG. 6. Controller 306
uses the abovementioned data related to the coordinates of point of
insertion 202 and point of target 206 for determining the direction
vector 212 from point of insertion 202 to point of target 206.
Controller 306 further computes the spatial orientation for the
needle guide to facilitate the entry of the needle into the
patient's body 108 at the point of target 206. Controller 306
manipulates guide manipulator 302 to precisely align the needle
guide with respect to the patient's body 108. The needle guide is
positioned such that it facilitates easy insertion of the needle
from point of insertion 202 to point of target 206. Guide
manipulator 302 is discussed in detail in conjunction with FIG. 4.
Controller 306 is discussed in detail in conjunction with FIGS. 5A
and 5B.
[0033] FIG. 4 is an orthogonal view of guide manipulator 302 in
accordance with an embodiment of the invention. Guide manipulator
302 is capable of motion in three linear directions that allows
guide manipulator 302 to position the needle guide to the point of
interest. Further, guide manipulator 302 can also have angular
motion in two directions that facilitates the angular entry of the
needle into the patient's body 108. Clamp 402 in guide manipulator
302 provides linear motion along three mutually perpendicular axes
while positioning element 404 provides two angular degrees of
freedom. Apparatus 102 is able to accurately position itself with
respect to patient's body 108 by using the movement in these five
axes.
[0034] Clamp 402 is mounted on a mobile platform 405. Mobile
platform 405 is mounted on wheels 407. In one embodiment, wheels
407 are of castor type which means that the wheels are mounted with
an offset steering pivot such that the wheels will automatically
swivel to align themselves in the direction where they are pushed.
Mobile platform 405 can be positioned near movable cradle 106 and
can be locked in the desired position using a magnetic lock. Wheels
407 allow easy movement of guide manipulator 302. Mobile platform
405 can be moved manually or can be computer controlled.
[0035] In an embodiment of the invention, clamp 404 has arms 408,
410 and 412 for movement along each of the three perpendicular
axes. Arm 408 provides movement along the x-axis, arm 410 provides
movement along the y-axis, and arm 412 provides movement along the
z-axis.
[0036] Arm 410 provides the height movement. This vertical distance
is affected by ball screw-spline and stepper motors. Ball screw
spline mechanism is used to provide the combination of rotation and
translation on a single compact design. The ball screw mechanism
can achieve three modes of motion (rotational, linear and spiral)
on a single shaft by rotating and stopping the ball-screw and
spline nuts through the motion coordination of two motors. The ball
spline has an angular-contact structure that causes no backlash in
the rotational direction, enabling precise positioning of the
needle guide. Stepper motors can be interfaced to computer using
few transistors and made to rotate using software. This provides
further precise control over the vertical movement of the
horizontal bar arms 408 and 412 by controller 306. An encoder is
used to provide information on the position of the needle guide.
Encoders measure the rotation of the motors to a precise degree.
The encoder provides feedback to the controller 306 to precisely
control the movement of the motors to an accuracy of less than 0.1
degrees.
[0037] The horizontal bar frame has two bar frame arms 408 and 412.
The bar frame arms are attached in an L-shape such that they can
slide perpendicular to the each other. The horizontal bar system
provides motion in x and z direction. A positioning element 404 is
attached to the horizontal bar frame. Positioning element has been
illustrated in detail in FIGS. 5A and 5B.
[0038] In an embodiment of the invention, a distance measurement
sensor is provided to measure distance of the cradle from the point
of insertion in order to position the guide manipulator
accurately.
[0039] A docking system is provided to dock guide manipulator 302
accurately with respect to gantry 110. The docking system also
ensures parallel alignment of the guide manipulator with respect to
table 107. Apparatus 102 is connected to a controller 306 that
controls the motion of guide manipulator 302 and clamp 402. Details
of controller 306 are discussed in conjunction with FIGS. 5A and
5B.
[0040] FIGS. 5A and 5B depict two orthogonal views of the
positioning element. Positioning element 404 provides angular
movement of a needle guide 502. Positioning element 404 comprises
two components--a first member 504, capable of rotating about a
first axis 506, and a second member 508 capable of rotating about a
second axis 510. Axes 506 and 510 are mutually perpendicular. FIGS.
5A and 5B show two different orientations of member 508. In FIGS.
5A and 5B needle guide 502 is shown in closed (gripped) and release
positions respectively.
[0041] Needle guide 502 is attached to second member 508. Needle
guide 502 holds the needle firmly in slot 512. Needle guide 502
also has a needle release knob 514. After the needle has been
inserted into the patient's body 108, needle release knob 514 is
actuated to release the needle. This can be done either manually or
automatically. As the needle release knob 514 is actuated, it
releases the needle from the guide manipulator 302.
[0042] The rotational motion about axes 508 and 510 helps in
orienting needle guide 502 along the computed direction vector 212.
This enables a surgeon to precisely insert the needle through
second member 508 along the computed position vector to reach the
point of target. This obviates the need for repeated incision in
the patient's body 108 to reach the target.
[0043] FIG. 6 is a schematic of controller 306 in accordance with
an embodiment of the invention. Controller 306 has a directional
vector computer 602 and an actuator 604. Directional vector
computer 602 determines the linear position of clamp 402, and the
angular position of positioning element 404. Directional vector
computer 602 computes the spatial orientation of needle guide 502
using point of target 206 and point of insertion 202. In
particular, directional vector computer 602 determines the linear
position (x, y, z) and the angular position (.alpha., .beta.) for
apparatus 102. Details of the algorithm used in directional vector
computer 602 are discussed in conjunction with FIG. 7. Actuator 604
is used for controlling motors 606-614. Motors 606-614 move the
arms of guide manipulator 302 to align them in accordance with
computed spatial orientation of guide manipulator 302 with the help
of encoders 616-624. Encoders 616-624 provide feedback to
controller 306 on the precise degree of movement of clamp 402 and
positioning element 404. In particular, motors 606-614 provide the
linear movement of clamp 402 in the x, y and z axis, and the
angular movement of positioning element 404 along the two
rotational axes. It will be apparent to one skilled in the art that
although five motors have been shown in the embodiment of FIG. 6,
there could be fewer than or more than five motors in the apparatus
without deviating from the scope of the invention.
[0044] FIG. 7 is a schematic of Data input means 304 in accordance
with an embodiment of the invention. Data input means 304 has a
User Interface 702, and an image receiver 704. User Interface (UI)
702 provides for input of various movement coordinates for
apparatus 102. UI 702 also displays the current position of each
axis after positioning using feedback mechanism. Image receiver 704
acquires DICOM images from CT system 104. UI 702 displays the
received DICOM images. UI 702 also allows for input of point of
target 206 and point of insertion 202 on the DICOM images. Such
input can be provided by a radiologist, or other medical
practitioners. Alternatively, point of target 206 and point of
insertion 202 can be determined automatically through the use of
advanced image recognition technology. It will be apparent to a
person skilled in the art that the point of target 206 and point of
insertion 202 may be determined using any other approach without
deviating from the scope of the invention.
[0045] FIGS. 8A, 8B, 8C and 8D are a series of illustrations
depicting the computation of direction vector 212 for aligning
needle guide 502. In accordance with an embodiment of the
invention, the coordinate system used is the Cartesian system. The
center of CT gantry 110 is chosen as the gantry zero 808 (origin:
x=0, y=0, z=0) of the coordinate system. The coordinates of point
of insertion 202 are (x2, y2, z2) and point of target 206 are (x1,
y1, z1). FIG. 8A depicts the initial position of the system. The
horizontal direction of movement of movable cradle 106 in and out
of gantry 110 is designated as the z-axis. Gantry zero 808 is
essentially the z=0 level 802. The CT scan provides image slices of
the body at different vertical sections. From the series of image
slices, the image slice for point of target 804 (z=z1) and the
image slice for point of insertion 806 (z=z2) are identified. Axis
804 is a vertical section of the body at point of target 202
denoted as (x2, y2, z2). Axis 806 is a vertical section of the body
at point of insertion 206 denoted as (x1, y1, z1).
[0046] FIG. 8B shows the image slices of different sections of the
body. A lateral scout view, with the planes of each CT slice
indicated, is included in the scanned image. It indicates the
z-distance (z-coordinates) for the frames. It shows the front view
of the slices at 804 (z=z1) and 806 (z=z2). Coordinates (x1, y1,
z1) and (x2, y2, z2) are coordinates seen on the image slices. The
spatial coordinates of needle guide 502 is 814 (x3, y3, and z3).
This position is offset from the surface of the body of the patient
by a dead space 812. A corresponding spatial orientation in the
actual patient's body 108 is determined by the following
formula:
X value in mm=((Graphical X-XOffset)/ZoomValue)*pixel-spacing;
Y value in mm=((Graphical Y-YOffset)/ZoomValue)*pixel-spacing;
Z value in mm=slice-location from DICOM header;
Where,
[0047] Graphical X=x1, or x2, or x3;
[0048] Graphical Y=y1, or y2, or y3; and,
[0049] Graphical Z=z1, or z2, or z3.
[0050] In the above formula, XOffset and YOffset are the offsets
introduced in x and y values due the dead space between the
patient's body and needle guide created due to the construction of
the device. Zoom value indicates the magnification value. It is the
ratio of the size of the image displayed on the screen to the
actual size of the image.
[0051] Pixel spacing is the spacing between the pixels on the UI.
The pixel spacing depends upon the size of the screen and the
number of pixels that are present on the screen area.
[0052] After computing the coordinates for point of insertion 202
and point of target 206 in real environment, the distance between
the two points is determined using the distance formula
d=(.DELTA.X.sup.2+.DELTA.Y.sup.2+.DELTA.Z.sup.2).sup.1/2 where
.DELTA.X, .DELTA.Y and .DELTA.Z are the differences in X, Y and Z
coordinates of point of target 206 and point of insertion 202,
i.e.,
.DELTA.X=x1-x2
.DELTA.Y=y1-y2
.DELTA.Z=z1-z2
[0053] Further the orbital angles alpha and beta are determined
by
alpha=a tan(ydiff/xdiff)
[0054] beta=a tan (zdiff/ydiff) where the angles alpha and beta are
as shown in FIG. 8C.
[0055] These angles determine the rotational values by which member
504 and member 508 must be rotated so as to align needle guide 502
along direction vector 212.
[0056] Needle slot 512 is positioned at 814 with coordinates (x3,
y3, z3). Guide manipulator 302 which is docked to the docking
system is thus at a known distance from gantry zero 808. The needle
pointer is placed at a distance equal to dead space 812 from point
of insertion 202 determined. Hence the coordinates are adjusted for
dead space 812 using
x3, y3, z3=x2, y2, z2+Dead space 812
[0057] In an embodiment of the invention, guide manipulator 302
positions itself in such a way that only a pre-determined portion
of the needle is inserted into the body. This is done by
determining the length of the needle to be used and the distance
between point of target 206 and point of insertion 202. The doctor
then chooses the dead space 812, which is communicated, to
controller 306. Controller 306 computes coordinates 814 (x3, y3,
z3) and thus the three coordinates, viz. point of insertion 202,
point of target 206 and the location of the needle guide 502, are
determined.
[0058] Although the above description of the computation of the
direction vector 212 is shown in Cartesian coordinates system, it
must be apparent to a person skilled in the art that any other
coordinate system can be used without deviating from the scope of
the invention. For example, point of insertion 202 and point of
target 206 can be determined and expressed in coordinate systems
like Cartesian, Polar, Spherical, curvilinear and the like or in a
combination of one or more of these coordinate systems.
[0059] FIGS. 9A and 9B illustrate a flowchart illustrating the
method of positioning a needle guide 502 in accordance with an
embodiment of the invention. At step 902, movable cradle 106 is set
to zero. This is done by moving the region of interest of the
patient into gantry 110. The region of interest is the area around
which the lesion is expected to be present. At step 904 a scout
view of the region of interest is taken. At step 906 a slain level
sensor is clipped onto movable cradle 106 at the identified region
away from the scan range. Details of the skin level sensor are
discussed in conjunction with FIG. 10. The position of skin surface
at the time of the scan is marked through the use of the skin level
sensor at step 908. This is done by asking the patient to hold
breath during the time of the scan. At step 910, guide manipulator
302 is docked to a docking rail. Thereafter at step 912, guide
manipulator 302 is initialized to zero position along all axes.
Movable cradle 106 is moved to a point where biopsy procedure could
be carried out conveniently on the patient's body 108.
[0060] At step 914, the guide manipulator 302 repositions itself to
point of insertion 202. This is achieved by moving the guide
manipulator 302 by a distance equal to the distance of the position
of insertion 202 from the gantry zero 808.
[0061] Thereafter at step 916, the point of insertion 202 and the
point of target 206 are identified. This is done by acquiring the
CT image slices into the system using a DICOM interface. In an
embodiment of the invention, the points of insertion and the point
of target are identified manually through a User Interface (UI)
console by a medical practitioner, such as a doctor, radiologist
and the like. Alternatively, the point of insertion and the point
of target can be determined automatically through the use of image
recognition technology. It will be apparent to a person skilled in
the art that any other method can be used to determine the point of
insertion and the point of target, without deviating from the scope
of the invention.
[0062] At step 918, the linear and angular displacement values for
the guide manipulator 302 are computed. In an embodiment of the
invention, guide manipulator 302 can be positioned along five axis,
three axes of linear motion (x, y, z) and two axes of angular
motion (.alpha., .beta.). The coordinates x, y and z, and the
angles .alpha. and .beta. are computed by controller 306. At step
920, the coordinates are communicated to the guide manipulator 302.
In an embodiment of the invention, this communication is achieved
through an RS 232 or any other data communication interface. At
step 922, guide manipulator 302 is positioned in accordance with
the computed linear and angular displacement values.
[0063] Once needle guide 502 has been positioned, it can be used
for conducting a biopsy procedure. A first set of co-ordinates are
communicated to position the guide manipulator 302 at a predefined
height and to point a laser light to make an incision on the
patient's body 108 at the needle entry point. The surgeon makes an
incision at the point of laser light. After this, a `position for
Biopsy` button is pressed in guide manipulator 302. Thereafter, the
next set of coordinates is communicated to position needle guide
502 close to patient's body 108. Skin surface position of the
patient's body is monitored in the breath sensor console and the
patient is asked to hold breath at that position. The surgeon
inserts the needle to the depth indicated in the UI console or to
the full length based on the option selected when analyzing the
image slice for marking the points of insertion 202 and the point
of target 206. The needle release knob is actuated and the needle
is made free from the guide manipulator 302. A check scan is
performed to confirm the position of the needle. In an embodiment
of the invention controller 306 allows the practitioner to
visualize the needle trajectory in the images. The Check scan data
from the CT system is acquired and the simulated versus actual
position of needle and the line of the needle is shown. Thereafter
the surgeon checks to confirm the position of the needle tip. When
the position is found to be correct, then the biopsy procedure is
performed.
[0064] FIG. 10 illustrates a skin level sensor for providing
correction to the spatial orientation of needle guide 502, in
accordance with another embodiment of the invention. The skin level
sensor can be a breath sensor. A breath sensor 1002 is placed on
abdomen 1004 of the patient. Breath sensor 1002 is attached to
movable cradle 106 through cradle clip 1006. A breath level
indicator 1008 is attached to breath sensor 1002. Breath level
indicator 1008 has a freeze key 1010 for capturing the position of
abdomen 1004 at the point of the CT imaging.
[0065] The patient is asked to hold breath just before the initial
target identification scan. Breath level indicator 1008 shows a bar
graph and the surgeon freezes the position of the skin level at the
time of taking the scan. This freeze point is indicated as graph
1012. The patient scan is taken and then the patient is allowed to
breathe normally. After positioning the needle guide, and just
before the needle is inserted into the patient, the patient is
asked to hold the breath again. Breath level indicator 1008
indicates the level of the skin in graph 1014. The needle insertion
procedure is conducted as long as graph 1014 remains within a
predefined tolerance zone of graph 1012. If before needle
insertion, the patient releases the breath such that graph 1014
moves outside of the predefined tolerance zone, an audio alert is
sounded and the patient is asked to hold the breath again.
[0066] In an embodiment of the present invention, a plane level
indicator is provided at the base of guide manipulator 302 to
account for any non-planar nature of the surface of mounting of
guide manipulator 302.
[0067] Controller 306 and data input means 304, as described in the
current invention or any of its components, may be embodied in the
form of a processing machine. Typical examples of a processing
machine include a computer, a programmed microprocessor, an
integrated circuit, and other devices or arrangements of devices
that are capable of implementing the steps of the method of the
current invention.
[0068] The processing machine executes a set of instructions that
are stored in one or more storage elements, in order to process
input data. The storage elements may also hold data or other
information as desired. The storage element may be in the form of
an information destination or a physical memory element present in
the processing machine.
[0069] The set of instructions may include various commands that
instruct the processing machine to perform specific tasks such as
the steps that constitute the method of the present invention. The
set of instructions may be in the form of a software program. The
software may be in various forms such as system software or
application software. Further, the software might be in the form of
a collection of separate programs, a program module with a larger
program or a portion of a program module. The software might also
include modular programming in the form of object-oriented
programming. The processing of input data by the processing machine
may be in response to user commands, or in response to results of
previous processing or in response to a request made by another
processing machine.
[0070] A person skilled in the art can appreciate that the various
processing machines and/or storage elements may not be physically
located in the same geographical location. The processing machines
and/or storage elements may be located in geographically distinct
locations and connected to each other to enable communication.
Various communication technologies may be used to enable
communication between the processing machines and/or storage
elements. Such technologies include session of the processing
machines and/or storage elements, in the form of a network. The
network can be an intranet, an extranet, the Internet or any client
server models that enable communication. Such communication
technologies may use various protocols such as TCP/IP, UDP, ATM or
OSI.
[0071] While the preferred embodiments of the invention have been
illustrated and described, it will be clear that the invention is
not limited to these embodiments only. Numerous modifications,
changes, variations, substitutions and equivalents will be apparent
to those skilled in the art without departing from the spirit and
scope of the invention as described in the claims.
* * * * *