Image-guided therapy of a tissue

• US 10,188,462 B2
• Filed: 03/25/2016
• Issued: 01/29/2019
• Est. Priority Date: 08/13/2009
• Status: Active Grant

• Current Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Original Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Inventors: Tyc, Richard, Qureshi, Salman, Grant, Mark Andrew, Fernandes, Luis Filipe Silva, Carreira, Daniel Prazeres, Schellhorn, John
• Primary Examiner(s): Jackson, Gary
• Assistant Examiner(s): Kuo, Jonathan
• Application Number:
  US15/081,060
• Publication Number:
  US 20160206374A1
• Time in Patent Office: 1,040 Days
• Field of Search: 606 1- 19, 607 77- 95
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/0206 ultrasonic, e.g. for destroying tissue or enhancing freezing
• CPC Class Codes: A61B 18/06 caused by chemical reaction , e.g. moxaburners
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 18/22 the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
• CPC Class Codes: A61B 18/28 for heating a thermal probe or absorber
• CPC Class Codes: A61B 2017/00017 Electrical control of surgical instruments
• CPC Class Codes: A61B 2017/00911 for fields applied by a magnetic resonance imaging system
• CPC Class Codes: A61B 2017/3407 including a base for support on the body
• CPC Class Codes: A61B 2018/00017 with gas
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00446 Brain
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00791 Temperature
• CPC Class Codes: A61B 2018/00994 combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
• CPC Class Codes: A61B 2018/0212 using an instrument inserted into a body lumen, e.g. catheter
• CPC Class Codes: A61B 2018/0293 : using an instrument interstitially inserted into the body, e.g. needle
• CPC Class Codes: A61B 2018/1807 : using light other than laser radiation
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2018/20351 : Scanning mechanisms
• CPC Class Codes: A61B 2018/2211 : Plurality of fibres
• CPC Class Codes: A61B 2018/2261 : with scattering, diffusion or dispersion of light
• CPC Class Codes: A61B 2034/107 : Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2068 : using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2034/301 : for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/374 : NMR or MRI
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 : User interfaces for surgical systems
• CPC Class Codes: A61B 34/71 : Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 5/015 : By temperature mapping of body part
• CPC Class Codes: A61B 5/055 : involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 5/4839 : combined with drug delivery
• CPC Class Codes: A61B 5/742 : using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 5/746 : Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• CPC Class Codes: A61B 90/10 : for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/14 : Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• CPC Class Codes: A61N 5/0601 : Apparatus for use inside the body
• CPC Class Codes: A61N 5/062 : Photodynamic therapy, i.e. excitation of an agent
• CPC Class Codes: A61N 7/022 : intracavitary
• CPC Class Codes: G01R 33/285 : Invasive instruments, e.g. catheters or biopsy needles, specially adapted for tracking, guiding or visualization by NMR
• CPC Class Codes: G01R 33/4804 : Spatially selective measurement of temperature or pH

Abstract

Image-guided therapy of a tissue can utilize magnetic resonance imaging (MRI) or another medical imaging device to guide an instrument within the tissue. A workstation can actuate movement of the instrument, and can actuate energy emission and/or cooling of the instrument to effect treatment to the tissue. The workstation and/or an operator of the workstation can be located outside a vicinity of an MRI device or other medical imaging device, and drive means for positioning the instrument can be located within the vicinity of the MRI device or the other medical imaging device. The instrument can be an MRI compatible laser probe that provides thermal therapy to, e.g., a tissue in a brain of a patient.

Claims

1. A method for effecting thermal therapy using an in vivo probe, comprising:

positioning the probe in a volume in a patient;

identifying a three-dimensional region of interest at which to apply thermal therapy;

identifying, by processing circuitry, a treatment profile for effecting thermal therapy to the three-dimensional region of interest,

wherein the treatment profile comprises a plurality of target positions,

wherein each target position of the plurality of target positions is associated with one or more of a respective power level, a respective energy level, a respective emission pattern, a respective time period, and a respective geometry of a target area of the three-dimensional region of interest, and identifying the treatment profile comprises calculating the plurality of target positions as a sequence of positions and alignments of the probe based on a symmetric or asymmetric output pattern of the probe and selecting for the treatment profile a selected sequence corresponding to at least one of a minimum number of positions of the probe, and a minimum treatment time for effecting the thermal therapy to the three-dimensional region of interest based on expected output of the probe,

wherein a desired trajectory of the probe is selected so as not to interfere with imaging equipment prior to the insertion of the probe into the volume; and

applying, by the processing circuitry, thermal therapy to the volume using the probe according to the treatment profile, wherein applying the thermal therapy comprises

a) activating delivery of therapeutic energy by the probe to the three-dimensional region of interest at a first target position of the plurality of target positions according to the treatment profile,

b) causing actuation of the probe to adjust at least one of a linear position and a rotational position of the probe to a next target position of the plurality of target positions in accordance with the sequence of positions and alignments of the probe for each of the plurality of target positions in the treatment profile,

c) activating delivery of therapeutic energy to the three-dimensional region of interest at the next target position according to the treatment profile, and

d) repeating steps (b) and (c) until therapeutic energy is delivered to at least a first volume of the three-dimensional region of interest.

2. The method of claim 1, wherein causing actuation of the probe comprises causing actuation of the probe while continuing to deliver therapeutic energy, such that therapeutic energy is continuously delivered during treatment of the three-dimensional region of interest.

3. The method of claim 1, wherein applying thermal therapy further comprises:

while delivering therapeutic energy at the first target position, monitoring a temperature of a point, wherein the point is one of within the three-dimensional region of interest and adjacent to the three-dimensional region of interest; and

prior to adjusting the probe to the next target position, determining, based at least in part upon at least one of i) the temperature of the point and ii) a thermal dose that is based on a temperature history of the three-dimensional region of interest over a specified time period, to conclude delivery of therapeutic energy at the first target position, the thermal dose including a thermal dose of the point.

4. The method of claim 3, wherein:

the imaging equipment is magnetic resonance imaging (MRI) equipment; and

monitoring the temperature of the point comprises performing thermographic analysis of magnetic resonance (MR) images captured by the MRI equipment.

5. The method of claim 4, wherein applying thermal therapy further comprises monitoring a temperature of an external point that is external to the three-dimensional region of interest,

wherein the thermal dose is calculated based on a temperature history over the specified time period of the respective external point, and

the external point is one of i) at a periphery of the three-dimensional region of interest and ii) between the periphery of the three-dimensional region of interest and an emission region of the probe.

6. The method of claim 5, wherein applying thermal therapy further comprises, responsive to monitoring the temperature of the external point, adjusting delivery of therapeutic energy to minimize damage to tissue near the probe.

7. The method of claim 5, wherein applying thermal therapy further comprises, responsive to monitoring the temperature of the external point, activating a cooling functionality of the probe to minimize damage to tissue near the probe.

8. The method of claim 7, wherein activating the cooling functionality of the probe to minimize damage to tissue near the probe is performed prior to adjusting the at least one of the linear position and rotational position of the probe to the next target position of the plurality of target positions.

9. The method of claim 3, wherein monitoring the temperature of the point comprises indicating, based at least in part upon the thermal dose of the point, thermal damage of tissue at the first target position.

10. The method of claim 1, wherein identifying the treatment profile for effecting thermal therapy to the three-dimensional region of interest further comprises:

calculating a first sequence of positions and alignments of a first probe based on a symmetric output pattern by the first probe;

calculating a second sequence of positions and alignments of a second probe based on an asymmetric output pattern by the second probe; and

selecting one of the first sequence or the second sequence as a selected sequence for the treatment profile, the selected sequence having at least one of a lowest number of positions of the first probe or the second probe that corresponds to the selected sequence, or a lowest treatment time for effecting the thermal therapy to the three-dimensional region of interest.

11. The method of claim 1, wherein the treatment profile includes a plurality of sequences of positions and alignments of the probe, wherein each of the plurality of sequences corresponds to a treatment trajectory for one of a plurality of three-dimensional regions of interest.

12. The method of claim 11, further comprising automatically executing a changeover from a first sequence of positions and alignments of the probe to a next sequence of positions and alignments of the probe upon completion of the first sequence.

13. The method of claim 12, wherein automatically executing the changeover from the first sequence of positions and alignments of the probe to the next sequence of positions and alignments of the probe includes changing at least one of a rotational alignment, longitudinal position, laser fiber selection, probe tip selection, energy output, and duty cycle of energy output of the probe.

14. A system for effecting in vivo thermal therapy comprising:

a processor; and

a memory having instructions stored thereon, wherein the instructions, when executed by the processor, cause the processor to, while at least one probe is positioned within a volume in a patient;

identify a treatment profile for effecting thermal therapy to a three-dimensional region of interest, wherein identifying comprises calculating a sequence of positions and alignments of the at least one probe based on a symmetric or asymmetric output pattern of the at least one probe and selecting for the treatment profile a selected sequence corresponding to at least one of a lowest number of positions of the at least one probe or a lowest treatment time for effecting the thermal therapy to the three-dimensional region of interest, wherein a desired trajectory of the at least one probe is selected so as not to interfere with imaging equipment prior to the insertion of the at least one probe into the volume, and

apply thermal therapy to the volume using the at least one probe according to the treatment profile, wherein applying thermal therapy comprises

a) activating delivery of therapeutic energy by the at least one probe to the three-dimensional region of interest at a first target position of a plurality of target positions,

b) monitoring a respective temperature of each point of the at least one point at the first target position, wherein each point of the at least one point at the first target position is one of within the three-dimensional region of interest and adjacent to the three-dimensional region of interest,

c) determining, based at least in part upon at least one of the respective temperature and a respective thermal dose of each of the at least one point at the first target position, completion of thermal therapy at the first target position, the respective thermal dose being based on a temperature history of each of the at least one point at the first target position over a specified time period,

d) directing a probe driver to adjust at least one of a linear position and a rotational position of the at least one probe to a next target position of the plurality of target positions in accordance with a sequence of positions and alignments of the probe for each of the plurality of target positions in the treatment profile,

e) activating delivery of therapeutic energy by the at least one probe to the three-dimensional region of interest at the next target position,

f) monitoring at least one of the respective temperature and the respective thermal dose of each point of the at least one point at the next target position, wherein each point of the at least one point at the next target position is one of within the three-dimensional region of interest and adjacent to the three-dimensional region of interest,

g) determining, based at least in part upon at least one of i) the respective temperature of each point of the at least one point at the next target position, and ii) the respective thermal dose of each point of the at least one point at the next target position, completion of treatment at the next target position, and

h) repeating steps (c) through (g) until therapeutic energy is delivered to at least a first volume of the three-dimensional region of interest.

15. The system of claim 14, further comprising a workstation located in a control room separate from a room containing the probe and probe driver, wherein the workstation comprises the processor.

16. The system of claim 15, wherein:

thermal therapy is initiated by user input received via the workstation; and

delivery of therapeutic energy is activated responsive to receipt of an activation input via an input device in communication with the workstation, wherein the input device is operable to be manipulated by a user.

17. The system of claim 16, wherein the input device is a foot pedal.

18. The system of claim 15, wherein the workstation comprises memory configured to store a plurality of sequences of positions and alignments of the probe, wherein each of the plurality of sequences corresponds to a treatment trajectory for a plurality of three-dimensional regions of interest.

19. A non-transitory computer readable medium having instructions stored thereon, wherein the instructions, when executed by a processor, cause the processor to:

identify a treatment profile for effecting thermal therapy to a three-dimensional region of interest, wherein identifying comprises

calculating a first sequence of positions and alignments of a first probe based on a symmetric output pattern by the first probe,

calculating a second sequence of positions and alignments of a second probe based on an asymmetric output pattern by the second probe, and

selecting, for the treatment profile, one of the first sequence or the second sequence as a selected sequence having at least one of a lowest number positions of the probe or a lowest treatment time for effecting the thermal therapy to the three-dimensional region of interest and

effect thermal therapy using a probe corresponding to the selected sequence, wherein effecting thermal therapy comprises

a) identifying, from the treatment profile, a first emission level for treatment of the three-dimensional region of interest and a first position of the probe,

b) activating delivery of therapeutic energy by the probe at the first emission level to the three-dimensional region of interest at the first position,

c) monitoring feedback related to the first target area, wherein the feedback comprises at least one of temperature feedback and imaging feedback provided by at least one of a magnetic resonance (MR) imaging system and a thermometry imaging system,

d) determining, based at least in part on the feedback, completion of thermal therapy at the first position,

e) activating at least one of rotation and linear displacement of the probe to a next position in accordance with the sequence of positions and alignments of the probe in the treatment profile,

f) identifying a next emission level for treatment of the three-dimensional region of interest at the next position of the probe,

g) activating delivery of therapeutic energy by the probe at the next emission level to the three-dimensional region of interest at the next position according to the treatment profile,

h) monitoring feedback related to the next target area,

i) determining, based at least in part on the feedback, completion of thermal therapy at the next position, and

j) repeating steps (f) through (i) until therapeutic energy is delivered to at least a first volume of the three-dimensional region of interest.