Stereotactic localizer system with dental impression

• US 20040015176A1
• Filed: 02/21/2003
• Published: 01/22/2004
• Est. Priority Date: 06/20/1994
• Status: Abandoned Application

• Current Assignee: Integra Radionics, Inc. (Integra LifeSciences Holdings Corporation)
• Original Assignee: Integra Radionics, Inc. (Integra LifeSciences Holdings Corporation)
• Inventors: Cosman, Eric R.
• Application Number:
  US10/371,098
• Publication Number:
  US 20040015176A1
• Time in Patent Office: Days
• US Class Current: 606/131
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/3954 magnetic, e.g. NMR or MRI
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• 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 90/14 Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• CPC Class Codes: A61B 90/16 Bite blocks
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61C 9/00 Impression cups, i.e. impression trays; Impression methods computer-assisted sizing A61C13/0004; instruments for determining occlusion A61C19/05

Abstract

Dental-based stereotactic localizers for non-invasively inducing computer tomographic (CT) slice images of the anatomy of a patient are disclosed. The localizer includes a dental piece configured and adapted to be received in the mouth of the patient, a support structure secured to the dental piece, the support structure defining an arcuate configuration which extends to the posterior margins of the teeth of the patient thus allowing an occipital region of the head of the patient to directly contact a surface of a treatment table, and a plurality of graphic reference elements, wherein the plurality of graphic reference elements produce index information on an image scan when intersected by a plane of a scan slice, wherein the index information is used to develop a mapping of data from the image scan so as to reference the data from the image scan to a coordinate system of the dental tray.

Claims

1. A dental-based localizer for non-invasively indexing computer tomographic (CT) slice images of the anatomy of a patient, the localizer defining x, y and z-axes, whereby upon positioning of the localizer with respect to a head of the patient, the z-axis is in general parallel relation to the axis of the body, the localizer comprising:

a discrete independent reference structure which is solely supported by the patient, the reference structure including;

a dental piece configured and adapted to be received in the mouth of the patient;

a base plate attached to the dental piece, the base plate having a single monolithic element defining a general arcuate configuration, the arcuate configuration having a first portion including a first end and a second portion including a second end, wherein the first portion and the second portion of the base plate extend an approximately equal distance from the dental piece and terminate in the first end and the second end, respectively, the first end and the second end being positioned approximately adjacent the opposed posterior regions of the teeth of the patient, the dental piece providing a fixed reference point for the base plate relative to the patient, the dental piece and the base plate being configured and adapted for use on the patient without an external support structure attached thereto; and

a plurality of elongated graphic reference elements connected to the base plate and being disposed in at least two planes, the graphic reference elements and base plate being configured to accommodate the positioning of the patient in a supine position on a treatment table such that the occipital region of the head of the patient is directly positionable on the treatment table.

2. The dental-based localizer of claim 1, wherein the graphic reference elements includes an elongate diagonal reference element the at least two planes, each diagonal reference element extending in a direction having at least two axial components of direction with respect to the x, y and z axes.

3. The dental-based localizer of claim 2, further comprising a pair of parallel horizontal reference elements in each of the at least two planes, wherein each pair of horizontal reference elements is connected to a respective diagonal reference element.

4. The dental-based localizer of claim 1, wherein the elongated graphic reference elements are disposed in at least three planes, wherein adjacent planes intersect and are in oblique relation.

5. The dental-based localizer of claim 4, further comprising an elongated diagonal graphic reference element disposed in at least one of the at least three planes and extending in a direction having at least two axial components of directions with respect to the x, y and z axes.

6. The dental-based localizer of claim 5, further comprising a diagonal graphic reference element disposed in each of the at least three planes.

7. The dental-based localizer of claim 1, wherein the dental based localizer is fabricated from light weight materials such as medical grade plastics and graphics.

8. The dental-based localizer of claim 1, wherein the graphic reference element is disposed in at least one plane.

9. The dental-based localizer of claim 1, wherein the graphic reference element includes at least two diagonal graphic elements.

10. The dental-based localizer of claim 1, wherein the dental piece is adapted to be connected to a support bar.

11. The dental-based localizer of claim 1, wherein the graphic reference element provides contact points connected to the dental piece, which contact points are adapted to be physical reference points for calibrating a stereotactic device.

12. A dental based target localizing apparatus configured for use with an external treatment apparatus comprising:

a dental piece positionable in the mouth of a patient;

a base plate solely attached to the dental piece, the base plate defining an arcuate configuration and extending from the dental piece to posterior regions of the teeth of the patient, the dental piece and base plate providing a dental based reference, wherein an occipital region of the head of the patient is directly positionable on a treatment table;

a plurality of plates solely connected to the base plate; and

a reticule system positioned on the plurality of plates and adapted for aligning a target tissue portion in the patient with an external treatment apparatus for the treatment of the target tissue portion by the external treatment apparatus through the reticule system, wherein the base plate and the plurality of plates are configured to accommodate the positioning of the patient in a supine position on a treatment table such that the occipital region of the head of the patient is directly positionable on the upper surface of the treatment table.

13. The dental based target localizing apparatus of claim 12, wherein the reticule system includes a grid system.

14. The dental based target localizing apparatus of claim 12, wherein the reticule system includes graphics for quantifying distances in a standard unit of measure.

15. The dental-based target localizing apparatus of claim 14, wherein the reticule system includes indices configured as graphic reference means adapted for use with an external image scanning apparatus to identify a location of the target tissue portion in the patient using a three dimensional coordinate frame relative to the dental piece, the tissue target location being calculated by means of the imaging data from image slices through the anatomy of the patient and indices by the imaging scanning devices.

16. The dental based target localizing apparatus of claim 15, wherein the external treatment apparatus is a linear accelerator X-ray beam apparatus.

17. The dental based target localizing apparatus of claim 12, wherein the reticule system is adapted for use with a registration means of the external treatment apparatus.

18. The dental based target localizing apparatus of claim 12, wherein the reticule system is adapted for use with a laser system, the laser system being the external registration means for the external treatment apparatus.

19. The dental based target localizing apparatus of claim 15, wherein the indices are radiopaque.

20. The dental based target localizing apparatus of claim 12, wherein the reticule system includes indices and at least a portion of the indices are radiopaque.

21. The dental based target localizing apparatus of claim 12, wherein the dental piece includes a dental tray.

22. A method of identifying the location of specific anatomical points in a patient comprising the steps of:

providing a dental-based localizer including;

a dental piece configured and adapted to be received in the mouth of the patient;

a base plate attached to the dental piece, the base plate having a single monolithic element defining a general arcuate configuration, the arcuate configuration having a first portion including a first end and a second portion including a second end, wherein the first portion and the second portion of the base plate extend an approximately equal distance from the dental piece and terminate in the first end and the second end, respectively, the first end and the second end being positioned approximately adjacent the to opposed posterior regions of the teeth of the patient, the dental piece providing a fixed reference point for the base plate; and

a plurality of elongated graphic reference elements connected to the base plate and disposed in at least two planes, the graphic reference elements and the base support plate being adapted for use with a treatment table having a treatment surface, the graphic reference elements and base plate being configured to accommodate the positioning of the patient in a supine position such that the occipital region of the head of the patient is directly positionable on the surface of the treatment table without additional support for the head of the patient and without any connection of an external support structure to the graphic reference elements, base plate, and dental piece;

positioning the dental piece of the dental-based localizer in the mouth of the patient;

positioning the patient in the supine position on the treatment table such that the head of the patient is directly contacting the surface of the treatment table; and

performing an image scan of the head of the patient and the dental-based localizer, the dental based localizer providing a reference structure to index the data of the imaging scanner to the dental piece and the head of the patient.

23. The method of identifying the location of specific anatomical points of claim 22, wherein the step of positioning the dental piece also includes positioning a strap over a top of and around a portion of a back of the head of the patient.

24. The method of identifying the location of specific anatomical points of claim 22, wherein the dental-based localizer includes a plurality of plates positioned on the base plate, the plurality of plates having a reticule system and a plurality of graphic reference elements configured as indices.

25. The method of identifying the location of specific anatomical points of claim 24, wherein the step of imaging the head of the patient further includes identifying specific anatomical points in the patient, the plurality of plates being adapted for aligning the specific anatomical points and a treatment machine through the reticule system.

26. The method of identifying the location of specific anatomical points of claim 22, further comprising the step of providing graphic reference elements suitably positioned on the dental-based localizer for locating at least one of the cranium, skull base, nose, jaw and spine of the patient.

27. A dental-based localizer for locating targets in the anatomy of a patient in the region of the ear, nose, throat and skull base during tomographic coronal scanning in ENT surgery, the anatomy of the patient defining a longitudinal axis when in a supine position, the localizer comprising:

a dental piece configured to be positioned on the teeth of the patient to locate the localizer in fixed relation relative to the anatomy of the patient;

pairs of graphic reference elements positioned in at least two planes, each pair of graphic reference elements including at least one elongate element transversely oriented with respect to the longitudinal axis; and

at least one diagonal element having at least one end joined to an end of the at least one elongate element and oriented at an angle relative to the elongate element, the pairs of graphic reference elements and the dental piece being interconnected by an attachment structure having connecting members and supporting members.

28. The dental-based localizer of claim 27, wherein the at least two planes are parallel and are positioned along a respective side of the head of the patient when the dental piece is positioned on the teeth of the patient.

29. The dental-based localizer of claim 27, wherein graphic reference elements are positioned in a third plane, the graphic reference elements of the third plane are connected with at least one of the pairs of graphic reference elements positioned in the at least two planes.

30. A dental-based localizer for locating targets in the anatomy of a patient in the region of the ear, nose, throat and skull base during tomographic scanning, the anatomy of the patient defining a longitudinal axis while in a supine position, the localizer comprising:

a dental piece fit to the teeth of the patient thereby locating the dental piece in fixed spaced relation to the anatomy of the patient, the dental piece connected to an angled platform; and

graphic reference elements positioned relative to the platform, the graphic reference elements including;

a first graphic reference element positioned adjacent the head of the patient and defining a first plane, the first graphic reference element including at least one axial element oriented parallel to the longitudinal axis and at least one diagonal element oriented at an angle relative to the at least one axial element;

a second graphic reference element positioned adjacent the head of the patient and defining a second plane, the second graphic reference element including at least one axial element oriented parallel to the longitudinal axis and at least one diagonal element oriented at an angle relative to the at least one axial element of the graphic reference element, the at least one diagonal element of the first graphic reference element has components in axes x, y, and z which are perpendicular to components of the diagonal element of the second graphic reference element; and

a third graphic reference element defining a third plane, the third graphic reference element having a first diagonal element connected to the first graphic reference element and a second diagonal element connected to the second graphic reference element, the first and second diagonal elements of the third graphic reference element being joined at one end to one another.

31. The dental-based localizer of claim 30, wherein the first plane of the graphic reference element and the second plane of the second graphic reference element are converging planes.

32. The dental-based localizer of claim 30, wherein the first diagonal element of the third plane is connected to the first graphic reference element at an end opposite the joined end thereof and the second diagonal element of the third plane is connected to the second graphic reference element of an end opposite the joined end thereof.

33. The dental-based localizer of claim 30, wherein at least two of the planes have reference elements which are oriented horizontally and vertically with respect to the longitudinal axis.

34. A dental-based localizer that can be used for locating targets in the anatomy of a patient in the region of the ear, nose, throat and skull base, comprising:

a dental piece configured to be positioned on the teeth of the patient so as to locate thereby the dental piece to the anatomy of the patient, the dental piece being connected to a platform having a substantially plate shape and defining a dental plane; and

a graphic reference element attached to and located in position relative to the dental piece, the graphic reference element being connected to the platform and including;

two quadrangles supported on the platform, wherein a quadrangle is positioned adjacent a respective side of the head of the patient; and

a triangle interconnecting the two quadrangles and oriented in an inverted “

V”

shape, the two quadrangles and the triangle defining three interconnected planes extending from a top of the skull of the patient to a base of the throat of the patient, each plane having at least one diagonal element which will produce varying index data in a coronal tomographic slice from a computer tomographic imaging machine.

35. The apparatus of claim 34, wherein the at least one diagonal element comprises a plurality of diagonal elements which are oriented at an angle with respect to each other such that the index data includes patterns of fiducial points such that the distances between the fiducial points give position data that can be used to reference the position of the coronal tomographic slice relative to said dental piece, and therefore of the anatomy of the patient.

36. The apparatus of claim 34, wherein each of the quadrangles is defined by a pair of parallel rods, wherein the parallel rods are either in parallel alignment with a longitudinal axis defined by the anatomy of the patient when in a supine position or transverse to the longitudinal axis, and the at least one diagonal element includes at least one diagonal rod which is oriented at an angle relative to the parallel rods such that when the coronal tomographic slice intersects the parallel rods and the diagonal rod, the computer tomographic slice produces fiducial marks in the index data which can be used to reference the coronal tomographic slice with respect to the dental piece, and therefore with respect to the anatomy, which is included in the coronal tomographic slice, the anatomy including that near the face of the patient.

37. The apparatus of claim 36, wherein the at least one diagonal element comprises a plurality of diagonal elements, wherein the plurality of diagonal elements and the parallel rods provide fiducial marks in the index data for an arbitrary coronal tomographic slice through the graphic reference and the anatomy so that a mapping and/or transformation can be performed using the index data to relate a plurality of points on the anatomy of the patient, as seen in the arbitrary coronal tomographic slice, to the frame of reference of the dental piece and of the graphic reference.

38. The apparatus of claim 34, further comprising:

a stereotactic instrument with a pointing element cooperatively coupled to the stereotactic instrument so that the orientation and/or location of the pointing element relative to the stereotactic instrument is readable as stereotactic instrument data; and

physical locating points on the graphic reference element which are adapted to be coupled to and located at predetermined positions with respect to the dental piece and which are adapted to be located in space by the pointing element of the stereotactic instrument, whereby the stereotactic instrument data associated with the physical locating points is used to relate the position of the stereotactic instrument to the dental piece, and thereby to relate the stereotactic instrument to the anatomy of the patient as determined by the coronal tomographic slice.

39. A dental-based stereotactic localizer for non-invasively inducing computer tomographic (CT) slice images of the anatomy of a patient, wherein the anatomy of the patient defines a longitudinal axis when in a supine position, the localizer comprising:

a dental piece configured and adapted to be received in the mouth of the patient;

a support structure secured to the dental piece, the support structure defining an arcuate configuration which extends to the posterior margins of the teeth of the patient thus allowing an occipital region of the head of the patient to directly contact a surface of a treatment table; and

a plurality of graphic reference elements, wherein the plurality of graphic reference elements produce index information on an image scan when intersected by a plane of a scan slice, wherein the index information is used to develop a mapping of data from the image scan so as to reference the data from the image scan to a coordinate system of the dental tray.

40. The dental-based stereotactic localizer according to claim 39, wherein the plurality of graphic reference elements are parallel to one another.

41. The dental-based stereotactic localizer according to claim 40, wherein the plurality of graphic reference elements are oriented in a direction parallel to the longitudinal axis.

42. The dental-based stereotactic localizer according to claim 41, further including at least one index marker on each graphic reference element.

43. The dental-based stereotactic localizer according to claim 42, wherein the index markers are radiopaque markers located at specific locations along graphic reference elements.

44. The dental-based stereotactic localizer according to claim 40, further including at least one diagonal graphic reference element extending between adjacent parallel graphic reference elements.

45. The dental-based stereotactic localizer according to claim 44, wherein at least one of a distal and a proximal end of each diagonal graphic reference element is connected to adjacent parallel graphic reference elements.

46. The dental-based stereotactic localizer according to claim 45, wherein a distal end of each parallel graphic reference element includes a mechanical contact point.

47. The dental-based stereotactic localizer according to claim 46, wherein the mechanical contact point includes at least one of an indentation, a divot and a drill hole.

48. The dental-based stereotactic localizer according to claim 44, further including a stereotactic apparatus having a pointer element at a distal end thereof, wherein the pointer element is used to touch various points along at least one of the diagonal and parallel graphic reference elements to produce a mapping between a coordinate system of the stereotactic apparatus and a coordinate system of the stereotactic localizer.

49. The dental-based stereotactic localizer according to claim 43, further including at least one detecting apparatus configured and adapted to monitor the position of the index markers.

50. The dental-based stereotactic localizer according to claim 49, wherein the at least one detecting apparatus is configured and adapted to detect at least one LED disposed on the at least one graphic reference element.