Method and apparatus for surgical navigation

• US 20050085720A1
• Filed: 09/15/2004
• Published: 04/21/2005
• Est. Priority Date: 10/17/2003
• Status: Active Grant

• Current Assignee: Surgical Navigation Technologies, Inc. (Medtronic Plc)
• Original Assignee: Surgical Navigation Technologies, Inc. (Medtronic Plc)
• Inventors: Jascob, Bradley A., Shaver, Scott, Hunter, Mark, Dukesherer, John H., Boes, Kirstin, Martens, Todd, Yared, Nadim
• Granted Patent: US 7,751,865 B2
• Time in Patent Office: Days
• US Class Current: 600/424
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2034/207 Divots for calibration
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2034/256 having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/367 creating a 3D dataset from 2D images using position information
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• 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 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/062 using magnetic field
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4405 the apparatus being movable or portable, e.g. handheld or mounted on a trolley
• CPC Class Codes: A61B 6/4423 related to hygiene or sterilisation
• CPC Class Codes: A61B 6/4441 : the rigid structure being a C-arm or U-arm
• CPC Class Codes: A61B 6/541 : involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 8/4245 : involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
• CPC Class Codes: A61B 8/543 : involving acquisition triggered by a physiological signal
• CPC Class Codes: H01F 2005/027 : wound on formers for receiving several coils with perpendicular winding axes, e.g. for antennae or inductive power transfer
• CPC Class Codes: Y10T 29/4902 : Electromagnet, transformer or inductor
• CPC Class Codes: Y10T 29/49071 : by winding or coiling
• CPC Class Codes: Y10T 29/49073 : by assembling coil and core
• CPC Class Codes: Y10T 29/4913 : Assembling to base an electrical component, e.g., capacitor, etc.
• CPC Class Codes: Y10T 29/49146 : with encapsulating, e.g., potting, etc.
• CPC Class Codes: Y10T 29/49171 : with encapsulating

Abstract

A surgical navigation system for navigating a region of a patient that may include a non-invasive dynamic reference frame and/or fiducial marker, sensor tipped instruments, and isolator circuits. The dynamic reference frame may be placed on the patient in a precise location for guiding the instruments. The dynamic reference frames may be fixedly placed on the patient. Also the dynamic reference frames may be placed to allow generally natural movements of soft tissue relative to the dynamic reference frames. Also methods are provided to determine positions of the dynamic reference frames. Anatomical landmarks may be determined intra-operatively and without access to the anatomical structure.

Claims

1. A navigation system for determining the location of a member relative to an anatomy, comprising:

a tracking system;

a sensor to be sensed by said tracking system; and

an anti-rotation mechanism to interconnect said sensor with the anatomy;

wherein the mechanism contacts at least two points on the anatomy to resist rotation of the sensor relative to the anatomy.

2. The navigation system of claim 1, wherein said sensor includes an electromagnetic sensor, an optical sensor, an acoustic sensor, or combinations thereof.

3. The navigation system of claim 1, wherein said sensor includes a conductive coil, an inductive coil, or combinations thereof.

4. The navigation system of claim 1, wherein said tracking system includes a coil array operable to induce a magnetic field that is received said sensor.

5. The navigation system of claim 1, wherein said anti-rotation mechanism includes a projection operable to penetrate a distance into the anatomy.

6. The navigation system of claim 1, wherein said anti-rotation mechanism includes a first leg and a second leg extending relative to one another.

7. The navigation system of claim 6, wherein said first leg is movable relative to said second leg to engage the anatomy.

8. The navigation system of claim 6, wherein said first leg is generally immobile relative to said second leg and said first leg is operable to engage a first point and said second leg is operable to engage a second point of the anatomy to substantially reduce rotation of said sensor.

9. The navigation system of claim 1, wherein said anti-rotation mechanism includes an interconnection member to positively interconnect said sensor with the anatomy.

10. The navigation system of claim 9, wherein said interconnection member includes a screw operable to be pass through a housing at least a portion of said sensor to engage the anatomy.

11. The navigation system of claim 1, further comprising:

a body surrounding at least a portion of said sensor;

wherein said anti-rotation mechanism includes a structure extending from said body.

12. The navigation system of claim 11, wherein said structure includes a spike, a drivable member, teeth, ridges, or combinations thereof.

13. The navigation system of claim 1, further comprising:

a body;

wherein said body houses said sensor;

wherein said body is selectively interconnected with said anti-rotation mechanism.

14. The navigation system of claim 13, wherein said anti-rotation mechanism includes a length of about 0.5 cm to about 20 cm.

15. The navigation system of claim 1, wherein said anti-rotation mechanism substantially fixes said sensor relative to the anatomy in at least one of a rotation, a translation, or combinations thereof.

16. The navigation system of claim 1, wherein said tracking system includes a mobile localizer includes a coil face area of less than or equal to about 200 cm²;

wherein said mobile localizer is operable to be positioned near said sensor by a user.

17. The navigation system of claim 16, wherein said mobile localizer has coil array that includes at least three coils for producing a field relative to said sensor.

18. The navigation system of claim 16, wherein said mobile localizer is operable to be positioned about 1 cm to about 1 meter from said sensor;

wherein said mobile localizer is operable to be quickly moved to said position.

19. The navigation system of claim 16, further comprising:

a sterile case surrounding said mobile localizer.

20. The navigation system of claim 19, wherein said sterile case is operable be sealed to an exterior environment and to be interchanged relative to said mobile localizer.

21. The navigation system of claim 19, wherein said sterile case includes a disposable cover for said mobile localizer.

22. The navigation system of claim 16, wherein said mobile localizer includes a face area of less than or equal to about 120 cm².

23. A navigation system for determining a position of a sensor relative to a portion of an anatomy including soft tissue, comprising:

a localizer operable to produce a field relative to the anatomy;

a tracking sensor for sensing the field produced relative to said tracking sensor to determine a position of said tracking sensor in the field; and

a housing including said sensor;

wherein the housing is operable to allow movement of the sensor relative to the soft tissue when affixed to the anatomy subcutaneously.

24. The navigation system of claim 23, wherein said housing includes a dimension of about 1 mm to about 5 cm.

25. The navigation system of claim 23, wherein said housing includes a dimension less than about 1 cm.

26. The navigation system of claim 25, wherein said dimension includes a height of said housing.

27. The navigation system of claim 23, wherein said housing includes a first surface operable to be positioned near said anatomy and a second surface extending from said first surface;

wherein said first surface extends from said second surface less than about 2 cm.

28. The navigation system of claim 27, wherein said first surface extends from said second surface a distance of less than or equal to about 1 cm.

29. The navigation system of claim 23, wherein said housing includes a shape operable to substantially allow free movement of the soft tissue relative to the housing.

30. The navigation system of claim 29, wherein said sensor includes at least one of an optical sensor, an electromagnetic sensor, an acoustic sensor, or combinations thereof.

31. The navigation system of claim 23, wherein said localizer includes a coil array to produce the field.

32. The navigation system of claim 23, further comprising:

a processor operable to determine a position of said sensor in at least one of the field or relative to the anatomy.

33. The navigation system of claim 32, further comprising:

a display operable to display a determined position of said sensor relative to an image space of the anatomy.

34. The navigation system of claim 23, wherein said localizer includes a mobile localizer operable with said sensor to determine the position of said sensor relative to the anatomy.

35. The navigation system of claim 34, wherein said mobile localizer is operable to be moved by a single hand of a user.

36. The navigation system of claim 34, wherein said mobile localizer is positionable relative to an exterior of the anatomy at a location to substantially eliminate interference for determining the position of said sensor.

37. The navigation of claim 35, wherein said mobile localizer defines a field stearable by a user relative to the anatomy.

38. The navigation system of claim 37, wherein said mobile localizer includes a face area of less than or equal to about 200 cm².

39. The navigation system of claim 23, wherein said housing is flexible.

40. The navigation system of claim 39, wherein said housing is operable to conform to a surface upon which it is placed.

41. The navigation system of claim 39, further comprising:

a plurality of said tracking sensors held fixed relative to one another while said housing is allowed to flex.

42. The navigation system of claims 23, further comprising:

a fixation mechanism to hold the housing relative to a selected portion of the anatomy.

43. The navigation system of claim 42, wherein said fixation mechanism is selected from a group comprising a self tapping screw, drill tapped screw, lockable screw, or combinations thereof.

44. The navigation system of claim 42, wherein said fixation mechanism includes a driving mechanism selected from a group comprising a hex drive, a cruciform drive, a box driver, a square drive, or combinations thereof.

45. A method of navigating a procedure relative to an anatomy with a tracking system including a localizer and a tracking sensor positioned relative to the anatomy, comprising:

providing a plurality of coils in the tracking sensor in a fixed geometry;

positioning the tracking sensor at a location relative to the anatomy;

determining a position of each of the plurality of coils; and

determining the position of at least one of the plurality of the coils based at least in part on the determined sensed position of the plurality of coils;

wherein determining the position includes determining a geometry of each of the coils and comparing the determined geometry to the fixed geometry.

46. The method of claim 45, further comprising:

saving the fixed geometry of the plurality of coils at the position in a tracking system.

47. The method of claim 46, wherein comparing the determined geometry to the fixed geometry includes comparing the determined geometry of the plurality of coils with the saved geometry in the tracking system.

48. The method of claim 47, further comprising:

selecting at least one of the coils determined to be at the geometry similar to the fixed geometry of the plurality of the coils provided at the position.

49. The method of claim 48, wherein determining the position of the sensor is based substantially on the determined position of the coil including the determined geometry closest to the fixed geometry of the coils at the position.

50. The method of claim 45, further comprising:

determining a position of at least a sub-plurality of the plurality of coils including a geometry closest to the fixed geometry of the plurality of coils in the tracking sensor; and

averaging the determined position for each of the plurality of coils.

51. A method of navigating a procedure relative to an anatomy with a tracking system including a localizer and a tracking sensor positioned relative to the anatomy, comprising:

providing a plurality of coils in the tracking sensor;

positioning the tracking sensor at a location relative to the anatomy;

determining a position of each of the plurality of coils;

averaging each of the determined position of the plurality of coils; and

determining the position of the tracking sensor based at least in part on the averaging of each of the determined positions.

52. The method of claim 51, wherein said averaging includes determining a single value decomposition of the determined position of each of the plurality of coils.

53. The method of claim 51, wherein averaging the determined positions includes combining the plurality of determined positions and forming a single determined position of the tracking sensor based on the single determined position.

54. A method of navigating a procedure relative to an anatomy with a tracking system including a localizer and a tracking sensor positioned relative to the anatomy, comprising:

providing a plurality of coils in the tracking sensor;

positioning the tracking sensor at a location relative to the anatomy;

collecting data regarding the position of the plurality of coils;

collecting a weight datum for each of the plurality of coils;

determining a weight for the data collected regarding each of the plurality of coils; and

determining a position of each of the plurality of coils.

55. The method of claim 54, wherein determining a position of each of the coils includes sensing a field strength, a field orientation, and at least a weighting datum for each of the plurality of coils.

56. The method of claim 55, wherein the weighting datum includes at least one of a phase angle, a frequency response, or combinations thereof.

57. The method of claim 56, wherein determining a position of each of the plurality of coils includes determining the position of the coils with the weighted data.

58. The method of claim 54, further comprising:

collecting a weighting datum of each of the plurality of coils;

determining a position of each of the plurality of coils including the collected data and the collected weighting datum for each of the plurality of coils; and

determining the location by at least weighting the sensed data with the weighting datum and calculating the position with the weighted data.

59. A method of using a tracking system to assist in reduction of interference in relation to the tracking system, comprising:

forming a field with a mobile localizer;

determining an interference member; and

moving the mobile localizer to reduce the affect of the interference member.

60. The method of claim 59, wherein moving the localizer includes moving the localizer with a hand of a user.

61. The method of claim 59, wherein said mobile localizer includes forming the mobile localizer to include a face area of less than or equal to about 120 cm².

62. The method of claim 59, further comprising:

positioning a tracking sensor relative to a surface;

providing a plurality of coils in a known geometry;

sensing the field with the plurality of coils;

determining a geometry of the coil based upon the sensed field;

comparing the geometry of the plurality of the coils with the known geometry; and

moving the localizer to a position wherein said compared geometries are the most similar.

63. The method of claim 59, wherein moving the localizer steers the field.

64. The method of claim 59, wherein moving the localizer includes moving the field relative to a patient having a tracking sensor positioned thereon.

65. The method of claim 59, further comprising:

positioning a tracking sensor relative to a member;

sensing the field with the tracking sensor; and

determining a location of the tracking sensor.

66. A method of navigating an anatomical position of an anatomy with an ultra-sound system, comprising:

positioning the ultra-sound system relative to a selected portion of the anatomy;

determining a plurality of points relative to a first portion of the anatomy subcutaneously;

selecting a first point within the determined plurality of points relative to the first portion of the anatomy;

determining a plurality of points relative to a second portion of the anatomy subcutaneously;

selecting a second point within the determined plurality of points relative to the second portion of the anatomy; and

determining a relationship between said first point and said second point.

67. The method of claim 66, wherein determining a plurality of points relative to a first portion of the anatomy subcutaneously includes forming a mosaic of the first portion of the anatomy;

wherein determining a plurality of points relative to a first portion of the anatomy subcutaneously includes forming a mosaic of the second portion of the anatomy.

68. The method of claim 66, wherein determining a first point includes determining a high point in the determined plurality of points relative to a first portion of the anatomy subcutaneously.

69. the method of claim 66, wherein determining a second point includes determining a high point in the determined plurality of points relative to a second portion of the anatomy subcutaneously.

70. The method of claim 66, wherein determining a relationship between said first point and said second point includes determining a substantially straight line connecting said first point and said second point.

71. The method of claim 66, wherein positioning the ultrasound system includes selecting a ultrasound system including at least one of mode A or mode B.

72. The method of claim 66, wherein determining a plurality of points relative to the first portion and the second portion of the anatomy subcutaneously, includes:

forming an ultrasonic wave with said ultrasound system; and

forming a mosaic of the first portion and the second portion with said ultrasonic waves.

73. The method of claim 66, wherein determining a relationship between said first point and said second point includes determining a transepicondylar axis.

74. The method of claim 66, further comprising:

tracking at least portion of said ultra-sound system.

75. A system for navigating a tool, comprising:

a tracking system;

a tracking sensor operable to be tracked by said tracking system;

an engagement member to interconnect said tracking sensor with a tool;

wherein said tracking system is operable to track said tool.

76. The system of claim 75, wherein said engagement member includes a plurality of engagement members;

wherein each of said plurality of engagement members are operable to be interconnected with said tracking sensor.

77. The system of claim 75, further comprising:

a member to selectively interconnect said tracking sensor with said engagement member.

78. The system of claim 75, wherein said tracking system includes a display;

wherein said display is operable to display a representation of the tool.

79. The system of claim 75, wherein said tracking system includes a display;

wherein said display is operable to display a cutting plane of the tool.

80. The system of claim 75;

wherein said tracking system is operable to track a position of the tool relative to an anatomy for placement of the tool relative to the anatomy.

81. A method of positioning an implant into a portion of an anatomy, comprising:

providing a first member of the implant in a portion of the anatomy including a tracking sensor;

moving a second member of the implant relative to the first member, the second member also including a tracking sensor;

tracking a position of the second member relative to the first member; and

positioning the second member relative to the first member.

82. The method of claim 81, further comprising:

planning a path of the second member relative to the first member; and

confirming the path of the second member matches the planned path.

83. The method of claim 81, wherein providing a first member includes implanting an intramedullary rod in a boney portion including a bore;

wherein positioning the second member relative to the first member includes passing the second member through the bore;

wherein tracking the position of the second member includes determining that the second member will pass through the bore as it is passed through the boney portion relative to the first member.

84. The method of claims 81, wherein tracking the second member relative to the first member includes tracking an electromagnetic tracking sensor with a tracking system.

85. The method of claim 81, further comprising:

displaying a position of the second member relative to the first member.