SYSTEM AND METHOD FOR SUPERIMPOSING A REPRESENTATION OF THE TIP OF A CATHETER ON AN IMAGE ACQUIRED BY A MOVING IMAGER

• US 20080183071A1
• Filed: 01/08/2008
• Published: 07/31/2008
• Est. Priority Date: 01/10/2007
• Status: Abandoned Application

• Current Assignee: ST JUDE MEDICAL INTERNATIONAL HOLDING S. R.L.
• Original Assignee: Mediguide Lit
• Inventors: Shmarak, Itzik, Strommer, Gera, Eichler, Uzi, Schwartz, Liat
• Application Number:
  US11/971,004
• Publication Number:
  US 20080183071A1
• Time in Patent Office: Days
• US Class Current: 600/424
• CPC Class Codes: A61B 2017/00694 with means correcting for movement of or for synchronisation with the body
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• 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 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/3764 with a rotating C-arm having a cone beam emitting source
• 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 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4441 the rigid structure being a C-arm or U-arm
• CPC Class Codes: G06T 2207/30101 Blood vessel; Artery; Vein; Vascular
• CPC Class Codes: G06T 7/30 Determination of transform parameters for the alignment of images, i.e. image registration
• CPC Class Codes: G06T 7/80 Analysis of captured images to determine intrinsic or extrinsic camera parameters, i.e. camera calibration
• CPC Class Codes: G06V 10/24 Aligning, centring, orientation detection or correction of the image
• CPC Class Codes: G06V 2201/034 of medical instruments

Abstract

A method displays a representation of the tip of a medical device located within a body region of interest of the body of a patient, on an image of the body region of interest, the image being acquired by an image detector of a moving imager. The method includes the procedures of acquiring a medical positioning system (MPS) sensor image of an MPS sensor, determining a set of intrinsic and extrinsic parameters, determining two-dimensional optical coordinates of the tip of the medical device, superimposing the representation of the tip of the medical device, on the image of the body region of interest, and displaying the representation of the tip of the medical device superimposed on the image of the body region of interest.

Claims

1. Method for displaying a representation of the tip of a medical device located within a body region of interest of the body of a patient, on an image of the body region of interest, the image being acquired by an image detector of a moving imager, the method comprising the procedures of:

acquiring at least one medical positioning system (MPS) sensor image of at least one MPS sensor, by said image detector, at a physical zoom setting of said image detector respective of said image, and at a selected image detector region of interest setting of said image detector, said at least one MPS sensor being associated with an MPS, said at least one MPS sensor responding to an electromagnetic field generated by a plurality of electromagnetic field generators, firmly coupled with a moving portion of said moving imager;

determining a set of intrinsic and extrinsic parameters, according to sensor image coordinates of each of said at least one MPS sensor image, in a two-dimensional optical coordinate system respective of said image detector, and according to non-real-time MPS coordinates of respective ones of said at least one MPS sensor, in an MPS coordinate system respective of said MPS;

determining two-dimensional optical coordinates of said tip of said medical device, according to said physical zoom setting, according to said set of intrinsic and extrinsic parameters, according to said selected image detector region of interest setting, and according to real-time MPS coordinates of an MPS sensor located at said tip of said medical device;

superimposing said representation of said tip of said medical device, on said image of said body region of interest, according to said two-dimensional optical coordinates; and

displaying said representation of said tip of said medical device superimposed on said image of said body region of interest.

2. The method according to claim 1, further comprising a preliminary procedure of removing a full span fiducial screen from a field of view of said image detector, said full span fiducial screen being placed in said field of view, in an off-line mode of operation of a system operating according to said method, said full span fiducial screen including a plurality of fiducials, every group of said fiducials being complementary to the rest of said fiducials in said group.

3. The method according to claim 2, further comprising a preliminary procedure of determining a scale function between different image detector regions of interest, according to fiducial image coordinates of a plurality of fiducials of said full span fiducial screen, in a plurality of fiducial images acquired by said image detector, from said full span fiducial screen, at said different image detector regions of interest, and at said respective physical zoom setting, and according to actual coordinates of said fiducials.

4. The method according to claim 3, wherein said procedure of determining said two-dimensional optical coordinates is performed according to said scale function.

5. The method according to claim 3, further comprising a preliminary procedure of acquiring said fiducial images by said image detector.

6. The method according to claim 5, further comprising a preliminary procedure of placing said full span fiducial screen in said field of view.

7. The method according to claim 1, wherein said at least one MPS sensor image includes a single MPS sensor image, and wherein said at least one MPS sensor includes a plurality of MPS sensors.

8. The method according to claim 1, wherein said selected image detector region of interest is the largest image detector region of interest, among a plurality of image detector regions of interest.

9. The method according to claim 1, wherein said procedure of determining said set of intrinsic and extrinsic parameters is performed with respect to a plurality of physical zoom settings of said image detector, by interpolating between two adjacent ones of said physical zoom settings.

10. The method according to claim 1, wherein said procedure of determining said set of intrinsic and extrinsic parameters is performed with respect to a plurality of physical zoom settings of said image detector, by extrapolating beyond two adjacent ones of said physical zoom settings.

11. The method according to claim 1, further comprising the preliminary procedures of:

firmly attaching a peripheral fiducial screen to said image detector, in front of said image detector, in a non-real-time mode of operation of a system operating according to said method, said peripheral fiducial screen including a plurality of peripheral fiducials, every group of said peripheral fiducials being complementary to the rest of said peripheral fiducials in said group;

acquiring at least one reference image of said body region of interest, by said image detector in said non-real-time mode of operation of said system, at a reference position of said moving imager, at each physical zoom setting of said image detector, and at each image detector region of interest setting of said image detector, each of said at least one reference image including a plurality of peripheral fiducial images of said peripheral fiducials, at a periphery of said at least one reference image; and

determining a viewing position transformation model respective of a viewing position of said image detector, in a real-time mode of operation of said system, according to a first set of coordinates of said peripheral fiducials in said at least one reference image, and according to a second set of coordinates of said peripheral fiducials, in a real-time image of said body region of interest acquired by said image detector.

12. The method according to claim 11, wherein said procedure of determining said optical coordinates of said tip of said medical device, is performed furthermore according to said viewing position transformation model.

13. The method according to claim 11, further comprising the procedures of:

determining a set of image rotation correction models respective of said first set of coordinates, in each of said at least one reference image, in a non-real-time mode of operation of said system;

constructing a logical relationship between each image rotation correction model of said set of image rotation correction models, and said respective first set of coordinates, in said non-real-time mode of operation of said system;

determining an image rotation correction model corresponding to said second set of coordinates, according to said logical relationship, in a real-time mode of operation of said system; and

performing said procedure of determining said two-dimensional optical coordinates of said tip of said medical device, furthermore according to said image rotation correction model.

14. The method according to claim 11, further comprising the procedures of:

determining a set of image flip correction models respective of said first set of coordinates, in each of said at least one reference image, in a non-real-time mode of operation of said system;

constructing a logical relationship between each image flip correction model of said set of image rotation correction models, and said respective first set of coordinates, in said non-real-time mode of operation of said system;

determining an image flip correction model corresponding to said second set of coordinates, according to said logical relationship, in a real-time mode of operation of said system; and

performing said procedure of determining said two-dimensional optical coordinates of said tip of said medical device, furthermore according to said image flip correction model.

15. The method according to claim 1, further comprising the procedures of:

determining a plurality of viewing position distortion models corresponding to respective ones of a plurality of viewing position values of said image detector, in a non-real-time mode of operation of a system operating according to said method,

constructing a first logical relationship between said viewing position distortion models, and said respective viewing position values, in said non-real-time mode of operation of said system;

receiving information respective of a viewing position value of said image detector, from a user interface, in a real-time mode of operation of said system; and

determining a viewing position distortion model corresponding to said viewing position value, according to said first logical relationship, in said real-time mode of operation of said system.

16. The method according to claim 15, wherein said procedure of determining said two-dimensional optical coordinates of said tip of said medical device, is performed furthermore according to said viewing position transformation model.

17. The method according to claim 15, further comprising the procedures of:

determining a plurality of image rotation correction models corresponding to respective ones of a plurality of image rotation values of another image of said body region of interest, in said non-real-time mode of operation of said system,

constructing a second logical relationship between said image rotation correction models and said respective image rotation values, in said non-real-time mode of operation of said system;

receiving information respective of an image rotation value of said image, from a user interface, in a real-time mode of operation of said system; and

determining an image rotation correction model corresponding to said image rotation value, according to said second logical relationship, in said real-time mode of operation of said system.

18. The method according to claim 15, further comprising the procedures of:

determining a plurality of image flip correction models corresponding to respective ones of a plurality of image flip values of another image of said body region of interest, in said non-real-time mode of operation of said system,

constructing a second logical relationship between said image flip correction models and said respective image flip values, in said non-real-time mode of operation of said system;

receiving information respective of an image flip value of said image, from a user interface, in a real-time mode of operation of said system; and

determining an image flip correction model corresponding to said image flip value, according to said second logical relationship, in said real-time mode of operation of said system.

19. The method according to claim 1, further comprising the procedures of:

firmly attaching a peripheral fiducial screen to said image detector, in front of said image detector, in a non-real-time mode of operation of a system operating according to said method, said peripheral fiducial screen including a plurality of peripheral fiducials, every group of said peripheral fiducials being complementary to the rest of said peripheral fiducials in said group;

acquiring at least one reference image of said body region of interest, by said image detector in said non-real-time mode of operation of said system, at a reference position of said moving imager, at each physical zoom setting of said image detector, and at each image detector region of interest setting of said image detector, each of said at least one reference image including a plurality of peripheral fiducial images of said peripheral fiducials, at a periphery of said at least one reference image;

determining a plurality of viewing position transformation models corresponding to respective ones of a plurality of viewing position values of said image detector, in a non-real-time mode of operation of a system operating according to said method, according to fiducial image coordinates of said peripheral fiducials in respective ones of said at least one reference image, and according to actual coordinates of said peripheral fiducials;

constructing a first logical relationship between said viewing position transformation models, and said respective viewing position values, in said non-real-time mode of operation of said system;

receiving information respective of a viewing position value of said image detector, from said image detector, in a real-time mode of operation of said system; and

determining a viewing position transformation model corresponding to said viewing position value, according to said first logical relationship, in said real-time mode of operation of said system.

20. The method according to claim 19, wherein said procedure of determining said two-dimensional optical coordinates of said tip of said medical device, is performed furthermore according to said viewing position transformation model.

21. The method according to claim 19, further comprising the procedures of:

determining a plurality of image rotation correction models corresponding to respective ones of a plurality of image rotation values of another image of said body region of interest, in said non-real-time mode of operation of said system;

constructing a second logical relationship between said image rotation correction models and said respective image rotation values, in said non-real-time mode of operation of said system;

receiving information respective of an image rotation value of said image, from said image detector, in a real-time mode of operation of said system; and

determining an image rotation correction model corresponding to said image rotation value, according to said second logical relationship, in said real-time mode of operation of said system.

22. The method according to claim 19, further comprising the procedures of:

determining a plurality of image flip correction models corresponding to respective ones of a plurality of image flip values of another image of said body region of interest, in said non-real-time mode of operation of said system;

constructing a second logical relationship between said image flip correction models and said respective image flip values, in said non-real-time mode of operation of said system;

receiving information respective of an image flip value of said image, from said image detector, in a real-time mode of operation of said system; and

determining an image flip correction model corresponding to said image flip value, according to said second logical relationship, in said real-time mode of operation of said system.

23. The method according to claim 1, further comprising the preliminary procedures of:

firmly attaching a peripheral fiducial screen to said image detector, in front of said image detector, in a non-real-time mode of operation of a system operating according to said method, said peripheral fiducial screen including a plurality of peripheral fiducials, every group of said peripheral fiducials being complementary to the rest of said peripheral fiducials in said group;

acquiring at least one reference image of said body region of interest, by said image detector in said non-real-time mode of operation of said system, at a reference position of said moving imager, at each physical zoom setting of said image detector, and at each image detector region of interest of said image detector, each of said at least one reference image including a plurality of peripheral fiducial images of said peripheral fiducials, at a periphery of said at least one reference image; and

determining an image rotation correction model respective of an image rotation value of said image, in a real-time mode of operation of said system, according to a first set of coordinates of said peripheral fiducials in said at least one reference image, and according to a second set of coordinates of said peripheral fiducials, in said image.

24. The method according to claim 23, wherein said procedure of determining said two-dimensional optical coordinates of said tip of said medical device, is performed furthermore according to said image rotation correction model.

25. The method according to claim 1, further comprising the preliminary procedures of:

firmly attaching a peripheral fiducial screen to said image detector, in front of said image detector, in a non-real-time mode of operation of a system operating according to said method, said peripheral fiducial screen including a plurality of peripheral fiducials, every group of said peripheral fiducials being complementary to the rest of said peripheral fiducials in said group;

acquiring at least one reference image of said body region of interest, by said image detector in said non-real-time mode of operation of said system, at a reference position of said moving imager, at each physical zoom setting of said image detector, and at each image detector region of interest of said image detector, each of said at least one reference image including a plurality of peripheral fiducial images of said peripheral fiducials, at a periphery of said at least one reference image; and

determining an image flip correction model respective of an image rotation value of said image, in a real-time mode of operation of said system, according to a first set of coordinates of said peripheral fiducials in said at least one reference image, and according to a second set of coordinates of said peripheral fiducials, in said image.

26. The method according to claim 25, wherein said procedure of determining said two-dimensional optical coordinates of said tip of said medical device, is performed furthermore according to said image flip correction model.

27. The method according to claim 1, further comprising the procedures of:

determining a plurality of image rotation correction models corresponding to respective ones of a plurality of image rotation values of another image of said body region of interest, in said non-real-time mode of operation of said system;

constructing a logical relationship between said image rotation correction models and said respective image rotation values, in said non-real-time mode of operation of said system;

receiving information respective of an image rotation value of said image, from a user interface, in a real-time mode of operation of said system; and

determining an image rotation correction model corresponding to said image rotation value, according to said logical relationship, in said real-time mode of operation of said system.

28. The method according to claim 1, further comprising the procedures of:

determining a plurality of image flip correction models corresponding to respective ones of a plurality of image flip values of another image of said body region of interest, in said non-real-time mode of operation of said system;

constructing a logical relationship between said image flip correction models and said respective image flip values, in said non-real-time mode of operation of said system;

receiving information respective of an image flip value of said image, from a user interface, in a real-time mode of operation of said system; and

determining an image flip correction model corresponding to said image flip value, according to said logical relationship, in said real-time mode of operation of said system.

29. The method according to claim 1, further comprising the procedures of:

determining a plurality of image rotation correction models corresponding to respective ones of a plurality of image rotation values of another image of said body region of interest, in said non-real-time mode of operation of said system;

constructing a logical relationship between said image rotation correction models and said respective image rotation values, in said non-real-time mode of operation of said system;

receiving information respective of an image rotation value of said image, from said image detector, in a real-time mode of operation of said system; and

determining an image rotation correction model corresponding to said image rotation value, according to said logical relationship, in said real-time mode of operation of said system.

30. The method according to claim 1, further comprising the procedures of:

determining a plurality of image flip correction models corresponding to respective ones of a plurality of image flip values of another image of said body region of interest, in said non-real-time mode of operation of said system;

constructing a logical relationship between said image flip correction models and said respective image flip values, in said non-real-time mode of operation of said system;

receiving information respective of an image flip value of said image, from said image detector, in a real-time mode of operation of said system; and

determining an image flip correction model corresponding to said image flip value, according to said logical relationship, in said real-time mode of operation of said system.

31. The method according to claim 1, wherein each of said representation and said image is real-time.

32. The method according to claim 1, wherein said representation is real-time and said image is acquired previously.

33. The method according to claim 1, wherein said representation is acquired previously and said image is real-time.

34. The method according to claim 1, wherein each of said representation and said image is acquired previously.

35. System for displaying a representation of the tip of a medical device located within a body region of interest of a patient, on an image of the body region of interest, the image being acquired by an image detector of a moving imager, the system comprising:

at least one magnetic field generator firmly coupled with a moving portion of said moving imager, said at least one magnetic field generator producing a magnetic field at said body region of interest;

a medical device medical positioning system (MPS) sensor coupled with said tip of said medical device, said medical device MPS sensor detecting said magnetic field;

an MPS coupled with said at least one magnetic field generator and with said medical device MPS sensor, said at least one magnetic field generator being associated with an MPS coordinate system respective of said MPS, said MPS determining MPS coordinates of said medical device MPS sensor, according to an output of said medical device MPS sensor; and

a processor coupled with said MPS, said processor determining two-dimensional coordinates of said tip of said medical device located within said body region of interest, according to a physical zoom setting of said image detector respective of said image, according to a set of intrinsic and extrinsic parameters respective of said image detector, according to a selected image detector region of interest setting of said image detector, and according to said MPS coordinates of said medical device MPS sensor, said processor superimposing a representation of said tip of said medical device, on said image, according to said two-dimensional coordinates.

36. The system according to claim 35, further comprising a user interface coupled with said processor, said user interface receiving an input from a user.

37. The system according to claim 36, wherein said input is selected from the list consisting of:

rotation angle of said image;

flip type of said image; and

viewing position value of said image detector.

38. The system according to claim 35, further comprising a display coupled with said processor, said display displaying a superposition of said representation on said image.

39. The system according to claim 35, further comprising a full span fiducial screen coupled with said image detector, in front of said image detector, in an off-line mode of operation of said system, said full span fiducial screen including a plurality of fiducials, every group of said fiducials being complementary to the rest of said fiducials in said group, said processor determining a scale function between different image detector regions of interest, according to fiducial image coordinates of said fiducials, in a plurality of fiducial images acquired by said image detector, from said full span fiducial screen, at said different image detector regions of interest, and at at least one physical zoom setting of said image detector, and according to actual coordinates of said fiducials.

40. The system according to claim 35, further comprising a peripheral fiducial screen located in a field of view of said image detector, in a non-real-time mode of operation of said system, said peripheral fiducial screen including a plurality of peripheral fiducials, every group of said peripheral fiducials being complementary to the rest of said peripheral fiducials in said group, said image detector acquiring at least one reference image of said body region of interest, in said non-real-time mode of operation of said system, at a reference position of said moving imager, at each physical zoom setting of said image detector, and at each image detector region of interest setting of said image detector, each of said at least one reference image including a plurality of peripheral fiducial images of said peripheral fiducials, at a periphery of said at least one reference image,

wherein said processor determines a viewing position transformation model respective of a selected viewing position of said image detector, in a real-time mode of operation of said system, according to a first set of coordinates of said peripheral fiducials in said at least one reference image, and according to a second set of coordinates of said peripheral fiducials, in said image.

41. The system according to claim 40, further comprising a database coupled with said processor, wherein said processor determines a plurality of image rotation correction models, respective of respective ones of a plurality of image rotation values of said at least one reference image, according to said first set of coordinates, in said non-real-time mode of operation of said system,

wherein said processor constructs a logical relationship between said image rotation correction models, and said image rotation values, in said non-real-time mode of operation of said system,

wherein said processor stores said logical relationship in said database,

wherein said processor determines an image rotation correction model corresponding to a selected image rotation value of said image, in said real-time mode of operation of said system, by incorporating said second set of coordinates in said logical relationship, and

wherein said processor determines said two-dimensional optical coordinates of said tip of said medical device, furthermore according to said image rotation correction model.

42. The system according to claim 40, further comprising a database coupled with said processor, wherein said processor determines a plurality of image flip correction models, respective of respective ones of a plurality of image flip values of said at least one reference image, according to said first set of coordinates, in said non-real-time mode of operation of said system,

wherein said processor constructs a logical relationship between said image flip correction models, and said image flip values, in said non-real-time mode of operation of said system,

wherein said processor stores said logical relationship in said database,

wherein said processor determines an image flip correction model corresponding to a selected image flip value of said image, in said real-time mode of operation of said system, by incorporating said second set of coordinates in said logical relationship, and

wherein said processor determines said two-dimensional optical coordinates of said tip of said medical device, furthermore according to said image flip correction model.

43. The system according to claim 35, further comprising:

a peripheral fiducial screen located in a field of view of said image detector, in a non-real-time mode of operation of said system, said peripheral fiducial screen including a plurality of peripheral fiducials, every group of said peripheral fiducials being complementary to the rest of said peripheral fiducials in said group, said image detector acquiring at least one reference image of said body region of interest, in said non-real-time mode of operation of said system, at a reference position of said moving imager, at each physical zoom setting of said image detector, and at each image detector region of interest setting of said image detector, each of said at least one reference image including a plurality of peripheral fiducial images of said peripheral fiducials, at a periphery of said at least one reference image;

a database coupled with said processor, wherein said processor determines a plurality of viewing position transformation models corresponding to respective ones of a plurality of viewing position values of said image detector, in a non-real-time mode of operation of said system, according to fiducial image coordinates of said peripheral fiducials in respective ones of said at least one reference image, and according to actual coordinates of said peripheral fiducials;

wherein said processor constructs a first logical relationship between said viewing position transformation models, and said respective viewing position values, in said non-real-time mode of operation of said system,

wherein said processor receives information respective of a viewing position value of said image detector, from a user interface, in a real-time mode of operation of said system; and

wherein said processor determines a viewing position transformation model corresponding to said viewing position value, according to said first logical relationship, in said real-time mode of operation of said system.

44. The system according to claim 35, further comprising a position detector coupled with said moving imager and with said processor, said processor determining a position of said moving imager according to an output of said position detector.

45. The system according to claim 35, further comprising a reference MPS sensor fixed at a reference location, said reference MPS sensor being coupled with said MPS, said MPS determining a position of said moving imager according to an output of said reference MPS sensor.

46. The system according to claim 35, further comprising an image detector MPS sensor coupled with said image detector and with said MPS, said moving imager including an emitter located on an opposite side of said patient relative to the location of said image detector, said emitter emitting radiation toward said image detector along a radiation axis, said MPS determining a position of said image detector along said radiation axis, according to an output of said image detector MPS sensor.

47. The system according to claim 35, further comprising a patient body MPS sensor firmly coupled with the body of said patient and with said MPS, said MPS determining a viewing position value of said image detector relative to said body, according to an output of said patient body MPS sensor, said processor compensating for the movements of said patient, and of said moving imager, while said processor processes data respective of images which said image detector detects.

48. The method according to claim 35, wherein each of said representation and said image is real-time.

49. The method according to claim 35, wherein said representation is real-time and said image is acquired previously.

50. The method according to claim 35, wherein said representation is acquired previously and said image is real-time.

51. The method according to claim 35, wherein each of said representation and said image is acquired previously.

52. The system according to claim 35, wherein said image detector is an image intensifier.

53. The system according to claim 35, wherein said image detector is a flat detector.

54. The system according to claim 35, wherein said magnetic field generators are coupled with said image detector.

55. The system according to claim 35, wherein said moving imager includes an emitter located on an opposite side of said patient relative to the location of said image detector, said emitter emitting radiation toward said image detector, said magnetic field generators being coupled with said emitter.

56. The system according to claim 35, wherein said moving imager is a computer assisted tomography (CAT) machine, said CAT including a CAT image detector and a CAT emitter, said CAT emitter being located on an opposite side of said patient relative to the location of said CAT image detector, said CAT emitter emitting radiation toward said CAT image detector, said magnetic field generators being coupled with said CAT image detector.

57. The system according to claim 35, wherein said moving imager operates according to a principle selected from the list consisting of:

X-rays;

nuclear magnetic resonance;

elementary particle emission; and

thermography.

58. The system according to claim 35, wherein said medical device is selected from the list consisting of:

balloon catheter;

stent carrying catheter;

medical substance dispensing catheter;

suturing catheter;

guidewire;

ablation unit;

brachytherapy unit;

intravascular ultrasound catheter;

lead of a cardiac rhythm treatment device;

lead of an intra-body cardiac defibrillator device;

guiding device of a lead of a cardiac rhythm treatment device;

guiding device of a lead of an intra-body cardiac device;

valve treatment catheter;

valve implantation catheter;

intra-body ultrasound catheter;

intra-body computer tomography catheter;

therapeutic needle;

diagnostic needle;

gastroenterology device;

orthopedic device;

neurosurgical device;

intra-vascular flow measurement device;

intra-vascular pressure measurement device;

intra-vascular optical coherence tomography device;

intra-vascular near infrared spectroscopy device;

intra-vascular infrared device; and

otorhinolaryngology precision surgery device.