METHOD AND APPARATUS FOR MAPPING A STRUCTURE

• US 20090264727A1
• Filed: 04/09/2009
• Published: 10/22/2009
• Est. Priority Date: 04/18/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc), Regents of The University of Minnesota (University of Minnesota)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Receveur, Rogier, Phillips, Lane A., Markowitz, H. Toby, Falkner, Phillip, Warman, Eduardo N., Karamanoglu, Mustafa, Waldhauser, Steven L., Zhang, Shangqian Peter, Larik, Vincent, Michels, Koen, Giese, Chad, Eick, Olaf, Craig, Brian Houston, Scanlon, David A., Interrante, Victoria, Kryger, Michael, Campbell-Massa, Sean, Smith, Marie P., Fleming, Ioana, Hurtig, Noelle Christine, Chelgren, Brent, Mehta, Pooja, Nowak, Karl Evan, Steeves, James
• Granted Patent: US 8,532,734 B2
• Time in Patent Office: Days
• US Class Current: 600/373
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• 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 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/063 for measuring volume
• CPC Class Codes: A61B 2090/371 with simultaneous use of two cameras
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• 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 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 : invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/063 : using impedance measurements
• CPC Class Codes: A61B 5/066 : Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
• CPC Class Codes: A61B 5/068 : using impedance sensors
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 8/06 : Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: G06T 19/003 : Navigation within 3D models or images

Abstract

An volume of a patient can be mapped with a system operable to identify a plurality of locations and save a plurality of locations of a mapping instrument. The mapping instrument can include one or more electrodes that can sense a voltage that can be correlated to a three dimensional location of the electrode at the time of the sensing or measurement. Therefore, a map of a volume can be determined based upon the sensing of the plurality of points without the use of other imaging devices. An implantable medical device can then be navigated relative to the mapping data.

Claims

1. A position sensing and map generating unit, comprising:

a mapping instrument having a position element and operable to be located in a volume, wherein the mapping instrument includes at least one of;

an inflatable portion;

at least two electrodes as the position element;

a guidewire operable to be positioned through a cannula;

a plurality of the position elements along a length of the mapping instrument; and

a temperature sensor;

a position determination processor operable to determine a position of the mapping instrument;

a display device operable to display a map based at least on the determined position of the mapping instrument;

a display processor operable to augment the map on the display device, wherein the display processor is operable to at least one of;

determine a position of the position element that is positioned to sense a voltage formed in a volume;

determine a position of a input impedance reference electrode and display it on the display device relative to the map;

display a pseudo the position of the axis electrodes on the display device relative to the map;

determine a path of the mapping instrument and display the path on the display device relative to the map; and

determine a position between at least two of the tracking elements of the mapping instrument and display the position on the display device;

render a filled volume and illustrate portions determined to be depressions relative to the flat surface on the display device; and

determine a position of a virtual point on the mapping instrument relative to one or more of the position element;

a physiological measuring device;

a state determining processor operable to determine a location of the mapping instrument;

an introducer operable to be located with the position determination processor;

a reference electrode at a fixed position on a surface of a volume and a location of the reference electrode is operable to be determined with the position determination processor; and

a distortion correction processor operable to determine a selected distance from a selected position element; and

a procedure instrument with a second position element operable to be located relative to the map;

wherein a map of a volume is displayed on the display device for visualization by a user based solely on the determined position of one or more of the position element.

2. The position sensing and map illustration unit of claim 1, further comprising:

a catheter including an opening in a sidewall of the catheter operable to allow a fluid into an interior of the catheter;

wherein the procedure instrument is operable to be moved within the catheter.

3. The position sensing and map illustration unit of claim 2, further comprising:

a catheter cover operable to selectively cover the opening in the sidewall of the catheter.

4. The position sensing and map illustration unit of claim 1, wherein the position element includes a distal position element distal to the inflatable portion and a proximal position element proximal to the inflatable portion.

5. The position sensing and map illustration unit of claim 1, wherein an impedance can be measured within the volume by a connection to the guidewire.

6. The position sensing and map illustration unit of claim 1, wherein the plurality of position elements includes at least one of:

a distal position element and a proximal position element, wherein the distal position element is operably interconnected with and further operable to move at least one of axially or laterally relative to the proximal position element; and

a single distal position element and a plurality of proximal position elements, wherein the plurality of position elements together or separately move at least one of axially or laterally relative to the single distal position element.

7. The position sensing and map illustration unit of claim 1, wherein the position determination processor is operable to determine the location of a sensed temperature with the temperature sensor and the display processor is operable to generate an icon representative of both temperature and position for display on the display device or change map color in a region as a function of temperature.

8. The position sensing and map illustration unit of claim 1, further comprising:

at least two axis generation electrodes positioned on an exterior surface of a volume;

a current injection system operable to inject a current in the volume between the two axis generation electrodes;

wherein the position element is operable to measure an impedance in the volume based on the injected current.

9. The position sensing and map illustration unit of claim 1, wherein the physiological measuring device is at least one of an electrocardiogram system or a respiration measuring system.

10. The position sensing and map illustration unit of claim 1, wherein the mapping instrument further includes:

a fixed position element; and

a flexible member having a moveable position element operable to flex due to a flow of material.

11. A method of determining a position and displaying a map, comprising:

tracking a mapping instrument or a procedure instrument in a volume;

collecting locations of the mapping instrument;

generating a map based on the collected locations;

displaying the map on a display device;

measuring a cyclic feature of a volume;

wherein the tracking the mapping instrument, includes at least one of;

inflating a portion of the mapping instrument;

fixing a location of a first position element relative to a second position element;

moving a flexible member with a flexible member position element relative to a fixed position element and measuring the position of the flexible member position element relative to the fixed position element;

measuring a temperature within the volume at the mapping instrument and generating a map data point including a position and a temperature; and

positioning a guidewire through a catheter and measuring the location of the guidewire within the volume; and

displaying on a display device at least one of;

illustrating a map data point including both the determined position and the measured temperature;

a corrected map data generated by reducing distortion of a measured position of the mapping instrument;

a pseudo location of an axis electrode relative to the map;

a location of a reference electrode relative to the map;

a location of a feature determined by generating a filled volume and determining curvilinear portions to be displayed relative to the filled volume with the mapping instrument;

a map point determined by generating a virtual point based on a known position of a physical portion of the mapping instrument relative to a position element of the mapping instrument;

a determined location of the mapping instrument or the procedure instrument based on measurements and a previous state location of the mapping instrument or the procedure instrument;

a location in a volume based on measuring evaluating an electrical property to determine a location a portion of a guidewire extending from a mapping instrument and positioned for determining a location of cannulation in the volume;

the map based on locations classified relative to the measured cyclic feature; and

a location of an introducer through which the mapping instrument or the procedure instrument is past.

12. The method of claim 11,

wherein measuring a rhythmic feature includes measuring a heart rhythm of a patient;

wherein collecting locations of the mapping instrument includes collecting and categorizing map data based on each portion of the heart rhythm;

wherein generating the map includes generating a plurality of maps wherein at least one map of a volume of the patient based on each portion of the heart rhythm and displaying the plurality of maps in time order.

13. The method of claim 11, further comprising:

measuring a motion of a fluid within the volume because the fluid acts on the inflated portion.

14. The method of claim 11, wherein the flexing of the flexible member with the flexible member position element relative to the fixed position element and measuring the position of the flexible member position element relative to the fixed position element includes:

placing the mapping instrument within the volume with the fixed position element;

moving the flexible member to extend a distance from the fixed position element; and

determining a location of the flexible member position element relative to the fixed position element due to movement of the flexible member position element relative to the fixed position element from fluid motion within the volume.

15. The method of claim 11, further comprising determining a location of a measurement of temperature.

16. The method of claim 11, wherein positioning a guidewire through a catheter and measuring the location of the guidewire within the volume includes,

measuring an impedance along a length of the guidewire;

averaging the measured impendence along the guidewire to determine a value;

determining a location of the value of the average measured impedance; and

determining a location of a distal tip of the guidewire as a location that is twice the distance from an insertion point of the guidewire and the location of the value.

17. The method of claim 11, wherein displaying the corrected map data generated by reducing distortion of a measured position of the mapping instrument, includes:

determining a distance between two position electrodes of the mapping catheter;

determining an illustrated location of a first of the position elements from a second of the position elements as a fixed distance along a vector from the first electrode and from only a measured location of the first electrode.

18. The method of claim 11, wherein displaying the pseudo location of an axis electrode relative to the map includes illustrating an icon representing a location of the axis electrode relative to the map.

19. The method of claim 11, wherein displaying the location of a reference electrode relative to the map includes illustrating an icon representing a location of the reference electrode relative to the map.

20. The method of claim 11, wherein displaying the location of a feature determined by generating filled volume and determining curvilinear portions to be removed with the mapping instrument, includes:

generating a virtual filled volume;

tracking the mapping catheter relative to the generated virtual filled volume;

determining points of a physical surface; and

augmenting the generated virtual filled volume to illustrate three dimensional features located in the physical space on the generated virtual filled volume.

21. The method of claim 11, wherein displaying the map point determined by generating a virtual point based on a known position of a physical portion of the mapping instrument relative to a position element of the mapping instrument, includes:

measuring the location of a position element;

determining a characteristic of a physical structure of a member relative to the position element; and

determining a location of a point on the member when the location of the position element is determined.

22. The method of claim 11, wherein displaying the determined location of the mapping instrument or the procedure instrument based on measurements and a previous state location of the mapping instrument or the procedure instrument, includes:

determining a list of possible current locations of the instrument from a previous location of the instrument;

measuring a feature of the instrument at the current location;

determining the current location of the instrument based on the measured feature or features and the limited number next possible locations based on previous locations and the known structure of a volume.

23. The method of claim 11, wherein the displaying the map based on locations categorized relative to the measured rhythmic feature, includes:

determining at least a first category and a second category of the rhythmic feature;

collecting a plurality of data for each one of the first category and the second category;

saving the plurality of data for each category; and

generating a first map based only on the collected plurality of data categorized in the first category and a second map based only on the collected plurality of data categorized in the second category.

24. The method of claim 11, wherein the displaying the location of an introducer through which the mapping instrument or the procedure instrument is past, includes tracking the introducer and illustrating with an icon the tracked location of the introducer relative to the map.

25. The method of claim 11, wherein the displaying the corrected map data generated by reducing distortion of a measured position of the mapping instrument includes determining a vector from a single position element of the instrument and displaying a second point on the vector relative to the single position element for all measured locations of the single position element.

26. A method of determining a position and displaying a map, comprising:

placing a current injecting electrode pair on a surface defining a volume;

injecting a current into the volume;

measuring an electrical characteristic for position determination within the volume with an instrument;

determining a location of the instrument based on the measurement of the electrical characteristic with instrument in a volume;

collecting locations of the instrument;

generating a map based on the collected locations;

measuring a rhythmic feature of a volume;

wherein the tracking the mapping instrument, includes at least one of;

inflating a portion of the mapping instrument;

fixing a location of a first position element relative to a second position element;

moving a flexible member with a flexible member position element relative to a fixed position element and measuring the position of the flexible member position element relative to the fixed position element;

measuring a temperature within the volume at the mapping instrument; and

positioning a guidewire through a catheter and measuring the location of the guidewire within the volume; and

displaying on a display device at least one of;

a corrected map data generated by reducing distortion of a measured position of the mapping instrument;

a pseudo location of an axis electrode relative to the map;

a location of a reference electrode relative to the map;

a location of a feature determined by generating a filled volume and determining points to be removed with the mapping instrument from the filled volume to form an augmented volume;

a map point determined by generating a virtual point based on a known position of a physical portion of the mapping instrument relative to a position element of the mapping instrument;

a determined location of the mapping instrument or the procedure instrument based on measurements and a previous state location of the mapping instrument or the procedure instrument;

the map based on locations categorized relative to the measured rhythmic feature; and

a location of an introducer through which the mapping instrument or the procedure instrument is past.