VOLUMETRICALLY ILLUSTRATING A STRUCTURE

• US 20090264748A1
• Filed: 04/15/2009
• 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: Cheigren, Brent, Glese, Chad, 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, Eick, Olaf, Craig, Brian Houston, Scanlon, David A., Interrante, Victoria, Kryger, Michael, Campbell-Massa, Sean, Smith, Marie P., Fleming, Ioana, Hurtig, Noelle Christine, Mehta, Pooja, Nowak, Karl Evan, Steeves, James
• Granted Patent: US 8,345,067 B2
• Time in Patent Office: Days
• US Class Current: 600/424
• 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

A 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 method of illustrating a selected path on a display, comprising:

positioning a mapping instrument in a volume of a patient;

moving a first position element in the volume with the mapping instrument;

determining a plurality of positions of the first position element in the volume;

generating a plurality of map data points of the volume based on the determined plurality of positions of the first position element;

displaying a map including the plurality of map data points on a display device to illustrate an interior surface of the volume;

withdrawing the mapping instrument from the volume along a selected pathway;

determining a plurality of pathway positions of the first position element along the pathway as the mapping instrument is being withdrawn;

illustrating the plurality of determined pathway positions superimposed on the displayed map as a pathway icon;

tracking a second position element on a second instrument; and

displaying a second instrument icon representing a location of the second instrument relative to the pathway icon.

2. The method of claim 1, wherein determining a plurality of positions of the first position element comprises determining a plurality of positions of the first position element using only a position sensing unit, including:

providing a set of axis generation electrodes on an exterior surface of the patient establishing an axis and a conductive path therebetween;

injecting an axis current into the patient between the set of axis generation electrodes and generating a voltage gradient between the set of axis generation electrodes;

evaluating an electrical property including sensing a voltage at the first position element at a plurality of positions between the set of axis generation electrodes; and

determining a plurality of positions of the first position element based at least on the sensed voltage at the plurality of positions along the voltage gradient between the set of axis generation electrodes.

3. The method of claim 2, wherein determining a plurality of pathway positions of the first position element along the pathway as the mapping instrument is being withdrawn includes:

evaluating the electrical property at a plurality of positions along the pathway as the mapping instrument is being withdrawn including sensing a voltage at the first position element along the voltage gradient at the plurality of positions along the pathway; and

determining a plurality of pathway positions of the first position element based at least on the sensed voltage at the plurality of positions along the pathway.

4. The method of claim 2, wherein illustrating a pathway icon includes illustrating a pathway icon in the form of a three dimensional elongated tube generated around only the plurality of determined pathway positions.

5. The method of claim 2, wherein illustrating a pathway icon includes illustrating a pathway icon in the form of a continuous line connecting only the plurality of determined pathway positions.

6. The method of claim 2, wherein tracking a second position element on a second instrument includes:

positioning the second instrument with the second position element in the volume; and

determining a position of the second position element in the volume based at least on sensing voltage along the voltage gradient.

7. The method of claim 6, further comprising guiding the second instrument in the volume along the pathway at least based on a position of the displayed second instrument icon relative to the pathway icon.

8. The method of claim 6, wherein one of the determined plurality of positions of the first position element in the volume includes a determined position for implantation of the second position element;

and

wherein withdrawing the mapping instrument from the volume along a selected pathway includes withdrawing the mapping instrument from the determined implantation position along a selected pathway from the volume.

9. The method of claim 8, further comprising illustrating the determined implantation position superimposed on the displayed map and the pathway icon as a landmark icon.

10. The method of claim 9, further comprising guiding the second instrument along the pathway towards the landmark icon at least based on a displayed position of the second position element relative to the pathway icon and the landmark icon.

11. The method of claim 1, wherein positioning a mapping instrument in a volume of a patient includes providing a mapping catheter and positioning the mapping catheter in a heart of the patient.

12. The method of claim 1, wherein the second instrument is a lead for an implantable medical device;

and

wherein tracking a second position element on a second instrument includes;

inserting the lead having a lead electrode as the second position element into the volume; and

tracking the lead as the lead is moved through a volume of a heart of the patient.

13. A method of illustrating a selected path on a display, comprising:

positioning a mapping instrument in a volume of a heart of a patient;

moving a first position element in the volume with the mapping instrument;

determining a plurality of positions of the first position element in the volume;

generating a plurality of map data points of the volume based on the determined plurality of positions of the first position element;

displaying a map including the plurality of map data points on a display device to illustrate an interior surface of the volume;

selecting an implantation position at a first time with the first position element for a lead electrode in the heart;

withdrawing the mapping instrument from the selected implantation position along a selected pathway;

determining a plurality of pathway positions of the first position element along the pathway as the mapping instrument is being withdrawn;

illustrating the plurality of determined pathway positions superimposed on the displayed map as a pathway icon, and illustrating the selected implantation position superimposed on the displayed map as a landmark icon;

tracking a second instrument having a lead electrode in the volume at a second time later than the first time;

displaying a second instrument icon representing a location of the lead electrode relative to the pathway icon and the landmark icon; and

guiding the second instrument along the pathway towards the landmark icon at least based on the displayed position of the lead electrode relative to the pathway icon and the landmark icon.

14. A system for illustrating a selected path on a display, comprising:

a mapping instrument having a first position element affixed to a portion of the instrument arranged to be inserted into a volume of a patient, the first position element arranged to sense an electrical property of the volume;

a position sensing unit having a set of axis generation electrodes for injecting current into the patient, the axis generation electrodes adapted to be positioned on an outer surface of the patient and establish an axis via a conductive path therebetween, the injected current generating a voltage gradient in the patient between the set of electrodes;

a processor coupled to the position sensing unit, the first position element and a display device, the processor operable to execute instructions to determine a plurality of positions of the first position element using only the position sensing unit and the first position element, and to display a map of the plurality of determined positions on the display device to illustrate an interior surface of the volume, the processor further operable to determine a plurality of positions along a selected pathway using only the position sensing unit and the first position element as the mapping instrument is being withdrawn from the volume, and to illustrate the determined plurality of pathway positions on the display device superimposed on the displayed map as a pathway icon; and

a second instrument having a second position element, the second instrument arranged to be inserted into the volume, wherein the processor is operable to determine a position of the second position element using only the position sensing unit and display a second instrument icon on the displayed map representative of a location of the second instrument relative to the pathway icon.

15. The system of claim 14, wherein the processor is operable to determine the plurality of positions of the first position element and the position of the second position element based on instructing the first and second position elements to sense a voltage along the voltage gradient.

16. The system of claim 14, wherein the second instrument includes a lead for an implantable medical device, and the second instrument icon is a lead icon;

and

wherein the processor is operable to execute instructions to identify one of the determined plurality of positions of the first position element as a determined position for implantation of the lead.

17. The system of claim 16, wherein the processor is operable to display the determined lead implantation position superimposed on the displayed map as a landmark icon and relative to the pathway icon.

18. The system of claim 17, wherein the second instrument is adapted to be moved in the volume relative to the pathway icon at least based on the processor being operable to display a plurality of determined positions of the lead as a plurality of lead icons relative to the pathway icon and the landmark icon.

19. The system of claim 14, wherein the displayed pathway icon includes a three dimensional tube generated around only the plurality of determined pathway positions.

20. The system of claim 14, wherein the mapping instrument includes a mapping catheter having a steerable sheath, and the first position element includes an electrode, and wherein the steerable sheath includes a plurality of apertures arranged to permit a fluid in the volume to pass through the apertures and contact the electrode when the mapping catheter is positioned in the volume.

21. The system of claim 14, wherein the mapping instrument is arranged to be inserted into a volume of a heart of the patient.

22. The system of claim 14, wherein the second instrument is a lead to be attached to an implantable medical device;

and

wherein the second position element is a lead electrode through which sensing or stimulation occurs with the implantable medical device.