MODELING OF PHARMACEUTICAL PROPAGATION

• US 20100030073A1
• Filed: 12/17/2007
• Published: 02/04/2010
• Est. Priority Date: 12/29/2006
• Status: Abandoned Application

• Current Assignee: Bayer Medical Care Inc. (Bayer AG)
• Original Assignee: Medrad Incorporated (Bayer AG)
• Inventors: Kalafut, John
• Application Number:
  US12/519,040
• Publication Number:
  US 20100030073A1
• Time in Patent Office: Days
• US Class Current: 600/431
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/7257 using Fourier transforms
• CPC Class Codes: A61B 6/03 Computed tomography [CT] echo-tomography A61B8/14
• CPC Class Codes: A61B 6/481 involving the use of contrast agents
• CPC Class Codes: A61B 6/503 for diagnosis of the heart
• CPC Class Codes: A61B 6/504 for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61B 6/507 for determination of haemodynamic parameters, e.g. perfusion CT
• CPC Class Codes: A61B 6/583 using calibration phantoms
• CPC Class Codes: A61B 8/0891 for diagnosis of blood vessels
• CPC Class Codes: A61B 8/13 Tomography A61B8/10, A61B8/12 take precedence; tomography for radiation diagnosis A61B6/02
• CPC Class Codes: G01R 33/5601 involving use of a contrast agent for contrast manipulation, e.g. a paramagnetic, super-paramagnetic, ferromagnetic or hyperpolarised contrast agent

Abstract

A method of delivering a contrast enhancing fluid to a patient using an injector system, including: determining at least one patient transfer function for the patient based upon data specific to the patient and, the at least one patient transfer function providing a time enhancement output for a given input; determining a desired time enhancement output; using the at least one patient transfer function to determine an injection procedure input; and controlling the injector system at least in part on the basis of the determined injection procedure input. The injection procedure input can determined considering at least one operational limitation or constraint of the injector system. A method of modeling propagation of a pharmaceutical fluid in a patient, includes: collecting data corresponding to a time response curve resulting from injection of the fluid; and determining at least one mathematical model describing the data. The mathematical model can, for example, be a model which is not determined by a continuous or a discrete-time Fourier deconvolution of the data. A method of controlling injection of a pharmaceutical fluid into a patient using an injector in a medical procedure, includes: collecting data corresponding to a patient response curve resulting from injection of the fluid; determining at least one mathematical model describing the data; and controlling the injector during the medical procedure to control injection of the fluid into the patient to create patient response at least in part on the basis of the mathematical model. A method of controlling injection of a contrast medium into a patient using an injector in a medical imaging procedure using an imaging scanner, includes: determining at least one mathematical model to predict a time enhancement response resulting from injection of the contrast medium; determining an injection protocol to approximate a predetermined time enhancement response in the patient by determining a constrained input solution to the mathematical model; and using the injection protocol to control the injector during the medical imaging procedure to control injection of the contrast medium into the patient to create an image of a region of interest. Patient transfer functions for the patient of the present invention can also be based at least in part on a measurement of cardiac output of the patient. Likewise, mathematical models of the present invention can be based at least in part on a measurement of cardiac output of the patient.

Claims

1. A method of delivering a contrast enhancing fluid to a patient using an injector system, comprising:

determining at least one patient transfer function for the patient based upon data specific to the patient and based at least in part on a measurement of cardiac output of the patient, the at least one patient transfer function providing a time enhancement output for a given input;

determining a desired time enhancement output;

using the at least one patient transfer function to determine an injection procedure input; and

controlling the injector system at least in part on the basis of the determined injection procedure input.

2. The method of claim 1 wherein the injection procedure input is determined considering at least one operational limitation or constraint of the injector system.

3. The method of claim 2 wherein the at least one patient transfer function is determined using a system identification model comprising parameters related to physiological parameters of the patient.

4. The method of claim 3 the system identification model is discretizable.

5. The method of claim 3 further comprising the steps of:

developing an initial patient transfer function using estimates of at least one physiological parameter of the patient;

performing an injection; and

revising the patient transfer function based upon at least one time enhancement output of the injection.

6. The method of claim 5 wherein at least one patient physiological parameter is measured from the at least one time enhancement output.

7. The method of claim 5 wherein the injection is a test injection performed prior to a diagnostic imaging procedure.

8. The method of claim 7 wherein time enhancement outputs resulting from the test injection are measured for at least two different regions of interest.

9. The method of claim 8 wherein differences between the time enhancement outputs provide a measure of at least one patient physiological parameter.

10. The method of claim 9 wherein the at least one patient physiological parameter is parameter of the cardiopulmonary system

11. The method of claim 10 wherein the at least one patient physiological parameter is cardiac output, blood volume in a region, a rate transfer term or a transit delay.

12. The method of claim 8 wherein a first time enhancement output is measured in the ascending aorta or the descending aorta and a second time enhancement output is measured in the pulmonary artery trunk.

13. The method of claim 9 wherein a first time enhancement output is measured in the ascending aorta or the descending aorta and a second time enhancement output is measured in the pulmonary artery trunk.

14. The method of claim 13 wherein the at least one patient physiological parameter is cardiac output, blood volume in a region, a rate transfer term or a transit delay.

15. The method of claim 2 wherein the at least one patient transfer function is determined by the steps:

collecting data corresponding to a time response curve resulting from injection of the fluid; and

determining at least one mathematical model describing the data.

16. The method of claim 15 wherein the mathematical model is not determined by a continuous or a discrete-time Fourier transform of the data.

17. The method of claim 15 wherein the model is a parametric model.

18. The method of claim 17 wherein the model is a moving average or an autoregressive moving average.

19. The method of claim 17 wherein the mathematical model assumes linearity and time invariance.

20. The method of claim 15 wherein the model is a non-parametric model determined by a spectral estimation technique.

21. The method of claim 20 wherein the spectral estimation technique is Welch'"'"'s method, Bartlett'"'"'s method, a multiple signal classification (MUSIC) method, or the Periodogram method.

22. The method of claim 15 wherein data is collected during at least one test injection prior to an imaging injection.

23. The method of claim 15 wherein the at least one patient transfer function is updated with data collected during the imaging injection.

24. The method of claim 3 wherein the at least one patient transfer function is updated with data collected during the imaging injection.

25. The method of claim 2 wherein the at least one patient transfer function is determined at least in part on the basis of at least one injection.

26. The method of claim 25 wherein the at least one injection is a test injection performed prior to a diagnostic imaging procedure.

27. The method of claim 26 wherein the test injection comprises injection of contrast medium followed by injection of a non-contrast fluid.

28. The method of claim 27 wherein the non-contrast fluid is injected at substantially the same volumetric flow rate as a flow rate of contrast medium preceding the injection of non-contrast fluid.

29. The method of claim 28 wherein the non-contrast fluid is saline.

30. The method of claim 26 wherein more than one test injection is performed.

31. The method of claim 30 where one test injection comprises injection of contrast medium only and another test injection comprises injection of contrast medium followed by injection of a non-contrast fluid.

32. The method of claim 2 wherein the injection procedure input is determined using an analytical solution or using a numerical, constrained optimization technique.

33. The method of claim 32 wherein the numerical, constrained optimization technique is a weighted least-squared numerical optimization.

34. The method of claim 32 wherein the injection procedure input is optimized to minimize the mass of a contrast enhancing agent in the contrast enhancing fluid delivered to the patient.

36. The method of claim 1 wherein the contrast enhancing fluid is a CT contrast enhancing fluid, a MRI contrast enhancing fluid, an ultrasound enhancing imaging fluid or a radioactive contrast enhancing fluid.

37. The method of claim 1 wherein at least two patient transfer functions are determined and the injection procedure input is determined on the basis of one of the patient transfer function.

38. The method of claim 37 wherein a first patient transfer function is determined using a system identification model comprising parameters related to physiological parameters of the patient and a second patient transfer function is determined using a mathematic model determined by collecting data corresponding to a time enhancement curve resulting from injection, the mathematical model describing the data.

39. The method of claim 37 wherein a determination is made as to which patient transfer function provides the best correlation between a given input and a resulting output.

40. The method of claim 1 wherein cardiac output is measured at least in part by a cardiac impedance measurement, a flow meter, a dilution catheters, pressure arterial flow or via an imaging procedure using.

35. The method of claim 35 wherein the contrast enhancing agent is iodine, xenon or gadolinium.

41. An injector system for the delivery of a fluid to a patient comprising:

an injector and a controller in communicative connection with the injector, the controller comprising at least one patient transfer function determined for the patient based upon data specific to the patient and at least in part on the basis of a measure cardiac output of the patient, the at least one patient transfer function providing a time enhancement output for a given input, the controller comprising a processor to determine an injection procedure input for a desired time enhancement output using the at least one patient transfer function.

42. The injector system of claim 41 wherein the injection procedure input is determined considering at least one operational limitation of constraint of the injector.

43. The injector system of claim 41 wherein the injection procedure input is determined using an analytical solution or a numerical, constrained optimization technique.

44. The injector system of claim 43 wherein the numerical, constrained optimization technique is a weighted least-squared numerical optimization.

45. The injector system of claim 43 wherein the injection procedure input is optimized to minimize the mass of a contrast enhancing agent in the contrast enhancing fluid delivered to the patient.

46. The injector system of claim 41 wherein the contrast enhancing agent is iodine, xenon or gadolinium.

47. The injector system of claim 41 wherein the contrast enhancing fluid is a CT contrast enhancing fluid, a MRI contrast enhancing fluid, an ultrasound enhancing imaging fluid or a radioactive contrast enhancing fluid.

48. A method of modeling propagation of a pharmaceutical fluid in a patient, comprising:

collecting data corresponding to a time response curve resulting from injection of the fluid; and

determining at least one mathematical model describing the data and based at least in part on a measure cardiac output of the patient, provided that the mathematical model is not determined solely by a continuous or a discrete-time Fourier deconvolution of the data.

49. The method of claim 48 wherein the fluid is a contrast medium used in an imaging procedure and the data collected corresponds to a time enhancement output resulting from injection of the contrast medium.

50. The method of claim 49 wherein the model is a parametric model.

51. The method of claim 50 wherein the model is a moving average or an autoregressive moving average.

52. The method of claim 50 wherein the mathematical model assumes linearity and time invariance.

53. The method of claim 49 wherein the model is a non-parametric model determined by a spectral estimation technique.

54. The method of claim 53 wherein the spectral estimation technique is Welch'"'"'s method, Bartlett'"'"'s method, a multiple signal classification (MUSIC) method, or the Periodogram method.

55. The method of claim 49 wherein data is collected during at least one test injection prior to an imaging injection.

56. The method of claim 49 wherein the model is updated with data collected during the imaging injection.

57. The method of claim 55 wherein the test injection comprises injection of contrast medium followed by injection of a non-contrast fluid.

58. The method of claim 57 wherein the non-contrast fluid is injected at substantially the same volumetric flow rate as a flow rate of contrast medium preceding the injection of non-contrast fluid.

59. The method of claim 58 wherein the non-contrast fluid is saline.

60. The method of claim 55 wherein more than one test injection is performed.

61. The method of claim 60 where one test injection comprises injection of contrast medium only and another test injection comprises injection of contrast medium followed by injection of a non-contrast fluid.

62. A method of controlling injection of a pharmaceutical fluid into a patient using an injector in a medical procedure, comprising:

collecting data corresponding to a patient response curve resulting from injection of the fluid;

determining at least one mathematical model describing the data and based at least in part on a measured cardiac output of the patient, provided that the mathematical model is not determined solely by a continuous or a discrete-time Fourier deconvolution of the data; and

controlling the injector during the medical procedure to control injection of the fluid into the patient to create patient response at least in part on the basis of the mathematical model.

63. A method of controlling claim 62 wherein the medical procedure is a medical imaging procedure using an imaging scanner and the collected data corresponds to a time enhancement curve resulting from injection of the contrast medium and the injector is controlled to control injection of the contrast medium into the patient to create an image of a region of interest at least in part on the basis of the mathematical model.

64. The method of claim 63 wherein the model is a parametric model.

65. The method of claim 64 wherein the model is moving average or an autoregressive moving average.

66. The method of claim 65 wherein the mathematical model assumes linearity and time invariance.

67. The method of claim 64 wherein the model is a non-parametric model determined by a spectral estimation technique.

68. The method of claim 67 wherein the spectral estimation technique is Welch'"'"'s method, Bartlett'"'"'s method, a multiple signal classification (MUSIC) method, or the Periodogram method.

69. The method of claim 63 wherein data is collected during at least one test injection prior to an imaging injection.

70. The method of claim 69 wherein the model is updated with data collected during the imaging injection.

71. The method of claim 69 wherein the test injection comprises injection of contrast medium followed by injection of a non-contrast fluid.

72. The method of claim 71 wherein the non-contrast fluid is injected at substantially the same volumetric flow rate as a flow rate of contrast medium preceding the injection of non-contrast fluid.

73. The method of claim 75 wherein the non-contrast fluid is saline.

74. The method of claim 69 wherein more than one test injection is performed.

75. The method of claim 74 where one test injection comprises injection of contrast medium only and another test injection comprises injection of contrast medium followed by injection of a non-contrast fluid.

76. The method of claim 63 wherein the injector is also controlled at least in part on the basis of information regarding the patient response during the imaging procedure.

77. The method of claim 63 wherein the injector is also controlled at least in part on the basis of information on at least one measured physiological variable of the patient.

78. The method of claim 77 wherein measured physiological variable is used to alter the output of the mathematical model.

79. The method of claim 63 wherein the step of controlling the injector comprises commencing injection of the contrast medium at one time and commencing an image scan of the region of interest at a second time determined at least in part on the basis of the mathematical model.

80. The method of claim 79 wherein the second time is determined on the basis of a prediction of a time of attainment of a predetermined enhancement level as determined by the mathematical model.

81. An injection system comprising:

an injector; and

a injector controller in operative communication with the injector to control the injector, the injector controller controlling injection of a fluid based upon at least one mathematical model, the mathematical model being determined by collecting data corresponding to a time enhancement curve resulting from injection of the contrast medium and being based at least in part upon a measured cardiac output of the patient, provided that the mathematical model is not determined by a continuous or a discrete-time Fourier deconvolution of the data.

82. The injection system of claim 81 wherein the controller comprises a computer comprising at least one processing unit and at least one memory, the memory having stored therein a computer program to determine the mathematical model.

83. A method of controlling injection of a contrast medium into a patient using an injector in a medical imaging procedure using an imaging scanner, comprising:

determining at least one mathematical model to predict a time enhancement response resulting from injection of the contrast medium, the mathematical model being based at least in part on a measured cardiac output of the patient;

determining an injection protocol to approximate a predetermined time enhancement response in the patient by determining a constrained input solution to the mathematical model; and

using the injection protocol to control the injector during the medical imaging procedure to control injection of the contrast medium into the patient to create an image of a region of interest.

84. The method of claim 83 further comprising the step of changing the injection protocol as a result of feedback regarding the time enhancement response during the imaging procedure.

85. The method of claim 83 further comprising the step of changing the injection protocol as a result of data regarding at least one patient physiological parameter during the imaging procedure.

86. The method of claim 83 wherein the step of determining an injection protocol to approximate the predetermined time enhancement response is accomplished using a numerical solver or a numerical optimizer.

87. The method of claim 83 wherein the constrained input solution to the mathematical model is constrained by at least one operational limitation of the injector.

88. The method of claim 83 wherein the constrained input solution to the mathematical model is constrained by at least one operational limitation related to patient safety or comfort.

89. The method of claim 83 wherein the injection of the contrast medium is commenced at one time and an image scan of the region of interest is commenced at a second time determined at least in part on the basis of the mathematical model.

90. The method of claim 89 wherein the second time is determined on the basis of a prediction of a time of attainment of a predetermined enhancement level as determined by the mathematical model.

91. The method of claim 83 wherein the at least one mathematical model is a patient transfer function for the patient based upon data specific to the patient, the at least one patient transfer function providing a time enhancement output for a given input.

92. The method of claim 91 wherein the patient transfer function is determined using a system identification model comprising parameters related to physiological parameters of the patient or is determined using a mathematic identification model determined by collecting data corresponding to a time enhancement curve resulting from injection of the patient, wherein the mathematical identification model describes the data.

93. A system for effecting a medical procedure comprising:

a sensing system to detect a patient response;

an injector adapted to inject a pharmaceutical fluid; and

a controller in operative communication with the injector to control the injector, the injector controller controlling injection of a fluid based upon at least one mathematical model, the mathematical model being determined by collecting data from the sensing system corresponding to a time response curve resulting from injection of the fluid and being based at least in part upon a measured cardiac output of the patient, provided that the mathematical model is not determined by solely a continuous or a discrete-time Fourier deconvolution of the data.

94. An imaging system:

an imager to create an image of a region of interest of a patient;

an injector adapted to inject a contrast medium; and

a controller in operative communication with the injector to control the injector, the injector controller controlling injection of the contrast medium based upon at least one mathematical model, the mathematical model being determined by collecting data from the imager corresponding to a time enhancement curve resulting from injection of the contrast medium and being based at least in part upon a measured cardiac output of the patient, provided that the mathematical model is not determined solely by a continuous or a discrete-time Fourier deconvolution of the data.

95. A method of controlling injection of a pharmaceutical fluid into a patient using an injector having a controller in communicative connection with a computer memory in a medical procedure, comprising:

collecting data corresponding to a patient response curve resulting from injection of the fluid;

choosing at least one mathematical model from a plurality of mathematical models stored in the computer memory to describe the data;

adapting the model to the collected data, the model being based at least in part upon a measured cardiac output of the patient; and

controlling the injector via the controller during the medical procedure to control injection of the fluid into the patient to create patient response at least in part on the basis of the mathematical model.

96. An imaging system:

an imager to create an image of a region of interest of a patient;

an injector adapted to inject a contrast medium; and

a controller in operative communication with the injector to control the injector, the controller comprising at least one patient transfer function determined for the patient based upon data specific to the patient, and based at least in part upon a measured cardiac output of the patient, the at least one patient transfer function providing a time enhancement output for a given input, the controller comprising a processor to determine an injection procedure input for a desired time enhancement output using the at least one patient transfer function.