Method and apparatus for stereotaxic placement of probes in the body utilizing CT scanner localization

• US 4,583,538 A
• Filed: 05/04/1984
• Issued: 04/22/1986
• Est. Priority Date: 05/04/1984
• Status: Expired due to Term

• Current Assignee: Sherwood Services AG
• Original Assignee: Eric R. Cosman, Gary M. Onik, Trent H. Wells
• Inventors: Cosman, Eric R., Onik, Gary M., Wells, Trent H.
• Primary Examiner(s): Howell, Kyle L.
• Assistant Examiner(s): Smith, Ruth S.
• Application Number:
  US06/607,175
• Time in Patent Office: 718 Days
• Field of Search: 128/303 B, 128/659, 128/653, 128/660, 128/630, 378/20, 378/207, 378/99
• US Class Current: 606/130
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/068 with a bubble level
• CPC Class Codes: A61B 2090/3937 Visible markers
• CPC Class Codes: A61B 2090/3966 Radiopaque markers visible in an X-ray image
• CPC Class Codes: A61B 6/08 Auxiliary means for directing the radiation beam to a particular spot, e.g. using light beams
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4423 related to hygiene or sterilisation
• CPC Class Codes: A61B 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/17 for soft tissue, e.g. breast-holding devices

Abstract

The method and apparatus are presented which allow for CT guided biopsies of the body. The method is based on the finding of a reference point on the patient'"'"'s body that exactly correlates to a point on the CT scan. This is accomplished by means of a localization device placed on the patient'"'"'s skin which can be identified in cross section on the CT scan. Measurements of the localization device on CT scan can then be correlated to the device on the patient.

Claims

1. A method for determining a target point within a human body by means of tomographic cut images from a tomographic scanner comprising the steps of:

(a) placing a localizer in a fixed position relative to the body and with at least a portion of said localizer being adjacent to the skin of the body such that a tomographic scan cut through said localizer will give a first image point location on the scan image which determines a first physical point on the patient'"'"'s skin adjacent to said localizer;

(b) taking a first tomographic cut through the body and through said localizer from which said first physical point on the skin can be determined and from which a second image point on the skin can be determined on the image of said first tomographic cut, whereby the coordinate differences between said first image point and said second image point enable the unique position of the associated second physical point on the patient'"'"'s skin to be determined;

(c) taking a second tomographic cut through the body with a known displacement distance from said first tomographic cut from which a target image point can be identified and from which the coordinate position of the associated physical target point in the body can be determined relative to said second physical point seen in said first tomographic cut; and

,

(d) calculating a trajectory in space relative to the planes of the tomographic cuts which passes through said second physical point on the skin and through said physical target point and calculating the distance along said trajectory between said physical point and said physical target point.

2. The method of claim 1 wherein said first image point coincides with said second image point, and correspondingly, said first physical point coincides with said second physical point in the body.

3. The method of claim 1 and further comprising the step of immobilizing the body by means of a flexible bag-like enclosure which can be partially filled with small, nearly incompressible objects, and which can be evacuated of air inside it and can be laid on a firm table means, whereby said immobilization step includes laying the body to be scanned on said bag-like enclosure which is on said firm table means, and evacuating said bag-like enclosure of air so that said bag-like enclosure takes the form of the body contacting it, thereby tending to fix the body'"'"'s confirguration.

4. A method for directing an instrument into the human body to reach a target point within the body by means of tomographic cut images from a tomographic scanner comprising the steps of:

(a) placing a localizer in a fixed position relative to the body and with at least a portion of said localizer being adjacent to the skin of the body such that a tomographic scan cut through said localizer will give a first image point location on the scan image which determines a first physical point on the patient'"'"'s skin adjacent to said localizer;

(b) taking a first tomographic cut through the body and through said localizer from which said first physical point on the skin can be determined and from which a second image point on the skin can be determined on the image of said first tomographic cut, whereby the coordinate differences between said first image point and said second image point enable the unique position of the associated second physical point on the patient'"'"'s skin to be determined;

(c) taking a second tomographic cut through the body with a known displacement distance from said first tomographic cut from which a target image point can be identified and from which the coordinate position of the associated physical target point in the body can be determined relative to said second physical point seen in said first tomographic cut; and

,

(d) calculating a trajectory in space relative to the planes of the tomographic cuts which passes through said second physical point on the skin and through said physical target point and calculating the distance along said trajectory between said second physical point and said physical target point;

(e) using a stereotaxic guidance apparatus means to guide said instrument along said calculated trajectory, such that said instrument will pass through the skin at said second physical point and reach said physical target point.

5. The method of claim 4 and further comprising the step of gating said step of guiding said instrument into said body with level of respiration by means of a respiratory gating device, which can detect the degree of expansion of the patient'"'"'s body relative to respiratory action and which provides a readout means of said degree of expansion so that the patient or surgeon can determine identical degrees of respiration action, said gating step consisting of using said respiratory gating device to make equivalent the degree of respiration at said steps of taking said first and said second tomographic scan cuts and said step of guiding said instrument into the body with said stereotaxic apparatus.

6. The method of claim 4 further comprising the step of establishing a predefined set of three orthogonal axes relative to said scanning machine with a z-axis which is perpendicular to the axial tomographic cut image planes and essentially parallel to the longitudinal axis of a living body placed in said scanning machine, an x-axis which is substantially in a horizontal plane and which is substantially perpendicular to the direction of gravity, and a y-axis which is substantially in a vertical direction which is substantially parallel to the direction of gravity, said stereotaxic guidance apparatus comprising:

(i) a fixation means which is adapted to be placed in a fixed position relative to said scanning machine;

(ii) a probe carrier means which is adapted to carry said instrument as it is being directed into the living body;

(iii) an articulating arm means which connects between said fixation means and said probe carrier means, said articulating arm means comprising at least one x-bar which enables movement of said probe carrier means along said x-axis, at least one y-bar which enables movement of said carrier along said y-axis, at least one z-bar which enables movement of said probe carrier means along said z-axis, an azimuth rotation means part of said articulating arms means which enables rotation of said probe carrier means about said y-axis, and a declination rotation means part of said articulating arm means which enables rotation of said probe carrier means about an axis which is perpendicular to said y-axis; and

further comprising the steps of;

(a) placing said instrument in said probe carrier means so it is being guided by said probe carrier means;

(b) adjusting said azimuth rotation means and said declination rotation means to positions so that the direction of said instrument corresponds to said calculated trajectory;

(c) moving said x-bar, y-bar, and z-bars so that the tip end of said instrument is at said second physical point on the patient'"'"'s skin.

(d) pushing said instrument into the living body an amount equal to said calculated trajectory distance, so that said instrument tip end reaches said physical target point.

8. A method for determining a target point within a human body by means of tomographic cut images from a tomographic scanner comprising the steps of:

(a) placing a localizer in a fixed position relative to the body and with at least a portion of said localizer being adjacent to the skin of the body such that a tomographic scan cut through said localizer will give a first image point location on the scan image which determines a first physical point on the patient'"'"'s skin adjacent to said localizer;

(b) taking at least one tomographic cut through the body and through said localizer from which said first physical point on the skin can be determined and from which a second image point on the skin can be determined on the image of said at least one tomographic cut, whereby the coordinate differences between said first image point and said second image point enable the unique position of the associated second physical point on the patient'"'"'s skin to be determined;

(c) identifying a target image point on the image of said at least one tomographic cut and from which the coordinate position of the associated physical target point in the body can be determined relative to said second phusical point seen in said at least one tomographic cut; and

,

(d) calculating a trajectory in space relative to the plane of said at least one tomographic cut which passes through said second physical point on the skin and through said physical target point and calculating the distance along said trajectory between said physical point and said physical target point.

7. The method of claim 8 wherein said first image point coincides with said second image point, and correspondingly, said first physical point coincides with said second physical point in the body.

9. The method of claim 8 wherein said localizer comprises a triangular means that can be placed on the body during tomographic scanning and which has a base side that can be aligned parallel to the scan plane prior to scanning, with a section of said triangular means being visible on a tomographic cut through it so that the edges of the triangle means sides can be identified in order that said first image and first physical points can be determined relative to said edges, and further comprising the step of making said at least one tomographic cut with said triangular means positioned on the body so as to determine said first physical point.

10. The method of claim 8 wherein said localizer comprises a triangular means having at least a portion of its interior area free of material so that it can lay on a curved portion of the body'"'"'s surface with its edges in close proximity to the body'"'"'s skin during tomographic scanning and which has a base side that can be aligned parallel to the scan plane prior to scanning with a section of said triangular means being visible on a tomographic cut through it so that the edges of the triangle means sides can be identified in order that said first image and first physical points can be determined relative to said edges, and further comprising the steps of positioning said triangular means on a curved portion of the body and then making said at least one tomographic cut with said triangular means positioned on the curved portion of the body so as to determine said first physical point.

11. The method of claim 8 wherein said localizer comprises a triangular means having lines on it parallel to said base edge and located such that they correspond to integral unit distances across said triangular means from one of its said side edges to another and further comprising the step of determining from said at least one tomographic cut the distance across said triangular means whereby said lines on said triangular means locate said first physical point.

12. A method for directing an instrument into the human body to reach a target point within the body by means of tomographic cut images from a tomograhic scanner comprising the steps of:

(a) placing a localizer in a fixed position relative to the body and with at least a portion of said localizer being adjacent to the skin of the body such that a tomographic scan cut through said localizer will give a first image point location on the scan image which determines a first physical point on the patient'"'"'s skin adjacent to said localizer;

(b) taking at least one tomographic cut through the body and through said localizer from which said first physical point on the skin can be determined and from which a second image point on the skin can be determined on the image of said at least one tomographic cut, whereby the coordinate differences between said first image point and said second image point enable the unique position of the associated second physical point on the patient'"'"'s skin to be determined;

(c) identifying a target image point on the image of said at least one tomographic cut and from which the coordinate position of the associated physical target point in the body can be determined relative to said second physical point seen in said at least one tomographic cut;

(d) calculating a trajectory in space relative to the plane of said at least one tomographic cut which passes through said second physical point on the skin and through said physical target point and calculating the distance along said trajectory between said physical point and said physical target point; and

,

(e) using a stereotaxic guidance apparatus means to guide said instrument along said calculated trajectory, such that said instrument will pass through the skin at said second physical point and reach said physical target point.