Stereotaxy wand and tool guide

• US 5,517,990 A
• Filed: 04/08/1994
• Issued: 05/21/1996
• Est. Priority Date: 11/30/1992
• Status: Expired due to Term

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Kalfas, Iain H., Kormos, Donald W., Barnett, Gene H., Piraino, David W.
• Primary Examiner(s): Smith, Ruth S.
• Application Number:
  US08/224,955
• Time in Patent Office: 774 Days
• Field of Search: 128/653.1, 128/653.2, 128/653.5, 128/653.4, 128/654, 606/130
• US Class Current: 600/414
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2055 Optical 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 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/3954 magnetic, e.g. NMR or MRI
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• 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 90/06 Measuring instruments not otherwise provided for
• CPC Class Codes: A61B 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

A patient is secured to a subject support (10). A stereotaxic wand (40) is inserted into a tool guide (60). The wand has a tip portion (44), a portion extending along a pointing axis (46) of the wand, an offset portion (42) which is offset from the pointing axis of the wand, and at least two wand emitters (48, 50), mounted in alignment with the pointing axis of the wand. The two emitters selectively emit wand signals which are received by three receivers (14) mounted to a frame assembly (12). The tool guide includes a bore (66) extending along a guide axis. The bore is configured for selectively receiving a tool and the tip portion of the wand. An entry point and a trajectory are identified by the surgeon with the wand in the guide. More specifically, a trajectory and location of the wand are superimposed on a diagnostic image on a monitor (30). If the surgeon is satisfied with the entry point and trajectory shown on the monitor, a surgical tool is inserted into the bore while the tool guide is held along the designated trajectory and at the designated entry point.

Claims

1. A system for designating a coordinate and trajectory on a subject and for guiding a tool at the coordinate and along the trajectory as the tool is applied to the subject, the system comprising:

a subject support;

a means for securing a preselected portion of the subject to the subject support;

a frame assembly which mounts at least three receivers in a fixed relationship to the subject support;

a wand having a tip portion, a portion extending along a pointing axis of the wand, an offset portion which is offset from the pointing axis of the wand, and at least two wand emitters being mounted in a spaced relationship to the offset portion in a fixed relationship to the pointing axis of the wand, the emitters selectively emitting wand signals which are received by the at least three receivers;

a guide defining a path extending longitudinally along a guide axis, the path being configured for selectively receiving a tool and the tip portion;

a wand position determining means for determining a position of the wand tip portion by measuring wand signal travel of the wand signals between the wand emitters and the at least three receivers.

2. The system of claim 1 further including:

a three-dimensional image memory for storing image data indicative of a three-dimensional region of the portion of the subject which is secured to the subject support;

a plane selecting means for selecting planar slices of data from the three-dimensional image memory;

a display for converting the selected slices of data from the plane selecting means into human-readable displays;

a transform means for transforming a position of the wand tip portion into a coordinate system of the image data stored in the three-dimensional image memory, the transform means being operatively connected with the plane selecting means such that the displayed images have a preselected relationship to a position of the wand.

3. The system of claim 2 wherein the frame assembly is mounted directly to the subject support to be movable therewith such that movement of the subject support does not alter the subject coordinate system.

4. The system of claim 2 further including:

at least three markers disposed at selected subject portions when the three-dimensional image data was acquired such that locations of the three markers are identifiable in the three-dimensional image data; and

a transform calculating means for calculating a transform between (1) positions of the markers on the subject denoted by selectively placing the wand tip on each of the markers and (2) the marker locations in the three-dimensional image data, whereby translational and rotational relationships are calculated between subject space coordinate system and a three-dimensional image data space coordinate system.

5. The system of claim 4 wherein the markers contain materials which are visible in both magnetic resonance and CT imaging techniques such that the same markers can be used for both CT and magnetic resonance examinations.

6. An apparatus for orienting a tool and guiding an application of the tool to a subject comprising:

a wand for designating at least a pointing axis, said wand having at least two signal emitters mounted thereto for emitting signals;

at least three receivers mounted in a fixed relationship for receiving the signals emitted by the wand emitters;

a wand position determining means for determining a position of the pointing axis by measuring travel of the signals between the wand emitters and the receivers; and

a guide for guiding a tool along a guide axis, said guide having a means for selectively receiving each of the tool and the wand individually and constraining the received wand.

7. The apparatus of claim 6 wherein the wand includes a tip end, a portion extending along the pointing axis of the wand, and an offset portion which is offset from the pointing axis, the wand emitters being mounted in a spaced relationship to the offset portion in alignment with the pointing axis of the wand.

8. The apparatus of claim 6 further including a plurality of tips and a connecting means for selectively connecting each of the tips to the wand.

9. The apparatus of claim 6 wherein the guide includes a tubular member defining a bore therethrough along the guide axis, the bore being configured to receive the tool and the wand.

10. The apparatus of claim 6 wherein the guide includes a grooved portion defining a groove extending therethrough along the guide axis, the groove being configured to receive the tool.

11. The apparatus of claim 10 wherein the guide includes a securing means connected to the grooved portion, for selectively (1) securing the tool to the grooved portion and (2) securing the wand in the grooved member with the pointing axis and the guide axis in alignment.

12. The apparatus of claim 6 wherein the guide and the wand are integrally connected.

13. The apparatus of claim 6 wherein the wand includes a tip portion, a portion extending along the pointing axis of the wand, and an offset portion which is offset from the pointing axis, the wand emitters being mounted in a spaced relationship to the offset portion in alignment with the pointing axis of the wand, said guide being configured to receive the wand portion which extends along the pointing axis such that the pointing and guide axes are coincident.

14. The apparatus of claim 13 wherein the wand includes a wand stop fixedly connected to the wand portion which extends along the pointing axis, the wand stop abutting a guide stop surface when the guide receives the wand.

15. The apparatus of claim 13 wherein the wand includes a laser mounted to the offset portion, an output light of the laser being projected along the guide axis.

16. An apparatus for guiding an application of a tool to a subject from an entry point along a trajectory, the apparatus comprising:

a guide member defining a guide axis and having a terminal end positionable on a selected subject entry point, said guide member being configured to support a tool along the guide axis;

a handle connected to the guide member, for holding the terminal end at the selected entry point and for holding the guide axis steady;

a means for emitting signals indicative of an orientation of the guide axis;

a receiver for receiving the emitted signals;

a means connected with the receiver for determining the orientation of the guide axis from the signals;

a means for storing a diagnostic image of the subject;

a means for correlating the guide axis with a coordinate system of the diagnostic data;

a display means for displaying a selected portion of the diagnostic data with the guide axis superimposed thereon.

17. The apparatus of claim 16 wherein the guide member defines a bore in alignment with the guide axis.

18. The apparatus of claim 16 wherein the guide member defines a groove extending in alignment with the guide axis.

19. The apparatus of claim 16 wherein the signal emitting means includes:

a wand which is configured for receipt in the guide member;

at least two emitters affixed to the wand, in a preselected relationship to the guide axis.

20. The apparatus of claim 19 further including a connecting means for releasibly interconnecting the wand and the guide member.

21. The apparatus of claim 19 further including a plurality of wand tips and a connecting means for selectively connecting each of the wand tips to the wand.

22. A method of orienting a tool and guiding an application of the tool to a subject, the method comprising:

a) maneuvering a wand and guide in combination to a proposed entry point and trajectory for application of the tool, the wand including signal emitters;

b) calculating coordinates of the signal emitters from travel times between signals emitted from the emitters and received by at least three receivers held in fixed relationship to the subject;

c) calculating a trajectory and entry point from the emitter coordinates;

d) correlating the calculated entry point and trajectory with electronic diagnostic image data of the subject stored in computer memory;

e) generating a human-readable display of at least a portion of the image data with the trajectory and entry point superimposed thereon;

f) inserting the tool into the guide while maintaining the guide steady at the proposed entry point;

g) applying the tool to the subject through the guide along the proposed trajectory to the proposed entry point.

23. The method of claim 22 further comprising:

inserting a pointing portion of the wand into the guide prior to the maneuvering step, the wand carrying the emitters; and

removing the pointing portion of the wand from the guide prior to the step of inserting the tool into the guide.