Magnetic resonance stereotactic surgery with exoskeleton tissue stabilization

• US 5,682,890 A
• Filed: 01/26/1995
• Issued: 11/04/1997
• Est. Priority Date: 01/26/1995
• Status: Expired due to Term

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Picker International, Inc. (Koninklijke Philips N.V.)
• Inventors: Kormos, Donald W., Piraino, David W.
• Primary Examiner(s): Lateef, Marvin M.
• Assistant Examiner(s): MANTIS MERCADER, ELENI M
• Application Number:
  US08/378,511
• Time in Patent Office: 1,013 Days
• Field of Search: 128/653.1, 128/653.2, 128/653.5, 128/303 B, 378/205, 378/206, 378/37, 356/247, 356/248, 606/130
• US Class Current: 600/417
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• 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 2090/374 NMR or MRI
• CPC Class Codes: A61B 2090/3954 magnetic, e.g. NMR or MRI
• 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 6/0421 with immobilising means
• CPC Class Codes: A61B 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/14 Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• CPC Class Codes: A61B 90/18 Retaining sheets, e.g. immobilising masks made from a thermoplastic material

Abstract

An exoskeleton material (12), such as a thermoplastic mesh, is heat softened. The heat softened material is stretched over and conformed to a soft tissue region of the patient, such as a patient'"'"'s breast. The material is allowed or caused to set or harden and is affixed (14) to a patient support (10) such that the soft tissue is firmly constrained. Magnetic resonance visible markers (18) are affixed to the exoskeleton material adjacent the soft tissue. The patient is examined with a magnetic resonance imaging device (20) to generate a three-dimensional image representation (28) for display on a monitor (32). Using the markers, a wand (40) with emitters (42) receivers (44), and a coordinate system relationship processor (48) determines, a relation or transform between a coordinate system of the patient and a coordinate system of the image is determined and displayed on the monitor. A trajectory for a biopsy, resection, or the like, is planned using a guide (50). Emitters (52) on the guide are activated to generate a corresponding human-readable trajectory display through the image displayed on the monitor. After repositioning the guide as necessary, an appropriate trajectory and depth through the patient is selected from the human-readable display. An appropriate medical instrument (64) is inserted along the guide to perform the biopsy, resection, or other medical procedure.

Claims

1. A stereotactic breast surgery method comprising:

stretching and conforming a stretchable non-ferrous exoskeleton material to a breast of a patient who is supported by a patient support;

fixing the exoskeleton material relative to the patient support such that the breast is constrained against movement;

affixing magnetic resonance markers to the exoskeleton material;

positioning at least the breast of the patient, the patient support, and the exoskeleton material in a magnetic resonance imaging system;

generating a volumetric electronic image representation with the magnetic resonance imaging system;

converting selected portions of the volumetric electronic image representation to a human-readable display of at least the breast and the markers;

establishing a relationship between a coordinate system of the human-readable displays of the volumetric electronic image representation and a coordinate system of the patient'"'"'s breast and the exoskeleton material;

positioning a guide for defining a trajectory along which a surgical instrument is to be inserted through the exoskeleton material into the breast;

generating a human-readable display of the trajectory superimposed on the human-readable display of the selected portions of the volumetric electronic image representation;

adjusting the trajectory toward intersecting a selected internal region of the breast;

generating a human-readable display of the adjusted trajectory superimposed on the human-readable display of the selected portions of the volumetric electronic image representation;

checking the trajectory to be sure it (1) intersects the selected region and (2) avoids regions that would be damaged by the surgical instrument passing therethrough;

inserting the surgical instrument along the adjusted trajectory;

removing at least a portion of the selected interior region in performing at least one of a biopsy and a resection;

withdrawing the surgical instrument.

2. The method as set forth in claim 1 further including causing the stretchable exoskeleton material to set to a relatively rigid state after conforming the exoskeleton material to the breast.

3. The method as set forth in claim 2 further including prior to stretching and conforming the exoskeleton material, temporarily softening the exoskeleton material.

4. The method as set forth in claim 1 further including prior to inserting the surgical instrument, removing a portion of the exoskeleton material adjacent the trajectory.

5. The method as set forth in claim 1 wherein the exoskeleton material has a plurality of apertures therethrough and wherein the trajectory defining step includes defining a trajectory through one of the exoskeleton material apertures.

6. The method as set forth in claim 1 wherein the exoskeleton material is a thermoplastic mesh, and further including:

prior to the stretching and conforming step, heat softening the thermoplastic mesh and cooling the heat softened thermoplastic mesh below human body temperature; and

after the stretching and conforming step, causing the thermoplastic material to set to a stiff, relatively rigid state.

7. A stereotaxy method comprising:

applying and conforming a stretchable non-ferrous material to a soft tissue patient portion which lacks a shape defining skeleton;

fixing the stretchable non-ferrous material relative to a support which supports at least a portion of the patient adjacent to the soft tissue such that the patient soft tissue is constrained against movement;

affixing markers to the material;

positioning at least the soft tissue portion of the patient, and exoskeleton material in a non-invasive diagnostic imaging system;

generating a volumetric electronic image representation with the non-invasive diagnostic imaging system;

converting selected portions of the volumetric electronic image representation to a human-readable display of the soft tissue portion and the markers;

positioning a guide for defining a trajectory along which a surgical instrument is to be inserted through the exoskeleton material into the soft tissue portion of the patient;

inserting the surgical instrument along the trajectory.

8. The method as set forth in claim 7 wherein the exoskeleton material is a thermoplastic mesh, and further including:

prior to the applying and conforming step, heat softening the thermoplastic mesh and cooling the heat softened thermoplastic mesh below human body temperature; and

after the applying and conforming step, causing the thermoplastic material to set to a stiff, relatively rigid state.

9. The method as set forth in claim 8 further including moving the patient to a remote site before the step of inserting the surgical instrument.

10. The method as set forth in claim 8 wherein the non-invasive diagnostic imaging system is a magnetic resonance imaging system and wherein the guide and the surgical instrument are non-ferrous and wherein the step of inserting the surgical instrument is performed in the magnetic resonance imaging system.

11. The method as set forth in claim 10 wherein the guide has at least portions which are imagable in a magnetic resonance imaging machine and further including imaging the guide along with the soft tissue portion of the patient to establish a relationship between a coordinate system of the human-readable display and a coordinate system of the soft tissue portion of patient and the guide.