Stereotaxy wand and tool guide

• US 5,732,703 A
• Filed: 05/20/1996
• Issued: 03/31/1998
• Est. Priority Date: 11/30/1992
• Status: Expired due to Term

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Steiner, Charles P., Kalfas, Iain H., Kormos, Donald W., Barnett, Gene H., Piraino, David W.
• Primary Examiner(s): Smith, Ruth S.
• Application Number:
  US08/650,455
• Time in Patent Office: 680 Days
• Field of Search: 128/653.1, 128/653.2, 128/653.4, 128/653.5, 128/654, 606/130, 364/413.13, 364/413.22
• US Class Current: 600/407
• 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 three wand emitters (48, 50, 52), mounted in alignment with the pointing axis of the wand. The three emitters selectively emit infrared light which is received by two CCD cameras (14) mounted to a frame assembly (12). The tool guide includes a bore (76) 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 two receivers in a fixed relationship to the subject;

a wand defining a tip portion and a pointing axis of the wand, and having at least three wand emitters mounted in a spaced relationship in a fixed relationship to the pointing axis and the tip, the emitters selectively emitting wand signals which are received by the at least two 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 from the wand signals from the wand emitters which are received by the at least two receivers.

2. The system as set forth in claim 1 further including teeth on one end of the guide for engaging the subject to inhibit the guide from slipping.

3. The system as set forth in claim 1 wherein the emitters emit light.

4. The system as set forth in claim 3 wherein the receivers include CCD arrays.

5. The system as set forth in claim 4 further including a circuit connected with the receiver for determining trajectories between the emitters and the receivers.

6. The system as set forth in claim 1 further including:

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

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

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

a transform means for transforming a position of the wand pointer into a coordinate system of the image data stored in the three-dimensional image memory means, 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.

7. The system as set forth in claim 6 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 positions of the markers on the subject denoted by selectively placing the wand tips on each of the markers with the marker locations in the three-dimensional image data, whereby translational and rotational relationships between a subject space coordinate system and a three-dimensional image data space coordinate system.

8. In a system including a pointer which defines a pointing axis and having a plurality of signal emitters connected therewith, a plurality of receivers for receiving signals emitted by the emitters, and a position determining means for determining an orientation of the pointing axis, an apparatus for orienting a tool and guiding an application of the tool to a subject, the apparatus comprising:

a guide for guiding a tool along a guide axis, said guide having a means for selectively receiving and constraining the pointer with the pointer axis aligned with the guide axis.

9. The system as set forth in claim 8 wherein the guide and the pointer are integrally connected.

10. The system as set forth in claim 8 wherein the receivers include video cameras.

11. 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 distal end positionable on a selected subject entry point, said guide member being configured to support a tool along the guide axis;

a means for holding, the distal end of the guide member at the selected entry point and for holding the guide axis steady;

a signaling means for sending light signals indicative of the guide axis;

a means for receiving the light signals and determining an orientation of the guide axis;

a means for storing a diagnostic image of the subject;

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

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

12. 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 distal end positionable on a selected subject entry point, said guide member being configured to support a tool along the guide axis;

a means for holding the distal end at the selected entry point and for holding the guide axis steady;

a signaling means for indicating a location of the guide member, the signaling means including;

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

at least three emitters affixed to the wand, in a preselected relationship to the guide axis;

at least two receivers for receiving signals emitted by the emitters; and

a means for determining the guide axis from the received signals;

a means for storing a diagnostic image of the subject;

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

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

13. The apparatus as set forth in claim 12 wherein the guide member includes teeth at the distal end of the guide member.

14. 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 distal end, said guide member being configured to support a tool along the guide axis;

a means for fixedly holding the distal end of the guide member at a selected location and orientation relative selected entry point into the subject; and

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

at least a pair of light sources mounted in a fixed relationship to each other and to the guide member;

at least a pair of light receiving means for receiving the light from the light sources;

a circuit for determining trajectories along which light travels between each light source and each light receiving means; and

a means for determining locations of the light sources from intersections of the trajectories and for determining at least an orientation of the guide axis from the determined light source locations.

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

a) maneuvering a guide to a proposed entry point and a proposed trajectory for application of the tool;

b) sending signals which are indicative of the proposed trajectory and the proposed entry point;

c) receiving the signals and deriving a signaled entry point and a signaled trajectory therefrom;

d) correlating the signaled entry point and the signaled 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 and trajectory; and

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

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

a) inserting a pointing portion of a wand into guide, the wand carrying a plurality of radiant energy emitters;

b) maneuvering the guide and wand such that the pointing portion indicates a proposed entry point and trajectory for application of a tool;

c) signaling the trajectory and entry point, the signaling step including;

c1) actuating the emitters to emit radiant energy signals;

c2) receiving the radiant energy signals at least at two fixed locations relative to the subject;

c3) calculating locations of the emitters from the received radiant energy signals; and

c4) calculating the proposed trajectory and the proposed entry point from the locations of the emitters;

d) correlating the signaled 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 and trajectory; and

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

17. The method as set forth in claim 16 wherein the radiant energy signal is infrared light.

18. The method as set forth in claim 16 wherein the step c3) of calculating the emitter locations includes:

calculating trajectories between the two fixed locations at which radiant energy signals are received and the emitters; and

determining intersections of the trajectories.

19. A tool guide for orienting a tool and guiding the tool along a selected trajectory to a subject, the tool guide comprising:

a guide member which receives and constrains a tool to a fixed orientation relative to an axis defined on the guide member; and

a plurality of light sources mounted to the guide member in a fixed relationship to each other, the light sources emitting light of a distinguishable characteristic.

20. The tool guide as set forth in claim 19 wherein the light sources are LED'"'"'s and the emitted light has the distinguishable characteristic of being infrared light.

21. In combination a tool guide for constraining a tool to a fixed orientation relative thereto, a means for holding the tool guide and tool in a fixed relationship relative to a subject, the tool guide having a plurality of light sources in a fixed relationship mounted thereto, and a system for generating a human readable display of diagnostic images of the subject with at least a trajectory of the tool superimposed thereon, the system including:

diagnostic image data representative of the diagnostic images of the subject;

a memory for storing the diagnostic image data;

a plurality of light receivers which receive light from the light sources, the receivers being mounted in a fixed relationship to the subject;

a circuit connected to the light receives for determining a location of the light sources relative to the light receivers and at least a trajectory of the tool relative to the subject;

a circuit for superimposing an indication of at least the trajectory of the tool and the diagnostic image data; and

a monitor for converting the superimposed trajectory indication and diagnostic image data into a human readable display.