Frameless stereotaxy system for indicating the position and axis of a surgical probe

• US 5,776,064 A
• Filed: 05/20/1996
• Issued: 07/07/1998
• 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., Steiner, Charles P., Kormos, Donald W., Barnett, Gene H., Piraino, David W.
• Primary Examiner(s): Smith, Ruth S.
• Application Number:
  US08/650,312
• Time in Patent Office: 778 Days
• Field of Search: 129/653.1, 129/653.2, 606/130, 364/413.13, 364/413.22, 378/4, 378/20, 378/205, 600/414, 600/417, 600/426, 600/429
• 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 stereotaxy system comprising:

a subject support;

a frame assembly which mounts a plurality of receivers in a fixed relationship to the subject support;

at least one of a pointer and a surgical tool;

a tool guide having at least two emitters mounted thereto, the at least two emitters selectively emitting signals which are received by the plurality of receivers, the tool guide defining a channel which selectively receives at least one of the pointer and the surgical tool such that at least one of the pointer and the tool is aligned with a trajectory defined by the tool guide; and

a position determining means for determining the trajectory defined by the tool guide from the emitted signals travelling between the emitters and the plurality of receivers.

2. The system according to claim 1 further including:

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

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;

a transform means for transforming the trajectory defined by the tool guide 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 the defined trajectory.

3. The system according to claim 2 wherein the pointer is received in the tool guide, the system further including:

at least three markers adapted to be disposed on selected portions, of a subject, locations of the three markers being identifiable in the three-dimensional image data; and

a transform calculating means for calculating a transform between positions of the markers, when disposed on the subject, denoted by selectively placing the pointer 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 are calculated.

4. The system according to claim 3 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.

5. The system according to claim 1 wherein the emitters emit infrared light.

6. The system according to claim 1 wherein the tool guide defines a bore through which the defined trajectory extends.

7. The system according to claim 1 further including:

a means for positioning the tool guide.

8. The system according to claim 7 wherein the tool guide positioning means includes a handle.

9. A stereotaxy method comprising:

a) securing a portion of a subject to a subject supporting surface in close proximity to a plurality of signal receivers that are mounted in a fixed relationship to the subject supporting surface;

b) positioning a wand in a tool guide having at least two emitters mounted thereon for selectively emitting signals which are received by the receivers;

c) positioning the wand and tool guide to designate selected locations on the subject portion;

d) actuating the emitters individually in close temporal proximity to emit signals; and

e) from the signals, calculating coordinates of the locations designated by the wand in a coordinate system of the subject support.

10. The method according to claim 9 further including:

conducting a first non-invasive diagnostic examination of the subject portion and generating three-dimensional electronic image data thereof;

storing the three-dimensional image data;

determining a transform between a first data coordinate system and the subject support coordinate system.

11. The method according to claim 9 wherein the transform determining step includes:

mounting at least three non-invasive examination visible markers to the subject portion such that the three-dimensional diagnostic image data includes indications of the at least three markers;

with the wand and tool guide designating a position of each of the three markers and determining a coordinate of each marker in the subject support coordinate system;

comparing the coordinates of the markers in the subject support coordinate system and a position of the marker indications in the image data coordinate system to determine at least a translation offset between the image data and subject support coordinate systems and a rotational offset between the subject support and image data coordinate systems.

12. The method according to claim 9 further including:

conducting a second non-invasive diagnostic examination of the subject portion and generating three-dimensional electronic image data thereof;

storing the second examination three-dimensional image data;

determining a transform between the second image data coordinate system and the subject support coordinate system;

determining a relationship between the first and second image data coordinate systems.

13. The method according to claim 9 wherein the actuating step includes actuating the emitters to emit infrared signals.

14. In combination a surgical tool and an apparatus for guiding the surgical tool in relation to a subject, the apparatus for guiding the surgical tool comprising:

a guide means for guiding the surgical tool along a trajectory; and

at least two signal emitters mounted in a fixed relationship to the guide means;

a receiving means for receiving the signals emitted by the signal emitters; and

a means connected to the receiving means for determining a position of the guide means.

15. In the combination according to claim 14, wherein the receiving means is mounted to one of a subject support, a ceiling of a room, and a mounting pole.

16. In the combination according to claim 14, wherein the emitters emit one of sonic, infrared, and radio frequency signals.

17. In the combination according to claim 14, wherein the means for guiding includes a bore adapted to receive the surgical tool.

18. In the combination according to claim 17, wherein the surgical tool is a drill.

19. In the combination according to claim 14, wherein the surgical tool is a biopsy needle.

20. In the combination according to claim 14, the apparatus for guiding the surgical tool further including:

a means for storing data indicative of an image of a subject, the image having an image coordinate system;

a means for determining the trajectory in relation to the image coordinate system; and

a display means for displaying a selected portion of the image data with the trajectory superimposed thereon.

21. A method for guiding the application of a surgical tool in relation to a patient, the method comprising:

acquiring electronic diagnostic image data of a patient;

maneuvering a tool guide to a proposed trajectory in relation to a patient for application of a surgical tool, the tool guide including at least two signal emitters and being configured to selectively receive the surgical tool;

receiving the signals emitted by the emitters;

calculating coordinates of the signal emitters based on the received signals;

calculating the trajectory to which the tool guide has been maneuvered based on the calculated emitter coordinates;

correlating the calculated trajectory with the electronic diagnostic image data of the patient; and

generating a human readable display of at least a portion of the image data with the trajectory superimposed thereon.

22. The method for guiding the application of a surgical tool according to claim 21, further including:

inserting the tool into the tool guide; and

applying the tool to the patient along the trajectory.

23. The method for guiding the application of a surgical tool according to claim 22, wherein the tool guide includes a bore in alignment with the proposed trajectory and in the applying step the tool is moved along and through the bore.

24. The method for guiding the application of a surgical tool according to claim 21, further including:

maintaining the tool guide in place at the proposed trajectory.