Fiducial positioning cup

• US 6,011,987 A
• Filed: 12/08/1997
• Issued: 01/04/2000
• Est. Priority Date: 12/08/1997
• Status: Expired due to Term

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Barnett, Gene H.
• Primary Examiner(s): Lateef, Marvin M.
• Assistant Examiner(s): SHAW, SHAWNA JEANNINE
• Application Number:
  US08/986,863
• Time in Patent Office: 757 Days
• Field of Search: 600/410, 600/414, 600/407, 600/426, 128/899, 606/116, 606/130, 901/46, 395/89, 395/86, 395/93, 378/205, 378/207
• US Class Current: 600/414
• 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 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/371 with simultaneous use of two cameras
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 2090/395 with marking agent for marking skin or other tissue
• CPC Class Codes: A61B 2090/3958 emitting a signal
• CPC Class Codes: A61B 2090/3979 infrared
• 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 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

A fiducial positioning cup (86) has a hemispherical well (92) in its top and a central bore (94) from a bottom of the hemispherical well (92) to a base of the positioning cup (86). The fiducial cup (86) is then attached to the skin (88) of a patient. A needle (110) is passed through the fiducial positioning cup (86) to mark an area of the patient'"'"'s skin (88) with a tattoo (112). Fiducials (84) are secured in the fiducial positioning cups (86). Magnetic resonance or other diagnostic images are taken. Once the images are taken, the fiducials (84) and fiducial positioning cups (86) are removed. The tattoo mark (112) remains. The fiducial positioning cups (86) are reattached when a stereotactic procedure is to be performed. The needle (110) is passed through the fiducial cups (86) and a tip of the needle (110) is aligned with the tattooed mark (112) on the patient'"'"'s skin (88). The fiducial cup (86) is then lowered and centered over the tattooed mark (112). A stereotactic wand (36) is aligned with the magnetic resonance image by placing a tip (42) of the wand (36) in the fiducial cups (86) and emitting signals. The stereotactic system decodes the signals to identify where the tip (42) of the wand (36) is on the magnetic resonance image.

Claims

1. A fiducial cup for a magnetic resonance imaging system for designating a coordinate and trajectory on a subject which includes a 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 two 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 wand position processor 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, an 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 means, a selecting means for selecting data from the three-dimensional image memory, a display for converting the selected data from the image memory into human-readable displays, a transform processor for transforming a position of the wand tip and trajectory into a coordinate system of the image data stored in the image memory, at least three fiducial markers which are imaged during generation of the image data disposed at selected subject positions when the three-dimensional image data was acquired such that locations of the three fiducial markers are identifiable in the three-dimensional image data, each of the fiducial markers being supported by a respective fiducial cup, each fiducial cup comprising:

a fiducial receiving cup having a hemispherical well, a fiducial marker, including an imageable material, being removably secured in the hemispherical well, the hemispherical well of the fiducial receiving cup and the fiducial marker having a common centroid, and the hemispherical well being accessible and defining a concave bearing surface when the fiducial marker is removed; and

a subject surface that is adapted to be removably affixed to a subject.

2. A fiducial cup, comprising:

a fiducial receiving surface defining a hemispherical well for removably receiving a fiducial which includes an imageable material which is imaged in a diagnostic imaging procedure;

a subject surface that removably engages a subject;

a central bore extending from a bottom of the hemispherical well to the subject surface; and

a screw extending through the central bore for attachment to the subject.

3. An apparatus for correlating a physical subject with diagnostic images of the physical subject, the apparatus comprising:

at least three fiducial cups, each fiducial cup including a subject surface, adapted to be secured to a physical subject, and a fiducial receiving surface;

a fiducial marker received in the fiducial receiving surface of said each fiducial cup, said each fiducial marker being spherical and containing an imageable material such that said each of the fiducial markers is imaged in diagnostic images;

a pointer having a tip portion including a spherical well of a common radius with said each fiducial marker which is selectively movable to be touched to each of the fiducial markers; and

an electronic circuit for correlating the pointer with the diagnostic images, the physical subject being correlated with the diagnostic images after the pointer is touched to at least three of the fiducial markers.

4. The apparatus as set forth in claim 3 wherein the imageable material has a physical mass which is centered on a geometric center of the respective fiducial marker, the tip of the pointer being offset from the physical center by a radius of the respective fiducial marker.

5. The apparatus as set forth in claim 4, wherein the pointer has a virtual tip offset from its physical tip by the common radius, such that when said each fiducial marker is received in the concave well of the tip, the virtual tip and the geometric center of the fiducial coincide.

6. The apparatus as set forth in claim 4, wherein the pointer tip includes a spherical end segment of common radius with said each fiducial marker and defines a virtual tip in an interior of the physical tip the common radius from a surface of the spherical segment, such that when the tip is positioned in the fiducial surface of the fiducial cup in the absence of one of the fiducial markers, the virtual tip coincides with the physical center of one of the fiducial markers.

7. The apparatus as set forth in claim 3, wherein the fiducial cup includes a central bore extending between the fiducial surface and the subject surface.

8. A method of correlating locations on a subject with a diagnostic image, the method comprising:

a) identifying at least three locations on a subject;

b) attaching fiducial positioning cups to the at least three locations on the subject;

c) securing respective fiducials to each of the at least three fiducial positioning cups, each fiducial positioning cup including a central bore and defining a well which is shaped to receive the respective fiducials;

d) performing a diagnostic imaging procedure to generate a diagnostic image, the fiducials being identifiable in the diagnostic image;

e) correlating locations on the subject with the diagnostic image;

f) removing the fiducials from the subject; and

g) marking the subject by passing a marker through the central bore such that the marker contacts the subject, the mark providing a reference for repositioning the fiducial positioning cups.

9. A method of correlating locations on a subject with a diagnostic image, the method comprising:

a) identifying at least three locations on a subject;

b) marking the subject to identify the at least three locations at which fiducial positioning cups are to be secured on the subject;

c) attaching the fiducial positioning cups to the at least three locations on the subject, including;

c1) inserting a needle through a central bore of each of the fiducial positioning cups to be secured;

c2) placing a tip of the needle on the mark on the subject; and

c3) sliding the fiducial positioning cup along the needle;

d) securing respective fiducials to each of the at least three fiducial positioning cups, the fiducial positioning cups defining a well which is shaped to receive the respective fiducials;

e) performing a diagnostic imaging procedure to generate a diagnostic image, the fiducials being identifiable in the diagnostic image;

f) correlating locations on the subject with the diagnostic image; and

g) removing the fiducials from the subject.

10. A method of correlating locations on a subject with a diagnostic image of the subject, the method comprising:

a) identifying at least three locations on a subject;

b) attaching respective subject surfaces of fiducial positioning cups to the at least three locations on the subject;

c) securing respective spherical fiducials to respective fiducial receiving surfaces of each of the at least three fiducial positioning cups, the fiducial receiving surfaces defining wells which are shaped to receive the respective spherical fiducials;

d) performing a diagnostic imaging procedure to generate a diagnostic image, the fiducials being identifiable in the diagnostic image;

e) correlating locations on the subject with the diagnostic image, including;

e1) selectively touching a tip of a stereotactic tool to each of the fiducials, the tip having a common radius with each of the fiducials; and

e2) correlating physical locations of the stereotactic pointer with the diagnostic images using an electronic circuit; and

f) removing the fiducials from the subject.

11. A method of correlating locations on a subject with a diagnostic image, the method comprising:

a) identifying at least three locations on a subject;

b) marking the subject to identify the at least three locations at which fiducial positioning cups are to be secured on the subject;

c) attaching respective subject surfaces of the fiducial positioning cups to the at least three locations on the subject, including;

c1) inserting a needle through a central bore of each of the fiducial positioning cups to be attached;

c2) placing a tip of the needle on the mark on the subject; and

c3) sliding the fiducial positioning cup along the needle;

d) securing respective fiducials to respective fiducial receiving surfaces of each of the at least three fiducial positioning cups, the fiducial receiving surfaces defining a hemispherical well which is shaped to receive the respective fiducials;

e) performing a diagnostic imaging procedure to generate a diagnostic image, the fiducials being identifiable in the diagnostic image;

f) correlating locations on the subject with the diagnostic image;

g) removing the fiducials from the subject;

h) defining a virtual point on a stereotactic tool, which virtual point is displaced from a physical point of a stereotactic pointer by a characteristic distance, the stereotactic pointer having a tip with a substantially same shape as each of the fiducials, the well in each of the fiducial positioning cups being shaped to also receive the stereotactic pointer tip, each of the fiducials containing a material including a characteristic point which is imaged during the imaging process and which appears in the diagnostic image, the characteristic point being displaced from a surface of the fiducial by a characteristic distance;

i) after performing the diagnostic imaging procedure, removing each of the fiducials from the respective fiducial positioning cups; and

j) inserting the stereotactic pointer tip in the fiducial positioning cups, such that the virtual tip is coincident with the position which was occupied by the characteristic portion of the respective fiducial before the respective fiducial was removed.

12. A fiducial cup, comprising:

a fiducial receiving cup defining an open well surrounded by a curved bearing surface that defines a cup bearing surface centroid, the cup bearing surface being contoured for selectively receiving a bearing surface of a tool and registering the tool relative to the cup bearing surface centroid;

a fiducial containing an imageable material surrounding an imageable material centroid, the bearing surface centroid and the imageable material centroid being coincident when the fiducial is removably mounted in the well for imaging in a diagnostic imaging procedure; and

a subject surface that is adapted to be removably affixed to a subject.

13. The fiducial cup as set forth in claim 12, further including:

a central bore extending from a bottom of the well to the subject surface.

14. The fiducial cup as set forth in claim 12, wherein the cup bearing surface of the fiducial receiving cup includes a spherical segment well of a common radius with the bearing surface of the tool.

15. The fiducial cup as set forth in claim 12, further including:

an adhesive which removably secures both the subject surface to the subject and the fiducial to the fiducial receiving cup.

16. The fiducial cup as set forth in claim 12, wherein the cup bearing surface is hemispherical for receiving a spherical fiducial.