Medical procedures and apparatus using intrabody probes

• US 6,332,089 B1
• Filed: 09/18/1998
• Issued: 12/18/2001
• Est. Priority Date: 02/15/1996
• Status: Expired due to Term

• Current Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Original Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Inventors: Shapiro, Avishai, Govari, Assaf, Fenster, Maier, Acker, David E.
• Primary Examiner(s): Lateef, Marvin M.
• Assistant Examiner(s): MANTIS MERCADER, ELENI M
• Application Number:
  US09/117,803
• Time in Patent Office: 1,187 Days
• Field of Search: 600/300, 600/424, 606/158, 128/898, 128/899
• US Class Current: 600/424
• 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 17/22012 in direct contact with, or very close to, the obstruction or concrement for removing obstructions in blood vessels by laser A61B18/245
• 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 17/3415 for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00482 with a code
• CPC Class Codes: A61B 2017/00725 Calibration or performance testing
• CPC Class Codes: A61B 2017/00876 magnetic
• CPC Class Codes: A61B 2017/22008 used or promoted
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• 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 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/0807 Indication means
• CPC Class Codes: A61B 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/3784 both receiver and transmitter being in the instrument or receiver being also transmitter
• CPC Class Codes: A61B 2090/3786 receiver only
• CPC Class Codes: A61B 2090/3788 transmitter only
• CPC Class Codes: A61B 2090/3908 Soft tissue, e.g. breast tissue
• CPC Class Codes: A61B 2090/3929 : Active markers
• CPC Class Codes: A61B 2090/3958 : emitting a signal
• CPC Class Codes: A61B 2090/3983 : Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 2560/0276 : Determining malfunction
• 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 5/06 : Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/065 : Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6852 : Catheters
• CPC Class Codes: A61B 5/6853 : with a balloon
• CPC Class Codes: A61B 5/6856 : with a distal loop
• CPC Class Codes: A61B 5/6858 : with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 8/0833 : involving detecting or locating foreign bodies or organic structures
• CPC Class Codes: A61B 8/0841 : for locating instruments
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61F 2/954 : for placing stents or stent-grafts in a bifurcation
• CPC Class Codes: A61F 2002/065 : Y-shaped blood vessels
• CPC Class Codes: A61M 2025/0025 : having a collapsible lumen
• CPC Class Codes: A61M 2025/0166 : Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61M 2025/1052 : for temporarily occluding a vessel for isolating a sector
• CPC Class Codes: A61M 25/0023 : by the form of the lumen, e.g. cross-section, variable diameter
• CPC Class Codes: A61M 25/0127 : Magnetic means; Magnetic markers
• CPC Class Codes: A61M 25/10 : Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00
• CPC Class Codes: A61N 5/1064 : for adjusting radiation treatment in response to monitoring
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

A medical probe such as a catheter (20) is guided within the body of a patient by determining the relative positions of the probe relative to another probe, as by transmitting non-ionizing radiation to or from field transducers (30, 230) mounted on both probes. In one embodiment, a site probe (28) is secured to a lesion within the body, and an instrument probe (200) for treating the lesion may be guided to the lesion by monitoring relative positions of the probes. Two or more probes may be coordinated with one another to perform a medical procedure.

Claims

1. A method of guiding a probe in the body of a patient comprising the steps of:

(a) providing a site probe at a site within the body of a patient and providing a instrument probe to be guided within the body of the patient;

(b) transmitting one or more non-ionizing fields to or from each of said probes and detecting each such transmitted field; and

(c) determining the relative disposition of said instrument probe and said site probe by determining a position of each said probe in a common frame of reference based upon the properties of said detected fields and determining said relative disposition based upon the so-determined positions; and

(d) directing said instrument probe toward said site probe based on relative deposition.

2. A method as claimed in claim 1 wherein said directing step includes the step of pointing said instrument probe toward said site probe.

6. A method as claimed in claim 1 further comprising the step of providing one or more elements external to the body of the patient defining said frame of reference, said step of transmitting said fields to or from said probes including the step of transmitting said fields between said probes and said external elements so that at least one property of each such detected field depends upon the dispositions of said probes relative to said one or more external elements.

7. A method as claimed in claim 1 further comprising the steps of placing a reference probe in or on the body of the patient, said transmitting and detecting steps including the steps of transmitting one or more fields to or from said reference probe, and detecting such fields so that at least one property of the detected fields depends upon a disposition of said reference probe, the method further comprising the step of determining a relative disposition of said reference probe and said site probe based upon one or more properties of detected fields.

8. A method as claimed in claim 7 wherein said steps of placing said site probe and said reference probe include the step of placing said reference probe adjacent said site probe.

9. A method as claimed in claim 8 wherein both said site probe and said reference probe are placed on or adjacent to a lesion.

10. A method as claimed in claim 7 further comprising the step of providing a warning signal in response to a change in said spatial relationship between said site probe and said reference probe.

11. A method as claimed in claim 7 further comprising the step of determining a relative disposition of said site probe and said reference probe by imaging the patient and providing a warning signal if the spatial relationship determined based upon said detected fields is different than the spatial relationship determined in said imaging step.

3. A method as claimed in 1 wherein said directing step includes the step of moving said instrument probe toward said site probe.

4. A method as claimed in claim 3 wherein said transmitting step includes the step of generating magnetic fields at said external elements and said detecting step includes the step of detecting said magnetic fields at said probes.

5. A method as claimed in claim 3 wherein said determining step includes the steps of calculating the position of each said probe in said frame of reference and calculating a distance and direction between said instrument and said site from said positions.

12. A method of guiding a probe in a medical patient comprising the steps of:

(a) providing a site probe at a site within the body of a patient and providing a instrument probe to be guided within the body of the patient;

(b) transmitting one or more magnetic fields to or from each of said probes and detecting each such transmitted field;

(c) determining the relative disposition of said site probe and said instrument probe from the properties of said detected fields;

(d) providing an indication of said relative disposition; and

(e) moving said instrument probe within the body of the patient toward said site in response to said indication.

13. A method as claimed in claim 12 wherein said step of providing an indication includes the step of providing said indication in human-perceptible form and said moving step includes the step of manually controlling movement of the instrument probe within the body in response to said indication.

14. A method as claimed in claim 12 wherein said step of providing said indication includes the step of providing said indication in the form of one or more audible signals.

15. A method as claimed in claim 12 wherein said moving step includes the step of automatically controlling movement of the instrument within the body in response to said indication.

16. A method as claimed in claim 12 wherein said step of providing said probes includes the step of imaging the patient'"'"'s body and placing said site probe at said site using the data in said image.

17. A method as claimed in claim 16 wherein said placing step is conducted during the imaging step and said imaging step is performed so that said site probe is included in said image.

18. A method as claimed in claim 17 wherein said site is a site adjacent a lesion, said imaging step being performed so that said lesion is included in the image, the method further including the step of treating the lesion using said instrument probe after said moving step, whereby the instrument is guided to the lesion during said moving step.

19. A method as claimed in claim 13 wherein said step of determining relative disposition includes the step of determining distance between said instrument and said site.

20. A method as claimed in claim 19 wherein said step of determining relative disposition includes the step of determining only said distance, without determining direction from said instrument to said site.

21. A method as claimed in claim 20 wherein said step of determining relative disposition includes the step of determining direction from said instrument to said site.

22. A method as claimed in claim 12 wherein said transmitting, detecting and determining steps and said step of providing said perceptible indication are performed during said moving step so as to alter said perceptible indication in real time as the instrument moves.

23. A method of coordinating two probes, comprising:

(a) providing a first and second probe, each of which has a field transducer mounted thereon;

(b) performing a first medical procedure at a first location using the first probe;

(c) performing a second medical procedure at a second location using the second probe;

(d) determining the relative positions of the probes in a common frame of reference by transmitting one or more non-ionizing magnetic fields to or from said field transducers on said probes; and

(e) coordinating the two medical procedures using the determined relative positions in the common frame of reference.

24. A method according to claim 23, wherein the second probe is a microbubble injecting probe.

25. A method according to claim 23, wherein said step of determining the relative positions of the probes comprises:

(a) determining the position of the first probe using non-ionizing magnetic radiation;

(b) determining the position of the second probe using non-ionizing magnetic radiation; and

(c) subtracting the two positions.

26. A method of displaying the relative positions of an instrument and a site within the body of a living subject for directing the instrument toward the site comprising the steps of:

(a) providing an arbitrary representation of the instrument on a planar display;

(b) providing a projection of space in a plane perpendicular to an axis of the instrument on said display, said projection of space including an arbitrary representation of the site, said projection being selected so that said representation of said site is aligned with said representation of the instrument when said axis of said instrument is aligned with said site; and

(c) altering the relative sizes of said site representation relative to said instrument representation as distance between said instrument and said site change.

27. A method as claimed in claim 26 wherein said altering step is conducted so that the size of the site representation increases as said distance decreases.

28. A method as claimed in claim 26 wherein said projection of space includes representations of a fixed coordinate system, whereby said fixed coordinate representations will move on said display as orientation of said axis of said instrument changes.

29. A method of coordinating a plurality of probes, comprising:

(a) providing a first probe, a second probe, and a third probe each of which has a field transducer mounted thereon;

(b) performing a first medical procedure at a first location using the first probe;

(c) performing a second medical procedure at a second location using the second probe;

(d) performing a third medical procedure at a third location using the third probe, wherein the third medical procedure is coordinated with the two medical procedures;

(e) determining the relative positions of the probes by transmitting one or more nonionizing fields to or from said field transducers on said probes; and

(f) coordinating the medical procedures using the determined relative positions.

30. A method of coordinating two probes, comprising;

(a) providing a first and second probe, each of which has a field transducer mounted thereon, wherein the second probe is an ultrasonic imaging probe;

(b) performing a first medical procedure at a first location using the first probe;

(c) performing a second medical procedure at a second location using the second probe;

(d) determining the relative positions of the probes by transmitting one or more non-ionizing fields to or from said field transducers on said probes; and

(e) coordinating the two medical procedures using the determined relative positions.

31. A method of coordinating two probes, comprising:

(a) providing a first and second probe, each of which has a field transducer mounted thereon;

(b) performing a first medical procedure at a first location using the first probe;

(c) performing a second medical procedure at a second location using the second probe;

(d) determining the relative positions of the probes by transmitting one or more non-ionizing fields to or from said field transducers on said probes; and

(e) coordinating the two medical procedures using the determined relative positions wherein the medical procedure performed using said first probe forms debris and said second probe is a vacuuming probe which removes said debris.