Method for producing high resolution real-time images, of structure and function during medical procedures

• US 6,556,695 B1
• Filed: 09/16/1999
• Issued: 04/29/2003
• Est. Priority Date: 02/05/1999
• Status: Expired due to Term

• Current Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic)
• Original Assignee: Mayo Foundation For Medical Education And Research (Mayo Clinic)
• Inventors: Robb, Richard A., Packer, Douglas L.
• Primary Examiner(s): Patel, Jayanti K.
• Assistant Examiner(s): AZARIAN, SEYED H
• Application Number:
  US09/397,546
• Time in Patent Office: 1,321 Days
• Field of Search: 382/128, 382/130, 382/132, 382/131, 382/133, 382/257, 382/285, 600/450, 600/438, 600/443, 600/440, 600/424, 600/408, 600/458, 600/447, 424/9.4, 345/418, 345/419
• US Class Current: 382/128
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2090/367 creating a 3D dataset from 2D images using position information
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3784 both receiver and transmitter being in the instrument or receiver being also transmitter
• 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 5/02007 Evaluating blood vessel condition, e.g. elasticity, compliance
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 6/503 for diagnosis of the heart
• CPC Class Codes: A61B 6/5247 combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
• CPC Class Codes: A61B 6/541 involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 8/0883 for diagnosis of the heart
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/445 Details of catheter construction
• CPC Class Codes: A61B 8/4488 the transducer being a phased array
• CPC Class Codes: A61B 8/5238 for combining image data of patient, e.g. merging several images from different acquisition modes into one image for image registration algorithms G06T7/30
• CPC Class Codes: G01R 33/563 : of moving material, e.g. flow contrast angiography
• CPC Class Codes: G01R 33/56308 : Characterization of motion or flow; Dynamic imaging
• CPC Class Codes: G01R 33/56333 : Involving spatial modulation of the magnetization within an imaged region, e.g. spatial modulation of magnetization [SPAMM] tagging perfusion imaging based on arterial spin tagging G01R33/56366
• CPC Class Codes: G01R 33/5673 : Gating or triggering based on a physiological signal other than an MR signal, e.g. ECG gating or motion monitoring using optical systems for monitoring the motion of a fiducial marker

Abstract

Images of a heart are acquired with a high resolution medical imaging system used to construct a dynamic high resolution 4D model. During a medical procedure such as endocardial physiology mapping and ablation, real-time images are produced by an ultrasonic transducer inserted into the heart. The high resolution heart model is registered with the acquired real-time images and used to produce dynamic, high resolution images for display during the medical procedure. An electrical activation map which depicts the spatial distribution of heart wall electrical activation is merged with the anatomic images to facilitate cardiac ablation therapy.

Claims

1. A method for producing cardiac images during a medical procedure on a subject, the steps comprising:

a) acquiring image data of the subject'"'"'s heart during successive cardiac phases;

b) reconstructing a high resolution model image of the subject'"'"'s heart from the acquired image data depicting the heart during successive cardiac phases of its functional cycle;

c) acquiring low resolution images of the subject anatomy as the medical procedure is being performed;

d) detecting the cardiac phase as the medical procedure is being performed;

e) registering the high resolution model image with acquired low resolution images as the medical procedure is being performed using the detected cardiac phase; and

f) displaying high resolution images during the medical procedure which employ the registered high resolution model image.

2. The method as recited in claim 1 in which the low resolution images include a medical device in their field of view and the medical device is displayed during the medical procedure by overlaying a depiction of the medical device on the higher resolution images.

3. The method as recited in claim 2 in which the medical device is an ablation device.

4. The method as recited in claim 2 in which the low resolution images are acquired with an ultrasonic transducer inserted into a chamber of the heart.

5. The method as recited in claim 4 in which the medical device is an ablation device inserted into the heart chamber.

6. The method as recited in claim 4 in which the medical device is an electrode assembly inserted into the heart chamber that produces electrical signals.

7. The method as recited in claim 6 in which the electrical signals produced by the electrode assembly are depicted on the high resolution images as activation wave fronts which indicate the timing of signals sensed on a heart chamber wall by the electrode assembly.

8. The method as recited in claim 7 in which the spatial distribution of the activation wave fronts are indicated by different colors.

9. The method as recited in claim 1 in which the high resolution images are depictions of three-dimensional anatomic surfaces.

10. The method as recited in claim 9 in which step e) is performed using a two-dimensional display device.

11. The method as recited in claim 9 in which step e) is performed using a three-dimensional display device.

12. The method as recited in claim 9 in which step e) is performed using a head mounted display.

13. The method as recited in claim 12 in which the anatomic surfaces that are depicted by the head mounted display is determined in part by the spatial orientation of the head mounted display.

14. The method as recited in claim 1 in which the low resolution images are acquired using a transducer having a limited field of view of the subject'"'"'s heart and the displayed high resolution images depict a larger field of view of the subject'"'"'s heart.

15. The method as recited in claim 14 in which the particular part of the subject'"'"'s heart depicted in the displayed high resolution images is determined by the images acquired by the transducer.

16. The method as recited in claim 1 in which the high resolution model image depicts the subject'"'"'s heart at discrete phases of the functional cycle.

17. The method as recited in claim 1 which includes selecting from the high resolution model image a depiction of the subject'"'"'s heart at the detected cardiac phase.

18. The method as recited in claim 16 which includes detecting the cardiac phase as each low resolution image is acquired and the registration in step e) includes producing a depiction of the patient'"'"'s heart by interpolating between two of the discrete phases depicted in the high resolution model image.

19. The method as recited in claim 1 in which an electrode assembly inserted into the heart produces electrical signals which indicate the timing of signals sensed on a heart chamber wall and the method includes:

locating the electrode assembly in the acquired low resolution images; and

depicting the signal timing measured by the electrode assembly on the displayed high resolution images.

20. The method as recited in claim 19 in which the signal timing is depicted by color coding the displayed high resolution images.

21. The method as recited in claim 19 in which the signal timing is depicted by texture coding of the displayed high resolution images.

22. The method as recited in claim 19 in which the signal timing is depicted by the gray scale of the displayed high resolution images.

23. A method for performing a medical intervention procedure on a subject using a medical device, the steps comprising:

a) producing an anatomical image of the subject with a medical imaging system and updating the anatomical image in real-time as the medical intervention procedure is performed by periodically acquiring a low resolution image of the subject which depicts the medical device;

b) acquiring physiological data from the subject with the medical device;

c) spatially registering the physiological data with the anatomical image by spatially registering a low resolution image acquired at substantially the same time as the physiological data is acquired with the anatomical image to thereby locate the medical device therein;

d) producing an output image which merges the spatially registered physiological data with the updated anatomical image; and

e) repeating steps b), c) and d) during the medical intervention procedure to display physiological changes in the subject as the intervention procedure is performed.

24. The method as recited in claim 23 in which the medical device is an endocardial mapping device and the physiological data is electrophysiological data.

25. The method as recited in claim 24 in which the spatially registered physiological data is an electrical activation map that overlays the updated anatomical image.

26. The method as recited in claim 23 in which the anatomic image is produced by acquiring a series of high resolution images that depict the subject as it changes as a function of time during a functional cycle.

27. The method as recited in claim 26 in which the anatomic image is updated by selecting a high resolution image based on information indicative of the functional cycle at the time it is updated.

28. A method for performing a medical procedure on a subject which moves in a repetitive functional cycle, the steps comprising;

a) acquiring image data of the subject during successive phases of the functional cycle prior to performing the medical procedure;

b) reconstructing a model image of the subject which depicts the subject at successive phases of the functional cycle;

c) storing the model image;

d) acquiring images of the subject as the medical procedure is being performed;

e) detecting the phase in the functional cycle of the subject as the medical procedure is being performed; and

f) producing images as the medical procedure is being performed by;

i) selecting from the stored model image an image which depicts the subject at the currently detected functional cycle phase;

ii) registering the image selected in step i) with the image currently acquired in step d);

iii) displaying the registered image; and

iv) repeating steps i), ii), and iii).

29. The method as recited in claim 28 which includes acquiring physiological data from the subject with a medical device during the medical procedure and the location of the medical device with respect to the subject is depicted in the images acquired in step d).

30. The method as recited in claim 29 in which the medical device is an endocardial mapping device and the physiological data is electrophysiological data.

31. The method as recited in claim 30 in which the electrophysiological data produced by the endocardial mapping device is displayed as an electrical activation map that overlays the registered image displayed in step iii).

32. The method as recited in claim 28 in which the medical procedure includes the use of an ablation device and the location of the ablation device with respect to the subject is depicted in the images acquired in step d).

33. The method as recited in claim 32 in which a depiction of the ablation device overlays the registered image displayed in step iii).

34. A method for performing a medical procedure using a medical device on a subject which moves in a repetitive functional cycle, the steps comprising:

a) acquiring image data of the subject during successive phases of the functional cycle prior to performing the medical procedure;

b) reconstructing a model image of the subject which depicts the subject at successive phases of the functional cycle;

c) storing the model image;

d) acquiring information as the medical procedure is being performed which indicates the location of the medical device relative to the subject;

e) detecting the phase in the functional cycle of the subject as the medical procedure is being performed; and

f) producing images as the medical procedure is being performed by;

i) selecting from the stored model image an image which depicts the subject at the currently detected functional cycle phase;

ii) registering the medical device with the image selected in step i) using the information currently acquired in step d);

iii) displaying an image depicting information related to the registered medical device; and

iv) repeating steps i), ii), and iii).

35. The method as recited in claim 34 which includes acquiring physiological data from the subject with the medical device during the medical procedure and the depicted information is derived from the acquired physiological data.

36. The method as recited in claim 35 in which the medical device is an endocardial mapping device and the physiological data is electrophysiological data.

37. The method as recited in claim 36 in which the electrophysiological data produced by the endocardial mapping device is displayed as an electrical activation map that overlays the image displayed in step iii).

38. The method as recited in claim 37 in which the medical procedure includes the use of an ablation device and the location of the ablation device is also acquired in step d) with respect to the subject and the ablation device is also depicted in the image produced in step iii).

39. The method as recited in claim 34 in which the medical procedure includes the use of an ablation device and the location of the ablation device is acquired in step d) with respect to the subject and the ablation device is depicted in the image produced in step iii).