Computerized workflow method for stent planning and stenting procedure

• US 7,650,179 B2
• Filed: 12/09/2005
• Issued: 01/19/2010
• Est. Priority Date: 12/09/2005
• Status: Active Grant

• Current Assignee: Siemens Healthineers AG (Siemens AG)
• Original Assignee: Siemens AG
• Inventors: Camus, Estelle, Redel, Thomas
• Primary Examiner(s): Le; Long V
• Assistant Examiner(s): Brutus; Joel F
• Application Number:
  US11/298,772
• Publication Number:
  US 20070135707A1
• Time in Patent Office: 1,502 Days
• Field of Search: None
• US Class Current: 600/427
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 5/0066 Optical coherence imaging
• CPC Class Codes: A61B 6/481 involving the use of contrast agents
• CPC Class Codes: A61B 6/504 for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61B 8/06 Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• 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 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61F 2/82 Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: G06T 19/006 Mixed reality object pose determination, tracking or camera calibration for mixed reality G06T7/00

Abstract

In a computerized workflow method for stent planning and conducting a stenting procedure, characteristics of a lesion to be stented are determined from a 3D planning image of the region and selection of an actual stent for stenting the lesion is made with computer-assisted analysis of the lesion based on the characteristics. A virtual stent is electronically generated based on the actual stent, and, using the virtual stent, a best position for the actual stent, for effectively stenting the lesion, is determined. A real time 2D image of the lesion-containing region is displayed during the stenting procedure, with the virtual stent included therein at the aforementioned best position. A physician manually guides the actual stent relative to the lesion during the stenting procedure until the position of the actual stent, as seen in the displayed real time 2D image, coincides with the virtual stent in that image.

Claims

1. A method for computer-assisted stenting, including stent planning, comprising the steps of:

acquiring image data from an internal region of a subject comprising a lumen afflicted with a lesion and reconstructing an at least 3D image of said region from said image data, said 3D image containing and representing characteristics of said lesion;

conducting a stenosis analysis of said lesion characteristics using only said 3D image with at least a portion of said stenosis analysis being automatically electronically conducted by computerized analysis of said lesion characteristics, to obtain a stenosis analysis result;

based on said stenosis analysis result, selecting an actual stent, from among a plurality of available, existing stents of different sizes, to treat said lesion;

in a computer, generating a virtual simulated stent corresponding to said actual stent;

electronically overlaying only said virtual stent on said 3D image and, in a computer, automatically electronically determining a best position of said virtual stent, relative to said lesion, for effectively treating said lesion as well as automatically electronically determining an angulation of a C-arm of an imaging system that will be used during a stenting procedure to implant said actual stent; and

conducting said stenting procedure to implant said actual stent, including generating a real time 2D image of said internal region using said imaging system with said C-arm thereof at said angulation, and combining only said virtual stent at said best position in said real time 2D image, and manually guiding said actual stent in said stenting procedure using said real time 2D image to bring said actual stent to an actual position in said internal region coinciding with said best position.

2. A method as claimed in claim 1 wherein the step of reconstructing an at least 3D image of said internal region comprises reconstructing a 4D image of said internal region from said image data.

3. A method as claimed in claim 1 wherein the step of acquiring said image data comprises acquiring image data from said internal region using a biplane or a monoplane C-arm imaging system.

4. A method as claimed in claim 3 wherein the step of acquiring said image data using a biplane or a monoplane C-arm imaging system comprises:

injecting contrast agent into said internal region and acquiring first image data from said internal region in a first plane with said C-arm in a first angulation position; and

with said contrast agent in said internal region, acquiring second image data from said internal region in a second plane with said C-arm in a second angulation position;

and wherein the step of reconstructing an at least 3D image from said image data comprises;

reconstructing a first 2D image of said internal region from said first image data set and reconstructing a second 2D image of said internal region from said second image data set, and displaying each of said first and second 2D images;

in each of the displayed first and second 2D images, manually indicating marks delimiting said lesion to indicate a lesion-containing portion in each of said first and second 2D images; and

reconstructing said at least 3D image of said region from the respective lesion-containing portions of said first and second 2D images.

5. A method as claimed in claim 1 wherein the step of conducting said stenosis analysis comprises conducting said stenosis analysis completely automatically electronically in a computer, with no manual intervention after starting said stenosis analysis.

6. A method as claimed in claim 1 wherein the step of conducting said stenosis analysis comprises automatically electronically determining at least one intermediate stenosis analysis result and making said intermediate stenosis analysis result available at a computer workstation, and allowing manual intervention via said computer workstation to obtain a final stenosis analysis result.

7. A method as claimed in claim 1 comprising selecting said characteristics in said 3D image, used to conduct said stenosis analysis, from the group consisting of size of said lesion, length of said lesion, extent of said lesion, tissue composition of said lumen, and lumen wall elasticity of said lumen.

8. A method as claimed in claim 1 wherein the step of selecting said actual stent comprises making said stenosis analysis result available to a user, and making a manual selection, by said user of said actual step from among a plurality of available actual stents.

9. A method as claimed in claim 1 wherein the step of selecting a stent comprises automatically electronically comparing said stenosis analysis result to respective sets of stored data representing different available actual stents, to obtain a comparison result, and automatically electronically selecting actual stent based on said comparison result.

10. A method as claimed in claim 9 comprising allowing a user to manually accept the automatically electronically selected actual stent at any time before beginning said stenting procedure.

11. A method as claimed in claim 1 wherein said actual stent comprises a stent marker that is visible in said real time 2D image, and wherein the step of simulating said actual stent as a virtual stent comprises including a virtual representation of said stent marker in said virtual stent.

12. A method as claimed in claim 11 comprising, in said stenting procedure, guiding said actual stent to cause said stent marker in said real time 2D image to coincide with said virtual representation of said stent marker in said virtual stent in said real time 2D image.

13. A method as claimed in claim 1 comprising, in said stenting procedure, guiding said actual stent using a catheter, and wherein the step of determining said best position comprises displaying said 3D image with said virtual stent overlaid thereon and including a representation of said catheter, associated with said virtual stent, in the displayed 3D image.

14. A method as claimed in claim 1 wherein the step of determining said best position comprises determining said best position automatically electronically in a computer without manual intervention after starting said determination of said best position.

15. A method as claimed in claim 1 wherein the step of determining said best position comprises automatically electronically determining an intermediate best position in a computer and making said intermediate best position determination available to a user at a computer workstation, and allowing said user, via said computer workstation, to modify said intermediate best position to obtain a final best position.

16. A method as claimed in claim 15 wherein the step of allowing said user to modify said intermediate best position includes allowing said user to select a different actual stent, and comprising, if a different actual stent is selected, automatically electronically simulating said different actual stent to obtain a virtual different stent, and re-determining said intermediate best position with said virtual different stent overlaid on said 3D image.

17. A method as claimed in claim 1 wherein the step of generating said real time 2D image comprises generating a fluoroscopic image using a C-arm fluoroscopy imaging system.

18. A method as claimed in claim 1 comprising automatically emitting a humanly perceptible signal when the position of said actual stent coincides with said best position.

19. A method as claimed in claim 1 comprising allowing a user, during said stenting procedure, to manually change said angulation of said C-arm to a changed angulation, and automatically electronically re-positioning said best position of said virtual stent in said real time 2D image dependent on said changed angulation.

20. A method for computer-assisted stenting and planning of said stenting, comprising the steps of:

using an imaging modality in a planning step orientation, generating an at least 3D image data set of an internal region of a subject containing a lumen afflicted with a lesion, and an environment around said lesion, at which an actual stent is to be positioned and deployed in a subsequent stenting procedure;

using a computer supplied only with said 3D image data set, analyzing said region and said environment in said 3D image data set and producing a lesion-characterizing data set representing anatomical and pathological characteristics of said lesion and said environment;

using said lesion-characterizing data set, selecting said actual stent for said stenting procedure, from among a plurality of available, existing stents of different sizes, said actual stent having a marker detectable by a stenting procedure imaging modality;

in said computer, generating a virtual stent corresponding to the selected actual stent, including a virtual marker corresponding to said marker of said actual stent, and electronically overlaying only said virtual stent in said 3D image data set at a virtual deployed position optimized to stent said lesion;

from said 3D image data set overlaid with said virtual stent, determining an imaging orientation of said stenting procedure imaging modality for conducting said stenting procedure;

conducting said stenting procedure, including orienting said stenting procedure imaging modality to the selected orientation and generating a real time 2D image of said region with said stenting procedure imaging modality; and

displaying said real time 2D image during said stenting procedure combined only with said virtual stent at said position optimized to stent said lesion, and manually guiding said actual stent relative to said lesion to cause a representation of said actual stent in said real time 2D image to coincide with said virtual stent.