Catheterscope 3D guidance and interface system

• US 7,901,348 B2
• Filed: 12/10/2004
• Issued: 03/08/2011
• Est. Priority Date: 12/12/2003
• Status: Active Grant

• Current Assignee: University of Washington
• Original Assignee: University of Washington
• Inventors: Seibel, Eric J., Glenny, Robb W., Soper, Timothy D.
• Primary Examiner(s): Sweet; Thomas J
• Assistant Examiner(s): SMITH, PHILIP ROBERT
• Application Number:
  US11/009,699
• Publication Number:
  US 20050182295A1
• Time in Patent Office: 2,279 Days
• Field of Search: 600/103, 600/117, 600/118, 600/411
• US Class Current: 600/117
• CPC Class Codes: A61B 1/000096 using artificial intelligence
• CPC Class Codes: A61B 1/00016 using wireless means
• CPC Class Codes: A61B 1/00045 Display arrangement
• CPC Class Codes: A61B 1/00097 Sensors
• CPC Class Codes: A61B 1/00172 with means for scanning
• CPC Class Codes: A61B 1/005 Flexible endoscopes
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• CPC Class Codes: A61B 1/2676 Bronchoscopes
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2090/3762 using computed tomography systems [CT]
• 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 5/062 using magnetic field
• 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 5/066 Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• 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 6/541 involving acquisition triggered by a physiological signal

Abstract

Visual-assisted guidance of an ultra-thin flexible endoscope to a predetermined region of interest within a lung during a bronchoscopy procedure. The region may be an opacity-identified by non-invasive imaging methods, such as high-resolution computed tomography (HRCT) or as a malignant lung mass that was diagnosed in a previous examination. An embedded position sensor on the flexible endoscope indicates the position of the distal tip of the probe in a Cartesian coordinate system during the procedure. A visual display is continually updated, showing the present position and orientation of the marker in a 3-D graphical airway model generated from image reconstruction. The visual display also includes windows depicting a virtual fly-through perspective and real-time video images acquired at the head of the endoscope, which can be stored as data, with an audio or textual account.

Claims

1. A system for visually guiding a flexible endoscope through linked passages within a body, comprising:

(a) a signal source that emits a reference signal useful for spatially tracking a progress of the flexible endoscope through the linked passages, as the flexible endoscope is flexibly bent around corners while being advanced through the linked passages;

(b) a sensor that produces an output signal indicating coordinates that define a three-dimensional disposition of a distal end of the flexible endoscope using the reference signal of the signal source to continuously determine the three-dimensional disposition of the distal end as it is advanced through the linked passages;

(c) a three-dimensional model of the linked passages;

(d) a processor for determining positions of branching points and for providing indicators that indicate positions of branching points on the three-dimensional model at which the linked passages connect or diverge, said processor specifying at least initially, at least one predefined path on the three-dimensional model from a plurality of paths formed by the linked passages connecting or diverging, along which to advance the flexible endoscope through the linked passages; and

(e) a display for displaying a view from within the linked passages as the flexible endoscope is advanced therethrough, to enable the flexible endoscope to be visually guided and tracked along a path actually followed through the linked passages, the output signal providing a record of the path followed as the flexible endoscope is advanced and enabling the display to show a current position of the endoscope, relative to the three-dimensional model of the linked passages.

2. The system of claim 1, wherein said three-dimensional model is derived from the record of the sensor output signal acquired during a previous exploration of at least a part of the linked passages.

3. The system of claim 1, wherein the three-dimensional model is derived from an image of a portion of a body in which the linked passages are disposed, the model providing an indication of an orientation and a disposition of the linked passages relative to a specific anatomical feature.

4. The system of claim 1, wherein the signal source comprises an electromagnetic field source, and wherein the signal source and sensor together comprise at least five coils configured to sense at least a three-dimensional position of a distal portion of the flexible endoscope relative to the electromagnetic field source.

5. The system of claim 1, wherein the signal source comprises an electromagnetic field source comprising three coils, and wherein the sensor comprises at least one coil configured to sense at least five degrees of freedom in regard to a three-dimensional position and an orientation of the distal portion of the flexible endoscope.

6. The system of claim 2, further comprising a body function sensor configured to be disposed adjacent to one of a sternum, a thorax, and a mouth of a patient, to monitor at least one of breathing, a chest orientation, and a deformation of airways of a patient, for at least one of updating the three-dimensional model in regard to changes caused by at least one body function, and gating a determination of a disposition of the distal end of the flexible endoscope in regard to the at least one body function.

7. The system of claim 1, wherein the flexible endoscope includes a vibrating optical fiber that scans a region adjacent to the distal end of the flexible endoscope, producing a signal that is used to drive the display.

8. A method for guiding a flexible endoscope through linked passages to either perform a diagnostic procedure or reach a desired location in a patient'"'"'s body, while tracking the disposition of a distal end of the flexible endoscope, comprising the steps of:

(a) creating a three-dimensional model of the linked passages;

(b) specifying positions of branching points at which the linked passages connect or diverge on the three-dimensional model and specifying at least one predefined path from a plurality of paths formed by the linked passages connecting or diverging on the three-dimensional model, along which to advance the flexible endoscope through the linked passages;

(c) providing an external tracking signal that serves as a reference relative to the linked passages within the patient'"'"'s body;

(d) tracking a disposition of the distal end of the flexible endoscope as it is flexibly bent around turns while being advanced along the predefined path through the linked passages, using an output signal produced in response to sensing the external tracking signal, said output signal being produced adjacent to the distal end of the flexible endoscope, the output signal indicating coordinates that define a disposition of the distal end of the flexible endoscope relative to the three-dimensional model as the flexible endoscope is advanced; and

(e) advancing the distal end of the flexible endoscope around bends through the linked passages along a path corresponding to the predefined path, as determined at least in part by the image of the region and the output signal, to reach the desired location in the patient'"'"'s body, while resolving any differences between;

(i) a current position of the distal end of the flexible endoscope within the linked passages, as determined by the sensor output signal; and

(ii) details of the linked passages as specified by the three-dimensional model.

9. The method of claim 8, wherein the step of providing the external tracking signal comprises the step of transmitting an electromagnetic signal that penetrates the patient'"'"'s body, the electromagnetic signal providing a three-dimensional reference for determining the position of the distal end of the flexible endoscope relative to the linked passages, as indicated by the output signal.

10. The method of claim 9, wherein the step of tracking further comprises the step of determining a position of the distal end of the flexible endoscope relative to the linked passages using the three-dimensional reference provided by the electromagnetic signal.

11. The method of claim 8, wherein the step of resolving any differences further comprises the steps of using the flexible endoscope for imaging a region of the linked passages that is adjacent to the distal end of the flexible endoscope, and comparing the imaging of the region with the three-dimensional model, to refine and correct an apparent error in the three-dimensional model.

12. The method of claim 11, further comprising the steps of:

(a) retracting the flexible endoscope away from a region of interest, through the linked passages;

(b) refining the three-dimensional model based upon the path followed to reach the region of interest; and

(c) assigning the path followed to reach the region of interest to a specific passage within the three-dimensional model.

13. The method of claim 11, wherein after the flexible endoscope has been withdrawn from the patient'"'"'s body, further comprising the step of adjusting the three-dimensional model to match a path followed through the linked passages in reaching at least one region of interest in the patient'"'"'s body.

14. The method of claim 11, further comprising the steps of:

(a) monitoring at least one body function that causes changes in a disposition of the linked passages; and

(b) adjusting the three-dimensional model in regard to data monitored for the at least one body function.

15. The method of claim 14, wherein the step of tracking the disposition of the distal end of the flexible endoscope as it is advanced through the linked passages comprises the step of only enabling tracking function when a state of the at least one body function is substantially identical to that when the three-dimensional model was produced, to minimize an error in tracking the distal end of the flexible endoscope that would otherwise arise due to differences in the state of the at least one body function.

16. The method of claim 8, further comprising the step of using the flexible endoscope for imaging a region of the linked passages that is adjacent to the distal end of the flexible endoscope, to display an image of the region.

17. The method of claim 11, further comprising the step of enabling a user to selectively rotate the three-dimensional model and images produced by imaging with the flexible endoscope.

18. The method of claim 11, wherein the step of advancing comprises the steps of:

(a) establishing an arbitrary reference point relative to the three-dimensional model for use in determining the path through the linked passages;

(b) with regard to the arbitrary reference point, establishing three-dimensional model frame coordinates for bifurcations in the linked passages and the desired location; and

(c) determining at least a portion of the path through the linked passages to the desired location, by reference to the three-dimensional model frame coordinates and by visually detecting each bifurcation as the distal end of the flexible endoscope is advanced through the linked passages.

19. The method of claim 18, wherein the step of advancing further comprises the step of establishing at least one calibration point relative to the three-dimensional model based on an anatomical feature within the patient'"'"'s body.

20. The method of claim 19, further comprising the step of scanning the anatomical feature with the flexible endoscope.

21. The method of claim 19, further comprising the step of contacting the anatomical feature with the flexible endoscope.

22. The method of claim 19, further comprising the step of imaging the anatomical feature with the flexible endoscope.

23. The method of claim 19, further comprising the step of imaging the anatomical feature with a calibrated field, using the flexible endoscope.

24. The method of claim 23, further comprising the steps of:

(a) imaging another anatomical feature with another calibrated field, using the flexible endoscope; and

(b) stitching images of the anatomical feature and the other anatomical feature together, using the calibrated fields.

25. The method of claim 23, further comprising the step of painting the optical image onto the three-dimensional model as a texture map.

26. The method of claim 19, providing a calibrated motion correction to the three-dimensional model for motion of the flexible endoscope relative to the three-dimensional model, by producing a time sequence of images of the anatomical feature.

27. The method of claim 18, wherein the step of advancing further comprises the steps of:

(a) displaying a graphic image of the three-dimensional model; and

(b) indicating a position of the distal end of the flexible endoscope on the graphic image, where the position is determined from the output signal.

28. The method of claim 27, wherein the step of advancing further comprises the steps of:

(a) plotting the path of the distal end of the flexible endoscope as a virtual fly-through of the three-dimensional model before advancing the flexible endoscope through the linked passages; and

(b) resolving a direction to take at any branching point of the linked passages in the graphic image that is displayed in real-time as the flexible endoscope is advanced through the linked passages along the predefined path, using the model and through direct comparison of the path that was plotted with the position of the distal end of the flexible endoscope indicated on the graphic image.

29. The method of claim 27, wherein the step of advancing further comprises the steps of:

(a) based on the three-dimensional model, determining an angle of deviation of each subtended branch in the linked passages along which the flexible endoscope may be advanced; and

(b) on the graphic image, overlaying a visual marker on a branch that should be followed for the path to reach the desired position, to indicate an appropriate direction of travel at the branch corresponding to the predefined path.

30. The method of claim 27, wherein the step of advancing further comprises the steps of:

(a) analyzing the graphic image showing the position of the distal end of the flexible endoscope to segment regions of low intensity associated with passages at a bifurcation, showing two-dimensional deflection angles for each passage; and

(b) choosing one of the passages through which to advance the flexible endoscope based upon how closely the two-dimensional deflection angles of said one of the passages correlates with a two-dimensional deflection angle of a passage indicated in the three-dimensional model.

31. The method of claim 27, wherein if the path to reach the desired location is beyond a limit of the three-dimensional model, the step of advancing further comprises the steps of:

(a) using the output signal employed for tracking, while beyond the limit of the three-dimensional model, computing a time-average position of the distal end of the flexible endoscope; and

(b) updating the three-dimensional model with a branching tree model, produced from the position of the distal end of the flexible endoscope that was computed and extending from the limit of the three-dimensional model showing each bifurcation and the path along which the flexible endoscope was advanced to produce the branching tree model.

32. The method of claim 31, further comprising the steps of:

(a) analyzing subsequent image frames produced by the flexible endoscope to evaluate movement of one of the flexible endoscope and the body of the patient based upon determining differences in successive images; and

(b) refining a position of the distal end of the flexible endoscope based upon the evaluation of the movement.

33. The method of claim 32, further comprising the step of comparing image frames of the linked passages currently produced by the flexible endoscope with previous image frames, for determining the path to follow through the linked passages when advancing the distal end of the flexible endoscope.

34. The method of claim 31, wherein the path followed by the distal end of the flexible endoscope in producing the branching tree model seeks to minimize a distance between the position of the distal end and the desired position, and wherein a predefined threshold for a deviation away from the desired position is applied to determine when to backtrack the flexible endoscope within the linked passages and select a different passage along which to advance the flexible endoscope.

35. The method of claim 31, further comprising the step of only following a path if a current position of the distal end of the flexible endoscope is less than a predefined threshold distance from a desired destination, and if the predefined threshold is exceeded, moving back along the path and taking a different path at a previous branch in the linked passages.

36. The method of claim 31, further comprising the step of displaying a vector indication of a current location and a bearing for the distal end of the flexible endoscope, as feedback to a user who is advancing the flexible endoscope through the linked passages.

37. The method of claim 31, further comprising the step of displaying a delta for each of a plurality of coordinates, and a delta for a total distance, between a current location of the distal end of the flexible endoscope and a desired location in the patient'"'"'s body.

38. The method of claim 27, further comprising the step of painting a surface of the three-dimensional model that is displayed, with an image that includes a texture, only at a location of an anatomical feature in the patient'"'"'s body.

39. The method of claim 27, further comprising the steps of:

(a) imaging anatomical features at spaced-apart locations in a patient'"'"'s body; and

(b) painting a surface of the three-dimensional model displayed between the anatomical features, using stitched images that are based on images of the anatomical features.

40. The method of claim 27, further comprising the steps of:

(a) imaging anatomical features in the patient'"'"'s body using a calibrated imaging field, producing calibrated images; and

(b) stitching the calibrated images together to carry out at least one of the steps of;

(i) offsetting any accumulated error in the three-dimensional model in regard to tracking the distal end of the flexible endoscope; and

(ii) more accurately tracking the distal end of the flexible endoscope when beyond a limit of the three-dimensional model.

41. The method of claim 8, wherein the step of creating the three-demensional model comprises the steps of:

(a) non-invasively imaging the patient'"'"'body where the linked passages are disposed; and

(b) creating the three-dementional model from the image of linked passages within the patientg'"'"'body.

42. The method of claim 8, further comprising the step of taking a tissue sample while the flexible endoscope is within the linked passages.

43. The method of claim 8, further comprising the step of storing data relating to a procedure carried out with the flexible endoscope on the patient.

44. The method of claim 43, wherein the data includes at least one of:

(a) an indication of the path followed by the flexible endoscope, including at least an indication of passages that were entered with the flexible endoscope;

(b) a location in the patient'"'"'s body where a tissue sample was taken with the flexible endoscope;

(c) a comment by a user of the flexible endoscope during the procedure; and

(d) an image of the location where the tissue sample was taken.

45. The method of claim 8, further comprising the step of correcting a current position of the distal end of the flexible endoscope in the linked passages for a movement caused by a physiological activity of the patient'"'"'s body that changes a disposition of a passage in which the distal end of the flexible endoscope is present.

46. The method of claim 8, wherein after the desired location is reached, further comprising the step of enabling a user to selectively record a most efficient path followed by the flexible endoscope through the linked passages to reach the desired location.

47. The method of claim 8, wherein the step of tracking the distal end of the flexible endoscope comprises the step of projecting a position of the distal end of the flexible endoscope to a point on a three-dimensional path defined by the three-dimensional model, said point representing a most likely position of the distal end of the flexible endoscope relative to the linked passages of the three-dimensional model.

48. The method of claim 16, wherein the step of tracking the distal end of the flexible endoscope comprises the step of further refining a position of the distal end of the flexible endoscope to align features identified in the image of the region with feature locations included in the three-dimensional model of the linked passages.