System for navigating a planned procedure within a body

• US 8,150,497 B2
• Filed: 10/20/2006
• Issued: 04/03/2012
• Est. Priority Date: 09/08/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gielen, Frans L. H., Hertel, Frank, Gemmar, Peter, Appenrodt, Peter
• Primary Examiner(s): Casler, Brian
• Assistant Examiner(s): Santos, Joseph M
• Application Number:
  US11/584,422
• Publication Number:
  US 20080097187A1
• Time in Patent Office: 1,992 Days
• Field of Search: 600/103, 600/117, 600/407, 600/426, 600/427, 600/429, 382/128, 382/154, 606/130
• US Class Current: 600/427
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• 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 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/256 having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/367 creating a 3D dataset from 2D images using position information
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• 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 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: G06T 2207/10072 Tomographic images
• CPC Class Codes: G06T 2207/30016 Brain
• CPC Class Codes: G06T 7/0012 Biomedical image inspection

Abstract

A system including a processor and/or processor system can be used to create a plan for a procedure, such as a surgical procedure. The plan for the surgical procedure can be based on various elements, including determined anatomical landmarks that can be used to determine anatomical targets of a patient. The planning processor can be used to determine the anatomical landmarks and identify anatomical targets in image data of a subject, even if the anatomical targets are indistinguishable in the image data.

Claims

1. A system to navigate a surgical plan relative to an anatomy, comprising:

an instrument operable to assist in performing the surgical plan;

a tracking device operable to be interconnected with the instrument;

a tracking system operable to track the tracking device wherein a location of the instrument is operable to be determined at least in part based upon the tracked position of the tracking device;

a planning processor operable to execute instructions configured to;

process image data to segment a third ventricle in a brain in at least a sub-plurality of a plurality of slices of the image data, wherein the image data is obtained by an imaging system;

align at least the sub-plurality of slices in the image data;

after aligning at least the sub-plurality of the plurality of slices of the image data, determine a mid-sagittal plane based on the aligned sub-plurality of slices;

after determining the mid-sagittal plane, determine at least one anatomical landmark, wherein the anatomical landmark includes at least one of an anterior commissure or a posterior commissure as a bright point in the image data at a boundary of the segmented third ventricle, where an intensity change at the edge of the segmented third ventricle that can be an edge where the at least one of the anterior commissure or the posterior commissure meet the third ventricle;

after determining at least one anatomical landmark, determine an anatomical target, which is a functional target that is relatively indistinguishable from the surrounding structures, based upon the identified anatomical landmark; and

after determining the anatomical target, determine a path through the anatomy based upon the image data of the anatomy to reach the determined anatomical target; and

a display operable to display at least one of a planned path icon illustrating a planned path, an instrument icon illustrating the position of the instrument, an instrument path icon illustrating the entire path of the instrument at an instant in time, the image data of the anatomy, or combinations thereof.

2. The system of claim 1, wherein the tracking system includes a localizer.

3. The system of claim 2, wherein the tracking system includes at least one of an electromagnetic navigation system, an acoustic navigation system, an optical navigation system, an accelerometer navigation system, a radiation navigation system, or a radar navigation system.

4. The system of claim 1, wherein the instrument includes at least one of a sensor, a recorder, a probe, a stimulator, a catheter, a cannula, a deep brain stimulator, or combinations thereof.

5. The system of claim 1, further comprising:

a navigation frame operable to be interconnected with the anatomy;

wherein the navigation frame guides the instrument relative to the anatomy.

6. The system of claim 1, further comprising:

the imaging system that obtains the image data of the anatomy that is accessed by the planning processor.

7. The system of claim 6, wherein the imaging system includes at least one of a magnetic resonance imaging system, a positron emission tomography system, an x-ray system, a computer tomography system, a single photon emission computer tomography, or a planar gamma tomography.

8. The system of claim 1, further comprising a memory system operable to store image data of the anatomy accessed by the planning processor, the plan, and procedure specific information.

9. The system of claim 8,

wherein the stored plan includes the determined anatomical target which is an initial anatomical target;

wherein the instrument includes at least a sensing device operable to sense the anatomy or physiology near the initial anatomical target;

wherein the instructions are further configured to determine a refined anatomical target location by refining the location of the initial anatomical target based on sensed anatomy or physiology;

wherein determine the path through the anatomy based upon the image data of the anatomy to reach the determined anatomical target includes determine a path to the refined anatomical target location.

10. The system of claim 1, wherein the planning processor operable to execute instructions is further configured to:

after segmenting the third ventricle and before aligning at least the sub-plurality of slices of the image data, skeletonize a line in the segmented third ventricle in at least the sub-plurality of the plurality of slices of the image data;

wherein determining the mid-sagittal plane is further based on the skeletonized line in the segmented third ventricle.

11. A system to navigate a surgical plan relative to an anatomy, comprising:

an instrument operable to assist in performing the surgical plan;

a tracking device operable to be interconnected with the instrument at a leading end of the instrument;

a tracking system operable to track the tracking device wherein a location of the instrument is operable to be determined at least in part based upon the tracked position of the tracking device;

an imaging system operable to obtain image data of the anatomy that includes a distinguishable anatomical landmark and a relatively indistinguishable anatomical target, wherein the image data of the anatomy includes a plurality of slices of image data of a brain;

a planning processor operable to execute instructions configured to automatically;

determine a third ventricle of the brain in at least a sub-plurality of the plurality of slices of the image data,

after determining the third ventricle, skeletonize a line in the determined third ventricle;

after skeletonizing a line, aligning at least the sub-plurality of slices based on the skeletonized line;

after aligning at least the sub-plurality of slices, determine a mid-sagittal plane of the brain based at least on the skeletonized line,

after determining a mid-sagittal plane, identify the distinguishable anatomical landmark in the image data;

after identifying the distinguishable anatomical landmark in the image data, determine the relatively indistinguishable anatomical target, which is relatively indistinguishable in the image data of the brain, based upon the identified distinguishable anatomical landmark;

determine an entry region into the anatomy to reach the determined relatively indistinguishable anatomical target;

weight the image data based on predetermined structures that are present in the image data;

determine a plurality of trajectories through the anatomy;

after determining the plurality of trajectories, determine a threshold trajectory from the determined plurality of trajectories based at least on the weighted image data; and

determine a planned path through an anatomical region based at least on the determined threshold trajectory and the image data to reach the determined relatively indistinguishable anatomical target; and

a display operable to display at least one of a planned path icon representing the planned path, an instrument icon illustrating the position of the instrument, an instrument path icon illustrating the entire path of the instrument at an instant in time, the image data of the anatomy, or combinations thereof.

12. The system of claim 11, wherein the tracking system includes at least one of an electromagnetic navigation system, an acoustic navigation system, an optical navigation system, an accelerometer navigation system, a radiation navigation system, or a radar navigation system.

13. The system of claim 11, wherein the instructions, prior to determining the third ventricle, are further configured to include segmenting a portion of the image data, removing unneeded data from the image data, smoothing the image data, or combinations thereof.

14. The system of claim 13, wherein the instrument includes a deep brain stimulator, a recording device, a probe, a cannula, or combinations thereof.

15. The system of claim 11, wherein the imaging system includes at least one of a magnetic resonance imaging system, an x-ray imaging system, a computer tomography imaging system, a positron emission tomography imaging system, an ultrasound imaging system, a single photon emission computer tomography system, or a planar gamma scintigraphy system.

16. The system of claim 11, wherein the

identifying the distinguishable anatomical landmark in the image data includes determine at least one of an anterior commissure or a posterior commissure in the aligned plurality of slices at a change in intensity from the determined third ventricle to the one of the anterior commissure or the posterior commissure.

17. The system of claim 11, further comprising:

a tracking frame operable to be positioned relative to the anatomy;

wherein the tracking device is interconnected with the tracking frame; and

a guide portion defined by the tracking frame and tracked with the tracking system, wherein the instrument is guided with the guiding portion relative to the anatomy.

18. The system of claim 17,

wherein the tracking device includes a first tracking device interconnected with the tracking frame and a second tracking device interconnected with the instrument;

wherein the tracking frame and the instrument can be tracked substantially independently relative to one another;

wherein the tracking frame can be fixed relative to the anatomy and the instrument can be tracked as it moves relative to the tracking frame and the anatomy.

19. The system of claim 11, further comprising:

a tracking system processor operable to execute instructions to determine a position of the tracking device.

20. A system to navigate a surgical plan relative to an anatomy, comprising:

a memory system operable to store a plurality of slices of image data of the anatomy;

a planning processor operable to execute instructions configured to;

process the image data to determine a third ventricle in a brain in the image data;

after determining the third ventricle, skeletonize a line in the determined third ventricle; and

after skeletonizing the line, determine a mid-sagittal plane from the skeletonized line;

after determining the mid-sagittal plane, determine a true axial plane through the image data with the mid-sagittal plane;

after determining the true axial plane, determine at least one anatomical landmark to include at least an anterior commissure or a posterior commissure as a bright point in the image data at a boundary of the determined third ventricle, where the intensity changes at the edge of third ventricle can be an edge where the at least one of the anterior commissure or the posterior commissure and the third ventricle meet;

after determining the at least one anatomical landmark, determine an anatomical target, which is a functional target that is relatively indistinguishable from the surrounding structures, based upon the determined anatomical landmark;

weight the image data regarding regions through which an instrument can pass;

determine an entry region into the anatomy;

determine a plurality of possible trajectories each with different entry points through the entry region of an instrument to the determined anatomical target; and

determine threshold trajectories from the determined plurality of possible trajectories of an instrument, wherein the determined threshold trajectories are determined at least based on the weighted image data and a respective individual trajectory from the determined plurality of possible trajectories of an instrument relative to portions of the weighted image data; and

a display device operable to illustrate at least the determined threshold trajectories;

wherein at least one of the determined threshold trajectories is saved to the memory as at least a portion of the surgical plan.

21. The system of claim 20, further comprising:

an instrument operable to assist in performing the surgical plan;

a tracking device operable to be interconnected with the instrument at a leading end of the instrument; and

a tracking system operable to track the tracking device wherein a location of the instrument is operable to be determined at least in part based upon the tracked position of the tracking device;

wherein the tracking system includes a navigation processor operable to determine the location of the instrument relative to the surgical plan;

wherein the display is further operable to display at least one of a trajectory icon illustrating at least one of the determined threshold trajectories, an instrument icon illustrating the navigated position of the instrument, a path icon illustrating the entire path of the instrument at an instant in time, and the image data of the anatomy.

22. The system of claim 21, wherein the instrument includes at least one of a deep brain stimulator, a probe, a recorder, a sensor, a cannula, or combinations thereof.

23. The system of claim 21, wherein the tracking system includes at least one of an electromagnetic navigation system, an acoustic navigation system, an optical navigation system, an accelerometer navigation system, a radiation navigation system, or a radar navigation system.

24. The system of claim 21, further comprising:

an imaging system operable to create the image data of the anatomy.

25. The system of claim 21, wherein the instrument includes:

a recorder operable to be positioned relative to a determined anatomical target;

wherein the recorder includes a sensor operable to sense an electrical activity; and

a communication system operable to transmit a signal based upon the electrical activity to the memory system;

wherein the planning processor is operable to determine a refined location of the anatomical target based on the transmitted signal and the tracked location of the recorder.

26. The system of claim 21, wherein the instrument is substantially flexible, substantially rigid, straight, curved, or combinations thereof.

27. The system of claim 21, further comprising:

a navigation frame;

wherein the navigation frame includes a guide portion interconnected with a frame electromagnetic tracking device;

wherein the guide portion is tracked with the tracking system via the frame electromagnetic tracking device and the instrument is moved relative to the guide portion.

28. The system of claim 27, wherein the tracking device includes an electromagnetic tracking device that includes a plurality of coils positioned at fixed angles relative to one another to provide at least 5 degree of freedom position information of the tracking device to the tracking system.