Methods and apparatuses for image guided medical procedures

• US 8,303,505 B2
• Filed: 12/02/2005
• Issued: 11/06/2012
• Est. Priority Date: 12/02/2005
• Status: Active Grant

• Current Assignee: Abbott Cardiovascular Systems Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Abbott Cardiovascular Systems Incorporated (Abbott Laboratories Incorporated)
• Inventors: Webler, William E., Chow, Mina
• Primary Examiner(s): Cattungal, Sanjay
• Application Number:
  US11/293,559
• Publication Number:
  US 20070167801A1
• Time in Patent Office: 2,531 Days
• Field of Search: 600437-467
• US Class Current: 600/447
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00455 Orientation indicators, e.g. recess on the handle
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 8/4245 involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
• CPC Class Codes: A61B 8/445 Details of catheter construction
• CPC Class Codes: A61B 8/483 involving the acquisition of a 3D volume of data
• CPC Class Codes: G06T 19/00 Manipulating 3D models or images for computer graphics
• CPC Class Codes: G06T 2207/30004 Biomedical image processing
• CPC Class Codes: G06T 2210/41 Medical
• CPC Class Codes: G06T 7/32 using correlation-based methods
• CPC Class Codes: G06T 7/38 Registration of image sequences
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders

Abstract

Methods and apparatuses for the image guidance and documentation of medical procedures. One embodiment includes combining small field of view images into a recorded image of with a large field of view and aligning the small field of view real time image with the recorded image through correlation of imaging data. A location and orientation determination system may be used to track the imaging system and provide a starting set of image alignment parameters and/or provide change updates to a set of image alignment parameters, which is then further improved through correlating imaging data. The recorded image may be selected according to real time measurement of a cardiac parameter during an image guided cardiac procedure. Image manipulations planned based on the recorded image can be stored and applied to the real time information. The position of the medical device may be determined and recorded through manipulating a cursor in a 3-D image space shown in two non-parallel views.

Claims

1. A system for imaging a body to guide a medical operation, the system comprising:

a transducer to scan an anatomy;

a signal processing unit coupled to the transducer to generate a plurality of first images of the anatomy including a heart, each of the first images corresponding to a particular position and orientation of the transducer relative to the anatomy;

means for combining the plurality of first images of the anatomy into a recorded image of the anatomy, the recorded image having a field of view of the anatomy larger than each of the plurality of first images;

means for obtaining a real time image of the anatomy during the medical operation, the real time image having a field of view of the anatomy smaller than the recorded image, the real time image containing an image of a medical device used in the medical operation in a portion of the anatomy;

means for receiving real time measurements of a cardiac parameter;

means for determining a cardiac phase in which the real time image corresponds to based on the real time measurements of a cardiac parameter;

means for selecting the recorded image based on the cardiac phase from a plurality recorded images that are associated with different cardiac phase of the heart, before aligning the real time image with the recorded image; and

means for aligning the real time image with the recorded image through correlation of imaging data from the real time image and the recorded image to determine a spatial relation between the real time image and the recorded image.

2. The system of claim 1, wherein the recorded image contains no image of the medical device in the portion of the anatomy.

3. The system of claim 1, further comprising:

means for displaying, on a display area, an image containing information derived at least partially from the real time image of the anatomy; and

means for updating the display area with information derived at least partially from real time images of the anatomy at a period substantially equal to a cardiac cycle of the heart.

4. The system of claim 1, wherein the transducer is ultrasound based;

and said means for obtaining the real time image of the anatomy couples to the transducer and the signal processing unit to obtain the real time image.

5. The system of claim 4, wherein at least one of the first images and the real time image is selected from the group consisting of:

transthoracic echocardiogram (TTE) images, transesophageal echocardiogram (TEE) images, and intracardiac echocardiogram (ICE) images.

6. The system of claim 1, wherein the medical device comprises a tip portion of a catheter with an omni-directional ultrasonic transducer.

7. The system of claim 1, further comprising:

means for displaying at least a portion of the anatomy based on both the real time image and the recorded image.

8. The system of claim 7, wherein the portion of the anatomy is displayed with a portion of the real time image superimposed on the recorded image.

9. The system of claim 7, wherein the real time image and the recorded image are displayed on a display surface in an alternating way with anatomically correct alignment on the display surface.

10. The system of claim 1, further comprising:

means for obtaining an image highlighting the medical device through subtracting the real time image and the recorded image;

means for detecting an outline of the medical device through edge detection in the image highlighting the medical device; and

means for determining a location of the medical device from the outline of the medical device.

11. The system of claim 1, wherein the real time image is obtained through an ultrasound based imaging modality;

the medical device includes a portion controllable to move; and

the system further includes;

means for detecting a location of the medical device through recognizing a Doppler shifted portion of image data corresponding to the portion of the medical device which is controllable to move; and

means for displaying a representation of the medical device over the recorded image according to the location of the medical device.

12. The system of claim 1, wherein the real time image is obtained through an ultrasound based imaging modality;

and the system further includes;

means for determining an ultrasound propagation delay between a portion of the medical device and an imaging probe of the ultrasound based imaging modality;

means for determining a position of the portion of the medical device using the ultrasound propagation delay; and

means for displaying a representation of the medical device over the recorded image according to the location of the medical device.

13. A method to guide a medical operation, the method comprising:

obtaining a plurality of first images of an anatomy comprising a heart;

combining the plurality of first images of the anatomy into a recorded image of the anatomy, the recorded image having a field of view of the anatomy larger than each of the plurality of first images;

obtaining a real time image of the anatomy during the medical operation, the real time image having a field of view of the anatomy smaller than the recorded image, the real time image containing an image of a medical device used in the medical operation in a portion of the anatomy;

receiving real time measurements of a cardiac parameter;

determining a cardiac phase in which the real time image corresponds to based on the real time measurements of a cardiac parameter;

selecting the recorded image based on the cardiac phase from a plurality of recorded images that are associated with different cardiac phases of the heart before said aligning; and

aligning the real time image with the recorded image through correlation of imaging data from the real time image and the recorded image to determine a spatial relation between the real time image and the recorded image.

14. The method of claim 13, wherein the recorded image contains no image of the medical device in the portion of the anatomy.

15. The method of claim 13, wherein the correlation includes searching for a maximum correlation value;

and the method further comprises;

displaying an indication of a degree of alignment between the real time image and the recorded image during said searching;

wherein the degree of alignment between the real time image and the recorded image is indicated in one of;

an image color change,

a label, and

a weight to blend the real time image and the recorded image.

16. The method of claim 13, wherein said correlation comprises:

detecting anatomical features in the real time image and the recorded image; and

matching the anatomical features to improve alignment between the real time image and the recorded image.

17. A non-transitory machine readable storage medium containing executable computer program instructions which when executed by a data processing system cause said system to perform a method to guide a medical operation, the method comprising:

obtaining a plurality of first images of an anatomy;

combining the plurality of first images of the anatomy into a recorded image of the anatomy, the recorded image having a field of view of the anatomy larger than each of the plurality of first images;

obtaining a real time image of the anatomy during the medical operation, the real time image having a field of view of the anatomy smaller than the recorded image, the real time image containing an image of a medical device used in the medical operation in a portion of the anatomy;

receiving real measurements of a cardiac parameter;

determining a cardiac phase in which the real image corresponds to based on the real time measurements of a cardiac parameter

selecting the recorded image based on the cardiac phase from a recorded images that are associated with different cardiac phases of the heart before said aligning; and

aligning the real time image with the recorded image through correlation of imaging data from the real time image and the recorded image to determine a spatial relation between the real time image and the recorded image.

18. The medium of claim 17, wherein the recorded image contains no image of the medical device in the portion of the anatomy and wherein the anatomy includes a heart;

and the method further comprises;

receiving real time measurements of a cardiac parameter;

determining a cardiac phase in which the real time image corresponds to based on the real time measurements of a cardiac parameter; and

selecting the recorded image based on the cardiac phase from a plurality of recorded images that are associated with different cardiac phase of the heart before said aligning;

displaying at least a portion of the anatomy based on both the real time image and the recorded image;

wherein the portion of the anatomy is displayed with a portion of the real time image superimposed on the recorded image, or on a display surface in an way alternating between the real time image and the recorded image with anatomically correct alignment on the display surface; and

wherein both the first images and the real time image are obtained from a same ultrasound imaging system; and

the ultrasound imaging system captures an image from the group consisting of;

transthoracic echocardiogram (TTE) images, transesophageal echocardiogram (TEE) images, and intracardiac echocardiogram (ICE) images.

19. The medium or claim 17, wherein the correlation includes searching for a maximum correlation value;

and the method further comprises;

displaying at least a portion of the real time image blended with the recorded image aligned according to a currently determined spatial relation between the real time image and the recorded image, a weight for blending the real time image and the recorded image being a function of a degree of correlation between the real time image and the recorded image.

20. The medium of claim 17 wherein the medical device is a needle catheter, and wherein the recorded image comprises guide information and is an ultrasonic image of the patient'"'"'s coronary anatomy indicating a spatial record of sites treated by the needle catheter.

21. The medium of claim 17 wherein the recorded image is generated by producing 3-D echo images of the patient'"'"'s heart with a TTE echo probe at different positions on the patient, and assembling the 3-D echo images to provide a recorded ultrasonic image of the patient'"'"'s heart.

22. The medium of claim 21, the method including processing the 3-D echo images to indicate on the recorded ultrasonic image of the patient'"'"'s heart a degree of heart wall motion and/or wall thickness for various locations of the heart wall.

23. The medium of claim 22 wherein the medical device comprises a needle catheter having an echogenic spherical distal tip, and wherein the obtaining of the real time image comprises ultrasonic imaging at least the spherical distal tip of the needle catheter using the TTE echo probe.

24. The medium of claim 23 wherein the spherical distal tip of the needle catheter comprises an electrode, and wherein the method further includes positioning the spherical distal tip at a desired location against a wall of the patient'"'"'s heart to generate an ECG, and performing a diagnosis of tissue forming the heart wall at the desired location based on at least one of the ECG amplitude at the desired location and the degree of heart wall motion and/or wall thickness at the desired location on the recorded ultrasonic image.

25. The medium of claim 24 wherein the method further includes after performing the diagnosis of the tissue forming the heart wall at the desired location, treating the desired location by slidably advancing a needle from the spherical distal tip of the needle catheter and injecting the tissue with an agent delivered from the needle to thereby produce a treatment location, and including recording the treatment location on the first recorded image.

26. The medium of claim 25 wherein the method further includes guiding the production of one or more additional treatment locations by comparing a diagnosis of the one or more additional treatment locations with a diagnosis of previous treatment locations indicated on the first recorded image.

27. The medium of claim 17 wherein the medical device comprises a needle catheter having a shaft with a distal section which has a plurality of rotational orientation echogenic portions, and wherein the obtaining of the real time images comprises ultrasonic imaging at least the distal section of the needle catheter shaft positioned within a coronary blood vessel of the patient.

28. The medium of claim 27 wherein the method further includes adjusting the rotational orientation of the distal section of the needle catheter within the blood vessel, slidably advancing a needle from the distal section of the needle catheter, and injecting tissue of the patient'"'"'s heart with an agent delivered from the needle to thereby produce a treatment location, and including recording the treatment location.