System for carrying out and monitoring minimally-invasive interventions

• US 8,335,557 B2
• Filed: 12/20/2007
• Issued: 12/18/2012
• Est. Priority Date: 12/22/2006
• Status: Expired due to Fees

• Current Assignee: Siemens Healthcare GMBH (Siemens AG)
• Original Assignee: Siemens AG
• Inventors: Maschke, Michael
• Primary Examiner(s): Casler, Brian
• Assistant Examiner(s): SHAHRESTANI, NASIR
• Application Number:
  US12/004,364
• Publication Number:
  US 20080247506A1
• Time in Patent Office: 1,825 Days
• Field of Search: 600407-480
• US Class Current: 600/427
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/301 for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3782 transmitter or receiver in catheter or minimal invasive instrument
• 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 34/30 Surgical robots
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4441 the rigid structure being a C-arm or U-arm
• CPC Class Codes: A61B 6/4458 the source unit or the detector unit being attached to robotic arms
• CPC Class Codes: A61B 6/4464 the source unit or the detector unit being mounted to ceiling
• CPC Class Codes: A61B 6/4476 related to motor-assisted motion of the source unit
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for

Abstract

There is described a system for carrying out and monitoring minimally-invasive interventions with an x-ray device, in which at least one x-ray emitter and a x-ray detector are attached to one or more robot arms of one or more multi-axis articulated-arm robots, with which they are able to be moved for recording images from different projection directions on a predeterminable path around a patient support facility. The system includes a control and evaluation unit with interfaces for catheters and devices for carrying out the minimally-invasive intervention. The control and evaluation unit is embodied for the processing of measurement and/or image data which it receives from the catheters and devices and for control of the catheters and devices for recording the measurement and/or image data. With the proposed system the workflow is covered completely and seamlessly from the examination to the therapy, especially in the treatment of tachycardial arrythmias.

Claims

1. A system for carrying out and monitoring a minimally-invasive intervention, comprising:

an x-ray device having an x-ray emitter and an x-ray detector;

a multi-axis articulated-arm robot, wherein the x-ray emitter and the x-ray detector are attached to at least one robotic arm of the multi-axis articulated-arm robot, wherein the x-ray emitter and the x-ray detector are moveable for recording images from different projection directions on a predetermined path around a patient support facility; and

a control and evaluation unit with interfaces for a plurality of catheters and devices to be used for the minimally-invasive intervention, wherein the control and evaluation unit processes data selected from the group consisting of measurement data, image data and a combination thereof, wherein the control and evaluation unit receives the data from the catheters and devices, and wherein the control and evaluation unit controls the catheters and devices for the detection of the data,

wherein the system has a position determination device connected for an exchange of data to the control and evaluation unit for a determination of a three-dimensional position of one or more of the catheters in the space which are equipped with position sensors for detection of the three-dimensional position, wherein at least one catheter has at least two coils or antennas arranged at an angle to each other as position sensors, and

wherein a navigation device is connected for the exchange of data with the control and evaluation unit for a magnetic navigation of one or more of the catheters, wherein the catheters have magnets for magnetic navigation using an external magnetic field generated by the navigation device.

2. The system as claimed in claim 1, wherein the articulated-arm robot is supported on mobile carrier.

3. The system as claimed in claim 1, wherein the patient support facility is inclineable or tilteable within a room.

4. The system as claimed in claim 1, wherein the patient support facility is rotateable on a circular or elliptical path around a fixed point in a room.

5. The system as claimed in claim 1, wherein the patient support facility is attached to a robot arm of a further multi-axis articulated-arm robot.

6. The system as claimed in claim 1, wherein the control and evaluation unit has a collision monitoring unit which warns before a collision of components of the x-ray device with the patient support facility and a patient supported thereon or with the operating personnel, wherein the system further comprises an imaging catheter, a mapping device with a mapping catheter and an ablation device with an ablation catheter, with an interface for a data exchange with the control and evaluation unit, and wherein a control unit provides a power assistance for a manual guidance of at least one robot arm.

7. The system as claimed in claim 6, wherein sensors are integrated into at least one robot arm to detect a force effect for a manual guidance of the robot arm, wherein, if a limit value for the force effect is exceeded, the manual guidance of the robot arm is power-assisted or a power assistance is increased.

8. The system as claimed in one of the claim 1, wherein the control and evaluation unit has an operator interface for central operation of all catheters and devices and a screen unit for a central display of the measurement or image data of the catheters and devices or of data derived from it, wherein a user selects a treatment program via the operator interface and subsequently power-assisted components of the system move based upon the control and evaluation unit to start positions for a selected treatment program.

9. The system as claimed in claim 8, wherein the screen unit has a 3D display for a three-dimensional visualization, and wherein the control and evaluation unit registers and overlays measurement or image data recorded by the catheters.

10. The system as claimed in claim 1, wherein the control and evaluation unit has a module for processing and displaying three-dimensional image datasets as well as optionally data of a 2D ultrasound device, wherein the control and evaluation unit has a module for an activation of x-ray devices for the recording of a 3D image dataset, and wherein the control and evaluation unit has a module for creating a 3D image dataset from image data of different projections of the x-ray device by way of discrete tomography.

11. The system as claimed in claim 1, wherein the catheter is selected from the group consisting of an ultrasound catheter for recording intraluminal sectional images, a MR catheter, an optical endoscope, and a Robotic Catheter Manipulator.

12. The system as claimed in claim 1, further comprising a 3D color doppler device connected for an exchange of data with the control and evaluation unit with an ultrasound scanner head.

13. The system as claimed in claim 1, further comprising a contrast medium injector connected for an exchange of data with the control and evaluation unit, and a physiological measuring device for an exchange of data with the control and evaluation unit which features a module for non-invasive measurement of the blood pressure or a module for partial oxygen measurement or a module for non-invasive cardiac output measurement.

15. The method as claimed in claim 13, wherein 4D image data is reconstructed from existing 3D image data by expansion with a timing sequence.

16. The method as claimed in claim 13, wherein no preoperative 3D image data is used.

17. The method as claimed in claim 13, wherein the system is used for carrying out and monitoring an intervention with a combination of an AcuNav catheter, a 3D ultrasound catheter or an OCT catheter.

18. The method as claimed in claim 13, wherein the system has an MPS position determination system.

14. A method of treating tachycardial arrhythmias of a heart, comprising:

providing a system for carrying out and monitoring a minimally-invasive intervention,

having;

an x-ray device having an x-ray emitter and an x-ray detector, a multi-axis articulated-arm robot, wherein the x-ray emitter and the x-ray detector are attached to at least one robotic arm of the multi-axis articulated-arm robot, wherein the x-ray emitter and the x-ray detector are moveable for recording images from different projection directions on a predetermined path around a patient support facility, and

a control and evaluation unit with interfaces for catheters and devices to be used for the minimally-invasive intervention, wherein the control and evaluation unit processes data selected from the group consisting of measurement data, image data and a combination thereof, wherein the control and evaluation unit receives the data from the catheters and devices, and wherein the control and evaluation unit controls the catheters and devices for the detection of the data;

using high-resolution 3D-images, wherein the high-resolution 3D-images are recorded before the minimally-invasive intervention, and wherein the high-resolution 3D images are updated while the minimally-invasive intervention is carried out with current 3D data of the x-ray device,

wherein the system has a position determination device connected for an exchange of data to the control and evaluation unit for a determination of a three-dimensional position of one or more of the catheters in the space which are equipped with position sensors for detection of the three-dimensional position, wherein at least one catheter has at least two coils or antennas arranged at an angle to each other as position sensors, and

wherein a navigation device is connected for the exchange of data with the control mid evaluation unit for a magnetic navigation of one or more of the catheters, wherein the catheters have magnets for magnetic navigation using an external magnetic field generated by the navigation device.

19. A method of operating a system for carrying out and monitoring a minimally-invasive intervention:

providing the system having;

an x-ray device having an x-ray emitter and an x-ray detector,

a multi-axis articulated-arm robot, wherein the x-ray emitter and the x-ray detector are attached to at least one robotic arm of the multi-axis articulated-arm robot, wherein the x-ray emitter and the x-ray detector are moveable for recording images from different projection directions on a predetermined path around a patient support facility, and

a control and evaluation unit with interfaces for catheters and devices to be used for the minimally-invasive intervention, wherein the control and evaluation unit processes data selected from the group consisting of measurement data, image data and a combination thereof, wherein the control and evaluation unit receives the data from the catheters and devices, and wherein the control and evaluation unit controls the catheters and devices for the detection of the data;

inputting demographic data of a patient in a hospital information system;

transmitting the patient information to a high-resolution 3D examination unit;

recording and reconstruction of the high-resolution 3D images or datasets;

transmitting patient information data and high-resolution 3D datasets to the system;

recording and reconstruction of the high-resolution 3D images or datasets with the x-ray device, updating the high-resolution 3D images created before a procedure;

calibrating the ultrasound catheter with position sensors and registration with the available high-resolution 3D images;

introducing a ultrasound catheter under control, wherein the control comprises a combination of an x-ray control, a positioning system, and a location from at least 2 projections in an x-ray image wherein a navigation device is connected for the exchange of data with the control and evaluation unit for a magnetic navigation of one or more catheters, wherein the catheters have magnets for magnetic navigation using an external magnetic field generated by the navigation device;

updating the high-resolution 3D imaged with current 3D ultrasound data in a target area;

introducing a mapping catheter;

recording an intracardial ECG under control, wherein the control is selected from the group consisting of an x-ray control, a positioning system, a location from at least 2 projections in an x-ray image, and a combination thereof;

updating the available high-resolution 3D image with current 3D ultrasound data in the target area;

overlaying the mapping images with an anatomical image of heart chambers;

introducing a ablation catheter under control, wherein the control is selected from the group consisting of an x-ray control, a positioning system, a location from at least 2 projections in an x-ray image, and a combination thereof;

updating high-resolution 3D image with current 3D ultrasound data in the target area of the available high-resolution 3D image;

ablating selected tissue locations;

checking the ablation based upon a method selected from the group consisting of an OCT catheter use, a temperature measurement, a pressure measurement, a renewed mapping, and a combination thereof;

removing medical instruments and aids from the target area;

documentating and archiving the procedure in a Hospital Information system;

discharging the patient;

creating a bill; and

billing by the Hospital Information system.